• Patterns and Predictors of Off-Label Antipsychotic Use Among Older Adults with Dementia in Ambulatory Care Settings in the United States (US)

      Bhattacharjee, Sandipan; Abou-Eid, Michelle; College of Pharmacy, The University of Arizona (The University of Arizona., 2019)
      Specific Aims: To examine the patterns and predictors of off-label antipsychotic use among older adults with dementia in the ambulatory care settings in US. Methods: This was a retrospective, cross-sectional study using pooled data from the National Ambulatory Medical Care Survey (NAMCS) (2005-2015). The study sample consisted of ambulatory visits by older adults (age ≥ 65 years) with dementia who were prescribed off-label antipsychotic(s). Dementia was identified by using ICD-9-CM codes of 290.xx, 294.xx, or 331.xx or by examining use of cholinesterase inhibitors or memantine. Antipsychotics are approved for treating individuals with schizophrenia (ICD-9-CM: 2950x–2959x), bipolar disorder (ICD-9-CM: 2960x, 2961x, 2964x–2969x), Tourette syndrome (ICD-9-CM: 307.23), or Huntington’s disease (ICD-9-CM: 333.4). Patients with these co-occurring diseases were excluded from the final study sample. Predictors of off-label antipsychotic use were determined using multivariable logistic regression adjusting for individual-level factors. All analyses were adjusted for the complex survey design of NAMCS to obtain nationally representative estimates. Main Results: Over the 11-year study period, there over 74 million visits by older adults with dementia without conditions approved for treatment with an antipsychotic, among whom 6.2 million (8.37%) visits received an off-label antipsychotic prescription. Factors that were significantly associated with off-label antipsychotic use were age, gender, race/ethnicity, physician specialty, region, number of medications recorded at the sampled visit, and number of past visits. Conclusions: Considering over 8% of older adults with dementia received off-label antipsychotic, appropriate interventions are warranted to minimize off-label antipsychotic use in this vulnerable population.
    • Examining Pharmacists’ Triggers for Hand Hygiene in a Community Pharmacy

      Matthias, Kathryn; Topping, Michelle; Suffecool, Sage; Charney, Alison; College of Pharmacy, The University of Arizona (The University of Arizona., 2018)
      Specific Aims To identify specific triggers that lead community pharmacists to perform hand hygiene and to identify hand hygiene methods utilized based on situation type. Methods In this IRB approved study, a questionnaire was administered electronically to pharmacists through RedCap(™). Questions included multiple choice and Likert-type to identify specific triggers that pharmacists encounter that lead them to perform hand hygiene and if applicable, which method of hand hygiene they use. Data analysis was performed using STATA 14.2 (College Station, Texas). Main Results The survey was completed by 105 pharmacists. Of the community-based pharmacist subgroup (N=61), 100% selected some form of hand hygiene after using the restroom. Prior to putting on gloves and administering an immunization, 65.5% selected a recommended form of hand hygiene (hand wash with water and soap or alcohol-based hand rub) while 22.4% selected no hand hygiene. After giving an immunization, 66.6 % use a recommended form of hand hygiene while 22.8% (13/57) use no hand hygiene. 42.9% use no hand hygiene after using the cash register. Conclusions Overall, performance of hand hygiene varied among pharmacists for potential triggers. Responses showed that if hand-hygiene was completed in response to a trigger, it was not always a recommended form of hand hygiene. Based off this preliminary research, further research is needed to examine pharmacists’ triggers for hand hygiene and methods of hand hygiene.
    • Rx Free Sleep: Improving Sleep Through Behavioral and Environmental Interventions and Pharmacy Driven Taper Recommendation of Hypnotic Sleep Medications for Assisted Living Residents

