• A 12-Month Comparison of Medication Adherence, Combination Therapies, Psychiatric Hospitalization Rates and Cost of Care in Patients with Schizophrenia on Clozapine versus Quetiapine in an Outpatient Mental Health Treatment Facility

      Fankhauser, Martha; Bahraini, Zhinus; Baqseh, Aftehar; Quah, Bee-Chin; College of Pharmacy, The University of Arizona (The University of Arizona., 2007)
      Objectives: This 12-month retrospective, naturalistic study determined medication adherence, psychiatric hospitalizations, cost of services, cost of prescriptions, and rates of polypharmacy (less than 4 versus greater than or equal to 4 concomitant psychotropic medications) for patients receiving clozapine versus quetiapine therapy for the treatment of schizophrenia in an outpatient mental health facility. Methods: The clozapine and quetiapine groups were compared for gender, age, medication adherence rates, hospitalizations, cost of care, polypharmacy, and types of concomitant psychotropic medications over 12-months. The polypharmacy groups for clozapine and quetiapine (e.g., greater than or equal to 4 psychotropic medications versus less than 4 psychotropic medications) were compared for medication adherence. Results: A total of 71 patients met the entry criteria (44 = clozapine and 27 = quetiapine). The two groups were similar for age, gender, court order, average daily dose, and hospitalization rates. The clozapine group had a higher medication adherence rate of 0.901 (e.g., 329 days supply) compared to the quetiapine group’s adherence rate of 0.723 (e.g., 264 days supply) (p=0.007). The clozapine group had higher costs for medication, labs, and other services compared to the quetiapine group, as well as total costs of services (p=0.004). The clozapine group was on fewer concomitant psychotropic medications compared to the quetiapine group based on the rates of polypharmacy. Conclusions: Patient on clozapine therapy had improved medication adherence and lower rates of polypharmacy, but higher costs of care compared to quetiapine. The frequent monitoring required with clozapine may result in medication adherence that results in improved efficacy, less polypharmacy, and lower hospitalization rates. Further studies in larger populations are needed to compare different frequency rates of monitoring patients on outcome measures over a longer period of treatment.
    • A 13-year Review of Initial Employment Trends for Pharmacy Graduates of the University of Arizona

      Boesen, Kevin; Tabis, Ryan; Short, Jeremy; College of Pharmacy, The University of Arizona (The University of Arizona., 2006)
      Objectives: To gain insight into current trends in pharmacy employment directly after graduation in the areas of community, hospital, pharmacy practice residencies and to relate those findings to environmental factors within the field. Methods: An exit survey was distributed to fourth-year students at The University of Arizona College of Pharmacy (UACOP) in the spring prior to graduation during the years 1993 to 2005. Among other items, the survey inquired about each student’s initial job selection. Group I consisted of data from the graduates of 1993-1995, Group II contained graduates from 1996-2000, and Group III included data from students during the years 2001-2005. The groups were compared using the chi-square method. Results: Data were collected from a total of 688 graduating students over the thirteen year period. Groups were assigned based upon the year of graduation. The largest reported difference between the groups was the percentage of students pursuing community practice, increasing from 25% to 51.8% between the groups, respectively (p <0.0001). Additionally, a significant reduction in percentage of students pursuing residency training was also noted, decreasing between Group I (36.2%) and Group III (23.7%), with p = 0.006. There were no significant changes in the percentage of students taking hospital positions throughout the study duration. Conclusions: Over the last 13 years, the percentage of students from The University of Arizona College of Pharmacy that choose community pharmacy as their initial employment is increasing. The percentage of students starting out in hospital pharmacy has remained relatively stable, while the fraction of students choosing to pursue residency training is declining. This trend may be influenced by a variety of factors, including increased salaries in community pharmacy, more openings in the retail practice area, and increased competition for residency positions.
    • Academic and Training Requirements in Advertisements for Pharmacy Management and Clinical Director Positions: A Follow up

