APhA2014 ABSTRACTS APhA2014 abstracts of contributed papers The following are abstracts of original research being presented at APhA2014, March 28–31, 2014, Orlando, FL. Inquiries specific to the research should be directed to the contact author, indicated in the abstracts by underlined name. The 2014 abstracts are grouped into the following themes to better facilitate review by specific topic or interest area: Adherence and Persistence; Reimbursement; Cardiovascular Care; Collaborative Practice; Communication/Patient Education; Diabetes; Educating the Educators; Geriatrics and Long-Term Care; Health Disparities and Cultural Issues; Health Literacy; Immunizations; Law and Regulations; Marketing and Management; Maternal, Child, and Women’s Health; Medication Reconciliation; Mental Health; Medication Therapy Management; Nuclear Pharmacy; OTC, Self-Care, and CAM; Pain Management; Patient Attitudes and Behavior; Patient Care Services; Per- Adherence and Persistence 1—ASSESSING THE IMPACT OF A PHARMACIST-DELIVERED MEDICATION SYNCHRONIZATION PROGRAM ON CHRONIC MEDICATION ADHERENCE. Rabey J, Monte S, McEvoy A, University at Buffalo School of Pharmacy and Pharmaceutical Sciences, E-mail: [email protected] Objective: The primary objective of this study is to determine how a pharmacist-led medication synchronization program impacts adherence to chronic medications. Methods: This retrospective study will be conducted at an independent community pharmacy. Patients will be included if they have been enrolled in the pharmacy’s medication synchronization program for ≥9 months with ≥3 consecutive synchronized refills and are taking ≥1 of the following chronic medications: oral hypoglycemic agents, antihypertensive agents with a renin–angiotensin system antagonist mechanism, agents with an HMG-CoA reductase inhibitor mechanism. Qualified patients will be matched to controls, not enrolled in the program, by age, sex, and active prescription(s) for the same chronic medication therapeutic class during the same time period. All patient medication profiles will be reviewed for chronic e76 JAPhA | 5 4 :2 | M AR/AP R 2014 Downloaded From: http://mustafa.japha.org/ on 06/09/2014 sonalized Medicine/Pharmacogenomics; Pharmacist Behaviors and Attitudes, Pharmacoeconomics and Outcomes, Professional Development; Public Health; Quality and Safety; Respiratory Care; Substance Abuse and Addictions; Specialty Pharmacy; Technology, Workforce and Manpower; and Emerging Topics. APhA is especially proud to note this year’s presented papers from current student pharmacists and pharmacy residents. The experience of presenting at a national meeting will surely serve these emerging practitioners well as they begin their careers in pharmacy. In the abstracts, “NA” denotes that the information was not available when the abstract was prepared or not applicable. Encore presentations—papers presented previously at other meetings—are marked with a special symbol (Q). doi: 10.1331/JAPhA.2014.14511 medication days’ supply and refill dates. Medication adherence will be calculated using proportion of days covered (PDC), where a PDC >80% will be considered adherent. Data will be analyzed to compare chronic medication adherence as determined by PDC of the synchronization program group to the control group. Results: Research in progress. An estimated 100 patients will be eligible for the study. This study will contribute to the lacking evidence on pharmacist-led medication synchronization programs and the potential for pharmacists to have an efficacious role in improving patients’ medication adherence to chronic pharmacotherapy. If successful, this study may provide the framework and impetus for larger studies and in structuring medication synchronization programs in the community pharmacy setting. 2—CHANGE IN MEDICATION NONADHERENCE AND BELIEFS IN MEDICATIONS OVER TIME IN OLDER ADULTS. Unni E, Roseman University of Health Sciences, Farris K, University of Michigan, E-mail: eunni@ roseman.edu Objective: This study seeks to determine how medication nonadherence and beliefs in medications change over time in older adults because this change can impact adherence interventions. ja p h a .org Methods: A longitudinal study was conducted using an Internet-based survey administered by Harris Interactive for a sample Medicare population on prescription drug utilization. The survey also collected data on medication adherence (using the 4-item Morisky scale) and beliefs in medications (using Horne’s Beliefs in Medications Questionnaire). The data were collected in two phases: a baseline survey in October 2005 and a follow-up survey in October 2007. Descriptive analyses, correlation, and t tests were used to determine the significant relationship between the variables over time. Results: A total of 436 respondents answered both surveys. The mean age was 72.54 (± 5.49) years for baseline survey and 74.53 (± 5.49) years for the follow-up survey. Fifty-five percent of the respondents were female; 16% had high school or equivalent education; 38% had some college and 40% had at least 4 years of college education; 56% had an annual income <$50,000; 92% were white; and 58% were married. For all respondents, from the baseline to follow-up survey, there was a significant increase in both necessity beliefs (16.42 to 17.13) and concern beliefs (11.62 to 11.69). There was a significant correlation between baseline and followup beliefs (0.656 for necessity beliefs and Journal of the American Pharmacists Association APhA2014 ABSTRACTS 0.534 for concern beliefs). The correlation between baseline and follow-up nonadherence (0.341) also was significant. In both baseline and follow-up survey, nonadherent individuals had significantly higher concern beliefs than adherent individuals. Additionally, concern beliefs had a significant correlation with both baseline and follow-up nonadherence rather than necessity beliefs. Baseline nonadherence was a significant predictor of follow-up nonadherence. Conclusion: Changes in necessity and concern beliefs in medications occur, and concern beliefs seem to be more important than necessity beliefs. to 365 days’ supply of opioid therapy were 25%. Adherence for the medications (MPR ≥80%) under study were, beta-blockers 40%, ACE inhibitors 46.6%, biguanides 41.3%, and sulfonylureas 45.5%. No statistical differences were found in adherence rates based on opioid therapy. Conclusion: Medication adherence remains problematic for many health conditions. Opioid use among the elderly could lead to untoward side effects. More research is needed to determine the appropriate use of opioids in the elderly and whether there is any impact on chronic medication adherence. 3—CHRONIC MEDICATION ADHERENCE AMONG OPIOID USERS IN A MEDICARE ADVANTAGE PLAN. Fleming M, Upadhyay N, University of Houston, E-mail: mlflemi2@ uh.edu Objective: Elderly patients are at greater risk of adverse effects associated with opioid therapy. Sedation and drug interactions may impact medication adherence with chronic disease therapies (e.g., antihypertensives). The study objectives were to describe the prevalence of chronic opioid therapy in an elderly population and examine the impact of opioid therapy on chronic medication adherence among patients with cardiovascular and diabetic disorders. Methods: A retrospective claims database study of a continuously enrolled (2009–2010) Texas Medicare Advantage Plan’s beneficiaries (>60 years of age) with an International Classification of Diseases–9th revision diagnosis code for cardiovascular and diabetic disorders were included. Prescription claims for beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, biguanides, diuretics, and sulfonylureas were examined to determine adherence using medication possession ratio (MPR) of ≥80%. Opioid use was categorized into 2 groups: <90 days and 90 to 365 days of use. Logistic regression was used to determine the impact of opioid therapy on medication adherence for each drug class. Results: Opioid prevalence in the study sample was 53.1%. Patients on 90 4—EFFECT OF AN ADHERENCE PROGRAM ON A1C IN PATIENTS WITH TYPE 2 DIABETES MELLITUS. Komaiko K, St. Louis College of Pharmacy, Seiler K, Medical Arts Pharmacy, Richard III L, Logan R, L&S Pharmacy, Deacon C, Medical Arts Pharmacy, Bollinger S, Health Priorities Inc., Gattas N, St. Louis College of Pharmacy, E-mail: [email protected] Objective: This study seeks to determine the effect of a pharmacist-run adherence program (AP) on A1C. Methods: This 28-week, singlecenter, parallel-design, intent-to-treat, randomized control trial will implement an AP at an independent community pharmacy in a low-income, rural area with a high prevalence of diabetes. The pharmacy will identify patients based on diabetes medication use and will involve a minimum of 110 patients. Patients included in the study will be age ≥18 years and have type 2 diabetes mellitus taking diabetes medication, and patients will be initially excluded if they have gestational diabetes, already enrolled in AP, take metformin for polycystic ovary syndrome, and/or had a change in diabetes medication in the 6 months prior to enrollment. Patients will be excluded from data analysis if diabetes medication is initiated, discontinued, or changed during the study data collection period or if patients change weight significantly. After patients’ consent, they will be randomized to either the control group (not enrolled in the AP) or the test group (enrolled in the AP). The primary endpoint Journal of the American Pharmacists Association Downloaded From: http://mustafa.japha.org/ on 06/09/2014 j apha.org is change in A1C, with secondary endpoints of change in weight and proportion of days covered (PDC) of diabetes medicines. A1C, weight, and PDC will be collected on all subjects initially, at 3 months (A1C only) and 6 months. Statistical analysis comparing groups will utilize a t test. Demographic information of patients also will be collected and reported. Results: Research is currently undergoing institutional review board approval. Previous studies have shown that this adherence program affects PDC, however it is unknown whether it affects overall diabetes outcomes. If it is found to be true, then use of a pharmacist-run adherence program should be encouraged among community pharmacy practices. 5—EFFECT OF A PHARMACYBASED INTERVENTION ON MEDICATION ADHERENCE AND HEALTH CARE COSTS. Pringle J, University of Pittsburgh School of Pharmacy, Boyer A, CECity.com Inc., Conklin M, Pharmacy Quality Solutions Inc., McCullough J, Rite Aid Corporation, Aldridge A, RTI International, E-mail: [email protected] Objective: The objective of this study was to evaluate the impact of a pharmacy-based intervention on patients’ adherence to 5 chronic medication classes and on health care costs. Methods: The Pennsylvania Project was a quasi-experimental prospective study conducted at community pharmacies. The study assessed 59,496 patients aged ≥18 years who received at least 2 medication fills during the period from January 2010 to December 2011. Pharmacies were assigned to an intervention or control group. Intervention group pharmacists received monthly performance measures via a cloud-based platform. Patients were universally screened for poor medication adherence risk at intervention pharmacies. Pharmacists gave patients who screened positive a brief intervention based on motivational interviewing principles. Improved medication adherence was measured by proportion days covered 80% or greater during the 12 months before and 12 months durMAR /APR 2014 | 54:2 | JAPhA e77 APhA2014 ABSTRACTS ing the intervention phase for patients whose pharmacy behaviors were available for at least 270 days in each period. Annual patient health care costs (2010 and 2011) were drawn from claims data provided by Commercial, Medicare, and Medicaid insurers. Results: For all medication classes, intervention significantly (P<0.01) improved adherence even after propensity score adjustments and controlling for differences in age, sex, insurance plan, pre-intervention adherence, health care costs, and diagnoses. This increase ranged from 4.8% for oral diabetes medications to 3.1% for beta-blockers. Calcium channel blockers, statins, and renin–angiotensin system antagonists had increases of 3.3%, 4.1%, and 3.7%, respectively. Additionally, there was a significant reduction in overall health care spending for patients taking statin medications and oral diabetes medications ($20 per patient per month [PMPM] and $28 PMPM, respectively). Conclusion: The pharmacist-provided intervention significantly improved medication adherence across all 5 medication classes examined and reduced health care costs for 2 medication classes. This study demonstrated that pharmacist-provided intervention is a cost-effective tool that may be applied in community pharmacies and other health care sites across the country. outcomes of patients with diabetes mellitus and/or hypertension, measured by a change in A1C and/or blood pressure, respectively, from baseline. Methods: Patient data will be collected through a retrospective chart review of patient medical and pharmacy dispensing records. Patients will be included in the study if they started receiving MAP between January 1, 2012 and June 30, 2012. Patients will be excluded if they fill chronic medications at >1 pharmacy or if they stopped receiving primary care at this PCMH prior to July 1, 2013. Patients will be separated into 2 cohorts: those who received only MAP and those who received both MTM and MAP. For the purpose of this study, patients will serve as their own controls and change from baseline will be analyzed. At baseline, the medication regimen complexity index will be assessed. To measure adherence, medication possession ratio will be retrospectively analyzed at baseline and on July 1, 2013. Clinical outcomes, including A1C and blood pressure, also will be analyzed at baseline and on July 1, 2013 (with or without MTM). Results: Research in progress. Data collection will begin post institutional review board approval. The anticipated outcome is that patients will have greatly improved adherence to chronic medications that will result in improved health outcomes. 6—THE EFFECTS OF BOTH MEDICATION ADHERENCE PACKAGING AND MEDICATION THERAPY MANAGEMENT ON ADHERENCE TO CHRONIC MEDICATIONS. Clemans S, Holyoke Health Center, Dietle A, Massachusetts College of Pharmacy and Health Sciences University, Cole T, Holyoke Health Center, E-mail: [email protected] Objective: The primary objective will be to assess the change in adherence to chronic medications in patients within a patient-centered medical home (PCMH) who receive medication adherence packaging (MAP) and in patients receiving both MAP and medication therapy management (MTM). The secondary objective will be to assess the effect of MAP, with or without MTM, on health 7—EVALUATING PATIENT INTEREST IN AN ADHERENCE-FOCUSED SMARTPHONE APP TO IMPROVE HIV CARE. Cillessen L, Gaborcik J, Ellis J, The Ohio State University, Clark A, AIDS Resource Center Ohio, Rodis J, The Ohio State University, E-mail: ellis.349@ osu.edu Objective: The objectives of this study are to: (1) evaluate patient need for adherence assistance; (2) evaluate patient perceptions of a smartphone app to assist in medication adherence; and (3) evaluate the potential adoption of an adherence app by a community pharmacy located within a clinic focused on patients with human immunodeficiency virus (HIV) infection. Methods: AIDS Resource Center (ARC) Ohio is a nonprofit organiza- e78 JAPhA | 5 4 :2 | M AR/AP R 2014 Downloaded From: http://mustafa.japha.org/ on 06/09/2014 ja p h a .org tion that leads the fight against HIV/ acquired immunodeficiency syndrome through awareness, advocacy, and care in Ohio. ARC Ohio Pharmacy, located within the ARC Ohio Medical Center, serves the general public across Ohio. With daily medication, HIV-positive individuals can live long, healthy lives. When HIV medication is not taken as prescribed, HIV may become resistant to medications, leading to HIV complications. Data on use of smartphone apps for medication adherence is sparse and unavailable in this population. This study involves conducting a survey to determine whether ARC Ohio Pharmacy will adopt an adherence-focused smartphone app to enhance adherence and thus patient health and longevity. Anonymous paper surveys will be distributed to patients of ARC Ohio Medical Center and Pharmacy in the reception area to assess patients’ current adherence habits and techniques as well as perceptions on utilization of a smartphone adherence app. Descriptive statistics will be used to analyze results. Results: Research in progress. Reported results will describe patients’ current use of adherence aids, need for adherence assistance, and perceptions of a smartphone app for adherence. Results will provide investigators with information to determine whether adoption of a smartphone app is reasonable in this local population. 8—EVALUATING PATIENTS’ PERCEPTIONS OF BLISTER PACKS DISPENSED IN A COMMUNITY SETTING AND ITS IMPACT ON THEIR ADHERENCE. Pinto S, Bechtol R, Gaffney K, The University of Toledo College of Pharmacy and Pharmaceutical Sciences, E-mail: [email protected] Objective: The purpose of this study is to evaluate patients’ perceptions of a blister packaging system and the impact of blister packs on their level of adherence after using the system. Methods: This qualitative study used a random sample of patients and caregivers >18 years of age, taking ≥6 medications, with ≥3 chronic conditions, and had used a blister packaging system for ≥6 months dispensed at a community Journal of the American Pharmacists Association APhA2014 ABSTRACTS pharmacy. Three focus group sessions were conducted over a 1-week period using a previously developed discussion guide. Participants were asked about their experiences with the blister packs and its impact on their level of medication adherence. Participants’ responses were noted, and video- and audio-recorded. Transcripts were created and analysis conducted using ATLAS v. 7.0. Results: Thirty patients and caregivers participated. The overwhelming consensus was that blister packs had many more advantages and were a preferred option compared with other medication organizing systems such as pill bottles/ vials, pillboxes, and medication pouches. All participants agreed that blister packs overcame all challenges they had experienced when using bottles/vials, pillboxes, and/or medication pouches. Nine themes arose depicting how blister packs helped counter these challenges. Among those reasons were that participants believed blister packs improved their adherence and quality of life by helping them remember to take their medications; improved organization and convenience of taking their medications; reduced their stress and gave patients a sense of security about their medications; and improved their health. Prior to using the blister packs, only 7% (2/28) said they were adherent to their medications. Following the use of blister packs, 93% (26/28) said they took their medications as prescribed by their doctor and it resolved their nonadherence issues. Conclusion: Adherence problems often seen when using the most readily available medication organizing systems were countered by the use of the blister packs. 9—EVALUATING STRATEGIES TO IMPROVE PERFORMANCE ON CENTERS FOR MEDICARE AND MEDICAID SERVICES STAR RATINGS IN CHAIN COMMUNITY PHARMACIES. Barton K, University of Arkansas for Medical Sciences, Schnur E, Walmart Stores Inc., Flowers S, University of Arkansas for Medical Sciences, Hiland S, Walmart Stores Inc., E-mail: evan. [email protected] Objective: The purpose of this study is to evaluate strategies for improving performance on Centers for Medicare and Medicaid Services (CMS) Star Ratings in a national chain community pharmacy. Methods: A quality improvement dashboard was recently implemented in a chain community pharmacy that provided visibility to pharmacies’ performance on certain CMS Star Rating metrics. To achieve optimum performance on these metrics, a program was developed to train pharmacy staff on how to positively impact the ratings. For the purposes of this study, approximately 48 pharmacies from 4 different regions will pilot the training. Each group will receive a different intensity of training. Training components include a webinar, e-mail reminders with improvement strategies, and store-level access to the quality dashboard that includes additional improvement strategies. All 4 groups will receive the initial webinar explaining the strategies to monitor performance on the 5 core measures: (1) adherence to angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB); (2) adherence to oral diabetic medications; (3) adherence to statins; (4) use of an ACEI/ARB in patients with diabetes; and (5) use of high-risk medications in elderly patients. The control group will receive only training from the webinar. The second group will receive the webinar and monthly e-mail reminders; the third group will receive the webinar and have access to the adherence dashboard; and the fourth group will receive the webinar and have access to both the e-mail reminders and access to the adherence dashboard. Each group will be blinded from one another and notified separately that their pharmacies are a pilot for implementing the dashboard. Results: Research in progress. The baseline performance of all 4 groups will be recorded as the study begins, and then monthly measure performance data will be collected. Data will be evaluated using descriptive analysis to show the trend for each group in improving performance on each of the 5 measures. 