• 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)
    • 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.
    • 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.
    • Family-Oriented Community Clinic: Impact of Regular Education on Health Literacy and Self-Care

      Tong, Theodore; Slack, Marion; Lee, Betty; Huynh, Sarah; College of Pharmacy, The University of Arizona (The University of Arizona., 2018)
      Specific Aims: To compare the impacts of regularly scheduled education and health clinic sessions on individual’s health outcomes and self-care. Subjects: Tucson community members who are participants of Project Taking Charge and have attended more than three clinic sessions during the six-month study period. Methods: A retrospective review of a central database was used to collect baseline characteristics, blood glucose, A1c, blood cholesterol, blood pressure, BMI and weight. These clinical values were then used to assess participant clinical health outcomes. The questionnaire surveys distributed at the last clinic session were collected and used to analyze the improvement in participant understanding of self-care. Main Results: For weight, a 1.5% decrease from 186.1 (±50.7) to 183.3 (±50.4) pounds (p=0.012) was observed to be statistically significant. In response to the importance and the frequency of different self-care questions, participants had an improved perspective on the importance of exercise by 0.9 scale (p=0.008), a better understanding of having a balanced nutritious meals by 1.34 (p=0.0002), proper hand-washing technique by 0.54 (p=0.027), and eating at home more often by 0.31 (p=0.039) compared to baseline. Conclusions: Participant responses reflect positive changed perceptions of exercise and healthy lifestyle choices. Although post-clinical values for BMI, fasting blood glucose, A1c, systolic blood pressure, and blood cholesterol levels, did not meet p<0.05 statistical significance, the trend towards improved cholesterol levels, blood sugar levels and blood pressure levels indicate there may be some benefits attributed from participation in the clinic project.
    • 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.
    • 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.
    • 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.
    • 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.
    • 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.
    • 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.
    • Retrospective Description of the Safety and Efficacy of Filgrastim-sndz as a Front-line Mobilization Agent in Combination with Plerixafor followed by Post autologous stem cell infusion use for Autologous peripheral blood stem transplantation in Multiple Myeloma

      McBride, Ali; Sandoval, Anthony; College of Pharmacy, The University of Arizona (The University of Arizona., 2018)
      Purpose Mobilization of hematopoietic stem cells, which has largely replaced bone marrow harvesting as a source of hematopoietic stem cells, utilizing filgrastim and/or plerixafor for peripheral blood stem cell collection for autologous stem cell transplantation. Current data has shown equicoval efficacy with G-CSF based mobilization, however, there has been little data with the combination of a biosimilar and plerixafor in upfront stem cell mobilization. Here we evaluate our institutional outcomes in this setting. Methods This study was a descriptive retrospective chart review. This study included all patients treated with filgrastin-sndz and filgrastim from January 1st 2016 to December 31st 2017, diagnosed with multiple myeloma. There was a total of 48 patients included in the study that met all of the criteria. The CD34+ cells/kg count and adverse events were all analyzed Results A total of 46 patients participated in this study. The goal of it was to collect an average of CD34+ stem cells > 7 x 106/kg. The average collected CD34+ stem cells was 14.7 x 106/kg. The average number of apheresis sessions was 3.59 and none of the patients has an adverse effect from the infusion of filgrastim-sdnz. The average days to 500 ANC and was 13.54 and the average days to platelet count of 50,000 was 22.82. Conclusions Patients treated with filgrastin-sndz had the expected outcomes and had similar adverse reactions to that of filgrastim when compared to other studies.
    • Self-reported Management of Back Pain by Community Dwelling Adults: A Systematic Review

      Slack, Marion; Martin, Jennifer; Azadbakht, Mostafa; Rahim, Rasoul; College of Pharmacy, The University of Arizona (The University of Arizona., 2018)
      Purpose: The purpose of this systematic review is to identify strategies that community dwelling adults use to manage chronic back pain. Methods: Studies were eligible for inclusion if the study participants were at least 18 years of age, and currently suffering from back pain and living in the community. Excluded were reports on individuals who were institutionalized. The articles had to be written in English language. We searched Pubmed, Embase, and conducted citation searches on identified articles. Two researchers independently reviewed studies for inclusion, and extracted data from identified studies. Any differences were resolved by consensus. Data were extracted on strategies used to manage pain and outcomes. Data were analyzed by constructing tables to report types of strategies used and outcomes. Main Results: A total of 1929 study reports were identified; 9 were included in the systematic review. The primary strategy to manage back pain was using medications. 5 studies reported the use of opioids. All studies except one reported the use of anti-inflammatories. Studies also reported the use of psychological strategies (e.g. coping strategies), physical strategies (e.g. exercise), and remedies (e.g. rest). Most studies were cross sectional, participants were 29-49 percent male, average age (31-66). All studies were of community dwelling adults. Conclusions Medication was the primary strategy used to manage back pain. Opioids, and anti-inflammatories were the most common classes of medications. The most commonly reported non-medication strategy were physical strategies. Only limited information was provided on all the other strategies.
    • 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.
    • 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.
    • 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.
    • 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.
    • In vitro aerodynamic analysis of co-spray dried fluticasone propionate (FP) and salmeterol xinafoate (SX) dry powder inhalation aerosols with lactose-alternative excipient