      Lee, Jeannie; Lee, Sandy; Kaitschuck, Angela; Sassenrath, Kimberly; Weng, Cindy; College of Pharmacy, The University of Arizona (The University of Arizona., 2018)
      Specific Aims: To safely reduce the use of potentially dangerous sleep medications in geriatric patients while simultaneously providing sleep hygiene techniques to improve sleep in a natural way without medications. Methods: Study participants enrolled in either sleep hygiene only or sleep hygiene and sleep medication taper track. All participants completed a Sleep Survey and IOWA Fatigue Scale (IFS) pre- and post-intervention. Student pharmacists provided an initial one-on-one educational session on sleep hygiene techniques and set individualized goals with each elder. Those enrolled in the medication taper track had a personalized taper schedule sent to their provider. Follow-up sessions were conducted 3 and 6 weeks after the initial session. Main Results: Among eight participants (mean age 74.8 years, 63% female), those with fatigue per the IFS was reduced from 6 to 3 post-intervention (p=0.375). Sleep questionnaire showed time-to-sleep was shortened by 8.3 minutes, nightly sleep increased by 0.69 hours, and coffee/tea consumption was reduced by 0.38 and 0.13 cups, respectively. While the results demonstrate no statistical improvement in the proportions of participants with fatigue, many participants subjectively reported that they noticed sleep improvements and plan to continue the behavioral changes after the study. Conclusions: Providing proper sleep hygiene education and reducing the use of sleep medications is beneficial in older assisted-living residents. This study showed no negative impacts on Elders’ quality of life and is a simple program that can be implemented at other facilities.
    • Hydrocortisone use in septic shock: weight-based variability and its effect on length of stay

      Erstad, Brian; Lee, Jennifer; Ringler, Casey; College of Pharmacy, The University of Arizona (The University of Arizona., 2018)
      Background In adult patients with refractory septic shock, hydrocortisone (HC) is frequently used at a fixed dose of 200 mg per day. Due to a lack of data, it is unclear if weight-based dosing would be more appropriate – particularly among obese patients – and if such dosing would impact length of stay (LOS) outcomes. Objective To evaluate whether or not fixed doses of HC in septic shock are associated with similar LOS outcomes in non-obese and morbidly obese adult patients. Methods In this retrospective cohort study, medical ICU adult patients who received HC for septic shock at an academic medical center between November 1, 2013 and October 27, 2016 were reviewed. Patients were categorized as non-obese (BMI < 30) or morbidly obese (BMI > 40). The primary outcome measures were the mean durations of ICU stay and total hospital stay, and the secondary outcome measure was in-hospital mortality. Results A total of 80 patients were included in the final study cohort (40 in each BMI group). No statistically significant differences were found in the mean LOS in the ICU between the non-obese and morbidly obese groups (6.4 days vs. 8.2 days, respectively; p=0.19) or in the hospital (14.6 days vs. 15.9 days, respectively; p=0.72). In-hospital mortality was similar between the two groups (35% in the non-obese vs. 45% in the morbidly obese, p=0.36). Conclusions In our study cohort of two groups that lie on the opposite ends of the BMI spectrum, non-weight-based dosing of hydrocortisone was not associated with significant differences in LOS or in-hospital mortality outcomes. These findings require stronger evidence before making recommendations for or against fixed dosing. Future research using a prospective, controlled design with a larger sample size is needed to clarify the effects of hydrocortisone and obesity on septic shock outcomes.
    • Pharmacogenetics Testing for Personalized Medication: Investigation of the Coverage Policies in Arizona

      Leal, Sandra; Bhakta, Mohit; Chun, Andrew; Nguyen, Dat; College of Pharmacy, The University of Arizona (The University of Arizona., 2018)
      Specific Aims: To determine which Arizona health insurance companies provide coverage for pharmacogenetic testing, and what those specific criteria are for coverage. In addition, providing these specific criteria of pharmacogenetic testing that will be valuable to physicians and patients in our continual improvement in personalized medicine. Methods: Retrospective study review of insurance companies in Arizona from a previous study to determine if changes of genetic coverage were made during April 1st, 2016 to February 25th, 2018. Changes to genetic coverage as well as genetic counseling, BRCA 1 and 2, tumor marker screening, cytochrome P450 (CYP P450), prior authorization requirements, and co-payments of each Arizona plan were conducted and reviewed. Data was obtained through a questionnaire that focused on the above criteria and was assessed through phone calls with customer service representatives of each participating Arizona insurance plan. Data then was recorded based on: 0 – “Unknown,” 1 – “Yes”, 2 – “No.” A Chi square test was used in assessment of the data obtained. Main Results: The subjects involved in this study included 36 insurance plans, however one of the plans did change and no longer existed. From the findings it showed that only three portions were statistically significant from our previous data which were: if it required a copay (p = 0.008), if they covered CYP P450 polymorphism screenings (p = 0.0078), and if they covered tumor marker screenings (p = 0.0076). Conclusions: Comparing our pre-data (two years ago) to our new collected data, the same number of insurance companies covered genetic testing. From the questionnaire that was used to collect our information, only three areas had statistically significant changes when comparing the pre-post data. This included copay requirement (P=0.0080), covering CYP P450 polymorphism screenings (p = 0.0078) and covering tumor marker screenings (p = 0.0076). When comparing the overall data, it showed that there was a statistically significant difference between our pre-post data (p = 0.009).
    • Improving Pharmacy Care in the Refugee Population in Tucson through the Creation and Implementation of Informational Pamphlets Translated in their Native Language