10—EVALUATION Journal of the American Pharmacists Association Downloaded From: http://mustafa.japha.org/ on 06/09/2014 OF MEDICAj apha.org TION ADHERENCE WHEN RECEIVING PRESCRIPTIONS FOR HEPATITIS C FROM AN OUTPATIENT PHARMACY WITHIN AN INTEGRATED HEALTH SYSTEM. Lakdawala L, Nathanson A, Katzianer J, Johns Hopkins Home Care Group, Email: [email protected] Objective: The primary objective of this study is to determine adherence to telaprevir and/or peginterferon and ribavirin, as the percent of patients with proportion of days covered (PDC) >80%. The secondary objectives are to: (1) compare adherence to chronic hepatitis C medications, as determined by PDC, between patients who received a pharmacist face-to-face initial encounter versus non–face-to-face initial encounter; and (2) differentiate adherence to chronic hepatitis C medication regimens for each patient, as determined by PDC, at treatment durations of 12 weeks, 24 weeks, 48 weeks, or any point of early discontinuation. Methods: This is a retrospective review of chronic hepatitis C medications filled at the Johns Hopkins Outpatient Pharmacies from September 2011 through December 2013. Patients included are >18 years of age, have chronic hepatitis C, and have received prescriptions from 1 of the 7 Johns Hopkins Outpatient Pharmacies for at least the first 3 months of therapy. Those excluded did not fill their chronic hepatitis C medications for the first 3 months, or received boceprevir triple therapy. Adherence will be calculated using PDC for the following medications: telaprevir and/or peginterferon and ribavirin. Reports will be generated from the pharmacy dispensing systems and electronic medical records. Descriptive statistics will be used to report the percent of patients with PDC >80%. Descriptive statistics will be used to compare adherence of patients based on pharmacist initial encounter and at defined points of treatment duration. Results: Research in progress. 11—EVALUATION OF A PHARMACIST-DELIVERED MEDICATION SYNCHRONIZATION PROGRAM IN AN INDEPENDENT COMMUNITY PHARMACY. Fillis R, McEvoy A, MAR /APR 2014 | 54:2 | JAPhA e79 APhA2014 ABSTRACTS derserved urban and rural areas. Data collection is currently underway with anticipated completion by the end of December 2013. Results from this project can be utilized to educate these and other pharmacists on possible ways to improve patient care by counseling in a way all patients can understand. Q 101—IMPACT OF HEALTH LITERACY IN A DIABETES SELFMANAGEMENT EDUCATION PROGRAM. Smith S, Shealy K, Threatt T, Presbyterian College School of Pharmacy, E-mail: [email protected] Objective: The purpose of this study was to: (1) determine whether baseline health status correlates to a patient’s health literacy level as indicated by A1C; (2) determine health literacy level correlates to health outcomes as indicated by A1C level at follow up; and (3) determine health literacy level correlates with attendance in diabetes self-management education (DSME) program. Methods: This cohort study assessed patient health literacy status using the Rapid Estimate of Adult Literacy in Medicine–Short Form (REALM-SF) and Newest Vital Sign (NVS) tools during initial consults with patients referred to a DSME program. Additional data collected included demographic information and baseline A1C. Follow-up A1C was compared with baseline. Attendance was determined by number of missed classes. Descriptive statistics were used to analyze the data collected; change in A1C was analyzed by paired Student t test and correlation coefficients (r) were calculated for attendance and A1C level by health literacy level. This study was approved by the institutional review board. Informed consent was obtained. Results: Thirty-nine patients were enrolled in the study. More patients were identified to have poor health literacy with NVS than with REALM-SF. No significant correlation was found between baseline health status and health literacy level. Significant reduction in A1C was seen in all patients; however, follow-up health status per A1C negatively correlated with NVS scores. Patients with poor health literacy missed an average of 2.4 appointments, compared with an av- erage of 1.3 missed appointments by patients with higher health literacy. Scores from REALM-SF negatively correlated with attendance and were statistically significant. Conclusion: Overall the DSME program successfully improves patients’ health, and health literacy level seems to affect attendance to DSME sessions. More research is needed to determine the optimal tools for assessing health literacy level and subsequent interventions to achieve health outcomes success in a DSME program. Original Citation: Smith S, Shealy KM, Threatt T. Impact of health literacy in a diabetes self management education program administered through a school of pharmacy. Presented at 19th Annual Diabetes Fall Symposium for Primary Health Care Professionals, Charleston, SC 102—THE INFLUENCE OF FUNCTIONAL HEALTH LITERACY ON QUALITY PATIENT-PHARMACIST COMMUNICATION. King S, Union University, Rogers E, Methodist Healthcare, Null K, University of Mississippi, E-mail: [email protected] Objective: The purpose of this study was to examine the relationship between functional health literacy (FHL) and quality patient-pharmacist communication among patients receiving anticoagulation therapy. Additionally, this study assessed whether the time patients spent within optimal therapeutic range differed by level of FHL. Methods: In this study, 232 patients from 2 rural, pharmacist-staffed anticoagulation clinics were asked to participate in detailed telephone interviews concerning their interactions with clinic pharmacists. A validated, 1-item screening question was used to classify patients as possessing either adequate or inadequate FHL. Patients’ perceptions regarding general communication with pharmacists were elicited using 6 domains from the Interpersonal Process of Care (IPC) questionnaire. Indication, target range, time in range of anticoagulation, and race/ethnicity were retrieved from the database of the respective clinic. Independent t tests were used to assess Journal of the American Pharmacists Association Downloaded From: http://mustafa.japha.org/ on 06/09/2014 j apha.org for differences between FHL groups on each of the 6 IPC domains. Logistic regression was used to measure the association between inadequate FHL and the IPC domains. Results: Telephone interviews were completed by 220 patients. Patients possessing inadequate FHL reported significantly worse ratings to the quality of pharmacist communication than did those possessing adequate FHL on 4 of the 6 IPC domains (P≤0.05). The odds of reporting poorer quality interpersonal processes of care across these 4 domains were significantly greater for those possessing inadequate FHL (P≤0.05). Patients with inadequate FHL did not differ significantly from those with adequate FHL in terms of time within therapeutic international normalized ratio (INR) range or percent of INRs in therapeutic range over the previous 12 months. Conclusion: Patients receiving anticoagulation therapy also possessing inadequate FHL appear more likely to experience poorer communication with pharmacists than patients possessing adequate FHL. Pharmacists may be failing to adequately determine the extent to which educational efforts for these patients leads to intended consequences. Educational efforts may be needed to improve pharmacists’ communication skills in these areas. 103—READERSHIP AND PERCEPTION OF MEDICATION GUIDES AND PATIENT PACKAGE INSERTS AT A STUDENT HEALTH PHARMACY. Buchman C, Boyce B, Muravez S, Oregon State University, E-mail: christina. [email protected] Objective: The printed Medication Guide (MedGuide) and Patient Package Insert (PPI) that are required with prescription drugs outline the risks of taking the medication in language that is patient-friendly and relatively easy to read. The aim of this study is to evaluate how often patients of a student health pharmacy read the MedGuides/PPIs of prescription medications and how useful they have found the information provided. The unique patient population of a university setting eliminates some potential confounders because it can be MA R /APR 2014 | 54:2 | JAPhA e113 APhA2014 ABSTRACTS [email protected] Objective: This study assessed the patent life of new molecular entities (NMEs) and new biologics (NBs) that had a patent extension in the period 1985–2012. Methods: Data were collected from the U.S. Food and Drug Administration (FDA), the U.S. Patent and Trademark Office (USPTO), and the U.S. Federal Register websites for all new drugs approved by the FDA in the period 1985–2012. Descriptive analysis was performed for all variables. Results: The USPTO listed 499 NMEs/NBs with patent extensions, representing 51.9% of NMEs/NBs approved in the study period. Complete drug regulatory and patent information was available for 283 pharmaceuticals. The average patent extension was 2.72 ± 1.39 years. The patent extension was longest for drugs in the Anatomical Therapeutic Chemical (ATC) classes alimentary tract and metabolism (3.36 ± 1.39 years), systemic hormonal preparations, excluding sex hormones and insulins (3.03 ± 1.48 years), and nervous system (3.03 ± 1.53 years). The shortest patent extensions were granted to antiinfectives for systemic use (2.47 ± 1.22 years), sensory organs (2.47 ± 1.09 years), and musculoskeletal system (2.34 ± 1.32 years). The average duration of the clinical trial period was 5.52 ± 3.41 years. The longest clinical trial periods corresponded to musculoskeletal system (8.45 ± 5.38 years) and the shortest was for sensory organs (4.31 ± 1.77 years). The average FDA review time was 1.65 ± 1.31 years; it was highest for respiratory system (3.22 ± 2.34 years) and lowest for systemic hormonal preparations (0.98 ± 0.56 years). The overall effective patent life without patent extensions was 8.70 ± 7.01 years, whereas the effective patent life with patent extensions increased to 11.71 ± 6.78 years. The longest effective patent life corresponded to dermatologicals (13.59 ± 1.03 years); and the shortest patent life corresponded to cardiovascular agents (6.56 ± 23.21 years). Conclusion: There were significant differences in the clinical trial periods, FDA review time, and effective patent life among the different ATC classes of e122 JAPhA | 5 4:2 | M AR/AP R 2014 Downloaded From: http://mustafa.japha.org/ on 06/09/2014 new NMEs/NBs approved by the FDA in the study period. 127—ASSESSING DIFFERENCES IN THE CHARACTERISTICS OF THE NEW PHARMACEUTICALS APPROVED BY THE FOOD AND DRUG ADMINISTRATION AND THE EUROPEAN MEDICINES AGENCY. Badawoud E, Alshehri N, Alqahtani S, Seoane-Vazquez E, Massachusetts College of Pharmacy and Health Sciences University, Rodriguez-Monguio R, University of Massachusetts, E-mail: [email protected] Objective: This study aims to explore some areas of discrepancies between the Food and Drug Administration (FDA) and the European Medicines Agency (EMA) in approving new molecular entities (NME) and new therapeutic biologics (BLA) in the period from 1999 to 2011. Methods: FDA and EMA websites were utilized to retrieve data regarding drug applications, approvals, orphan status, and indications for new NMEs and BLAs. The 2 systems were compared using descriptive statistics and a t test was applied to assess differences in averages. Significant level was set at 0.05. Results: Both regulatory agencies approved a total of 101 drugs (82 NME and 19 BLA; all were FDA priority reviews). BLAs were submitted 1.25 ± 4.18 months later (median 0.33 months) and approved 7.14 ± 5.47 months later (median 5.75 months) by EMA compared with FDA. NMEs were submitted to EMA 1.44 ± 24.52 months later (median 0.44 months) and approved by FDA 6.67 ± 23.43 months later (median 7.49 months) than EMA. The BLA average review time was statistically significantly lower (P<0.001) for FDA 7.67 ± 2.24 months (median 6.21 months) than EMA 14.6 ± 3.33 (median 14 months). The NME average review time was statistically significantly lower (P<0.001) for FDA 9.25 ± 9.10 months (median 5.98 months) than for EMA 14.48 ± 4.09 (median 13.72 months). The number of products with orphan designation was lower in EMA (n = 33) than in FDA (n = 57). EMA granted orphan designation to 2 products that did not have orphan designation in the ja p h a .org United States. The United States granted orphan designation to 13 products that did not have orphan designation in the European Union. Differences in the indications approved in both systems were observed in 24.8% (n = 25) of the drugs. Conclusion: Significant differences exist in the time elapsed between the filing and the approval of drugs as well as in orphan designation. Harmonization of the regulatory systems could facilitate timely approval of essential pharmaceuticals. 128—COMMUNITY PHARMACISTS’ ATTITUDES TOWARD AN EXPANDED CLASS OF NONPRESCRIPTION DRUGS. Shah R, Holmes E, West-Strum D, University of Mississippi School of Pharmacy, Patel A, Medical Marketing Economics, E-mail: [email protected] Objective: There has been considerable discussion about creating a third class of drugs which would not require a prescription, but would require a pharmacist’s consultation upon purchase. Recently the Food and Drug Administration (FDA) held a hearing that repositioned a third class as an expanded nonprescription drug class termed as the “new paradigm” using innovative technologies. The objectives of this study were to: (1) measure community pharmacists’ attitudes toward the new paradigm; and (2) determine whether these attitudes differed according to practice and demographic characteristics. Methods: This cross-sectional study was conducted using a self-report, webbased survey administered to a national panel of community pharmacists. The survey items were developed based on existing scales in the literature and the FDA’s proposed guidelines for the new paradigm. A principal components analysis (PCA) with VARIMAX rotation and reliability analyses were conducted to identify the factors affecting community pharmacists’ attitudes toward the new paradigm. Descriptive statistics were used to describe pharmacists’ attitudes. Multivariate Analysis of Variance (MANOVA) was used to determine whether attitudes toward the new paradigm differed based on practice and de- Journal of the American Pharmacists Association APhA2014 ABSTRACTS (DM), and/or dyslipidemia medications. Methods: This is a retrospective cohort study in HIV-positive patients ≥18 years of age who filled their antiretroviral, HTN, DM, and/or dyslipidemia medications at a North Carolina community pharmacy after January 1, 2013. Patients who receive personalized care from a pharmacist for management of their antiretroviral medications and who have HTN, DM, and/or dyslipidemia will be evaluated. Refill dates over a 6-month period will be collected for antiretroviral, HTN, diabetes, and/or dyslipidemia medications. Medication adherence will be calculated for each disease state in which the patient received the same medication regimen for at least 6 consecutive months. The proportion of days covered method will be utilized to calculate adherence. The mean antiretroviral adherence rate will be compared with the mean medication adherence rate for HTN, DM, and dyslipidemia using a Student t test. Results: Research in progress. 17—NONADHERENCE IN RHEUMATOID ARTHRITIS PATIENTS: INFLUENCE OF PATIENT-CENTERED FACTORS ON DISEASEMODIFYING ANTIRHEUMATIC DRUGS AND LABORATORY COMPLIANCE. Akpoji U, University of Pittsburgh, Cerussi N, Aggarwal R, University of Pittsburgh Medical Center Presbyterian, Coley K, University of Pittsburgh, E-mail: [email protected] Objective: The objectives of this study are to: (1) assess the extent of oral disease-modifying antirheumatic drug (DMARD) nonadherence in patients with rheumatoid arthritis (RA); (2) assess factors contributing to nonadherence; and (3) assess the degree of nonadherence to crucial laboratory toxicity monitoring. Methods: This study is being conducted in an outpatient, hospital-based autoimmune clinic, where a student pharmacist works with rheumatologists and staff to interview patients after their visits. Patients included in this study are adults diagnosed with RA who are prescribed DMARDs. Patients are screened e82 JAPhA | 5 4 :2 | M AR/AP R 2014 Downloaded From: http://mustafa.japha.org/ on 06/09/2014 to determine their level of adherence by utilizing the Morisky adherence scale. A Likert-scale questionnaire is then used to assess the relative contributions of unintentional and intentional factors driving patients’ medication nonadherence. Patient-centered factors can be divided into 2 categories: unintentional factors that limit patients’ capacity to take their medication and intentional factors that lead to a decision toward nonadherence. Laboratory monitoring adherence is measured by assessing whether the time elapsed was >3 months or <3 months since patients’ last blood tests. Results: Research in progress. To date, there have been 7 low-, 10 medium-, and 6 high-adherers observed. Preliminary results demonstrate that forgetfulness of doses affected more patients’ adherence in the low adherence category (4/7) than that of the other 2 categories. Furthermore, 3 of 4 patients who did not obtain their labs as prescribed had forgotten to make appointments. Overall, more patients identified with the unintentional factors of nonadherence (11/20) than the intentional factors (9/20), with forgotten doses and side effects sharing equal proportions. The surveys utilized in this project may identify traits of high adherers that are lacking in the other nonadherent groups. Furthermore, this process may improve the efficiency of medication therapy management interventions by tailoring them to patients’ predominant factors of nonadherence, a feature commonly lacking in published interventions for patients taking DMARD therapy. 18—PATIENTS’ PERCEPTIONS OF MEDICATION ORGANIZING SYSTEMS AND THEIR LEVEL OF ADHERENCE USING THESE SYSTEMS. Pinto S, Bechtol R, Gaffney K, The University of Toledo College of Pharmacy and Pharmaceutical Sciences, E-mail: [email protected] Objective: The purpose of this study is to identify patients’ perceptions of medication organizing systems and their level of adherence using these systems. Methods: This research project used a qualitative study design. Participants included patients and caregivers >18 ja p h a .org years of age, taking at ≥6 medications, and having ≥3 chronic conditions. Three focus group sessions were conducted over a 1-week period using a previously developed discussion guide. Participants were asked about their positive and negative experiences with using pill bottles, pillboxes, medication pouches, and blister packs. Additionally, researchers asked how these systems impacted participants’ level of adherence to medications. Participants’ responses were noted, and video- and audio-recorded. Transcripts were created verbatim and themes and findings were summarized using ATLAS.ti 7.0. Results: Thirty patients and caregivers participated. All participants reported using vials and pillboxes. Four participants had used medication pouches. Participants believed vials were difficult to open, contributed to forgetting to take their medications, and did not provide privacy in public settings. Pillboxes helped minimize the need to open several pill bottles at a time and helped consolidate medications. Eighty-six percent (24/28) said they missed ≥1 pill per week using the 3 organizing systems. Fiftyfour percent (15/28) reported missing ≥10 pills per week with numbers as high as 40 pills per week. Participants emphasized the need for an adherence solution with characteristics, which included but are not limited to: a system that serves as a memory aid; provides a level of comfort and security with organizing their medications; reduces stress and time spent in organizing their medications providing a sense of independence and freedom; easy to use and travel friendly; and aids in improving their health and quality of life. Conclusion: Current medication organizing systems pose challenges to medication adherence. There is a need for a better solution that counters these problems and aids in adherence. 