      Murphy, John E.; Ashby, Jade; College of Pharmacy, The University of Arizona (The University of Arizona., 2008)
      Objectives: A follow-up analysis of academic and training requirements found in advertisements for pharmacy management, assistant director, and clinical pharmacy director positions. Methods: Advertisements appearing in the American Journal of Hospital Pharmacy (AJHP) were analyzed for academic and training criteria that were either preferred or required for pharmacy management, assistant director, or clinical pharmacy director positions. Included advertisements were for pertinent positions found in AJHP between January 2002 and December 2007. Some of the requirements or preferences that appeared in the advertisements that were analyzed included the type of pharmacy or other degree, postgraduate training including residencies and/or fellowships, board certification, and experience qualifications. Results: There was a total of 426 advertisements that met inclusion criteria. Results were listed in percentages of advertisements either requiring or preferring a certain qualification. A significant portion of ads sought applicants who had completed a residency (24% - pharmacy manager/director, 50% - clinical director, 47% - assistant/associate manager). Preferences and requirements of the PharmD or MS degree qualification decreased in percent from a previous study. However there was an increase in the relative number of ads pertaining to the MBA preference (9%, n=27). Conclusions: Many of the results from this study were similar to previous studies which looked at job qualifications in pharmacy manager and clinical directors. It remains evident that education, training, and experience play a major role in meeting the qualifications associated with obtaining a job as a pharmacy manager, clinical director, or associate director.
    • Access to Primary Medical Care among Patients with and without Mental Illness in a Rural Setting

      Hall-Lipsy, Elizabeth; Leutz, Kenneth; Elmer, Cody; Elmer, Sarah; College of Pharmacy, The University of Arizona (The University of Arizona., 2017)
      Objectives: To assess access to and quality of primary health care services by individuals receiving meals at a food bank in a rural location using the Primary Care Assessment Tool- Short Form (PCAT-S). Also, to investigate whether individuals with a mental health condition at a rural community food bank receive different care compared to those without a mental health condition. Methods: The PCAT-S, a survey developed by John Hopkins University, was administered to evaluate care at first contact, ongoing care, coordination of care, and comprehensiveness of care. Demographics data (age, gender, health conditions, insurance status, etc.) was also collected. Results: The majority of our participants surveyed lived within an urban zip code (84.8%), had government insurance (81.4%), were male (61.9%), or were Native American (45%). The groups with the highest mean PCAT-S scores were participants with diabetes (mean score= 96.8), participants with no insurance (94.63), and participants who were female (91). The patient populations with the lowest scores were those with less than a high school education (63.11) with serious mental illness (64), or who had bipolar disorder (69). Groups with higher mean PCAT-S scores indicated more involvement with a primary care provider or overall better care within that section of the PCAT-S. Conclusions: Participants with a mental health condition may be receiving less healthcare than those without a mental health condition, especially in the coordination of care between healthcare services, as indicated by lower mean PCAT-S scores. Those living in a rural community, among our population, do not appear to be receiving less healthcare than those in an urban setting.
    • Accuracy of House, MD Season Five Episodes 1-12