      Cooley, Janet; Samara, Leah Samantha; Kim, Gahyun; Wong, Anny L; College of Pharmacy, The University of Arizona (The University of Arizona., 2018)
      Background Health literacy is the degree to which individuals have the capacity to obtain, process, and understand basic health information. It is a vital component to achieving adequate health care. A frequent request from refugees is to increase and improve language services. This study evaluated the effect of healthcare education on refugees, which reflects the importance of language services. Methods We analyzed the effects of an educational pamphlet and presentation to refugees speaking Arabic, Swahili, and Somali. Fourteen participants attended a one hour presentation on Medicine Safety and the interpretation of prescription labels. Each participant answered a pre-questionnaire before the presentation and a post-questionnaire after. The pre- and post-questionnaire included five questions on understanding prescription labels, two questions on demographics, and two opinion-based questions. Results Statistical analysis was completed using the two-tailed paired t-test with an a priori p-value of <0.05. The participants were similar in number and gender, but significantly different in age (p=0.02). The total mean score of post-questionnaire was significantly higher (0.64) than pre-questionnaire (0.47) (p=0.03). The mean score for Arabic, Swahili, and Somali pre- and post-questionnaire were 0.56 and 0.84 (p=0.13), 0.44 and 0.44, and 0.40 and 0.65 (p=0.19) respectively. There was no significant difference when comparing individual questions asked on the questionnaires. Conclusion Participants from all three groups showed improvement in their ability to understand prescription labels after the presentation. However, the mean score of each individual group was not significantly improved potentially due to different baseline, such as educational level.
    • The Association Between Factors Related to Vitamin D and Depression in Future Pharmacists

      Campbell, Ashley; Slack, Marion; Isemede, Tosan; Frent, Adina; Zehri, Sumaiyya; College of Pharmacy, The University of Arizona (The University of Arizona., 2018)
      Specific Aims: To determine whether there is a relationship between factors related to vitamin D and depression in pharmacy students. Methods: A questionnaire was administered to subjects that included questions regarding history of vitamin D levels, diet, supplementation, sun exposure, the Patient Health Questionnaire-9 (PHQ-9), and demographic information. Students were classified as adequate or inadequate in vitamin D. Based on PHQ-9 scores, subjects were placed into different severity categories of depression. Chi-square test was performed to determine whether inadequate vitamin D levels were associated with depression. Main Results: The questionnaire was completed by 218 subjects; 96 males and 122 females (71.6% were ≤26 years old). Approximately 74% of subjects failed to meet the RDA recommendation of 600 units of vitamin D per day through diet and/or supplementation. The average amount of vitamin D consumed from diet alone by all subjects was 1125 ± 1644.15 units/week. There was a significant difference in the amount of vitamin D obtained from diet between the first-year students compared to the second-year students (p= 0.008). Although there was not a significant difference in depression (any severity) between those who had inadequate versus adequate vitamin D consumption (p= 0.56), 4 (6.6%) of first-year students were categorized as having severe depression whereas none of the second and third-year students fell into this category. Conclusions: Although results from this study did not demonstrate a relationship between inadequate vitamin D consumption and depressive symptoms, almost 30 students were classified as at least moderately-depressed, suggesting the possible need for further interventions.
    • Effect of Liposomal Bupivacaine (Exparel) on Length of Stay in Total Knee Replacement Surgery