19—PHARMACIST-LED FACILITATION OF ENROLLMENT IN A PATIENT ASSISTANCE PROGRAM TO IMPROVE ADHERENCE AND REDUCE COSTS IN A COMMUNITY PHARMACY WITHIN A MEDICARE ADVANTAGE PATIENT-CENTERED Journal of the American Pharmacists Association APhA2014 ABSTRACTS MEDICAL HOME. Poole T, Belmont University College of Pharmacy, Arije S, Rite Aid Pharmacy, Hagan A, Belmont University College of Pharmacy, Milliken A, Smith A, James C, Cigna-HealthSpring, E-mail: [email protected] Objective: Cost is commonly cited as a barrier to medication adherence and many geriatric patients are at an increased risk of nonadherence due to complex medication regimens and lowincome status. It has been reported that more than 10% of Medicare beneficiaries have engaged in cost-related nonadherence activities to reduce out-of-pocket costs. Enrollment in a patient assistance program (PAP) is a way to mitigate costrelated adherence issues; however, patients often find them cumbersome and difficult to navigate. Through a concerted effort to facilitate successful enrollment of patients who qualify for patient assistance, it is anticipated that cost savings to the health plan and patients will be demonstrated and adherence will be improved through overcoming patient cost barriers. Methods: Patients in need of assistance are identified through interaction in the pharmacy or referral by a primary care physician (PCP) in the on-site primary care clinic. Patients are screened with general qualification requirements to determine potential qualification. If patients appear to qualify based on initial assessment, they are asked to return with the necessary supporting documentation required for a 15-minute visit with pharmacy personnel. At the visit, all parameters of the application are completed and corresponding prescriptions are gathered through collaboration with the patient’s PCP. Complete applications are faxed to the respective manufacturer. Any errors or appeals that occur are managed by the pharmacy and results are communicated to the patient. Documentation of intervention occurs in a standardized format within the clinic electronic medical record. Results: Research in progress. A total of 202 patients were seen in the service from January 2011 to December 2012. Preliminary data analysis indicates an estimated cost savings of $318,033 to the health plan and $60,843 to patients. Further analysis of impact on cost savings and adherence is in progress. 20—PHARMACISTS’ INTERVENTIONS TO IMPROVE NONADHERENCE TO STATIN THERAPY: THE SIGNIFICANCE OF PATIENT EDUCATION IN THE COMMUNITY SETTING. Bonner B, Bailey-Wheeler J, Sarpong D, Hart T, Harris M, Xavier University of Louisiana, E-mail: bbonner1@ xula.edu Objective: The objective of this study is to assess the effectiveness of pharmacist-driven patient education on improving medication adherence to statin therapy. Methods: The study will enroll 100 nonadherent patients receiving a statin prescription from the pharmacy, who are >18 years old and on a statin for ≥6 months. Patients on automatic refill will be excluded from this study. Nonadherence, defined as failing to refill a statin prescription consecutively within a 90day period, will be identified based on prescription fill rates. Study participants will have consented prior to enrollment. Data collection will be by surveys including: demographics, medication adherence (Morisky 8-Item Medication Adherence Questionnaire), and health literacy (Rapid Estimate of Adult Literacy in Medicine, Revised). The intervention, pharmacist-driven patient education, will instruct patients on dyslipidemia and the cardiovascular benefits of statin therapy. Tailored intervention will be administrated to 3 stratified groups (classes A–C) based on individual Morisky scores (classes A, B, and C are low-, medium-, and high-adherence groups, respectively). The primary outcome will be measured based on statin fill rates for the next 60 to 90 days post intervention. The effectiveness of the intervention will be assessed by the hypothesized increase of the statin prescription fill rates. The following statistical methods will be employed to assess the effectiveness of the intervention in improving medication adherence: paired t test and McNemar test as univariate analysis; and analysis of covariance as a test that accounts for potential confounders such as demographic factors and health literacy level. Journal of the American Pharmacists Association Downloaded From: http://mustafa.japha.org/ on 06/09/2014 j apha.org All significance tests will be at the alpha level of 0.05. By providing the benefit of patient medication and disease state education, this study will promote medication adherence, which has been proven to improve morbidity and mortality. Results: Research in progress. 21—PREDICTING FACTORS LEADING TO PRIMARY MEDICATION NONADHERENCE AND ITS EFFECT ON HEALTH SERVICE UTILIZATION AMONG MEDICARE BENEFICIARIES WITH CARDIOVASCULAR DISEASE. Gangan N, Vaidya V, Pinto S, The University of Toledo College of Pharmacy and Pharmaceutical Sciences, Amialchuk A, The University of Toledo, E-mail: Varun.Vaidya@utoledo. edu Objective: The objectives of this study are to: (1) identify primary medication nonadherence (PMN); (2) determine its effect on health service utilization; and (3) assess sociodemographic factors associated with it among Medicare beneficiaries with newly diagnosed cardiovascular disease (CVD). Methods: This was a retrospective, cross-sectional cohort study. Medicare beneficiaries with newly diagnosed CVD were identified using Medicare Current Beneficiary Survey data from 2002 to 2006. Andersen’s model of health service utilization was used as a theoretical framework to explain factors that may predict PMN. A multiple nonlinear regression model was built to identify factors associated with PMN. To determine the effect of PMN on health service utilization, adherent and nonadherent patients were matched by characteristics using propensity scores. Results: There were 7,542 Medicare beneficiaries newly diagnosed with CVD from years 2002 to 2006; 334 of those beneficiaries did not fill prescriptions representing 4.43% of the cohort under study. Female patients (odds ratio [OR] 0.682, 95% confidence interval [CI] 0.522–0.890), lower patient satisfaction with health service (OR 1.074, 95% CI 1.040–1.109), and higher cardiovascular burden (OR 1.248, 95% CI 1.122–1.388) were significantly associated with PMN. Nonadherent patients had fewer physiMAR /APR 2014 | 54:2 | JAPhA e83 APhA2014 ABSTRACTS cian visits (P<0.0001) and outpatient visits (P = 0.03) than adherent patients. Conclusion: Many patients failed to fill their prescriptions showing PMN among the study population. PMN was particularly significant in female patients, patients having low satisfaction with health service received, and patients with higher number of cardiovascular conditions. With the recent health care reform targeted at improving overall quality of care, findings from this present study provide guidance toward identifying populations vulnerable to PMN. PMN is a severe issue especially in cases of chronic conditions such as CVD than secondary adherence. A comprehensive approach involving physicianpharmacist collaborations could lead to provision of appropriate interventions to eliminate PMN. Future research should focus on identifying more factors leading to causality of PMN and devise strategies to reduce prevalence of PMN. 22—PRESCRIBING TRENDS IN NONADHERENT HYPERTENSIVE PATIENTS. Ta T, PGPA Pharmacy and Ferris State University, Heetderks L, PGPA Pharmacy, Meny L, Ferris State University, E-mail: [email protected] Objective: The objectives of this study are to: (1) document the effects of antihypertensive medication nonadherence on blood pressure; (2) describe antihypertensive medication changes due to medication nonadherence; and (3) report the frequency of nonadherence documentation in patient charts. Methods: Prior to initiation, this study will be submitted to the institutional review board for approval. This study is a retrospective chart review of nonadherent hypertensive patients from Federally Qualified Health Centers (FQHC) serviced by Pharmacy Group Practice Associates (PGPA) Pharmacy. Eligible patients will include those ≥18 years of age who have a documented diagnosis of hypertension, a documented initial and follow-up appointment with a primary care provider, a recorded blood pressure measurement, and are considered to be nonadherent to their antihypertensive medication regimen. Nonadherence will be defined as a prescrip- e84 JAPhA | 5 4 :2 | M AR/AP R 2014 Downloaded From: http://mustafa.japha.org/ on 06/09/2014 tion sent from a primary care provider practicing in a FQHC that resulted in the medication not being picked up within 4 weeks by the patient or patient representative and being returned to PGPA Pharmacy. Exclusion criteria include: patients with congestive heart failure, chronic kidney disease, atrial fibrillation, pulmonary hypertension, a history of myocardial infarction or stroke within the past 6 months, no hypertension diagnosis; patients receiving dialysis; patients utilizing other primary care facilities or pharmacies; and patients utilizing only nonpharmacological treatment for hypertension. Information to be collected from the chart review will include blood pressure at the initial and follow-up appointment, the class of antihypertensive medication prescribed at the initial appointment, how medication therapy was modified because of nonadherence, and if nonadherence was documented in the patient’s chart. Appropriate statistics and tests will be utilized and a P value of 0.05 will determine statistical significance. Results: Research in progress. 23—A QUALITATIVE ANALYSIS ASSESSING PATIENTS’ PERCEPTIONS OF SERVICES OFFERED IN AN ADHERENCE PHARMACY PROGRAM. Pinto S, Bechtol R, Omerza K, The University of Toledo College of Pharmacy and Pharmaceutical Sciences, E-mail: [email protected] Objective: The objectives of this study are to: (1) describe an adherence pharmacy model; and (2) assess patients’ perceptions of the services offered. Methods: Three focus group sessions were conducted over a 1-week period using a previously developed structured guide. Participants were patients and caregivers receiving products and services at a community adherence pharmacy for ≥6 months. Experiences with pharmacy services, pharmacists, and staff were evaluated. Responses were noted, and video- and audio-recorded. Dialogue was transcribed and analysis was conducted using ATLAS 7.0. Themes and findings were identified and summarized. Results: A new community pharmacy with a goal to impact medication ja p h a .org adherence was established in August 2011. Patients learned about the pharmacy via flyers, billboard signs, televised ads, and/or physician referrals. At enrollment, a medication list was created, medications synchronized, patients counseled, and medications dispensed in blister packs. Counseling sessions with patients and caregivers included education on their conditions, medications, and side effects. Follow-up phone calls were made monthly or quarterly corresponding with their refill dates. These calls monitored changes to medications, addressed patient questions, and assessed the need to schedule a follow-up face-to-face session. Blister packs were picked up or delivered to patient homes. Regarding patient perceptions, participants felt pharmacists and staff helped resolve pharmaceutical concerns and genuinely cared about them. Service benefits included receiving health care needs in a stress-free environment, keeping track of patient refills, and receiving medications timely. Adherence was impacted through patients better understanding their medications, having pharmacists identify drug problems and interactions, and assisting patients with their therapy by making recommendations. Conclusion: With emphasis placed on medication adherence as a performance indicator, new practice models impacting medication adherence are needed. This newly developed adherence pharmacy seems to provide a platform for this service. Services provided at the adherence pharmacy were positively received and were successful in positively effecting medication adherence and changing medication-taking behavior. 24—WITHDRAWN. 25—VARIABILITY OF ADHERENCE OUTCOME MEASURES IN STUDIES EVALUATING ORAL ANTINEOPLASTIC TREATMENTS. Banda S, Toscani M, Rutgers University, E-mail: [email protected] Objective: The current trend in oncology shows a shift in patient selfmanagement efforts, namely medication Journal of the American Pharmacists Association APhA2014 ABSTRACTS adherence, due to an increasing number of antineoplastic treatments being made available as oral therapies. Patient adherence to these therapies is a major concern, however there is currently no universally accepted definition or optimal method to measure and evaluate adherence. The objective of this study was to conduct a systematic literature review assessing the variability of adherence definitions and measurement methods used in antineoplastic treatment studies. Methods: A structured literature search and review was performed using MEDLINE to identify research articles on controlled and uncontrolled studies involving oral antineoplastic agent treatments from 2010 to 2013. Articles were included if patient adherence and/or non-adherence to an oral antineoplastic therapy was a primary or secondary objective of the study. MeSH terms and keywords including “adherence,” “compliance,” “persistence,” etc. were used as part of the search strategy. Articles that did not measure patient adherence in an oral antineoplastic agent were excluded. An assessment will be done on the adherence definition criteria and the adherence measurement methods defined in each study. The variability in these adherence outcomes measures within the respective cancer types will be a focus for evaluation, organization, and future reporting best practices. Results: Research in progress. Reimbursement 26—DO CHARACTERISTICS OF THE MEDICAID POPULATION EXPLAIN DIFFERENCES IN MEDICAID FEE-FOR-SERVICE GENERIC OUTPATIENT DRUG UTILIZATION AND REIMBURSEMENT?. Alshehri A, Balkhi B, Seoane-Vazquez E, Massachusetts College of Pharmacy and Health Sciences University, Szeinbach S, The Ohio State University, E-mail: [email protected] Objective: This study aimed to determine whether Medicaid demographics would account for differences in generic utilization, expenditures, and reimbursement among different Medicaid programs in 2011. Methods: Medicaid fee-for-service outpatient pharmacy utilization and expenditures, and reimbursement rates for the year 2011 were extracted from state-level data provided from the Centers for Medicare and Medicaid Services. Descriptive analyses were performed for all variables and linear regression analysis was performed to test the hypothesized association between Medicaid demographic variables and differences in generic utilization and reimbursement rates. Results: Fee-for-service Medicaid expenditures (n = 46 states) reached $27.8 billion and 173.4 million claims in 2011. Generic expenditures represented 17.3% of total expenditures (range 10.3%–29.2%) and generic utilization 72.2% of the claims (range 66.1%–84.8%). Generic utilization rates were highest in the Midwest (75.6% of total claims, n = 11) and lower in the Northeast (69.4%, n = 9). The states belonging to the West (72.2%, n = 10), South (72.0%, n = 14), and Pacific (70.3%, n = 2) regions had similar generic utilization rates. The average reimbursement was lowest in the Midwest ($14.27, n = 11), followed by the Northeast ($16.83, n = 9), South ($18.77, n = 14), West ($21.10, n = 10), and Pacific ($28.93, n = 2) regions. There were no statistically significant associations between statelevel generic utilization rates and total number of claims, total expenditures, percentage of Medicaid eligible in each age group, percentage of aged/disabled eligible population, or sex of the eligible population. Conclusion: Substantial differences were found in generic utilization rates and reimbursement among the different Medicaid programs. The states of the Midwest region had the highest generic utilization rate and the lowest average generic reimbursement amount. However, differences in utilization rates and reimbursement amount were not related to differences in Medicaid demographics or in generic dispensing fees and reimbursement amounts among the different states. Encouraging generic utilization could result in substantial saving for the Medicaid program. 27—PHARMACIST Journal of the American Pharmacists Association Downloaded From: http://mustafa.japha.org/ on 06/09/2014 BILLING j apha.org IN MEDICARE PART A AND PART B CLAIMS. Schroeder M, Zhang Y, Brooks J, University of Iowa, E-mail: [email protected] Objective: Although pharmacists have advocated for Medicare provider status in order to expand pharmaceutical care services, little is known about reimbursement practices outside of Part D. The objective of this study was to identify individuals who have successfully gained reimbursement and characterize the service mix and payment amounts for products and services unrelated to dispensing. Methods: Medicare data for 2010 were obtained from the Chronic Condition Warehouse. This analysis included Part A institutional claims (inpatient, outpatient, skilled nursing facility, home health agency, and hospice), and Part B noninstitutional providers and claims (carrier and durable medical equipment [DME]). Pharmacists and pharmacies were identified through National Provider Identification (NPI) numbers. Healthcare Common Procedure Coding System (HCPCS) codes were used to determine services and products provided. Average claim amounts also were calculated. Results: Although 186,805 pharmacists and pharmacies obtained an NPI, only 7,725 were identified in 2010 Medicare Part A and Part B claims. The majority (68%) was found in the DME file and almost three-quarters were selfidentified individuals. A total of 189,313 claims were filed to Medicare and 93% were for DME. Reimbursement amounts varied widely. Carrier claims (i.e., for non-institutional providers) on average were reimbursed $31.87, compared with $96.32 for DME and $132.04 for outpatient. “Incident toù” codes (HCPCS codes 99211–99215) were found only in outpatient claims and were used by 11 individuals. Average reimbursement amount for these claims was $71.91. Approximately 7% of claims were found on the carrier file and nearly 100% of these claims were for influenza and pneumococcal vaccinations. There also existed geographic variation in the number of claims across claim files. Conclusion: Although pharmacists MAR /APR 2014 | 54:2 | JAPhA e85 APhA2014 ABSTRACTS are reimbursed by Medicare, this study found little evidence of pharmaceutical care being reimbursed through Part A and Part B. The majority of claims were for vaccinations and DME. This is likely to be the case until pharmacists are recognized more widely as providers. 28—REIMBURSEMENT AND FINANCIAL JUSTIFICATION FOR CLINICAL PHARMACY SERVICES USING A COMBINATION PHARMACIST-PHYSICIAN VISIT MODEL. Willey V, Lim A, Reinhold J, University of the Sciences–Philadelphia College of Pharmacy, Willey K, Quality Family Physicians, E-mail: v.willey@usciences. edu Objective: Pharmacists provide direct patient care services in a variety of settings, however suboptimal payment is a major barrier to proliferation of these services. One approach to increase revenue to appropriate levels is to combine the pharmacist-physician visit and bill as a single visit under the physician. The study objective was to describe the revenue generated and determine the feasibility of this billing model. Methods: A billing record review was performed on all patients with a pharmacist-physician visit from August 1, 2012 to July 31, 2013 within a 4-physician, medical home, primary care practice where pharmacists have practiced since 2009. Pharmacist-physician visits, which were 1 hour for new patients and one-half hour for follow-ups, focused on patients with diabetes, dyslipidemia, hypertension, pulmonary diseases, and mental health disorders. Data collected included the amount paid for visits, diagnosis and procedure codes, and pharmacists’ availability. Outcomes assessed were overall revenue generated, level of visit codes, revenue by various visit levels and procedures, and viability of the business model. Results: A total of 248 patients (mean age = 49 ± 17 years; 61.7% female) had 486 pharmacist-physician visits. Pharmacists were available for 646.5 hours and total revenue generated was $43,852 for the 1-year period ($67.83 revenue/hour). Visit coding was 31.6% for 99213, 68.0% for 99214, and 0.4% e86 JAPhA | 5 4 :2 | M AR/AP R 2014 Downloaded From: http://mustafa.japha.org/ on 06/09/2014 for 99215. The mean amount paid was $66.16 for 99213 visits, $100.06 for 99214 visits, and $154.99 for visits that included spirometry. Based on a median pharmacist salary (salary.com—October 2013) of $119,421 ($57.41/hour), revenue generated from this model could meet pharmacist expenses. Conclusion: Pharmacist-physician visits billed as a combined visit are a potential way to fund direct patient care services that pharmacists can provide. More exploration of this and other business models is needed to see how successful it could be in varying practice sizes, patient volumes and types, length of visits, and services provided. 