      Apgar, David; Armstrong, Edward; Nye, Adam; Post, Tracy; Vomocil, Elisa; Apgar, David; Armstrong, Edward; College of Pharmacy, The University of Arizona (The University of Arizona., 2012)
      Specific Aims: This study was performed to assess the accuracy of the presenting signs and symptoms, diagnostic procedures, and treatments depicted in episodes one through twelve of the fifth season of House, MD. Methods: This study was a descriptive, retrospective evaluation of the accuracy of the first twelve episodes of the fifth season of House, MD. Dependent variables in this study were presenting signs and symptoms, diagnostic procedures, and treatment of the final diagnosis for the primary patient case. A rating of one to four was assigned to each variable, with one being most accurate and four being inaccurate. Statistical analysis consisted of ANOVA and Tukey HSD post-hoc test Main Results: The signs and symptoms had a mean of 2.42 ± 0.669 (95% CI 1.99 to 2.84). The diagnostic tests had a mean of 2.42 ± 1.084 (95% CI 1.73 to 3.11). The treatment had a mean of 1.42 ± 0.9 (95% CI 0.84 to 1.99). ANOVA showed a statistically significant difference among the accuracy ratings of the groups (p = 0.013). Tukey HSD did not show a significant difference between the accuracy of the signs and symptoms and diagnostic tests (p = 1). The test did reveal a statistically significant difference between accuracy of treatment and both the signs and symptoms (p = 0.027) and diagnostic tests (p = 0.027). Conclusions: The treatments shown in House, MD, season five, episodes one through twelve are significantly more accurate than both the diagnostic tests and the presenting signs and symptoms.
    • Accuracy of Medical Information in the Seventh Season of the Medical Television show House, M.D

      Apgar, David; Armstrong, Edward; Warholak, Terri; Foote, Kristy; Marciano, Jackelyn; Pellerito, Joseph; Apgar, David; Armstrong, Edward; Warholak, Terri; College of Pharmacy, The University of Arizona (The University of Arizona., 2016)
      Objectives: To evaluate the level of accuracy of medical information presented in the seventh season of the medical drama, House M.D. To assess the accuracy of the presentation, diagnostic procedures and treatment presented in season seven. Methods: A descriptive, retrospective assessment of the accuracy of all the episodes of the seventh season of House M.D. Three reviewers independently rated the accuracy (on a scale of one to four) for the presenting signs and symptoms, diagnostic procedures, and treatment in each episode. A rating of one meant a correct and usual representation while a rating of two indicated a correct but somewhat unusual representation. A three was given for a correct but extremely unusual representation and a rating of four indicated an incorrect representation. Each researcher independently rated the episodes, and an average for each rating was used for analysis. Results: Results of the ANOVA test demonstrated no statistically significance differences between the three dependent variables (p=0.0782), therefore the Tukey HSD post-hoc test was unnecessary. The average rating for the treatment variable was 2.17 (±1.19), whereas the average ratings for the signs and symptoms and diagnosis variables were 2.74 (±0.92), and 2.87 (±1.14), respectively. The ratings for the treatment variable were more accurate compared to the other two variables. Conclusions: All three dependent variables observed in season seven of House, MD were similar in regards to accuracy falling between a rating of 2.0-3.0 representing a correct but somewhat unusual to a correct and extremely unusual representation.
    • Activation Rates of the ADD-Vantage Medication Delivery System in a Community Teaching Hospital

      Bergstrom, Eric; Wolk, Robert; McLain, Michelle; Palese, Ian; Bergstrom, Eric; Wolk, Robert; College of Pharmacy, The University of Arizona (The University of Arizona., 2013)
      Specific Aims: The objective of this study was to describe the failure rate of activation of medications that employ the ADD-Vantage medication delivery system in one community hospital, Tucson Medical Center (TMC). Methods: A daily, hospital-wide summary was generated identifying all patients currently receiving ADD-Vantage medications using the TMC electronic medical record system, Epic. Data collection occurred on arbitrary days and times from July 2012 to March 2013. Direct observation of a failure or a success in activation occurred by entering a patient’s room after the ADD-Vantage medication was administered by the nurse. Important data collected included: medication, frequency of administration, nursing unit, time of administration, administering nurse, the shift during which the nurse was working and whether or not the medication was or was not properly activated. Main Results: All medications utilizing the ADD-Vantage medication delivery system at TMC were analyzed. The rate of failure across 347 total samples collected on various days and times was 6.92%. Night shift had a higher rate of failure at 11.43% versus 6.41% for day shift (χ2 = 1.23). The General Surgery and Cardiac units of the hospital had the highest rates of failure with 18.18% and 15.38% respectively. Zosyn was improperly activated with greatest frequency with 12 total failures. Conclusion: No statistically significant difference was found between the rates of activation failure for those samples collected during nursing day shift versus night shift. The overall rates of activation failure suggest a significant opportunity for nursing education to improve outcomes.
    • Adherence in Exercise Meta-Analyses: Assessment and Effect on Study Outcomes