      Wolk, Robert; Anderson, Seth; College of Pharmacy, The University of Arizona (The University of Arizona., 2018)
      Specific Aims Specific Aim #1: The primary outcomes of this study are to measure the length of stay (LOS), opioid use per 24 hour inpatient time period, and over all opioid rate in total knee replacement (TKA) patients who receive liposomal bupivacaine as compared to standard post-operative pain management protocol. Specific Aim #2: The second aim of this study is to analyze 30 day admissions between the two groups. Methods A Retrospective chart review was used to compare LOS and 24, 48, and 72 hour opioid use between the treatment group, liposomal bupivacaine and the control group consisting of Tucson Medical Center pain management protocol in patients who received a single TKR. Opioid use will be measured by postop 24-hour time intervals: 0-24, 25-48, and 49-72 hrs. All doses of opioids will be converted to oral morphine milligram equivalents (MME) using Tucson Medical Centers Equianalgesic dosing protocol. Non-normal continuous data was analyzed using the Wilcoxon Rank Sum test, normally distributed continuous data was analyzed using an independent t-test and categorical data was analyzed using a 𝜒2 test with the significance level set at 𝑎= 0.05. Main Results: The treatment group had a mean age of 70.7 (years) (SD=8.6), 25 females (50%), 31 right TKR (62%), and 34 surgeries performed by Dr Cohen (68%). The control group consisted of a mean age of 72 (years) (SD=9.4), 32 females (64%), 29 right TKR (58%), and 25 (50%) surgeries performed by Dr Cohen. (table 1) The treatment group had a mean LOS of 47.63 hrs (SD=18.8) vs 64.65 hrs (SD=23.0) (P<0.0001). in the control group. The average 0-24 opioid morphine milligram equivalents for the treatment group was 62.96 mg (SD=31.9) vs 99.00 mg (SD=60.3) (P=<0.001) in the control group . The average 25-48 opioid morphine milligram equivalents for the treatment group was 43.04 mg (SD=35.8) vs 73.04 mg (SD=46.2)(P=<0.001) in the control group . The average 25-48 opioid morphine milligram equivalents for the treatment group was 73.04 mg (SD=38.3) vs 51.06 mg (SD=39.1) (P=0.06) in the control group . Conclusions: Liposomal Bupivacaine was associated with a statically significant shortening of length of stay (47.63 hrs vs 64.65 hrs, P<0.0001) Liposomal Bupivacaine was associated with a statically significant lowering of opioid use over the first 24 and 48 hour inpatient stay (62.96 mg vs 99.0 mg, P=<0.001) Both Liposomal Bupivacaine and control groups had a non-significant difference in opioid use over 49-72 hour inpatient stay (43.3 mg vs 73.04 mg, P=0.06) There were a total of three readmissions, one in the liposomal bupivacaine group and two in the control group a non-significant difference (73.04 mg vs 51.06 mg , P=0.56) Liposomal bupivacaine group was associated with a statically significant lowering of rate (mg/hour) of opioid use over the entire length of stay (2.24 mg/hr vs 3.06 mg/hr, P=0.002)
    • Physician Response to Pharmacist Statin Therapy Recommendations for Type 2 Diabetes Patients

      Kale, Andrea; Cavender, Cole; Castaneda, Luciano; Nguyen, Steven; College of Pharmacy, The University of Arizona (The University of Arizona., 2018)
      Specific Aims: To determine if the response rate will be greater than the 14% response rate that was shown in the AUDIT study in 2006. The rationale is since statin therapy is recommended as part of the American Diabetes Association (ADA) guidelines, physicians will be more open to the suggestion and the response rate will be higher. Our secondary analysis is that at least an additional 5% of patients will be on statin therapy even though their physician did not respond to the fax. The rationale is that even though a physician may not respond to us via fax, they may be prompted to evaluate statin therapy for their patient and write a prescription for statin therapy. Subjects: Using Albertson’s pharmacy database, patients between the ages of 40 to 75 on metformin were filtered. Methods: This before/after study with independent groups used data obtained from a manual fax and compared the response to a previous study that was done in 2006. Main Results: A total of 26 faxes were sent out to providers notifying them that their patient qualified for statin therapy. A total of 4 responses were received with 1 patient that was appropriately initiated on statin therapy. Conclusions: There were no differences in physician response rates in our study compared to the AUDIT study with recommending statin therapy in patients 40 to 75 with type 2 diabetes mellitus that qualify for statin therapy per ADA guidelines.
    • Teaching About Quality and Safety at Colleges/Schools of Pharmacy in the United States: Exemplars