29—ROLE OF OVER-THE-COUNTER DRUGS IN MEDICAID DRUG UTILIZATION AND EXPENDITURES: 1991 TO 2008. Fikru B, Schondelmeyer S, Adams D, University of Minnesota College of Pharmacy, E-mail: fikru002@ umn.edu Objective: The objective of this study was to estimate the magnitude of expenditures and claims for over-the-counter (OTC) drug products in the Medicaid program from 1991 to 2008. National aggregate experience was examined and state level variations also were assessed. Methods: The Medicaid State Drug Utilization Data from the Centers for Medicare and Medicaid Services (CMS) was obtained with utilization data for each drug within each state by quarter by year from 1991 to 2008. The CMS data included expenditures, number of drug claims, and number of drug units provided to Medicaid recipients. This data set was assembled, cleaned, and merged with the Master Drug Data Base (Wolters Kluwer). Results: The OTC drug expenditure in 1991 was $133 million of $4.8 billion total Medicaid drug expenditures. In 2008 the OTC drug expenditures were $131 million of $24.3 billion total Medicaid drug expenditures. OTC drugs accounted for 4.4% of claims in 1991, 2.6% in 2005, and 3.3% in 2008. OTC expenditures were 2.8% of Medicaid drug expenditures in 1991, 0.7% in 2005, and 0.5% in 2008. The average prescription price per claim was $30.84 for brands, $8.25 for ja p h a .org generics, and $12.56 for OTCs in 1991. By 2008 the price per claim was $201.52 for brands, $22.01 for generics, and $12.79 for OTCs. Conclusion: Since 1975 more than 100 drug entities have been switched from prescription to OTC status. The cost per claim for OTCs is well below the claim cost of the average brand and generic prescriptions. Brand prescription claims on average cost more than 15-times the average OTC claim. As the number of blockbuster patented drugs losing their patents slows, safe and effective OTCs may represent the new focus of savings in drug benefit and formulary management for Medicaid and private health insurance programs. 30—VARIATIONS IN OVER-THECOUNTER DRUG UTILIZATION BY STATE AND THERAPEUTIC CATEGORY: 1991 TO 2008. Fikru B, Schondelmeyer S, Adams D, University of Minnesota College of Pharmacy, E-mail: [email protected] Objective: The purpose of this study is to assess variations in the pattern of utilization of over-the-counter (OTC) drugs in state Medicaid programs by state and therapeutic category from 1991 to 2008. State policies related to coverage of OTC drugs were identified and assessed empirically. Methods: This was a retrospective observational study using Medicaid State Drug Utilization Data reported by the Centers for Medicare and Medicaid Services for each state by quarter by year from 1991 to 2008. This data set was assembled, cleaned, and merged with the Master Drug Data Base (Wolters Kluwer). Results: State Medicaid programs varied considerably with respect to the share of drug claims and expenditures for OTC drugs from 1991 to 2008. At the state level, there were states with <1.0% of claims for OTCs (e.g., West Virginia, New York, Idaho). Other states saw OTCs used for 10% to 15% of the claims (e.g., Maine, Hawaii, Indiana). The variation in percent of claims as OTC drugs across the states is wide with more than 10-fold difference between minimum and maximum percent over this period. Journal of the American Pharmacists Association APhA2014 ABSTRACTS OTCs represented a greater percent of the gastrointestinal drug claims with the national average ranging from >16% in 1991 down to 6% in 2008. Topical OTC products were 4% of the claims in 1991 and rose to >8% of claims by 2008. Other therapeutic categories including analgesics, respiratory products, nutritional products, and insulins were examined. Conclusion: Coverage of OTC products by Medicaid varies by state and therapeutic categories. OTC drugs cost much less than brand name drugs and even less than generic drugs. OTC drug products for selective therapeutic categories may offer an opportunity for reducing Medicaid drug spending with safe and effective therapies. Cardiovascular Care 31—THE ABCS OF HEART HEALTH: STUDENT SUPPORT OF THE MILLION HEARTS INITIATIVE. Arnall J, Turingan E, Marciniak M, University of North Carolina at Chapel Hill Eshelman School of Pharmacy, E-mail: macary_ [email protected] Objective: In September 2012 and March 2013, the National Association of Chain Drug Stores Foundation sought proposals from schools and colleges of pharmacy to host community health fairs and outreach events. Events should support the Million Hearts initiative and the ABCs of appropriate aspirin therapy, blood pressure control, cholesterol management, and smoking cessation. The objective of this study is to report on the impact of this school’s projects to the local community and student pharmacists. Methods: A planning committee composed of 2 faculty members, 1 cardiology pharmacist, and 20 student pharmacists was created. Local events that would reach the targeted patient populations and health conditions were identified. Potential sites that could serve as community partners were contacted. A list of needed resources and supplies was developed. Results: Twelve health fairs were conducted, serving 507 patients. In total, 39 patients were educated on the importance of daily aspirin, 187 patients received blood pressure screenings, 220 patients received cholesterol screenings, and 79 patients were educated about smoking cessation. Student pharmacists made a significant impact on patient care; 25% of patients screened had an elevated blood pressure measurement and 11% were referred for cholesterol follow-up. Feedback from student pharmacists indicated how participation in the events positively impacted learning. The grant funding provided for purchase of cholesterol testing supplies, a service that students in the organization had not previously offered. Students utilized Million Hearts initiative materials and created new resources on the ABCs of heart health and immunizations. Conclusion: The outcomes of this initiative demonstrate the impact that a well-organized and motivated student pharmacist-led organization can have on a community. Further, these health fairs presented opportunities for student pharmacists to participate in event coordination and direct patient care, which serve to enhance learning and professional development. Grant funding enabled students to make a positive impact on their community’s health. 32—COMPARATIVE EFFECTIVENESS OF ANGIOTENSIN-CONVERTING ENZYME INHIBITORS AND ANGIOTENSIN II RECEPTOR BLOCKERS IN HEART FAILURE. Sharma M, Johnson M, Aparasu R, Chen H, University of Houston, E-mail: manvi. [email protected] Objective: The objectives of this study were to: (1) determine the comparative effectiveness of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) in patients with heart failure (HF); and (2) determine comparative effectiveness of individual drugs within ACEI and ARB classes. Methods: A retrospective cohort study was employed. A national cohort of Veterans Affairs patients with at least 1 outpatient claim of HF from fiscal year (FY) 1997 to FY 2002 was identified. The exposure to drugs was seen in FY 2002 and patients were followed for 1 year to study the outcome. The main independent variables were ACEI therapy and Journal of the American Pharmacists Association Downloaded From: http://mustafa.japha.org/ on 06/09/2014 j apha.org ARB therapy. Outcome assessed was death. The study adjusted for 45 patient risk factors including sociodemographics, comorbidities, co-medications and severity of illness. Multivariate Cox proportional hazards regression and propensity scoring techniques were employed to determine the adjusted estimates of the outcomes associated with the treatment. Results: In the cohort of 299,462 patients, 200,552 patients were on either ACEIs or ARBs; 187,478 patients were taking ACEIs and 25,987 were taking ARBs. There was no significant difference in reduction of risk of mortality with use of ARBs versus ACEIs (hazard ratio [HR] 0.955, 95% confidence interval [CI] 0.907–1.006). Results from propensity score analysis also suggest the same. Among ACEIs, enalapril (HR 0.715, 95% CI 0.584–0.876), fosinopril (HR 0.778, 95% CI 0.729–0.830), and lisinopril (HR 0.784, 95% CI 0.740–0.831) were significantly better than captopril in reducing risk of mortality. Among ARBs, candesartan (HR 0.847, 95% CI 0.751–0.994) and irbesartan (HR 0.892, 95% CI 0.795–1.00) were significantly better than losartan in reducing risk of mortality. Conclusion: Results from the study suggest that ARBs are equally effective as ACEIs in reducing risk of mortality in patients with HF and there are significant differences in effectiveness of individual drugs within ACEIs and ARBs in reducing risk of mortality in HF. 33—COMPARING THE LONGTERM CLINICAL AND ECONOMIC OUTCOMES OF ATORVASTATIN AND ROSUVASTATIN FOR MANAGING ELEVATED CHOLESTEROL IN CLINICAL PRACTICE SETTINGS USING SIMULATION MODELING. Balu S, AstraZeneca LP, Folse H, Lee J, Schuetz C, Archimedes Inc., E-mail: [email protected] Objective: Using simulation modeling, this study compared the long-term clinical and economic impact of atorvastatin and rosuvastatin therapy on patients with low-density lipoprotein cholesterol (LDL-C) above Adult Treatment Panel III (ATP III) goal. Methods: Two treatment scenarios MAR /APR 2014 | 54:2 | JAPhA e87 APhA2014 ABSTRACTS were investigated using the Archimedes model, a clinically detailed simulation model of human physiology, disease progression, and health care delivery, where patients initiated atorvastatin (10, 20, 40, and 80 mg) or rosuvastatin (10, 20, and 40 mg), and then periodically intensified treatment or maintained therapy, per U.S. pharmacy claims-based rates. Simulated individuals (from the National Health and Nutrition Examination Survey 1999–2006) were aged 45 to 70 years and had LDL-C exceeding goal after discontinuing prior prescribed lipid-lowering therapies. Major adverse cardiovascular events (MACE; myocardial infarction [MI], stroke, or cardiovascular death) were tracked for 10 years for the overall population and several high-risk subpopulations. Event costs (normalized to 2012 dollars), excluding pharmacy costs, were estimated using several sources, including Medicare Current Beneficiary Survey and Medicare Limited Data Set. Results: At baseline, the overall study population (N = 50,000) characteristics were: 56.3% men, mean age 57.2 years, mean LDL-C 162.8 mg/dL, 30% diabetic, and 6.1% with prior MI. Ten-year relative risks of MACE for rosuvastatin versus atorvastatin were 0.90 (95% confidence interval [CI] 0.89–0.91) for overall population, 0.88 (95% CI 0.86–0.90) for diabetes mellitus patients, and 0.89 (95% CI 0.88–0.91) for ATP III high-risk group patients; all P<0.05. Corresponding 10-year average event costs per patient were lower for rosuvastatin as follows: overall $600 (95% CI, $300– $1,000), diabetes mellitus $800 (95% CI $500–$1,200), and ATP III high risk $800 (95% CI $400–$1,200); all P<0.05. Conclusion: In this simulated study, rosuvastatin treatment reduced MACE incidence more than atorvastatin over a 10-year period across the overall population and diabetes mellitus and ATP III high-risk subpopulations, with significant event-related economic (nonpharmacy) savings. Further studies in appropriate statin use among patients with hyperlipidemia are warranted. 34—DABIGATRAN AND WARFARIN FOR STROKE PREVENTION IN e88 JAPhA | 5 4 :2 | M AR/AP R 2014 Downloaded From: http://mustafa.japha.org/ on 06/09/2014 ATRIAL FIBRILLATION: FACTORS ASSOCIATED WITH USE FOLLOWING NEW MARKET ENTRY IN REAL-WORLD PATIENTS. Lauffenburger J, Farley J, Rhoney D, University of North Carolina at Chapel Hill Eshelman School of Pharmacy, Gehi A, University of North Carolina at Chapel Hill School of Medicine, Brookhart M, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Fang G, University of North Carolina at Chapel Hill Eshelman School of Pharmacy, Email: [email protected] Objective: The purpose of this research is to investigate the factors associated with anticoagulant choice in patients with atrial fibrillation (AF) to prevent ischemic stroke. Warfarin, the main therapy choice for decades, has many safety issues and requires frequent monitoring. The first alternative, dabigatran, was approved by the Food and Drug Administration on October 19, 2010. However, the use of dabigatran in AF is unknown outside of clinical trials with limited patient diversity. Examining patient, provider, and health-system factors associated with new use of either warfarin or dabigatran may allow for better understanding of factors associated with uptake of newly approved therapies, influencing comparative effectiveness research. Methods: A retrospective cohort study is being conducted using the Truven Health Commercial Claims and Encounters and Medicare Supplemental Databases from 2008 through 2011. Patients were included if they: (1) received ≥1 inpatient or 2 outpatient AF diagnoses on separate days (International Classification of Diseases–9th revision diagnosis code of 427.31) after October 19, 2010; (2) are aged ≥18 years of age; (3) filled a prescription for warfarin or dabigatran following the first diagnosis date; and (4) maintained continuous eligibility and had no previous AF diagnosis or warfarin claim in the 12 months prior to the fill. Factors identified for the analysis included demographic information such as age, sex, race, geographic vicinity, type of insurance plan, prescription benefits generosity; clinical data include patient disease history, medication history, ja p h a .org medication adherence, ischemic stroke and bleeding clinical prediction risk scores, and surgical history. Multivariate log-binomial regression is being used to investigate whether significant differences are associated with anticoagulant initiation, adjusting for baseline clinical and demographic characteristics. Results: Research in progress. In the 1% sample of the data, 298 newly diagnosed new users of anticoagulants meeting the above inclusion criteria were identified. Further results on the 100% data are forthcoming. 35—EVALUATION OF THE ANTIFIBRILLATORY DRUG INTERACTIONS BETWEEN AMIODARONE AND DILTIAZEM IN ISOLATED PERFUSED RABBIT HEARTS. Almotrefi A, Alhumayyd M, King Saud University, E-mail: [email protected] Objective: The alarming reports of the proarrhythmic effects of several antiarrhythmic agents have stimulated interest to study the antifibrillatory drug interactions that may occur when antiarrhythmic drugs from different classes are combined. Recently, the authors presented the results of interactions between amiodarone (the prototype of class III antiarrhythmic drugs) and ibutilide (a newer drug from the same class) using the serial-shock method of measuring ventricular fibrillation threshold (VFT), a method that have proved reliable in quantitatively assessing the antifibrillatory potency of many antiarrhythmic drugs during the last few decades. This project reports the results of the interactions between amiodarone and diltiazem as an example of class IV antiarrhythmic agents. Methods: Hearts isolated from New Zealand white rabbits of either sex weighing 1.5 to 2 kg were perfused by the Langendorff method with McEwen’s solution. The method of measuring VFT and the stimulation connections have been described in details previously. Results: Perfusion with either amiodarone or diltiazem produced significant, dose-dependent increase in VFT. In addition, there was significant difference in the increase in VFT produced by the combined infusion of 1 µmol of amioda- Journal of the American Pharmacists Association APhA2014 ABSTRACTS rone and 0.02 µmol of diltiazem and the summation of the increases produced by the separate infusion of these 2 concentrations. This is in contrast to the results of the combined infusion of amiodarone and ibutilide), where no significant synergistic antifibrillatory effect was observed. Among the several studies of different antiarrhythmic drug combinations, this synergistic effect was only observed when lidocaine and propranolol were perfused simultaneously. Conclusion: The possible relevance of these results to their combined use in the treatment of cardiac arrhythmias is discussed. 3 6 — P H A R M AC IST-P H YSIC I A N COLLABORATION IN A SPECIALTY LIPID CLINIC TREATING PATIENTS WITH STATIN INTOLERANCES. Sabato L, Pruchnicki M, The Ohio State University, Snider M, Sharma K, Gulati M, The Ohio State University Wexner Medical Center, E-mail: [email protected] Objective: The purpose of this study is to characterize success rates of an interdisciplinary practice model utilizing physician and pharmacist collaborations to improve treatment of patients with intolerances to statin medications. The goal is to characterize the status of patients referred for statin intolerances and identify regimens associated with successful rechallenge and continuation as well as attainment of low-density lipoprotein (LDL) goal. Methods: The Comprehensive Cardiac Risk Reduction and Lipid Clinic at The Ohio State University Wexner Medical Center treats primary and secondary prevention patients to improve cardiovascular risk profiles and enhance lifestyle habits. Patients interact with physicians and pharmacists at team appointments and at separate pharmacy clinics. This research will be conducted as a retrospective chart review of medical records, using a convenience sample of established patients seen in 3 physician-pharmacist clinics and 3 pharmacist-only clinics during a 1-year study period (September 2012 to September 2013). All patients with a referral reason of statin intolerance and/or documented statin intolerances at the initial clinic appointment and having attended at least 2 follow-up visits in either clinic setting will be included. Results: Research in progress. Data will include patient demographics, documented history of previous statin medications and dose, type of adverse effect(s), and concurrent medications and medical conditions. Subjects will be classified as statin users if they were on a statin and instructed to continue at the current dose or an adjusted dose at study visits. Type and dose level of statin will be described as well as patient status regarding LDL goal attainment according to the National Cholesterol Education Program’s Adult Treatment Panel III guidelines. Descriptive analyses will be performed to aggregate the data. Continuous variables will be represented using means and standard deviations, while categorical data will be represented using percentages and frequencies. 37—PHYSICIANS’ PERCEPTIONS AND PRESCRIBING HABITS OF WEIGHT-BASED DIURESIS IN PATIENTS WITH HEART FAILURE. Murphy E, South Carolina College of Pharmacy, Newsome R, University of Georgia, Galdo J, Barney’s Pharmacy, Brittain K, South Carolina College of Pharmacy, E-mail: emilyaprilmurphy@ gmail.com Objective: The purpose of this study is to evaluate physicians’ perceptions and prescribing habits of weight-based diuresis in patients with heart failure. Methods: The study is a survey of physicians’ perceptions and prescribing habits surrounding weight-based diuresis in patients with heart failure. Study participants will be identified, through dispensing software at an independent pharmacy, as physicians who routinely prescribe loop diuretics. The survey will be sent electronically to physicians with an individualized access code, and a reminder e-mail will be sent 14 days after the initial contact for participants who did not respond. The survey will obtain information regarding demographics, area of practice, drug information utilization, rationale for prescribing weightbased loop diuretics, barriers to prescrib- Journal of the American Pharmacists Association Downloaded From: http://mustafa.japha.org/ on 06/09/2014 j apha.org ing, and prescribing habits. The survey will be conducted from November 1, 2013 through December 31, 2013; physicians may complete the survey only once. Results: Research in progress. Data will be analyzed using statistical analysis software through the electronic survey program. All research information will remain anonymous and in accordance with the research protocol. 