      Slack, Marion; Bae, Jeffrey; Kobleski, Robert; College of Pharmacy, The University of Arizona (The University of Arizona., 2005)
      Objective: The purpose of this study was to explore whether current meta-analyses on exercise interventions assess adherence and/or compliance of the studies included in the meta-analyses and to determine if subject adherence had any effect on outcomes of the analyses. Methods: Data was collected through a search of the MEDLINE database using the key words exercise, adherence, compliance, clinical trials, and meta-analysis. Data on study title, author, number of studies screened, number in meta-analysis, range of sample sizes, total number of subjects, primary intervention, primary outcome, how study quality was assessed, how adherence was assessed, whether adherence was used as a control variable, and did adherence affect the outcome was recorded on a paper and pencil data extraction form. Data was analyzed by constructing a table describing the meta-analyses and calculating the number and percent of analyses that included adherence. The table allowed for the evaluation of the strength and methodology of each piece of literature with respect to acknowledging adherence as a significant variable in the strength and legitimacy of each analysis. Results: Nineteen meta-analyses met our search criteria and were evaluated. Five of the nineteen meta-analyses (26 percent) described a method for assessing adherence. It was found that none of these used adherence as a control variable. Four of the nineteen meta-analyses did not assess the quality of the studies contained within the analysis. One of these meta-analyses suggested that adherence may have confounded outcomes, but did not provide any data to address their concerns. Conclusions: In meta-analyses, adherence is unlikely to be addressed. Current meta-analyses frequently lack methods for assessing adherence, and do not use adherence as a control variable. Whether adherence to exercise regimens affects outcomes cannot be determined from current meta-analyses.
    • Adherence to Mood Stabilizers Using a Pharmacy Prescription Database Analysis: Assessment of the Relationship of Non-Adherence to Hospitalization Rates, Cost of Care, and Gender for Patients with Bipolar Type I Disorder

      Fankhauser, Martha; Slack, Marion; Kale, Andrea; Kuchanskaya, Yuliya; College of Pharmacy, The University of Arizona (The University of Arizona., 2006)
      Objectives: This study utilized a prescription claims database to retrospectively assess the relationship between adherence rates with a mood stabilizer in bipolar type I patients for: gender, age, psychiatric hospitalization rates, cost of services, and concomitant psychotropic medications. Methods: Adult patients with bipolar type I disorder (N=149; F=92 and M=57) who received at least two prescriptions of a mood stabilizer (i.e., carbamazepine, lamotrigine, lithium, oxcarbazepine, and valproic acid) during a 3-month intake period were included. Adherence to the mood stabilizer was retrospectively analyzed using high: >75% (> 274 days) vs. low: < 75% (< 274 days) supply of a mood stabilizer during 12-months. Results: Only 35.6% of the patients (N=53) met the criteria for > 75% adherence and 11.4% (N=17) met the criteria for > 90% adherence. There was a trend toward women having more days supply of a mood stabilizer compared to men (p=0.08) and older patients having a higher adherence rate with a mood stabilizer (p=0.06). The high adherence group had greater prescription costs (p<0.001) and total cost per year (R2=0.34, p=0.064) and more concomitant medications (p=0.04) than the low adherence group. Overall, there were no significant differences between the high and low adherence groups for mean hospital days, inpatient costs, and total cost of care. Among those patients that were hospitalized there was a negative correlation between adherence and inpatient cost (R2=0.49, p=0.024). Conclusions: Our findings suggest that patients with bipolar type I disorder demonstrate poor medication adherence with a mood stabilizer and that adherence rates based on a prescription claims database using two adherence categories may not be a predictive factor for psychiatric hospitalizations or cost of care.
    • Aerobic Exercise and its Effects on HbA1c and BMI in Patients With Type 2 Diabetes Mellitus: a Meta-Analysis