      Warholak, Terri; Cooley, Janet; McManus, Katherine; Metrejean, Christina; Schweitzer, Kali; College of Pharmacy, The University of Arizona (The University of Arizona., 2018)
      Specific Aims:. The purpose of this project is to: 1) catalog various methods quality improvement (QI) is being taught in colleges and schools of pharmacy in the United States (US); 2) describe how some colleges/schools of pharmacy are teaching QI; and 3) showcase QI program exemplars. Methods: This descriptive, multi-phase study included an online questionnaire, syllabi review, and semi-structured phone interviews. The study was approved by the University of Arizona Institutional Review Board (IRB). One representative from each Accreditation Council for Pharmacy Education (ACPE) accredited or candidate college/school of pharmacy in the US was invited to participate. Participants indicated the type of QI education their college/school provided via online questionnaire. Following questionnaire completion, syllabi were requested and phone interviews were scheduled to obtain additional information. From the data, exemplars were chosen using a pre-determined, evidenced-based rubric. Results: One hundred thirty-six colleges/schools of pharmacy were contacted and 56 colleges/schools (41.2%) completed the survey. Of the responding colleges/schools reporting their QI/safety offerings, 41 (73.2%) reported a required session/module; 24 (42.9%) reported a required course; 21 (37.5%) reported an elective course; 21 (37.5%) reported a clerkship or experiential opportunity; 17 (30.4%) reported a required project; 17 (30.4%) reported interprofessional education integrated into their course; 15 (26.8%) reported an error lab; and 11 (19.6%) reported post-graduate training. Conclusions: Many of the responding US colleges/schools of pharmacy expose students to some aspect of QI/safety, most often via class session or module. The exemplar programs provide examples of how QI can be further integrated into pharmacy curricula.
    • The impact of a comprehensive policy change on the number of patients appropriately screened for HBV prior to administration of rituximab

      McBride, Ali; McGinnis, Stephen; Pham, Ann; College of Pharmacy, The University of Arizona (The University of Arizona., 2018)
      Specific Aims In patients with current or previous infection with the hepatitis B virus (HBV), immunosuppressive effects of rituximab can lead to viral reactivation of HBV. Screening patients for HBV prior to initiating rituximab is important in preventing reactivation. This project aims to examine the effects of a policy change on the rate of HBV screening. Methods A local system-wide policy change was implemented in April 2014 that provides criteria and requirements for HBV screening prior to the initiation of rituximab therapy. In this project, a retrospective chart review was performed to analyze the impact of the policy change on the rate of appropriate HBV screening. Only patients receiving rituximab for non-oncology indications were included in this project. All patients who received rituximab for cancer were excluded. Main Results In total, 253 patients were initiated on rituximab for non-oncology indications during the study period. The rate of screening for HBsAg increased from 24% before the policy change to 31% after the policy change (p=0.34). Similarly the rate of screening for HBcAb increased from 20% to 26% (p=0.42). Conclusions Although the findings were not statistically significant, the project remains important because similar studies have not targeted non-oncology indications for rituximab. This shows that policies with clearly stated criteria and requirements could potentially improve the rates of appropriate HBV screening across all medical subspecialties.
    • Assessment of a Vancomycin Dosing Protocol in Obese Patients

      Frick, Jacob; Apodaca, Paloma; Landwehr, Sara; College of Pharmacy, The University of Arizona (The University of Arizona., 2018)
      Specific Aims: To identify the percentage of obese patients who received subtherapeutic doses of vancomycin at a single community medical center using a standardized dosing algorithm. Methods: A single-center, retrospective chart review was performed analyzing data from the records of 100 patients who received an initial vancomycin dose with a trough drawn after 24 hours of the initial dose. Data was collected at a 170-bed community medical center. The facility’s electronic health record (EHR), was used to extract data from patient charts. The first 100 patients that qualified between 01/01/2017 and 06/30/2017 were used for analysis. Main Results: The results of the study demonstrated that 52% of all patients achieved subtherapeutic trough concentrations. A vancomycin dose given within +/- 1 hour of its scheduled time (P = 0.0000094) was found to be associated with attaining a desired trough goal. A 95% confidence interval of 38.46 to 58.22% for non-therapeutic trough levels was calculated via the Adjusted Wald Method. Conclusion: Algorithms for vancomycin dosing may not be reliable tools for the dosing of this medication in obese persons. Individualized dosing in this population remains essential for the optimal treatment of infection in this cohort of patients.
    • Systematic Review of the Pharmacogenomics of Cyclosporine, Methotrexate, and Tacrolimus as Prophylactic Agents Against Graft Vs. Host Disease in Allogeneic Hematopoietic Stem Cell Transplant