38—PROJECT IMPACT HYPERTENSION: OUTCOMES OF A PHARMACIST-PROVIDED HYPERTENSION SERVICE. Mariani N, Moser L, Wayne State University, Nemerovski C, Henry Ford Hospital, Stutrud C, Wayne State University, Young M, University Pharmacy, E-mail: [email protected] Objective: The objective of the study is to evaluate the impact of pharmacists, working collaboratively with patients, on blood pressure control, lifestyle goal setting, adherence to antihypertensive therapy, patient knowledge and satisfaction, and modification of cardiovascular risk factors. Methods: Self-declared hypertensive patients, identified through a university wellness plan, met with a pharmacist for blood pressure monitoring, lifestyle goal setting, and education about medications and disease state on 4 occasions over a 6-month period. Patients self-monitored using blood pressure cuffs that wirelessly transmitted data to the pharmacist. Investigators compared baseline and post-study blood pressures. Adherence, lifestyle goal setting, knowledge about medications and disease, and satisfaction with the pharmacy service were determined through patient self-report and surveys. Results: Across the population, no changes were seen in the primary outcome, lifestyle goals, medication adherence, or modification of cardiovascular risk factors. Patient knowledge increased from baseline and satisfaction with the service was high. Subgroup analyses revealed that those with baseline blood pressures ≥120/80 mm Hg had a significant decrease in blood pressures and those not at their goal blood pressure at baseline had a significant decrease MAR /APR 2014 | 54:2 | JAPhA e89 APhA2014 ABSTRACTS in blood pressures and a significant increase in achievement of their blood pressure goals. Conclusion: Blood pressure control improved in patients with a blood pressure ≥120/80 mm Hg or those not at their treatment goal. All patients increased their knowledge about hypertension and reported high satisfaction with the pharmacy service. Pharmacy services should be offered to patients who are more likely to reap a benefit. Home blood pressure readings are useful to inform clinical decision making and supplement patient consultation within the pharmacy setting. 39—STUDENT-DRIVEN COMMUNITY PHARMACY INTERVENTIONS FOR SCALABILITY OF THE MILLION HEARTS “TEAM UP. PRESSURE DOWN.” PIONEER CHALLENGE. Ellis A, Brown M, Harrell K, Bloodworth L, Ramsey L, Ross L, University of Mississippi School of Pharmacy, E-mail: [email protected] Objective: The primary purpose of this study was to evaluate studentimplemented Tier 1 interventions of the Million Hearts “Team Up. Pressure Down.” (TUPD) Pioneer Challenge, which included increasing awareness about adherence to medications and goals in patients with hypertension. The secondary purposed was to evaluate student interest and confidence in providing community outreach. Methods: After each spring semester, second professional year (PY2) student pharmacists complete a 2-week community pharmacy introductory pharmacy practice experience (IPPE), typically, as a requirement to implement an original project. In April 2013, preceptors received TUPD training at the annual preceptor conference, and PY2 students received similar training and blood pressure technique review in the Skills Lab course. During the IPPE, students were required to: (1) counsel patients for antihypertensive prescriptions and emphasize the importance of adherence, and (2) plan a blood pressure screening and utilize the pharmacist Drug Adherence Work-Up (DRAW) tool for appropriate participants. Students e90 JAPhA | 5 4 :2 | M AR/AP R 2014 Downloaded From: http://mustafa.japha.org/ on 06/09/2014 were assessed both pre- and post-intervention regarding confidence and interest in providing community pharmacy outreach and completed a reflective essay. Results: Community pharmacy IPPEs were completed by 71 PY2 students at 46 sites; they completed a median of 14.7 patient counseling encounters, 19.2 blood pressure screenings, and 8.7 DRAW tool assessments per student. A paired sample t test of the pre- and post-intervention survey showed a statistically significant (95% confidence interval) increase in both student interest (P = 0.027) and confidence (P<0.001) in providing community pharmacy intervention events (n = 42). Reflective essays were primarily positive and included critical analysis of self-performance in providing the event, counseling, and student-initiated modifications to TUPD provided resources. Conclusion: Use of the current community pharmacy IPPE structure was successful in scaling up TUPD interventions and enhancing student-patient interaction. Increases in student interest and confidence, and positive feedback via reflective essays indicated that focused student-driven interventions may be useful IPPE tools for schools and preceptors. Collaborative Practice 40—ADVANCING PROVIDERPHARMACIST TEAM MANAGEMENT OF HIGH BLOOD PRESSURE IN COMMUNITIES. Lickteig C, Doucette W, University of Iowa, Veach S, University of Iowa College of Pharmacy, Carter B, Levy B, University of Iowa, Email: [email protected] Objective: Control of high blood pressure (BP) has improved with team management within clinics; many communities lack resources to place a pharmacist in a clinic. The purpose of this project was to foster provider–community pharmacist teams in small communities to manage high BP using a team approach. The objectives were to: (1) conduct team-building activities for provider–community pharmacist teams in Iowa and (2) determine the impact of ja p h a .org the team-building on the development of a team approach to managing high BP in the community. Methods: Providers and community pharmacists in rural and metropolitan communities were contacted about participating in the project. Once a provider–community pharmacist team was recruited, a 1-hour, facilitated, faceto-face team-building session was held with the practitioners and project team. Each team-building session discussed team member roles and activities, identification of patients, and preferred communication modes. A project guide and resources were given to team members. For evaluation, baseline and post online surveys were completed by team members, and redacted BP visit logs were collected from the pharmacists after 3 to 5 months. Using a multicase approach, a case report was written for each team, and cross-case comparisons were made. Results: Eleven provider–community pharmacist teams participated throughout Iowa. Each case was rated on the following criteria: (1) extent to which they established a system for team management and (2) number of patient connections by community pharmacist for team BP management. Four teams were rated as “worked well” (26.5 mean pharmacist BP visits); 5 teams had “limited success” (6.8 mean pharmacist BP visits); and 2 teams had “no team approach” (1 mean pharmacist BP visit). Conclusion: Overall, the project was somewhat successful in fostering provider–community pharmacist team management of BP in smaller communities. Interested stakeholders are encouraged to use such a team building approach. Future modifications, such as additional follow-up, could improve team formation and performance. 41—ASSESSING MEDICAL STUDENTS’ AWARENESS TOWARD PHARMACIST-PROVIDED COUNSELING SERVICES AND THEIR INTENT TO COLLABORATE USING A MODIFIED THEORY OF PLANNED BEHAVIOR. Shah S, University of Georgia, Bechtol R, Pinto S, Stone G, The University of Toledo, E-mail: sshah7@uga. edu Journal of the American Pharmacists Association APhA2014 ABSTRACTS Objective: The objectives of this study are to: (1) assess medical students’ awareness on pharmacist-provided counseling services; (2) evaluate medical students’ attitude, subjective norm, and perceived behavioral control (PBC); (3) assess whether these constructs predict medical students’ intention to collaborate with pharmacists who provide counseling services; and (4) examine the relationship between the constructs of the modified theory. Methods: A prospective, cross-sectional study design was used involving first- and second-year medical students enrolled at the University of Toledo. An online survey was developed based on a modified version of the Theory of Planned Behavior and sent to participants. Data were analyzed using SPSS v. 17.0. Frequency distribution, multiple regression, and Pearson’s correlation were conducted. Results: Eighty-seven usable surveys were returned. Nearly 83% of the medical students were unaware of the counseling services that pharmacists provide. Those who wanted to improve their awareness felt it was important for building future collaborations and providing more effective treatment for patients, and could be enhanced through workshops and lectures. All of the medical students had positive attitudes toward collaboration. Almost 84% of the medical students did not feel any social pressure to collaborate with pharmacists. Nearly 95% of the respondents felt that collaborating with pharmacists providing counseling services was not difficult for them. Regression results showed that subjective norm (beta = 0.059; P<0.05) and PBC (beta = 0.130; P<0.05) were significant predictors of intention. A moderate positive correlation existed between all the constructs. Conclusion: In order to increase the intent of medical students to collaborate with pharmacists, it is important to raise awareness along with a positive attitude, high subjective norm, and high PBC. Although subjective norm and PBC predicted intention, unawareness was found to be a noteworthy barrier at this stage in their educational career. Efforts should be made toward raising aware- ness through interprofessional workshops and classroom lectures in medical school. 42—AN ASSESSMENT OF PHARMACIST-PROVIDED MEDICARE ANNUAL WELLNESS VISITS IN AN INTERNAL MEDICINE PRACTICE. Musselman K, Kelly D, Bon Secours Medical Group, E-mail: [email protected] Objective: The objectives of this study were to: (1) increase number of Medicare annual wellness visits (AWVs); (2) develop reimbursement strategy for pharmacist services; and (3) assess health outcomes and recommendations identified during AWVs. Methods: A retrospective chart review was completed for program evaluation of new service procedure, piloted over 6 months. A pharmacist employed by a medical group provided initial Medicare AWVs to Medicare beneficiaries at an internal medicine practice under a collaborative practice agreement. Patients were referred by physician and staff for a 45-minute appointment scheduled a half day every other week based on availability of the pharmacist, physician, and exam room. An AWV template was utilized for visit documentation. During the visit, the pharmacist identified health outcomes; medication-related problems (MRP) based on Hepler and Strand, preventive screenings based on U.S. Preventive Task Force, and recommended immunizations based on Advisory Committee on Immunization Practices. The physician billed the visit and was consulted as appropriate. Results: Of the 41 AWVs performed over 6 months, 20 were performed by the pharmacist. Six months prior, 4 AWVs were performed. Eleven additional preventive care screenings were identified and ordered based on collaborative practice agreement. Twelve MRPs were identified; 8 recommendations were accepted in collaboration with the physician. Sixteen immunizations were recommended; 14 immunizations were accepted and administered by the pharmacist during visit or given a prescription. Twenty-five percent of the initial AWV reimbursement covered the pharmacists’ time. Journal of the American Pharmacists Association Downloaded From: http://mustafa.japha.org/ on 06/09/2014 j apha.org Conclusion: The pilot enhanced patient care utilizing a multidisciplinary approach. The pharmacist increased the number of AWVs provided during the pilot. Patient care was enhanced as additional preventive care, MRPs, and immunizations were identified. As a result, AWVs will be conducted by the pharmacist for all providers in the office. Moving forward, 2 additional pharmacists are being hired to assist with Medicare AWVs in practices affiliated with the medical group. 43—IMPACT OF A COMMUNITY PHARMACY SPECIALTY PROGRAM FOR THE TREATMENT OF PATIENTS WITH RHEUMATOID ARTHRITIS. Newsome R, University of Georgia, Murphy E, South Carolina College of Pharmacy, Galdo J, Bourgh C, University of Georgia, E-mail: [email protected] Objective: The aim of this study is to determine whether a community pharmacy specialty program for patients with rheumatoid arthritis (RA) results in a change in disease severity based on Patient Activity Scale-II (PAS-II) score. Methods: A retrospective chart review will be conducted evaluating the clinical outcomes of a specialty program at an independent pharmacy. The RA specialty program is offered to all patients with RA, as determined by prescription history and confirmation of diagnosis of RA. All patients using the service will be eligible for inclusion in the study. The specialty program consists of administering the PAS-II to determine disease severity, assessing current pharmacotherapy and side effects, calculating medication adherence based on the medication possession ratio, and then contacting the prescriber via fax with the information obtained and recommendations to provide continuity of care. The study is comparing the clinical outcomes at baseline to 3 months after initiation of the specialty program. Results: Research in progress. The primary endpoint will be change in disease activity based on PAS-II score after 3 months. Ordinal data from the PAS-II will be analyzed using the Wilcoxon signed-rank test. Secondary endpoints MAR /APR 2014 | 54:2 | JAPhA e91 APhA2014 ABSTRACTS will include change in medication adherence, pharmacotherapy, and patientreported medication side effects. Results of this service could indicate the ability of independent pharmacies to become more involved in specialty disease states such as RA. Furthermore, results could show the clinical benefit of pharmacistled disease assessment. 44—IMPACT OF AN INTERPROFESSIONAL SERVICE-LEARNING ELECTIVE COURSE ON HEALTH PROFESSIONAL STUDENTS’ ACHIEVEMENT OF INTERPROFESSIONAL EDUCATION COLLABORATIVE COMPETENCIES. Sevin A, Hale K, McAuley J, The Ohio State University College of Pharmacy, E-mail: [email protected] Objective: The purpose of this study is to investigate the effectiveness of an interprofessional (IP) service-learning elective course involving patient care in underserved populations for improving health professions students’ confidence in Interprofessional Education Collaborative competencies. Methods: This study evaluates pharmacy, nursing, and social work students at the completion of an IP service-learning course involving patient care in underserved populations. The course consists of: (1) a service component where students provide patient care in an IP student-run free clinic; and (2) workshops in which students reflect on their experiences and discuss roles, team dynamics, communication skills, and challenges with underserved patient populations in IP groups. All students enrolled in the course (approximately 30) will be invited to complete a previously validated, 42-question survey in a retrospective post-test then pre-test design (i.e., at the conclusion of the course, students will assess themselves on each competency and reflect back to assess their proficiency in each competency prior to participating in the course). The survey instrument assesses Interprofessional Education Collaborative competencies in four domains: values and ethics, roles and responsibilities, IP communication, and teams and teamwork. Data also will be collected relating to participant de- e92 JAPhA | 5 4 :2 | M AR/AP R 2014 Downloaded From: http://mustafa.japha.org/ on 06/09/2014 mographics and previous IP experience. Descriptive statistics will be generated for each survey item with responses expressed using frequencies and percentages, and a paired t test will be utilized to compare differences in post- and retrospective pre-test scores. Results: Research in progress. Results are expected to provide evidence of the impact of an IP service-learning course on students’ confidence in their abilities to practice as a part of an IP team. As IP competencies are incorporated into educational accreditation standards, health professions schools will need to identify effective ways to achieve those competencies. 45—IMPLEMENTATION OF A MEDICATION RENEWAL PROTOCOL AT COMMUNITY PHARMACIES WITHIN AN ACADEMIC MEDICAL CENTER. Weaver A, Hartkopf K, Goldrosen K, University of Wisconsin Hospital and Clinics, E-mail: aweaver@ uwhealth.org Objective: The objectives of this study are to: (1) implement a medication renewal protocol (MRP) at 11 community pharmacy sites; (2) decrease patient wait times for medication renewals at community pharmacies through implementation of the MRP; and (3) evaluate health care provider perspectives of pharmacist involvement in the MRP. The MRP has been approved by the medical board within the academic medical center and allows pharmacists to renew chronic medications under authority of a physician if specific criteria are met. Patient-specific criteria include appropriate and up-to-date laboratory values and a recent office visit with the prescribing provider. Pharmacists at this organization have not yet implemented the MRP. Consequently, patients who present with no refills on a prescription cannot receive the full medication quantity until the physician’s staff respond to a fax request. Methods: This pre- and post-implementation study will occur in 11 community pharmacies within an academic medical center. Stakeholder meetings will be held to determine how to operationalize the MRP across the community ja p h a .org pharmacy sites. Stakeholder members will include physicians, pharmacists, pharmacy technicians, clinic managers, nurses, and medical assistants. Standardized educational training and materials will be developed and presented to community pharmacists. Educational training will emphasize the medications included in the MRP, how to re-order these medications, and procedures for documentation. Pre- and post-implementation data collected from the pharmacy dispensing system software and electronic medical records will be used to calculate the time required to complete prescription renewal requests. Additionally, pharmacy staff will collect data on the number of prescriptions included in the MRP that present to the pharmacy without refills. An anonymous, post-implementation survey will be sent to pharmacists and other health care professionals impacted by the MRP to evaluate perspectives of pharmacist involvement in the MRP. Results: Research in progress. 46—MEDICATION MANAGEMENT PROGRAM IN PEDIATRIC PATIENTS WITH ASTHMA: A COMMUNITY PHARMACY AND CHILDREN’S HOSPITAL MEDICAL CENTER PARTNERSHIP. Bradley C, Luder H, University of Cincinnati/Kroger Pharmacy, Bowen R, Kroger Pharmacy, Heaton P, University of Cincinnati James L. Winkle College of Pharmacy, Frede S, Kroger Pharmacy Cincinnati-Dayton KMA, Kahn R, Beck A, Cincinnati Children’s Hospital Medical Center, Mansour M, Cincinnati Children’s Hospital Medical Center, E-mail: [email protected] Objective: The purpose of this study is to implement a collaborative asthma management program consisting of counseling and medication management targeting pediatric patients with uncontrolled asthma in a community pharmacy. This study aims to determine the impact of this service on 30-day hospital utilization rates, 90-day hospital utilization rates, number of primary care physician visits, and asthma control. Methods: Numerous community pharmacy asthma programs demon- Journal of the American Pharmacists Association APhA2014 ABSTRACTS strated improved asthma control; however, there are limited and contrasting results in pediatric patients and in transitions of care. Furthermore, there is no evidence of pharmacist and physician collaboration to establish continuity of care in this setting. A collaboration will be formed between a large grocery store chain community pharmacy and a children’s hospital medical center to proactively identify patients with uncontrolled asthma. Information from asthma control tests, refill history, and recent health care utilization will be used to form a targeted list of patients. Community pharmacists will target these jointly identified patients at the pharmacy and provide an educational and medication management service. Counseling will be provided as patients present to the pharmacy and will focus on general asthma education, appropriate directions and administration of asthma medications, and environmental triggers. All counseling topics and handouts will contain similar educational messages received at the children’s medical center to ensure continuity of care. Pharmacists will fax a summary report to the physician with specific medication recommendations. Pharmacists will follow-up in 30 days to assess asthma control, provide additional education, and propose further recommendations as appropriate. To assess this intervention, aggregate data will be evaluated in a pre-post design. The children’s hospital medical center will offer data on hospital utilization rates and physician visits. The community pharmacy will assess asthma control. The results will be analyzed by descriptive and inferential statistics as appropriate. Results: Research in progress. 