      Slack, Marion; Aguilar, Alejandra; Gruhl, Steven; Slack, Marion; College of Pharmacy, The University of Arizona (The University of Arizona., 2014)
      Specific Aims: To assess the effect of aerobic exercise dose has on diabetes control monitoring parameter of HbA1c and BMI. Methods: Studies were found from previous studies and through a search of PubMed. These studies were screened for eligibility and data was extracted using a data extraction tool. The outcomes of HbA1c and BMI were analyzed using Comprehensive Meta-Analysis software and standardized mean difference (SMD) was used to assess the impact of different doses of exercise on the outcome measures. Variability was measured using the I2 statistic and publication bias was assessed. Main Results: Nineteen studies met inclusion criteria and were analyzed. Moderate dose aerobic exercise was found to have moderate effect in reducing HbA1c and BMI (p = 0.00 & 0.03 respectively). Low dose and high dose aerobic exercise were not to reduce HbA1c (p = 0.07 & 0.13) or BMI (p = 0.61 & 0.25). There was excess variation found in both the HbA1c analysis and the BMI analysis (I2 = 72.28 & 84.04 respectively). There was no publication bias found (Kendall’s tau = 0.809). Conclusion: Moderate dose aerobic exercise was effective in reducing HbA1c and BMI, while low dose and high dose aerobic exercise were not found to have a statistically significant effect on either HbA1c or BMI.
    • Analysis of Community Pharmacy Workflow Processes in Preventing Dispensing Errors

      Armstrong, Edward P.; Hoxsie, DeAnna; Keller, Amanda; College of Pharmacy, The University of Arizona (The University of Arizona., 2005)
      Objectives: 1) Determine the compliance rate with 12 dispensing workflow criteria; 2) note if any dispensing errors occurred; and 3) summarize characteristics of the pharmacies studied (pharmacy staffing, dispensing workload, presence of a drive-through window, etc.). Methods: At least fifty out-window (i.e., pharmacy prescription pick up window) transactions per store were observed within 18 community retail pharmacies. Based on the historic pharmacy error incidence reports, pharmacies were categorized as being either high- or low-risk pharmacies. The compliance rates for the dispensing workflow criteria were observed between high- and low-risk pharmacies and also between different employee categories. Employee categories included pharmacists, pharmacy interns, and pharmacy technicians who were involved in the dispensing process. Results: Between August 2004 and January 2005, a total of 950 out-window transactions were observed. There were statistically significant differences seen between high- and low-risk pharmacies and between the various categories of employees. The lack of the verification of patients’ name and number of prescriptions being picked up were procedures that were more commonly associated with pharmacies reported to have high dispensing error rates. Implications: This study identified several areas where the dispensing workflow criteria were not being performed. Based on this study, the lack of the verification of patients’ name and number of prescriptions being picked up were procedures that were more commonly associated with pharmacies reported to have high dispensing error rates.
    • Analysis of Electronic Prescribing Errors and Impact on Patient Care: Would a Collaborative Practice Agreement be Beneficial?

      Herrier, Richard; Smith, Charity; Swartzfager, Theresa; Lugo, LeAnna; Herrier, Richard; College of Pharmacy, The University of Arizona (The University of Arizona., 2016)
      Objectives: Analyze electronic prescription errors made by a community health center. Determine the time it takes to correct electronic prescription errors in a community pharmacy. Ascertain whether or not a collaborative practice agreement would be beneficial. Methods: The store computer system was used to generate a report of all prescriptions received at a community pharmacy from a community health center during a 6-month period. Using an Excel sheet, one author kept track of how many electronic prescriptions were received, the number and type of errors, and the time it took to get an error corrected. Results: There were 1896 electronic prescriptions sent from a community health center to a community pharmacy; 61 contained an error (3.24%). On average, it took the doctor’s office 111.7 hours to call back and clarify the mistake. Conclusions: There was not a significant amount of prescribing errors that occurred during the data collection period. However, the time it took for the doctor’s office to call back was significant and translates to patients not being able to get their medications on time.
    • Analysis of Gentamicin Extended Interval Dosing Protocols in a Neonatal Population     