      Mansour, Heidi M.; Malapit, Monica; Mallory, Evan; College of Pharmacy, The University of Arizona (The University of Arizona., 2017)
      Objectives: Milk protein allergy is estimated to affect 1.2% to as much as 17% of people of all ages. Advair® Diskus® (FP/SX) utilizes lactose as an excipient which limits the utility of this product for this population. Furthermore, Advair® Diskus® is formulated as an interactive physical mixture via a micronization process. Alternatively, spray dried engineering achieves narrow particle size distribution, allowing greater deposition in the targeted respiratory bronchioles. The purpose of this dry powder inhaler (DPI) study was to conduct an in vitro comparative analysis of the aerodynamic performance of a co-spray dried lactose-free formulation of FP/SX with a mannitol excipient as a molecular mixture versus the Advair® Diskus® 250/50 (FP/SX) interactive physical mixture product. Methods: Utilizing mannitol as an excipient, a co-spray dried FP/SX powder was prepared using the Buchi Mini-Spray Dryer B-290 under closed system configuration. The resulting feed solution was spray dried at pump rates of 25%, 50%, and 100% with all other parameters remaining constant (aspiration, atomization rate, nitrogen gas rate). The primary outcome measure, aerodynamic performance, was assessed using the Copley Next-Generation Impactor (NGI). NGI data for the DPIs was used to calculate mass median aerodynamic diameter (MMAD), geometric standard deviation (GSD), and fine particle fraction (FPF) of each powder, including the Advair® Diskus®. Residual water content was quantified by Karl Fischer titration. Particle characteristics were visualized by scanning electron microscopy. Results: FPF, MMAD, and GSD were calculated from NGI data; Wolfram Alpha software was used to calculate MMAD and GSD. T-test regression was used for comparative analysis of spray-dried and Advair® Diskus® powders. MMAD for each spray dried sample was analyzed using a t-test regression against the MMAD values from the Advair® Diskus®. Using aerodynamic analysis studies triplicated for each powder, there was no significant difference between the spray dried powder and Advair® Diskus® for MMAD and GSD (p-values >0.05). The 50% and 100% pump rate samples had similar FPF to the Advair® Diskus® (p-values >0.05). However, the 25% pump rate sample had a significantly improved FPF compared to the Advair® Diskus® (p <0.01). Conclusions: A co-spray-dried lactose-free formulation of FP/SX with a mannitol excipient demonstrated similar aerodynamic performance to the Advair® Diskus® which consists of a physical mixture of two drugs with lactose. Of significance, 25% pump rate spray-dry conditions demonstrated an improved FPF compared to the Advair® Diskus®.
    • Evaluation of Safety and Efficacy Outcomes from use of Extended Infusion of Beta-Lactam in the treatment of Acute Pulmonary Exacerbations in Cystic Fibrosis

      Matthias, Kathryn; Tien, Quang; Sivinski, Jared; Lew, Darren; College of Pharmacy, The University of Arizona (The University of Arizona., 2017)
      Objectives: The objective of this retrospective cohort chart review was to evaluate the safety and efficacy of extended infusion beta-lactam regimens as part of treatment of acute CF pulmonary exacerbations in adults and pediatric patients. Methods: Inclusion criteria: adult and pediatric patients (age 1 month or older) with CF diagnosis who were admitted to BUMC-T for acute pulmonary CF exacerbation, and who received meropenem, imipenem, aztreonam, piperacillin-tazobactam, and or cefepime during their hospitalization (between 1/1/2011 and 10/30/2015). Exclusion criteria: pregnant women and admissions less than 24 hours. The two groups evaluated were patients receiving treatment (group 1) prior to extend infusion practices (Jan 2011 – Dec 2012) and (group 2) after implementation of extend infusion practices (Jan 2013 – Oct 2015). Data was collected from medical records using both the Sunrise Clinical Manager and EPIC electronic medical record systems. The data was then analyzed for differences in efficacy outcomes (e.g., length of hospitalization, lung function, return to baseline lung function), changes in renal and hepatic function, incidence of documented adverse drug effects, and potential factors associated with increased risk for changes in renal or hepatic function with use of extended infusion beta‐lactam regimens. Results: Pending. Efficacy outcomes: - length of hospitalization - improvement in lung function - return to baseline lung function Safety outcomes: - changes in renal and hepatic function - incidence of documented adverse drug effects - potential factors associated with increased risk for changes in renal or hepatic function Conclusions: Pending. As this study is being conducted at one academic medical center, conclusions may not be generalizable to other institutions.
    • Evaluation of a Specialty Pharmacy Counseling Program on Patient Outcomes for Oral Oncolytic Medications

      Mathews, Kelly; Voight, Michael; Ketterer, James; Kennedy, Kyle; College of Pharmacy, The University of Arizona (The University of Arizona., 2017)
      Objectives: Our working hypothesis is that patients who opt in to pharmacist counseling will have a higher medication possession ratio and longer length on therapy than patients who opt out of pharmacist counseling. Methods: Using data extracted from patient’s charts we retrospectively calculated medication possession ratio and length on therapy in relation to the patient receiving or not receiving counseling. Results: The patients analyzed were receiving 8 specific oral oncolytic medications provided by Avella Specialty Pharmacy in 2015. There were no significant differences found in MPR values for any of the 8 oral oncolytic medications included in the study. Iressa (p=0.826), Lonsurf (p=0.392), Stivarga (p=0.838), Zydelig (p=0.633), Zykadia (p=0.077), Tagrisso (p=0.060), Imbruvica (p=0.263) and Tarceva (p=0.326). No statistically significant differences were found in LOT values for any of the 8 oral oncolytic medications included in the study. Iressa (p=0.885), Lonsurf (p=0.868), Stivarga (p=0.326), Zydelig (p=0.502), Zykadia (p=0.212), Tagrisso (p=0.089), Imbruvica (p=0.540), Tarceva (p=0.129). Conclusions: Pharmacist counseling does not appear to affect MPR or LOT for patients taking oral oncolytic medications. Further research is warranted targeting other chronic disease states with complex oral regimens where medication adherence has not already been established from prior therapy options and adequate disease state knowledge.