      Larriva, Marty; Campbell, Patrick; Ju, Hee; Kim, Gahyun; Ahn, David; College of Pharmacy, The University of Arizona (The University of Arizona., 2018)
      Purpose: Review available literature to determine any overlap in targeted genes associated with prophylactic agents and to review specific outcomes such as severity of Graft vs. Host Disease (GvHD). Methods: Using the GRADE approach, a systematic review was conducted by three investigators. Eligible studies had one of the followings in the title: methotrexate, cyclosporine, tacrolimus, pharmacogenomics, polymorphism, single nucleotide polymorphism (SNP), transplantation, allogeneic, or GvHD. A total of 15 databases were used including EMBASE, PubMed, AHRQ guideline search, BIOSIS, CINAHL, ClinicalTrial.gov, Cochrane Library, Global Health Library, IPA, National Guideline Clearinghouse, PharmGKB, Phenopedia, SciFinder, Scopus, and Web of Science. Main Results: From 15,907 of total search results, 15,484 was left after removing exact duplicates and 13,234 after removing close duplicates. 168 studies were left after title screening, 16 after abstract screening, and 7 after full text screening. The MTHFR CT/TT polymorphisms may reduce the incidence of GvHD. MTHFR and ATIC polymorphisms in CsA/MTX had a greater incidence of acute GvHD, while ABCC1 SNP had a decreased risk of acute GvHD. No pharmacogenomic association was found with FK. Conclusions: Reviewing the literatures from 16 databases on the pharmacogenomics of methotrexate, cyclosporine, and tacrolimus, we found that there may be a strong relationship between methylenetetrahydrofolate reductase (MTHFR) polymorphisms and GvHD outcomes when using methotrexate as a prophylactic agent. However, no consensus could be made regarding the relationship between cyclosporine or tacrolimus and their genes of interest due to lack evidence, and studies identified during the screening process.
    • Systematic Review of Omega-3 Fatty Acids on Rheumatoid Arthritis

      Malone, Daniel; Bourland, Adam; Summa, Joseph; College of Pharmacy, The University of Arizona (The University of Arizona., 2018)
      Specific Aims: The specific aim of this systematic review is to examine the effects of omega-3 fatty acid (FA) treatment on delaying rheumatoid arthritis progression. Our primary working hypothesis is that omega-3 fatty acid treatment increases quality of life while decreasing overall pain and inflammation. Methods: A systematic review was conducted using the following terms on Pubmed and Embase: “omega 3”, or “fish oil”, or “DHA”, or “EPA” and “rheumatoid arthritis”. The search included articles occurring between 2003 and 2018. Included studies were written in English and performed on humans. Inclusion and exclusion criteria were applied to each study resulting in five analyzed articles.. Main Results: Of 681 identified articles, five were reviewed. In Proudman, S.M. et al., patients receiving omega-3 FA experienced a lower failure rate with triple DMARD therapy (HR=0.28 (95% CI 0.12 to 0.63;p=0.002). In Bahadori et al., swollen joint count was significantly lower in the omega-3 FA group compared to the placebo group after a week of daily infusions (omega-3 FA group: median 3; range, 0-7; placebo group: 8; 1-19; P = .002) and also 2 weeks after daily infusions (omega-3 FA group: 1, 0-9; placebo group: 7; 0-16; P =. 046). The three remaining studies indicated considerable improvements in tender and swollen joints counts, joint pain intensity, and hand strength after omega-3 FA supplementation. Conclusions: Supplementation of omega-3 fatty acids was associated with benefits such as: lower swollen joint count, improvement in tender and swollen joints, improvement in joint pain intensity, and increased hand strength.
    • Systematic review meta analysis of adherence measures for common chronic medications used in the treatment of cystic fibrosis

      Phan, Hanna; Slack, Marion; Martin, Jennifer; Park, Haeun; Park, Sohyun; Tam, Katie; College of Pharmacy, The University of Arizona (The University of Arizona., 2018)
      Specific Aims: The aim of this systematic review and meta analysis is to determine the best method to measure medication adherence in cystic fibrosis patients by assessing the rates of adherence to cystic fibrosis medications using different measuring methods. Methods: Using multiple bibliographic databases (including Embase, Pubmed, Cochrane, PsychINFO, WHO, Web of Science, Scopus, and IPS) and reviewing grey literature and association websites, a systematic literature search of articles related to medication adherence in cystic fibrosis patients was conducted in February 2018. The limits applied to all articles were the English language and publication dates between 1989 to the present day. The literature screening was conducted by 3 pharmacy students, professors at the University of Arizona College of Pharmacy, and members of the Cystic Fibrosis Foundation (CFF). The studies were assessed for quality using a abstract and data extraction screening tool. Main Results: The bibliographic database searches generated 1,955 articles, and the grey literature and association websites generated 15 articles. 1,549 of the 1,955 articles and 0 of the 15 articles met the inclusion criteria and underwent data extraction screening. Then, after the abstract screening, 42 articles were identified for eligible to proceed to data extraction. Medication adherence was measured using paper/hard copy reminder tool, pager application, mobile application, electronic device, medication container with tracking, education sessions, and medication organizer. Conclusions: In the preliminary results, seven studies were included in the meta-analysis measuring five different methods of adherence: written diary, electronic monitoring, self-report, Medication Possession Ratio (MPR) and Proportion of Days Covered (PDC). Overall, adherence measured by written diary was significantly different than all other adherence measures except MPR. Further data analysis will be conducted when the data extraction and review is completed by Cystic Fibrosis clinicians and experts.
    • Oseltamivir Prescribing Practices for Influenza in Patients in the Intensive Care Unit and Associated Outcomes