      Murphy, John; Genzlinger, Kristin M.; Murphy, John; College of Pharmacy, The University of Arizona (The University of Arizona., 2011)
      OBJECTIVES: The purpose of this study was to analyze various published gentamicin dosing protocols in a neonate population to determine the percentage of patients that fell within defined concentration ranges, and determine which protocol was the most efficient at being within the desired concentration ranges. METHODS: Data from three published studies were used to create a database of 331 neonates who were up to seven days old and received gentamicin. Pharmacokinetic data was obtained and applied to specific dosing protocols from six published studies. The protocols were used to simulate peak and trough concentrations for each neonate. Desired trough concentrations include < 0.5 mg/L or < 1 mg/L and peak concentrations within 7-10 mg/L. Results were analyzed for frequency of achieving pre-specified concentration ranges based on dosing protocols from the study. RESULTS: The Begg protocol was adjusted for a desired Cmax of 8.5 mg/L and an estimated volume of distribution based on weight and was found to be the most efficient at achieving the highest percentage of patients achieving peaks of 7-10 mg/L and a trough of < 1 mg/L and < 0.5 mg/L, 63.0% and 61.5%, respectively. Also, other protocols which adjusted the dose based primarily on weight or gestational age such as the Fullas, Blackmer and Darmstadt protocols frequently achieved their desired trough however the average peak varied significantly, and was higher than the pre-specified concentration range. CONCLUSION: Achieving acceptable concentration ranges was suboptimal with much variability between each protocol requiring therapeutic drug monitoring and adjusting accordingly until a more efficient protocol is developed for this patient population.
    • Analysis of Interventions Performed on Electronic Versus Traditional Prescriptions

      Warholak, Terri; Schwar, Jake; Miller, Kim; College of Pharmacy, The University of Arizona (The University of Arizona., 2010)
      OBJECTIVES: To investigate whether the use of electronic-prescriptions reduces the amount of interventions being performed by pharmacists in a retail community setting. METHODS: Investigators directly observed local community pharmacist for a period of 3 weeks, during the working hours of 9am to 6pm. Information recorded with each intervention was the type of prescription, drug in question, reasons for intervention, final outcome, and time spent performing intervention. RESULTS: After 3 weeks of direct observation a total of 21 interventions were performed on electronic-prescriptions versus 154 interventions on other types of prescriptions (handwritten, faxed, verbal). The percentage of prescriptions that needed interventions was 11.7% of electronic-prescriptions versus 10.3% of all other types (p = 0.565). CONCLUSIONS: In this limited study, the rate of interventions appears to be similar between electronic-prescriptions and other types of prescriptions as a whole.
    • An Analysis of Job Satisfaction Among Pharmacy Faculty in the United States

      Murphy, John; Rice, Laura; Morelli, Luke; College of Pharmacy, The University of Arizona (The University of Arizona., 2007)
      Objectives: The purpose of this study was to determine the level of job satisfaction among faculty in Colleges and Schools of Pharmacy in the United States. Responses to survey questions regarding personal and demographic information were used to analyze differences in satisfaction among the faculty. Methods: A prospective study was performed by distributing an email containing a weblink to a questionnaire to 1,000 randomly selected full-time faculty members in Colleges and Schools of Pharmacy in the United States. The American Association of Colleges of Pharmacy (AACP) Roster of Faculty and Professional Staff for the 2005-2006 academic year was used to generate the list. The weblink directed prospective participants to a questionairre constructed on www.surveymonkey.com. Responses were collected from the website questionairre and analyzed using analysis of variance to interpret the data. Results: A total of 266 participants responded. The mean level of overall job satisfaction for the faculty was 3.6 (+ 1.0). The survey demonstrated significant differences in levels of overall job satisfaction particularly when related to faculty salary categories with the higher salaries generally showing higher levels of satisfaction than those in lower salary categories. Additionally, it showed that factors such as having time for family and other personal needs and opportunity to educate were more important than good salary and benefit packages. Conclusions: Faculty members employed in Colleges or Schools of Pharmacy in the United States are generally satisfied with their jobs.
    • Angiotensin Converting Enzyme Inhibitor Cough: A Review of Characteristics, Frequency, Mechanism, and Treatment