47—PATIENT-REPORTED DIABETES SELF-EFFICACY AND SATISFACTION WITH CARE IN A PRIMARY CARE SAFETY NET CLINIC. Hurley K, Western University of Health Sciences, Wang A, Pomona Valley Hospital Medical Center, Hess K, Western University of Health Sciences, E-mail: [email protected] Objective: The primary objectives of this study are to: (1) measure patients’ self-efficacy regarding their ability to effectively participate in their diabetes care; (2) evaluate patient satisfaction with their medical care at this clinic; and (3) examine correlations between patient self-efficacy, satisfaction, and clinical and demographic variables. Secondary objectives include describing the clinical pharmacy operations at this site and the types and frequency of interventions made. Methods: In an effort to further promote safe and effective medication use, clinical pharmacy services were recently incorporated into an existing primary care safety net clinic. A descriptive background review of clinical pharmacy functions and operations at this clinic will be completed concurrently with a prospective patient survey. The Perceived Diabetes Self-Management Scale will be utilized along with questions from a separate validated patient satisfaction survey to measure diabetes self-efficacy and satisfaction. Beginning January 2014, surveys will be administered to approximately 300 patients by clinic staff immediately following patient appointments. Responses will be stratified by patient demographics (e.g., age, sex, ethnicity) and whether the patient saw a clinical pharmacist and/or another provider (i.e., physician, nurse practitioner, physician’s assistant). All data will be collected in Excel databases. Statistical analysis of the background review will consist of proportions and means to document interventions made while survey data will be analyzed using Pearson’s correlation and t tests to examine the relationships between selfefficacy, A1C, number of comorbidities, number of medications used, and other patient demographics. Results: Research in progress. 48—PROVIDER RESPONSE RATE TO PHARMACIST FAXED INTERVENTIONS AND THE IMPACT ON PATIENT OUTCOMES IN AN UNDERSERVED POPULATION. Risner J, Hall L, The Ohio State University, Seifert J, Pharmaceutical Horizons, Porter K, The Ohio State University, E-mail: [email protected] Objective: The purpose of this study is to evaluate provider response rate to Journal of the American Pharmacists Association Downloaded From: http://mustafa.japha.org/ on 06/09/2014 j apha.org community pharmacist faxed medication interventions from Charitable Pharmacy of Central Ohio (CPCO), which provides medications at no cost to an underinsured and uninsured population. Patients at CPCO endure barriers involving finances, literacy, and transportation making it difficult to obtain optimal, routine health care. Without routine care, their visit to the community pharmacy may be their primary contact with a health care professional. At CPCO, prescribers are frequently contacted via fax or phone to provide clinical information and request medication changes to improve the health of patients. The primary objective is to determine provider response rate to pharmacist faxed interventions. The secondary objective is to analyze the effect of faxed pharmacist interventions on clinical outcomes, specifically blood pressure (BP) and blood glucose (BG). Methods: This study will be conducted as a retrospective chart review. All patient charts at CPCO will be reviewed for faxed interventions (approximately 3,500 charts). Provider response rate, within 3 months, to these interventions will be recorded along with type of intervention requested. A subset of interventions and outcomes will be examined, involving BP and BG. Patient clinical status will be analyzed before and after faxed interventions to determine if an accepted intervention (versus not accepted or no response) corresponds to a positive clinical response. A percentage (number of responses/number of interventions) will be used to report provider response rates, while comparison of BP and BG will be analyzed using chisquare and/or t test. Results: Research in progress. By evaluating provider response rates to pharmacist faxed interventions, a potential barrier found in underserved populations may be elucidated. Secondary measures may quantify benefits of pharmacy services in this population. Overall, results may lead to discussion on how to better collaborate as health care professionals to serve these individuals. Communication/Patient Education MAR /APR 2014 | 54:2 | JAPhA e93 APhA2014 ABSTRACTS 49—ASSESSMENT OF COMMUNITY PHARMACIST–PROVIDED EDUCATION ON PATIENT KNOWLEDGE AND BEHAVIORS REGARDING PHARMACOLOGIC AGENTS THAT CAUSE DRY MOUTH. Elswick B, Baugh G, Scott V, West Virginia University School of Pharmacy, E-mail: [email protected] Objective: The objectives of this project were to: (1) educate pharmacists and patients on the role of dry mouth and dental decay; and (2) enhance the dentist-pharmacist-patient relationship. Methods: An open-enrollment study was conducted at 5 community pharmacies across a wide geographic area. Prior to study implementation, pharmacists completed an online educational self-study module and quiz; 2 optional educational sessions were conducted at state pharmacist conventions. Participants were community pharmacy patrons identified as taking medications that could cause dry mouth. Pharmacists provided education to participants on dry mouth, poor dental health, potential treatment strategies, or referred them to their dentist. Participants completed a questionnaire about their personal risk, knowledge, and self-treatment of dry mouth pre- and post-education. Results: Nearly 80% of all participants (n = 142) indicated that they suffered from dry mouth. Participants reported symptoms such as chapped lips (52%), gastrointestinal problems (32%), and bad breath (24%). Nearly one-third of participants reported having used a product to treat dry mouth. Self-treatments included water (6%), dry mouth symptom relief products (4%), and gum or mouthwash (2% each). Participants indicated an increase (41%, 41% vs. 82%) in overall knowledge of medication-related dry mouth in post–pharmacist education. Whereas, an even greater percentage of participants (57%, 28% vs. 85%) noted an increase in their knowledge regarding strategies available to treat dry mouth and the relationship between dry mouth and dental decay following education. It was unclear what effect pharmacist-provided education had on referral rates for additional dental care. Conclusion: Dry mouth is a poten- e94 JAPhA | 5 4 :2 | M AR/AP R 2014 Downloaded From: http://mustafa.japha.org/ on 06/09/2014 tial adverse effect of over 400 medications and a leading cause for dental caries in the United States. Community pharmacists have an important role in identifying risk for drug-induced dry mouth and provide valuable self-treatment recommendations. More research and initiatives are needed to increase the interprofessional relationship between community pharmacists and dentists. 50—ASSESSMENT OF PATIENT PERCEPTIONS OF STUDENT-RUN HEART AND DIABETES PATIENT OUTREACH INITIATIVES. Wei A, Uppala A, Banda S, Lin M, Cheng S, Rubino A, Shah K, Feudo D, Ernest Mario School of Pharmacy, Rutgers University, E-mail: [email protected] Objective: Current challenges in medication adherence and general disease state knowledge for hypertensive and diabetic patients prompted the creation of student initiatives to reach the community. However, the impact of such student initiatives has not been evaluated. The objectives of this project are to: (1) identify the impact of studentrun patient care outreach initiatives at local events at department stores and senior centers on patients’ overall knowledge of prevention and management of hypertension and diabetes; and (2) identify areas of improvement for studentrun patient care outreach initiatives. Methods: For each of the 2 studentrun patient care initiatives, operation heart and operation diabetes, 6-question surveys will be divided into multiplechoice style with 3 pre-screening and 3 post-screening questions. The questionnaires are divided into the following categories: knowledge-based (about hypertension or diabetes), lifestyle modification (maintain normal blood pressure or glucose levels), screening, and perceived impact of event. Participants will be asked to sign informed consent and answer the pre-screening questions initially. Then, they will be screened for blood pressure and/or glucose levels and educated via posters about sodium intake, carbohydrate monitoring, and healthy lifestyle changes. Immediately afterward, they will be prompted to answer the post-screening questions to evaluate ja p h a .org their knowledge after the screening and education process. Students with institutional review board (IRB) approval will distribute IRB-approved surveys on site during several events from October 2013 to March 2014. Inclusion criteria include participants who are literate English speakers, sign informed consent, are ≥18 years of age, and are willing to complete the survey. Participants who do not complete each question in both the pre- and post-surveys will be excluded. Results will be analyzed to compare any trends between the pre-screening questions and corresponding post-screening questions. The implication of the results will demonstrate the overall effectiveness and any areas of improvement. Results: Research in progress. 51—CHUNK AND CHECK: PHARMACISTS’ ORGANIZATION AND EVALUATION OF PATIENT EDUCATION. Margolis A, Martin B, University of Wisconsin–Madison School of Pharmacy, E-mail: [email protected] Objective: New information is best learned in small chunks with brief assessments or checks. The objective of this study was to observe pharmacists’ primary method for organizing or “chunking” patient medication information and checking patient understanding. Methods: This qualitative study observed 6 pharmacists performing new and renewal medication consultations for 55 patients. Patient consultations for 3 inpatient and 3 community pharmacists were observed by the investigator and were audiotaped. The tapes were transcribed and coded to uncover common themes, consultation chunk patterns, and examples of pharmacists’ checking technique. The frequencies of techniques were tallied by pharmacist; descriptive statistics and chi-square were used when appropriate. Results: The 3 major chunk patterns were: time of day the medication should be taken, education by each medication, and the 3 prime questions. Inpatient and community pharmacists used different chunk patterns when performing patient education. Inpatient pharmacists were more likely to vocalize their organizational structure to the patient (P = Journal of the American Pharmacists Association APhA2014 ABSTRACTS 0.002 compared with community pharmacists). Both inpatient and community relied heavily on informal evaluation or checking (85.7% and 40.7% respectively, P = 0.001). Inpatient pharmacists were more likely to formally assess patient understanding and used higher level check techniques that promoted patient problem solving (46.4% and 3.7% respectively, P <0.001). Conclusion: Pharmacists should verbalize the way they plan to chunk or organize their consultation to help orient the patient to the education plan and improve patient understanding. The complexity of the medication consultation may drive the primary chunking pattern the pharmacist uses. Formal assessment of patient understanding was minimal, however all pharmacists consistently used final checks. Even among pharmacists who excelled at evaluation, techniques to encourage patient problem solving and vocalization of directions could enhance learning. Additional research is needed to evaluate the effect of chunk and check on patient retention of medication information and patient outcomes. 52—DEVELOPMENT OF A COMPREHENSIVE COMPETENCY RUBRIC FOR EVALUATING PHARMACY STUDENT SELF-CARE COUNSELING. Franz T, Thornton P, Chen A, Fox N, Frame T, Cedarville University, E-mail: [email protected] Objective: The aim of this study is to create and evaluate a comprehensive rubric assessing student pharmacists’ ability to counsel patients on self-care topics. Methods: Assisting and counseling patients on appropriate self-care use is a significant component of pharmacy, especially in community practice. A review of the literature did not find a satisfactory assessment tool to evaluate students’ ability to apply self-care knowledge when counseling patients. A rubric was developed for faculty to evaluate students’ interpersonal skills and clinical knowledge in simulated patient encounters, with an abbreviated rubric developed for pharmacy preceptors to assess counseling during practice experiences. The rubric was created from an extensive review of the literature and underwent comprehensive review by student pharmaicsts and faculty with expertise in selfcare, assessment, and scale development to establish content and face validity. The final faculty rubric contained 14 items (4-point, Likert-type [1 = unsatisfactory; 4 = commendable]); 7 of the items were on interpersonal skills (e.g., attitude, empathy, professionalism) and 7 items were on appropriate self-care counseling (e.g., QuEST SCHOLAR-MAC, self-care candidacy, teach-back method). The abbreviated preceptor rubric contained 5 items (1 interpersonal and 4 self-care). Faculty rubric validation will be obtained in 10 simulated encounters with a faculty rater. A select number of encounters will be recorded, reviewed, and rated by a team of faculty for further validation. Preceptor rubric validation will be obtained in 10 actual patient encounters during weekly practice experiences. The instrument will be assessed for internal consistency, inter-rater reliability, and intra-rater reliability. Results: Research in progress. Data collection is in progress with 3 simulated and actual encounters completed for 47 students. Preliminary reliability analyses from the first encounter provided a Cronbach alpha of 0.752 and 0.751 for the faculty and preceptor scales, respectively. While removing a few individual items (3 items faculty, 1 item preceptor scale) would lead to a slightly higher Cronbach alpha, removal does not lead to a Cronbach alpha >0.78. 53—DEVELOPMENT OF A COUNSELING SERVICE BY THE PHARMACY TEAM TO OVERCOME WORSENING SIDE EFFECTS RELATED TO HEPATITIS C MEDICATIONS IN A U.S.–MEXICO BORDER COMMUNITY HEALTH CENTER. Heredia G, Sias J, University of Texas at El Paso, Kelly J, Lucero A, Centro de Salud Familiar La Fe Inc., E-mail: [email protected] Objective: The purpose of this project is to pilot an interdisciplinary hepatitis C virus (HCV) counseling service based out of the community health center pharmacy for a predominantly Mexican-American population. By the end of Journal of the American Pharmacists Association Downloaded From: http://mustafa.japha.org/ on 06/09/2014 j apha.org the pilot phase of this project, the study will: (1) identify perceptions, barriers, and fears related to HCV and treatment in a pilot group of subjects; and (2) develop pharmacy tools that expand on current HCV services (for approximately 30 patients) to enhance counseling and side effect management from the community pharmacy team. Studies have found that a common reason patients decline or prematurely discontinue HCV treatment is due to medication side effects. Methods: Initial steps to develop this service include conducting a literature search about HCV, side effect management, and patient perceptions of the disease. Part of the project includes collecting demographic information and employing qualitative methods using a semi-structured interview (open- and close-ended) in English and Spanish in a subset (n = 10) of adult patients with HCV infection at the community health center. The interview process, which is approved by the institutional review board and based in the Health Belief Model and Kleinman’s Patient Explanatory Model, is designed to give the pharmacist more detailed insight into patient concerns and will be conducted from December 2013 through March 2014. Descriptive statistics and a summary report of interviews, as well as findings from literature search and guidelines, will be used to aid in the creation of counseling tools in English and Spanish. Other pharmacy tools to be created include a guide for the pharmacist to counsel on appropriate injection technique, side effects of medications used to treat HCV, and management. Patient consultation tools focusing on side effect management, over-the-counter, and nonpharmacologic recommendations also will be created. Results: Research in progress. 54—DEVELOPMENT OF HEALTH COACHING SKILLS TO ENHANCE STUDENT PHARMACISTS’ COMMUNICATION TECHNIQUES. Middendorf A, Veach S, University of Iowa College of Pharmacy, Tonn M, Shen R, CarePro Health Services, Catney C, Tien Y, University of Iowa College of Pharmacy, E-mail: [email protected] Objective: The aim of this project MAR /APR 2014 | 54:2 | JAPhA e95 APhA2014 ABSTRACTS is to develop and implement a series of learning modules for advanced pharmacy practice experience (APPE) students that focus on enhancing specific health coaching skills and demonstrating those skills with case-based simulated patient encounters. The Accreditation Council for Pharmacy Education highlights the importance of communication-related competencies for pharmacy graduates. Health coaching is a method of communicating with patients where practitioners work with and empower patients to become active participants in their own care. Pharmaceutical care services offered at community pharmacies offer opportunities for APPE students to put health coaching skills into practice. Methods: Evidenced-based learning modules to enhance health coaching skills for APPE students will be developed and implemented as part of each APPE rotation cycle at 2 small chain community pharmacies. A literature review of essential health coaching skills necessary for pharmacists will be conducted to aid in the development of learning modules. Examples of possible module topics include the transtheoretical model of change, motivational interviewing, and coaching styles. Learning modules will consist of interactive reading-based assignments followed by simulated patient cases to demonstrate specific skills. Cases will be adapted from the American Pharmacists Association’s PharmacyLibrary to present opportunities for the student to demonstrate specific skills and for the preceptor to provide interactive feedback. Medication therapy management, diabetes education, wellness screening consultations, and other pharmaceutical care services available at the community pharmacy sites will provide opportunities for APPE students to incorporate what they learn through the health coaching modules into real-world patient interactions. The development and implementation of this project will be described and barriers or limitations will be identified. Results: Research in progress. Crane L, O’Neal K, Honey B, Crosby K, University of Oklahoma College of Pharmacy and Health Sciences Center–Tulsa, E-mail: [email protected] Objective: According to the Centers for Disease Control and Prevention, in 2010, 18.7 million adults had a diagnosis of asthma. In 2008, asthma caused 14.2 million missed days of work. To help manage and improve outcomes of this chronic disease, it is imperative that patients receive education on self-management and interventions to reduce modifiable risk factors. However <7 out of 10 adults are taught how to recognize asthma symptoms, and <1 out of 3 adults get an asthma action plan from their health care provider. The objective of this study is to assess and compare disease state knowledge, asthma control, and self-management skills in adults with asthma. Methods: This will be a pilot study enrolling 30 to 60 adult patients seen within an internal medicine ambulatory care clinic. Patients with a documented diagnosis of asthma will be selected to participate. Patients will be administered an asthma knowledge questionnaire and the Asthma Control Test. In addition, the patient’s inhaler technique will be assessed using a predefined checklist of steps. Descriptive statistics will be used to analyze the data collected. Results: Research in progress. The primary outcome of this study is to determine whether there is any comparison between asthma knowledge and selfmanagement skills in adults. It is thought that a lack of knowledge exists in the adult population, which contributes to asthma that is not well-controlled. Consequently, there may be an opportunity for increasing and raising awareness of the need for asthma education in this patient population. Study results may show an opportunity for pharmacists to get involved in adult asthma education. This evidence would be useful in presenting collaborative practice ideas to other health care providers and thirdparty payers. 