      Erstad, Brian; Oman, Nathaniel; Vraney, Jamie; College of Pharmacy, The University of Arizona (The University of Arizona., 2018)
      Specific Aims: To assess appropriateness of prescribing practices of oseltamivir to package insert recommendations and identify significant differences in length of intensive care unit (ICU) stay, length of mechanical ventilation, and mortality in critically ill patients with influenza who received oseltamivir within 48 hours of symptom onset compared to those who did not. Methods: Patients were included in this retrospective, Institutional Review Board (IRB)-approved chart review if they were at least 18 years old with confirmed diagnosis of influenza in an intensive care unit at Banner University Medical Center – Tucson from 2015-2016. Categorical data were analyzed using Fisher’s exact test. Continuous variables were analyzed using a two-sample T-test assuming equal variances. The alpha priori level was 0.05. Main Results: All patients with confirmed influenza were treated with oseltamivir. 52% of patients received oseltamivir within 48 hours of symptom onset and 55% received an appropriate dose based on renal function. 30% of patients received oseltamivir for the recommended 5-day duration. Oseltamivir was prescribed with correct onset, dose, and duration based on package insert recommendations in only 3 instances (9.1%). No difference was seen in ICU length of stay (p = 0.67), hours on mechanical ventilation (p = 0.41), or mortality (p = 0.34) in those patients who received oseltamivir within 48 hours of symptom onset versus those who did not. Conclusions: High variation existed in observed oseltamivir prescribing practices. Future studies should incorporate multiple influenza seasons to permit a larger sample size and involve multiple facilities to allow for greater generalizability.
    • Using Short Messaging Service (SMS) Technology to Improve Medication Adherence in Patients with Specialty Chronic Diseases at Avella Specialty Pharmacy

      Mathews, Kelly; Cooley, Janet; Gianninoto, Jenna; Goal, Oliver; Lok, Daniel; Wilkerson, Aaron; College of Pharmacy, The University of Arizona (The University of Arizona., 2018)
      Purpose: The purpose was to evaluate the use of the CareSpeak Text Message Service (SMS) on adherence rate, time on therapy, and patient satisfaction. Methods: This retrospective, chart review evaluated patients using the CareSpeak SMS program at Avella Specialty Pharmacy receiving medications for cancer, hepatitis C, Human Immunodeficiency Virus (HIV), and inflammatory conditions from November 1, 2016 through November, 30 2017. Patients were grouped by disease state as well as Carespeak enrollment status. Information on proportion of days covered (PDC), time on therapy, and patient satisfaction were collected. Main Results: A total of 17,890 patients were evaluated. The median PDC ratio for patients with HIV was 94.63% for the non-Carespeak group and 96.5% for patients using Carespeak (P<0.001). Median Time on Therapy in days was significantly greater in the Carespeak group compared to the non-Carespeak group for patients receiving medications for oncology (340 vs 266.5 days, P<0.001), Hepatitis C (106 vs 101, P<0.001), HIV (396 vs 389, P=0.010), and Inflammatory Conditions (162 vs 160, P<0.001). Of a total of 1,159 satisfaction survey responses collected, Carespeak SMS received A’s or B’s (on a letter grade scale of A to F) in 91% of responses for helpfulness in managing patient health and 94.5% for ease of use. Conclusions: The CareSpeak SMS program was associated with improved PDC ratios in patients with HIV as well as prolonged Time on Therapy across all disease states. The Carespeak SMS service was generally graded highly in terms of helpfulness and ease of use.
    • Utilization of electronic order sets based on the Center for Disease Control’s Surviving Sepsis Campaign guidelines in a community hospital