      Herrier, Richard; Sulzbach, Robert M.; College of Pharmacy, The University of Arizona (The University of Arizona., 2008)
      Objectives: : The purpose of this paper is to provide greater understanding of ACE inhibitor cough and appropriate treatment options. Methods: A Medline search of key terms from 1975-2008 was conducted and all types of published material were included in this review. The articles were evaluated for relevance and appropriateness for inclusion in this review. Subjects considered appropriate included ACE inhibitor cough treatment, mechanism of action, incidence and prevalence, genetics, cough characteristics, onset and resolution of cough, and others. Whenever possible, original studies were obtained but several reviews were also used. Results: ACE inhibitor cough is typically a dry, non-productive, persistent but benign cough reportedly occurring in anywhere from 0.5%-50% of patients receiving ACE inhibitors, though most studies indicate less than 20%. The mechanism is not completely understood but seems to be related to a complicated mechanism involving pathways caused by ACE inhibition and including bradykinin, C fibers, and prostaglandins. Several treatment options have been successful in resolving or relieving cough, including NSAIDs, baclofen, cromolyn and others. Results, however, are inconsistent. Anti-tussive agents, switching to a different ACE inhibitor, or lowering the dose of the current ACE inhibitor do not seem to be effective. Conclusions: In spite of its benign nature, ACE inhibitor cough is usually bothersome enough to discontinue the medication and therefore can not be ignored. Several treatments have appeared effective, all of which carry the risk of drug interactions and additional side effects, and alternative therapy such as angiotensin receptor blockers seem to be reasonable in indicated patients.
    • Appropriate Use of Meropenem: A Pharmacy Intervention

      Rubal-Peace, Georgina; Natkowski, Jamie; Stacey Abbott; Rubal-Peace, Georgina; Natkowski, Jamie; College of Pharmacy, The University of Arizona (The University of Arizona., 2014)
      Specific Aims: The primary objective was to determine the effectiveness of a criteria-based antibiotic order form (CBAOF) at increasing appropriate meropenem use at University of Arizona Medical Center –South Campus (UAMCSC). The secondary objective was to assess any cost savings associated with increased appropriate meropenem use. Methods: A retrospective chart review of patients (n = 133) meeting inclusion criteria at UAMCSC during the pre and post-intervention periods was conducted. Outcomes included appropriate empiric use of meropenem, appropriate treatment of a known pathogen use of meropenem, appropriate dose and frequency of meropenem, appropriate antibiotic streamlining after culture and susceptibility report, and meropenem acquisition costs. Main Results: Appropriate empiric use of meropenem was significantly higher after the implementation of the CBAOF (100% vs. 65.8%, p = 0.002). Although not statistically significant, the post-intervention group had more patients meeting the criteria for appropriate use of meropenem for a known pathogen than the pre-intervention group (50% vs. 40%, p = 0.809). There were no differences between the pre and post-intervention groups with respect to appropriate dose of meropenem or appropriate frequency. After the implementation of the CBAOF there were significantly more patients who received antibiotic streamlining within 24 hours of culture and susceptibility reports (12.5% vs. 48.7%, p = 0.002). Drug acquisition costs for meropenem were reduced by approximately $30,000 after CBAOF implementation. Conclusion: The CBAOF was effective at increasing appropriate empiric meropenem use and decreasing meropenem acquisition costs at UAMCSC.
    • Appropriateness and Use of Medications by Patients with Persistent Asthma in a Community Health Center