55—DISEASE STATE KNOWLEDGE AND SELF-MANAGEMENT SKILLS FOR ADULTS WITH ASTHMA. 56—EVALUATION OF MERCK’S HEADACHE SCHOOL: A QUASIEXPERIMENTAL EXAMINATION e96 JAPhA | 5 4 :2 | M AR/AP R 2014 Downloaded From: http://mustafa.japha.org/ on 06/09/2014 ja p h a .org OF EFFECTIVENESS. O’Neal K, University of Oklahoma Health Sciences Center–Tulsa, Murray K, University of Oklahoma, Desselle S, California Northstate University, Weisz M, University of Oklahoma Health Sciences Center–Tulsa, E-mail: [email protected] Objective: The objectives of this research were to: (1) evaluate the school for its perceived utility among migraineurs and accompanying pharmacist-tailored medication session; (2) determine whether the school and/or addition of a pharmacist are associated with self-efficacy in migraine management, behaviors, and improvement of outcomes; and (3) identify any intervening variables in the “Headache School” utility. Methods: Three-group, quasi-experimental design was employed in this study. Patients were recruited from the Tulsa and Oklahoma City metropolitan area if they had a migraine diagnosis. Group 1 served as a control. Group 2 was enrolled in the Headache School. Group 3 was enrolled in the Headache School and received a pharmacist-tailored medication session. All groups were surveyed at baseline for self-efficacy in migraine management behaviors, knowledge, and Migraine-Specific Quality of Life (MSQ). Groups 2 and 3 also were surveyed at 1 month and all 3 groups surveyed again at 3 and 6 months. Follow-up surveys included questions regarding the Headache School. Statistical analyses will include descriptive statistics (patient perceptions), inferential statistics (Headache School association with self-efficacy, migraine knowledge, management behaviors, and MSQ), and Cronbach alpha (internal consistency reliability and psychometric suitability). Additionally, analyses will be done to determine if observed differences are sustained/improved at the 6-month interval. This project has been approved by the institutional review board. Results: Research in progress. The 120 patients recruited were evenly distributed into groups. Baseline results show that only 10% of patients rated themselves as completely confident in migraine trigger management. Fiftythree percent answered all 9 knowledge questions correctly. With the MSQ, <10% Journal of the American Pharmacists Association APhA2014 ABSTRACTS of patients responded they did not have migraines that impacted their quality of life or did not have a migraine in the preceding 4 weeks implying that the majority of patients had some degree of a debilitating migraine. 57—IDENTIFYING COMMON BARRIERS AND DEVELOPING STRATEGIES TO IMPROVE COUNSELING SKILLS OF DOCTOR OF PHARMACY STUDENTS WHOSE FIRST LANGUAGE IS NOT ENGLISH. Oh S, Massachusetts College of Pharmacy and Health Sciences University, E-mail: [email protected] Objective: This study seeks to address the most common barriers that English as Second Language (ESL) students encounter during counseling and to identify the effective educational methods to overcome those barriers. Methods: The study subjects are student pharmacists completing their first professional year (P1) and entering their second professional year in an accelerated doctor of pharmacy program. A group of ESL students who are not participating in the study will serve as a direct control group, and the data also will be compared with the data from all P1 students regardless of their first language. At the first meeting, initial selfevaluation will be conducted. Each student will make an appointment for the first patient counseling activity. One preceptor and 1 advanced pharmacy practice experience student will attend the counseling session, then will complete the evaluation forms afterward. Both preceptor/peer and self-evaluations will consist of 5-point Likert scale–type questions, and each question will have a comment box for a more elaborated description. The focus will be on styles of communication, mannerisms, and interactions rather than the content of counseling. Use of appropriate nonverbal communication, pace, flow, transition and patient-friendly specific language use will be evaluated. Results: Research in progress. Recruitment begins on November 12, 2013, and the data collection/analysis period is through May 12, 2014. The data will be analyzed using descriptive statistics. Verbal communication skills of pharmacists are a vital component to effective pharmacy intervention. The number of ESL students in pharmacy school is increasing rapidly, and those who lack acceptable counseling skills will not interact with patients effectively. The findings of this study will help in identifying unique challenges that ESL students encounter during counseling and developing tactics for those students to overcome such challenges. 58—IMPACT OF A COMMUNITY PHARMACIST IN RESOLVING MEDICATION-RELATED CARE GAPS FOR A COMMERCIALLY INSURED PATIENT POPULATION. On P, AccessCare, Pfeiffenberger T, Community Care of North Carolina, Lundeen K, Scott J, Branski S, AccessCare, Watkins R, Community Care of North Carolina, E-mail: [email protected] Objective: While studies exist that evaluate the impact of ambulatory care pharmacists in resolving medicationrelated care gaps, little has been said about the effectiveness of the community pharmacist. The primary objective of this study is to evaluate the effectiveness of interventions made by a community pharmacist to close medication-related care gaps for a commercially insured patient population. The secondary objective is to describe the types of interventions made by a pharmacist that are most successful in resolving care gaps. Methods: This quasi-experimental study will be submitted to the institutional review board for approval. The community pharmacist will review a list of alerts provided by a commercial payer to identify patients with at least one medication-related care gap. Medication-related care gaps include the need for drug monitoring and/or the addition of medication(s) to meet the standard of care. Care gaps that are determined by the pharmacist to already be closed will be excluded. The pharmacist will communicate with the patient regarding the care gap and provide education as needed. Additionally, the pharmacist will provide recommendations to the patient and/or primary care provider in an attempt to close the identified care Journal of the American Pharmacists Association Downloaded From: http://mustafa.japha.org/ on 06/09/2014 j apha.org gap. Recommendations may include drug monitoring and/or the addition of medication(s) needed to meet the standard of care. As appropriate, the pharmacist may communicate with other health care professionals needed to close the care gap. Patients will be referred to a care manager as needed for care coordination. The following data will be collected: categories of medication-related care gaps, types of interventions used by the pharmacist, provider acceptance of the pharmacist’s recommendations, and/or actions taken by patients that close the care gaps. Success rates will be measured by closure of care gaps within 60 days after the pharmacist’s interventions. Data will be analyzed using descriptive statistics. Results: Research in progress. 59—IMPACT OF STUDENT PHARMACIST–LED INTERACTIVE SESSIONS ON PATIENT HEALTH LITERACY. Laliberte B, Gillis C, Taglieri C, Matthews M, Massachusetts College of Pharmacy and Health Sciences University, E-mail: benjamin.laliberte@ my.mcphs.edu Objective: Pharmacists’ impact on patient care is clearly documented. As future health care providers, student pharmacists are encouraged to participate in community service activities. However, there is a lack of data to assess the full impact of student pharmacist community engagement. The objective of this study is to quantitatively assess patients’ comprehension of health-related topics before and after a 1-hour student-developed and directed interactive session, and the impact of the utilized open discussion format. Methods: A prospective, crosssectional study was conducted during 3 sessions in the Boston area from November 2012 through March 2013 on topics chosen by each site: hypertension at the South Boston Neighborhood House, hyperlipidemia at the ABCD Parker Hill/ Fenway Center, and nutrition at the Cambridge Senior Center. All attendees who completed pre-session surveys were included. Surveys were composed of a 5-point categorical Likert scale (1 = strongly disagree; 5 = strongly agree). MAR /APR 2014 | 54:2 | JAPhA e97 APhA2014 ABSTRACTS Microsoft Excel was employed to calculate statistics and 2-sided t tests. The primary endpoint was the change in overall mean survey score. Secondary endpoints included change in individual question means and cumulative patient feedback score. Results: Because some attendees arrived after pre-session surveys were collected, 27 of 50 attendees were included. Overall mean scores increased post-survey from 4.085 to 4.9 (P<0.0001), 3.013 to 4.166 (P<0.0001), and 4.3 to 4.625 (P = 0.101), respectively. Individually, 1 question from the hypertension session and 3 questions from the hyperlipidemia session reached significance. The cumulative patient feedback score was 4.744/5. Conclusion: This study provides evidence that student pharmacist–led interactive sessions had a positive impact on health literacy. Patient feedback supports the use of the open discussion format as a valuable learning tool. Thus, community outreach should be encouraged among student pharmacists and pharmacists alike. More robust data collection is required to examine the full benefit. 60—IMPLEMENTATION OF MEDICATION ADHERENCE SKILLS TRAINING (GROUP MEDICATION THERAPY MANAGEMENT) WITHIN A COLLABORATIVE FRAMEWORK OF SKILLS TRAINING FOR AFRICAN AMERICAN BREAST CANCER SURVIVORS: A RANDOMIZED CONTROLLED STUDY. Rust C, South College School of Pharmacy, Brown L, Chapman University, E-mail: [email protected] Objective: The objectives of this study were to: (1) evaluate the efficacy of a medication adherence skills training alone compared with a medication adherence skills training in conjunction with a cancer skills psychoeducational program in increasing medication adherence and self-efficacy; and (2) determine the role of health literacy in medication adherence and self-efficacy in African American breast cancer survivors. Methods: This pilot study utilized a 3-arm, randomized, repeated measures, experimental design. The study sample e98 JAPhA | 5 4 :2 | M AR/AP R 2014 Downloaded From: http://mustafa.japha.org/ on 06/09/2014 consisted of an intervention group (n = 23) of cancer survival skills training, which included medication adherence skills training, an intervention group (n = 24) of medication adherence skill training only, and a control group (n = 24) for a total study population of 71 participants. The Self-Efficacy for Appropriate Medication Use Scale was used to measure patient confidence (self-efficacy) in the ability to take medications properly. The Adherence to Refills and Medications Scale measured patient adherence to medications. The 3-question measure for health literacy was used to assess level of health literacy. Results: Results revealed that the study could not confirm that cancer skills training plus medication adherence training or medication adherence skills training alone had a positive effect on medication adherence or self-efficacy. Even so, results support previous research that higher self-efficacy is associated with higher medication adherence. Ad hoc testing of health literacy did not show a statistically significant association between health literacy and medication adherence or self-efficacy. Conclusion: Although there were no significant findings with respect to medication adherence and self-efficacy, additional studies with larger sample sizes, expanded eligibility criteria, and alternative measures of health literacy and medication adherence are suggested. 61—IMPROVING IMPLEMENTATION OF WRITTEN ASTHMA ACTION PLANS THROUGH PHARMACIST-DRIVEN INTERVENTION AT THE POINT OF CARE IN A COMMUNITY SETTING. Adams S, Virginia Commonwealth University, Oliver K, Jefferson Pharmacy, Moczygemba L, Goode J, Virginia Commonwealth University, E-mail: [email protected] Objective: The primary objective of this study is to determine whether a pharmacist-driven intervention at the point of care will increase the percentage of patients with asthma to have written asthma action plans. This study also will assess the knowledge and understanding of asthma for patients with action plans compared with patients who do ja p h a .org not have action plans, including comparison of demographics, medications, and asthma control. Methods: This prospective study will be conducted at an independent pharmacy in Palmyra, Virginia. Patients ≥18 years of age who self-report a diagnosis of asthma and have a prescription for an albuterol inhaler will be selected for inclusion in this study. The study duration will be 12 weeks. All patients picking up a new or refill prescription for an albuterol inhaler will be flagged in the pharmacy software system and approached at the pick-up counter. Patients will self-select into the study by filling out a brief survey assessing asthma history, knowledge about asthma, and status of a written asthma action plan. If the patient does not have an action plan, the pharmacist will provide education about asthma action plans and offer to complete a standardized action plan with the patient. At the end of the study, a comparison will be made between the number of written asthma action plans already in place at the beginning of the study and the number of action plans developed by pharmacists. An assessment will be made comparing knowledge and understanding of asthma for patients who self-reported having an asthma action plan at the time of survey completion to patients who denied having an action plan. Comparisons also will be made between these two groups to assess differences in age, race, highest education level completed, income, current asthma medications, and asthma control. Results: Research in progress. 62—PATIENT PERCEPTIONS AND THE EFFECTS OF PROMOTING THE USE OF A SINGLE COMMUNITY PHARMACY SYSTEM: A KEY ELEMENT FOR IMPROVED TRANSITIONS OF CARE. Murthy L, Myftari K, Kshatriya S, Dominick’s Pharmacy, Winkler S, Harpe S, Midwestern University, Vatanka P, Safeway, E-mail: [email protected] Objective: The primary objective of the study is to evaluate baseline patient perception on the use of single versus multiple community pharmacy systems. The secondary objective is to determine Journal of the American Pharmacists Association APhA2014 ABSTRACTS the effects of a community pharmacist– provided educational intervention on the patient perception of using a single community pharmacy system. Methods: This will be a prospective survey-based study implemented in a single grocery store chain pharmacy site. The primary investigator or designated representative will administer an anonymous pre-survey to eligible patients who drop off or pick up prescriptions during the study period. The pre-survey is designed to collect demographic data and determine subject perception on the use of single versus multiple pharmacy systems at baseline. The pharmacist will then deliver a brief educational intervention, which will include the benefits of using a single community pharmacy system and the risks of using multiple community pharmacy systems. The educational component will emphasize the roles and responsibilities of community pharmacists, medication safety both at home and when transferring between health care systems, and services offered in the community pharmacy. An anonymous post-survey will be administered after the educational intervention with the pharmacist. The post-survey will be used to determine whether a change in the perception of the key components assessed in the pre-survey has occurred. Data will be analyzed utilizing descriptive statistics. Results: Research in progress. It is anticipated that a brief pharmacist intervention will increase patients’ awareness on the benefits of using a single community pharmacy system. Using a single community pharmacy system will increase accuracy on the medication record and thus will position the community pharmacist for a key role in improved transitions of care. 63—PATIENT-REPORTED PROBLEMS WITH USING GLAUCOMA MEDICATIONS AND QUESTIONASKING ABOUT GLAUCOMA MEDICATIONS DURING GLAUCOMA MEDICAL VISITS. Sayner R, Blalock S, Carpenter D, University of North Carolina at Chapel Hill Eshelman School of Pharmacy, Muir K, Duke University Medical Center, Hartnett M, Uni- versity of Utah, Lawrence S, University of North Carolina at Chapel Hill School of Medicine, Robin A, Johns Hopkins University, Sleath B, University of North Carolina at Chapel Hill Eshelman School of Pharmacy, E-mail: [email protected]. edu Objective: This study examined the extent to which patients who expressed glaucoma medication problems asked 1 or more questions about those problems during medical visits, the association between sociodemographic characteristics and whether patients asked at least 1 question related to their reported problems, and the extent to which patients reported the same medication problem 1 month after the medical visit. Methods: This was a cross-sectional study conducted at 6 ophthalmology clinics. English-speaking adults with glaucoma were recruited. Their medical visits were videotaped. They were interviewed afterward. Patients returned 1 month later to be interviewed again. Bivariate analyses were used to analyze the data. Results: In this analysis, there were 142 patients who expressed at least 1 glaucoma medication problem; 54% of those who expressed problems with using their glaucoma medications asked their physicians at least 1 question about these problems during their examinations. African Americans were significantly less likely to ask at least 1 glaucoma medication question relating to their reported problems compared with non–African Americans (Pearson chisquare = 4.229, P = 0.040). Other patient and provider characteristics were not significantly associated with asking 1 or more glaucoma medication questions regarding their reported problem areas. One hundred (70%) patients reported the same glaucoma medication-related problems 1 month later. Conclusion: Approximately half of the patients who reported at least 1 glaucoma medication-related problem asked 1 or more questions during their medical visits. Many reported the same glaucoma medication problems 1 month later. Pharmacists can help patients with glaucoma by offering to demonstrate how to administer glaucoma medications and Journal of the American Pharmacists Association Downloaded From: http://mustafa.japha.org/ on 06/09/2014 j apha.org by answering any glaucoma medication questions. Additionally, pharmacists could work with the provider to resolve any glaucoma medication issues. Finally, pharmacists should encourage patients with glaucoma to report to their doctor any glaucoma medication problems that they may be experiencing. 