      Campbell, Ashley; Weibel, Jamie; Bhattacharjee, Sandipan; Soontornprueksa, Supranee; Raheem, Farah; College of Pharmacy, The University of Arizona (The University of Arizona., 2018)
      Specific Aims To evaluate the impact of providers’ adherence to selecting order sets based on the Center for Disease Control’s Surviving Sepsis Campaign (CSSC) guidelines when treating sepsis at a community hospital, while secondarily exploring outcomes of this population, including in-hospital mortality and length of stay. Methods This was a retrospective, single-center study. Patients were included if they were 18 years and older with a diagnosis of sepsis at any time during their admission between August 2014 and December 2016. Use of CSSC guideline-based electronic order sets, age, gender, hospital length of stay, and in-hospital all-cause mortality were collected from the electronic health record. Descriptive statistics were used to analyze the data. Main Results A total of 451 patients diagnosed with sepsis at any time during their hospitalization between August 2014 and December 2016 were identified. All patients met the inclusion criteria. Of the 451 admissions, 32.1% were treated based on the CSSC guideline-based electronic order sets. Of the overall study sample, 9% expired during hospitalization and the average hospital length of stay for the entire study population was 5.8 ± 4.8 days. Conclusions During the 28-month study, prescribers adhered to the CSSC guideline-based electronic order sets in less than one-third of the identified sepsis cases, prompting a need for further exploration into the reasons for lack of use and possible re-education of providers on the availability of these order sets.
    • Perceptions of Healthcare Workers on the Cost and Safety of Oral Oncolytic Agents for Patients: A Survey of Healthcare Worker

      McBride, Ali; Abraham, Ivo; Tompkinson, Madeline; College of Pharmacy, The University of Arizona (The University of Arizona., 2018)
      Specific Aims: The number of newly approved agents continues to increase with over 800 new oncology agents in the pipeline and 25% of these being oral agents. Oral chemotherapy agents have advantages including patient convenience, prolonged drug exposure, and non-invasive administration. These advantages come at a premium that many patients cannot afford leading to change or therapy abandonment. Methods: This is a descriptive, non-experimental, cross-sectional study of healthcare professionals in hematology/oncology patient care across the United States. Data was collected using a 35-item online questionnaire to measure quality improvement areas when using oral chemotherapy agents. Results: Results of 503 survey respondents comprised of pharmacists (54%), physicians (5%), advanced practitioners (4%), nurses (10%), pharmacy administrators (15%), social workers (2%), and other professionals (9%). Treatment abandonment due to cost is seen by 46.6% of respondents. The most common agents abandoned due to cost included capecitabine, abiraterone, and palbociclib. Prior authorization delays occur in 1-2 patients weekly creating a 4-6 day wait to initiate therapy and 24.0% of respondents spend more than 30 hours weekly resolving these issues. The most utilized medication assistance programs include Manufacturer Assistance Programs, Disease-Based Foundations, and Manufacturer Co-Pay Cards. Conclusions: This survey addresses healthcare worker perspective on prevalence of and issues relative to chemotherapy and indicate a high incidence in abandonment of therapy, delay in therapy initiation, and significant resources allocated to issues associated with the cost of oral chemotherapy agents. Further evaluation is required to resolve issues in therapy and minimize impact on patient care.
    • Assessing pharmacists’ opinions on the use of pharmacogenomic testing

      Karnes, Jason; Slack, Marion; Kasher, Alyssa; College of Pharmacy, The University of Arizona (The University of Arizona., 2018)
      Specific Aims: To describe pharmacist opinions regarding when pharmacogenomic testing should be implemented to optimize drug therapy and assess whether their opinions differ based on their practice setting. Subjects: Currently practicing pharmacists with valid e-mail addresses within the selected listservs. Methods: An online questionnaire was sent out via email to describe how pharmacists view the use of pharmacogenomic testing, what point in drug therapy they think its use is most beneficial, perceived barriers to implementing pharmacogenomics and familiarity with the subject. General demographics including sex, years spent practicing, practice setting, and type of degree held were also collected. Main Results: The survey was completed online by 35 licensed and actively practicing pharmacists. The subjects consisted of 17 females and 18 males; 40% of the total group are between the ages of 25 to 35. 66% of the subjects have been practicing for < 10 years. When comparing 16 inpatient pharmacists with 19 outpatient pharmacist respondents, there was no statistically significant difference in opinion regarding when pharmacogenomic testing should be implemented (p= 0.35). Conclusions: The prevailing opinion among pharmacists was that the best time to implement pharmacogenomic testing is before a patient starts any initial therapy and there is not a significant difference of opinion on the matter between outpatient and inpatient pharmacists.