      Slack, Marion; Redding, Greg; Guzman-Lopez, Mayra; College of Pharmacy, The University of Arizona (The University of Arizona., 2017)
      Objectives: A chart will be used to assess the need for the asthma education program. The chart review aims to: analyze the refill history of asthma medications along with verifying adherence via electronic health record and assess if patients are getting appropriate asthma therapy per 2007 NHLBI asthma guidelines. Methods: The patient’s MHC Healthcare electronic record profile and pharmacy refill record will be accessed. The information that will be obtained from the electronic health record will be: ethnicity, age, sex, allergic rhinitis diagnosis, flu vaccine status, pneumonia vaccine status, GERD diagnosis, spirometry measure if available, use of prednisone for exacerbation, prescribed asthma therapy, and provider’s (MD, NP, PA, etc)’s notes that might indicate nonadherence. The information that will be obtained from the pharmacy record are controller and rescue medication refill history. The information will be recorded in paper data collection forms and electronic versions will be saved to the secure college of pharmacy workgroup. The raw physical information described above will be stored in a locked cabinet at MHC healthcare pharmacy inside the pharmacy director’s office and the de-identified information will be stored in the secure workgroup. Results: Conclusions:
    • Appropriateness of Antibiotic Therapy During the First 72 Hours of a Hospital Visit in Patients with Community-Acquired Pneumonia

      Matthias, Kathryn; Morey, Nick; Matthias, Kathryn; College of Pharmacy, The University of Arizona (The University of Arizona., 2013)
      Specific Aims: The objectives of this project were to determine the time to appropriate antibiotic therapy for community-acquired pneumonia, evaluate the appropriateness of antibiotic changes within a 72 hour period, and to determine the rate of re-admissions for pneumonia. Methods: A retrospective chart review of patients admitted to an academic medical center in March 2012 with a diagnosis of pneumonia was performed. Subjects under the age of 18 years or who were not treated for infectious pneumonia were excluded. Relevant data were extracted from the subjects’ electronic charts and recorded onto a data collection form. Data collected included antibiotics given within the first 72 hours and times of administration, laboratory results, culture and susceptibility results, radiology results, testing for coccidiodomycosis, reason for readmissions within 30 days if applicable, and demographic information. A descriptive analysis of these data was performed. Main Results: A total 100 subjects were included in the final data analysis with a mean age of 64 years. During the first 48 hours, patients were prescribed vancomycin (52%), azithromycin (48%), ceftriaxone (41%), moxifloxacin (30%), piperacillin-tazobactam (25%), meropenem (22%), and other antibiotics (26%). The mean (+SD) number of antibiotics prescribed within the first 24 hours was 2.5 (1.1). Either azithromycin, azithromycin plus ceftriaxone, or moxifloxacin only were prescibed in 21% of subjects within the first 24 hours. Within the first day, combinations of broadspectrum antibiotics (meropenem, piperacillin-tazobactam, cefepime) or a combination of ceftrixone plus either meropenem or piperacillin-tazobactam were prescribed in 6% and 12% of subjects, respectively. The appropriateness of empiric therapy and antibiotic changes is currently in progress. A total of 53% of subjects were discharged with prescriptions for extended course oral or intravenous antibiotics. While 27% of subjects were readmitted within a 30-day period, 9% of subjects were readmitted with either a diagnosis of pneumonia or related respiratory condition. One subject was readmitted within 30 days with Clostridium difficile associated diarrhea. During the initial admission, coccidioidomycosis testing was performed in 38% of subjects. Conclusion: A variety of combinations of antibiotic agents were prescribed to subjects diagnosed with community-acquired pneumonia. Changes to antibiotic therapies were frequent and often without explanation. Readmission rates for a respiratory related illness within 30-days was approximately 9% and less than 40% of subjects were tested for coccidioidomycosis.