64—PATIENTS’ PERSPECTIVES ON HEALTH CARE PROVIDERS’ MEDICATION COUNSELING. LaBuz M, Cipollone D, Hartzell K, Hartzell’s Pharmacy, E-mail: [email protected] Objective: The purpose of this study is to evaluate patient perspectives on best practice medication counseling provided by all health care providers. Methods: Medications play a primary role in increasing patients’ life expectancy and quality of life. Misunderstandings associated with prescribing decisions between practitioners and patients have been reported due to lack of participation of patients in the counseling session. This qualitative study will utilize focus groups of patients who use a community pharmacy to determine their perspective on “best practice” medication counseling by health care providers. Patients will be recruited through patient–pharmacy staff interactions at the point of dispensing, phone interactions based on lists developed in both pharmacy and home medical department, and direct mailers. Patients will be provided with a brief explanation of the research project and questioned if they meet inclusion criteria. Inclusion criteria will include but is not limited to ≥30 years of age or a caregiver and ≥1 encounter with a health care professional within the year. A guided focus group question set will be used. Sessions will continue until saturation is reached and will be analyzed and coded using grounded theory to elect theses. Themes of patient perceptions of medication counseling will provide areas for focused improvements and education for staff and patients. Results: Research in progress. 65—USING VIDEOS TO IMPROVE CHILDREN’S INHALER TECHNIQUE: A RANDOMIZED CONTROLLED TRIAL. Carpenter D, Geryk MAR /APR 2014 | 54:2 | JAPhA e99 APhA2014 ABSTRACTS L, Blalock S, University of North Carolina at Chapel Hill Eshelman School of Pharmacy, Lee C, Polyglot Systems Inc., Weaver M, Reuland D, Coyne-Beasley T, Loughlin C, University of North Carolina at Chapel Hill School of Medicine, Sleath B, [email protected], Pharmaceutical Outcomes and Policy , Email: [email protected] Objective: Prior research has shown that most children with asthma have suboptimal inhaler technique. This primary objective of this study was to determine whether a brief video intervention could improve inhaler technique in children with asthma immediately after a doctor’s office visit and 1 month later. The study also evaluated whether the intervention led to better inhaler selfefficacy and asthma control at 1-month follow-up. Methods: Ninety-nine children aged 7 to 17 years with persistent asthma were recruited at 2 nonurban pediatric practices in North Carolina. Eligible children demonstrated their inhaler technique for metered-dose inhalers (MDIs) either with or without a spacer. A trained research assistant used a validated inhaler technique checklist to record which steps children performed correctly. After a regularly scheduled office visit, children were randomized to watch either a 3-minute MDI video (intervention group) or a nutrition video (control group) in English or Spanish. Children’s technique was assessed again after watching the video and 1 month later. Results: Children were primarily male (56%) and non-white (60%). Children in the intervention group demonstrated a significant improvement in MDI technique immediately post-intervention (mean = 1.12, 95% confidence interval [CI] 0.73–1.50) and at 1-month follow-up (mean = 0.87, 95% CI (0.47– 1.26); however, the between-group difference was only significant post-intervention (mean = 1.08, 95% CI 0.53–1.63). At 1-month follow-up, the intervention group reported higher inhaler self-efficacy (mean 0.28, 95% CI 0.01–0.55) and asthma control (mean = 1.93, 95% CI 0.71–3.16); however, the between-group differences were not significant. Conclusion: A brief video interven- e100 JAPhA | 5 4:2 | M AR/AP R 2014 Downloaded From: http://mustafa.japha.org/ on 06/09/2014 tion offered during pediatric clinic visits can improve children’s inhaler technique. Future research should evaluate whether it is feasible to offer the intervention in a pharmacy setting and determine whether booster training is necessary to yield long-term improvements in inhaler technique. Diabetes 66—ASSESSMENT OF A COMMUNITY PHARMACY–BASED EDUCATION PROGRAM AND PHARMACIST INTERVENTION TO OPTIMIZE INSULIN DELIVERY. Ahmed L, Kshatriya S, Dominick’s Pharmacy, Goliak K, University of Illinois at Chicago, Shah A, Dominick’s Pharmacy, Vatanka P, Safeway Inc., Touchette D, University of Illinois at Chicago, E-mail: [email protected] Objective: The primary objective of this study is to determine the number and type of interventions identified by pharmacists and assess patient satisfaction with their insulin delivery experience following a pharmacist-conducted insulin delivery education program. The secondary objective is to evaluate the effectiveness of the Insulin Administration Assessment Tool (I-AAT) in identifying patients who would benefit from pharmacist education and/or intervention. Methods: This is a prospective, survey-based, multi-site study evaluating the development and implementation of an insulin delivery education program in the community pharmacy setting. Adults ≥18 years of age using any type of insulin will be recruited for this study. Exclusion criteria include patients using an insulin pump, GLP-1 agonists, amylin analogs, and those who have not filled their insulin since January 1, 2013. At the time of enrollment, participants will sign a consent form and complete the IAAT. This tool will assess each participant’s confidence with administration technique, level of discomfort, adverse reactions, adherence, and affordability of their current insulin device. Each participant will attend a one-on-one education session with a pharmacist, who will show an educational video on proper injection technique, demonstrate how ja p h a .org to use the insulin device, and allow participants to practice injecting themselves using various size needles or devices. Pharmacists will intervene, as needed, to optimize each patient’s insulin delivery experience. The number and type of interventions will be documented using an insulin delivery intervention record. A short survey, evaluating the same factors as the I-AAT, will be administered 4 weeks after pharmacist education to determine the impact on patient satisfaction with their insulin delivery experience. Results: Research in progress. The number and type of interventions will be presented and compared with I-AAT scores. Responses to I-AAT and the telephone survey will be analyzed. 67—ASSESSMENT OF SELF-CARE ADHERENCE IN PATIENTS WITH DIABETES. Brocious B, Virginia Commonwealth University, Grimes M, Buford Road Pharmacy, Oliver K, Jefferson Pharmacy, Moczygemba L, Goode J, Virginia Commonwealth University, Email: [email protected] Objective: The objectives of this study are to: (1) evaluate diabetic patients’ adherence with their self-care measures; and (2) design a pharmacybased intervention program to improve adherence to self-care measures for patients with diabetes. Methods: A prospective, descriptive study of approximately 150 participants will be conducted over 3 months at 2 independent pharmacies located in Richmond and Palmyra, Virginia. Participants are eligible for the study if they are ≥18 years of age and are receiving medication to treat diabetes. Participants in the study will complete a survey consisting of questions about their adherence to evidence-based diabetes self-care recommendations, including adherence with immunizations, diet, exercise, eye and dental exams, and medications. The survey was adapted from the Summary of Diabetes Self-Care Activities. Patient demographics will be collected and summarized, including sex, age, race, education level, annual income, type of diabetes, time since diabetes diagnosis, whether the patient is being followed Journal of the American Pharmacists Association APhA2014 ABSTRACTS by an endocrinologist/specialist, and whether the patient has ever been counseled by a pharmacist or physician on self-care needs. Results will be calculated comparing the percentage of patients who are adherent to their self-care with those who are not adherent. Results will be used to develop a pharmacy-based intervention program for patients with diabetes. Results: Research in progress. 68—CLINICAL OUTCOMES OF SWITCHING FROM INSULIN GLARGINE TO NPH INSULIN IN INDIGENT PATIENTS AT A CHARITABLE PHARMACY: THE CINCI STUDY. Curington R, University of Cincinnati, E-mail: russell.curington@ uc.edu Objective: The objective of this study is to assess the clinical outcomes (i.e., changes in A1C; 30-day average, high, and low blood glucose; number of hypoglycemic episodes; and Morisky Medication Adherence Scale [MMAS] scores) following a therapy change from insulin glargine to an NPH-based insulin regimen in indigent patients with diabetes type 2 at a charitable pharmacy. Methods: Subjects who qualify for charitable prescription services at St. Vincent de Paul Charitable Pharmacy through a financial verification process to prove low income are enrolled in this prospective cohort pilot study for 24 weeks following an insulin therapy change from insulin glargine to NPH insulin. Current patients of the pharmacy with diabetes type 2, an established health care provider, English-speaking, >18 years old, and a history of using insulin glargine within 3 months prior to enrollment are enrolled in the experimental group of this study. Subjects using an NPH-based insulin regimen for diabetes control >3 months and meeting eligibility requirements are enrolled in the control group of this study. Blood glucose and signs/symptoms of hypoglycemia/ hyperglycemia are reported weekly for 4 weeks following enrollment. Clinical outcomes of A1C, blood glucose, signs/ symptoms and frequency of hypoglycemia/hyperglycemia, 30-day low, 30-day high, and 30-day average are reported at baseline, 3 months, and 6 months after enrollment. Outcome variables (i.e., changes in A1C; 30-day average, high, and low blood glucose; number of hypoglycemic episodes; and MMAS scores) are compared at baseline and follow-up appointments at 1 month, 3 months, and 6 months. Safety is assessed by reports of hypoglycemia, effectiveness is assessed by changes in A1C and blood glucose readings, and changes in compliance are assessed by MMAS scores. Confidence intervals are used to assess whether the intervention is non-inferior to the control. P values are used to determine statistical significance. Baseline data are reported as means and standard deviation for continuous data and numbers and percentages for categorical data. Results: Research in progress. Subjects in both control and experimental groups will be followed for the duration of this study. Data will be collected through study completion and analyzed to determine whether the intervention displays non-inferiority to the control. 69—DIABETES AND IMMUNIZATIONS: UNDERSTANDING THE GAP IN PREVENTIVE CARE. Frease A, Butler M, Mercer University College of Pharmacy, Carmon M, Rite Aid Pharmacy, E-mail: [email protected] Objective: The objectives of this study are to: (1) describe diabetic patients and health care providers throughout the local area with regard to their views and knowledge of diabetic immunization guidelines; (2) provide information on the role of the pharmacists in educating and immunizing diabetic patients; and (3) identify correlations in knowledge and viewpoints of patients with respect to demographic factors. Methods: Two survey instruments will be utilized to assess diabetic patients and their health care team. The patient survey will evaluate their understanding of vaccine recommendations and their reason for making decisions to receive vaccinations. The health care providers and their team (i.e., internal medicine physicians, medical assistants, nurses, pediatricians, pharmacists, and physician assistants) will be surveyed regarding their knowledge of diabetic-specific Journal of the American Pharmacists Association Downloaded From: http://mustafa.japha.org/ on 06/09/2014 j apha.org vaccine guidelines and patient adherence to recommended vaccines. Patients who are currently enrolled in a diabetes education program will be excluded from the survey. New patients will be able to participate in the survey. Results: Research in progress. The study has received institutional review board approval, and data collection will begin October 2013. Data will be analyzed appropriately to report findings. The results of the patient survey will be used to better understand diabetic patients’ resistance and knowledge on appropriate immunization therapy. The results of the health care provider survey will be used to determine provider understanding of diabetic-specific guidelines and their perception on the role of pharmacists in administering immunizations. 70—DURATION OF DISEASE AND PREVIOUS EDUCATION AS INDICATORS OF DEGREE OF KNOWLEDGE: A SURVEY OF PATIENTS WITH DIABETES. Atchley D, University of Tennessee/Kroger, Crain J, Marchetti M, Kroger, Bess D, University of Tennessee College of Pharmacy, E-mail: [email protected] Objective: The primary objective of this study is to explore the relationship between duration of diabetes diagnosis, level of previous diabetes education, and level of diabetes knowledge in a diverse population to help identify and further understand gaps in diabetes care and education. Based on how long a patient has been assigned a particular diagnosis, health care providers may assume patients are knowledgeable and welleducated regarding that chronic disease state. For this reason, patients may be overlooked for interventions and targeted education opportunities. Methods: Patients will be identified at the pharmacy during the prescription filling process. All patients aged ≥18 picking up an antihyperglycemic medication will be eligible to take a diabetes knowledge assessment. The surveys will be distributed in 7 Kroger pharmacies located in Robertson, Sumner, and northern Davidson counties in Tennessee. The questionnaire will be distributed by the MA R /APR 2014 | 54:2 | JAPhA e101 APhA2014 ABSTRACTS pharmacy resident or other pharmacy staff. Once collected, data will be compiled and analyzed using appropriate statistical methods to determine the correlation between duration of diabetes diagnosis, level of previous diabetes education, and level of diabetes knowledge. Results: Research in progress. 71—AN EVALUATION OF A PHARMACIST’S IMPACT ON PHYSICIAN ADHERENCE TO CLINICAL PRACTICE GUIDELINES FOR THE TREATMENT OF HYPERTENSION IN PATIENTS WITH DIABETES. McConaha J, Tedesco G, Duquesne University, E-mail: [email protected] Objective: Current American Diabetes Association guidelines recommend that the treatment of hypertension in patients with diabetes should include an angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) medication. Despite these recommendations, studies have shown that only approximately half of patients with diabetes are currently being treated with an ACEI or an ARB. This study utilized a pharmacist embedded within a primary care physician (PCP) practice to perform electronic chart reviews and document the effect that the pharmacist’s recommendations had on improving physician adherence with these guidelines. Methods: Patients whose chart contained an International Classification of Diseases–9th revision (ICD-9) diagnosis code 250 (diabetes mellitus type 2), ICD-9 diagnosis code 401 (hypertension), and were not already on an ACEI or ARB medication were identified in the electronic medical record (EMR) via an established search function. The pharmacist, with the help of student pharmacists, then reviewed these charts to establish whether the patient would be a candidate for therapy. Exclusion criteria included: drug allergy, other compelling indications for alternative antihypertensive therapy, hyperkalemia, blood pressure controlled without medication, and age >75 years. If a patient met the criteria, a standard electronic communication was sent to the patient’s PCP via the EMR explaining the purpose of the review and any relevant findings. e102 JAPhA | 5 4:2 | M AR/AP R 2014 Downloaded From: http://mustafa.japha.org/ on 06/09/2014 Results: Of the initial patients identified (N = 954), a total of 169 patients were believed to be eligible for therapy and recommendations were sent. Of the 143 responses received, 78 were acceptance of the recommendation (54.5% acceptance). A total of 42 patients went on to receive therapy, 9 patients did not subsequently receive therapy, and 27 patients needed to schedule follow-up before therapy could be initiated. Conclusion: Pharmacists and student pharmacists can provide an important service in ensuring physician compliance with clinical practice guidelines. Access to the EMR can facilitate this process and improve physician acceptance rates. 72—IMPACT OF AMBULATORY CARE PHARMACY SERVICES IN A PRIVATE PHYSICIAN’S PRACTICE ON PATIENTS WITH DIABETES. Murphy B, Byrd J, Kuhl D, Midha S, Union University School of Pharmacy, E-mail: [email protected] Objective: This study evaluates the impact of newly implemented ambulatory care pharmacy services on surrogate disease markers in diabetic patients treated in a private physician’s practice. Methods: Under institutional review board approval, retrospective and concurrent electronic medical record review was conducted of diabetic patients receiving care at an outpatient clinic managed by private family practice and internal medicine providers. Ambulatory care pharmacy services were implemented in January 2012 at the clinic, located within a small city in a predominantly rural area. Services consist of a comprehensive diabetes education program combined with medication therapy adjustments as required in collaboration with the providers. Baseline data were obtained for all referred patients. Follow-up data were collected from January 1 through December 31, 2012. Data collection included: patient’s age, weight, body mass index (BMI), systolic and diastolic blood pressure, A1C, low-density lipoprotein (LDL), triglyceride, total cholesterol, and high-density lipoprotein (HDL). A paired t test was used to compare variables at baseline ja p h a .org versus follow-up. Attainment of clinical marker goals at baseline and follow-up was compared using chi-square or Fisher’s exact test, as appropriate. alpha was set a priori at 0.05. Results: Baseline data were collected in 86 patients. A1C values significantly decreased by 1.3 ± 2.1% (P = 0.0003) with significantly more patients being at goal A1C (25.3% vs. 60.0%, P = 0.0002). Patients lost an average of 4.472 lb (P = 0.0002). Statistically significant improvements also were seen in LDL (–10.758 mg/dL, P = 0.042), HDL (+2.879 mg/dL, P = 0.0239), triglyceride (–37.758 mg/dL, P = 0.017), and total cholesterol (–16.061 mg/dL, P = 0.0059) levels. Changes seen in systolic and diastolic blood pressure, as well as BMI, were not statistically significant. Conclusion: Despite a relatively short follow-up, pharmacist involvement in an outpatient, private practice significantly improves most established objective surrogate markers associated with diabetes management. Longer follow-up is ongoing to further assess this impact. 73—IMPACT OF PHARMACIST INTERVENTION ON A1C IMPROVEMENTS IN A COMMUNITY PHARMACY SETTING. Turner J, Southwestern Oklahoma State University College of Pharmacy/Walgreens, Williams N, Southwestern Oklahoma State University College of Pharmacy, Kinnard J, Walgreens, E-mail: [email protected] Objective: The purpose of this project is to determine whether pharmacistprovided education and coaching in a community pharmacy setting can help low-income patients with poorly controlled diabetes improve their A1C. Diabetes affects over 25 million adults in the United States, with the majority of the population diagnosed with type 2 diabetes. Glycemic control has been shown to minimize complications. Patients with low income may pose a greater challenge in maintaining their diabetes control. Because pharmacists are easily accessible health care providers, they may be able to impact diabetes care. Methods: Adult patients ≥18 years of age presenting to the community Journal of the American Pharmacists Association APhA2014 ABSTRACTS pharmacy with type 2 diabetes on >1 oral diabetic medication, or on an oral medication and insulin or other injectable medication, will be contacted to enroll in the study. These patients will be identified through a medication report, as well as upon presentation of prescriptions that meet study criteria. Study duration will occur during a 6-month period from November 2013 through May 2014. Exclusion criteria will include patients <18 years of age. Data collection will include A1C and body composition taken at initial visit and at 3- and 6-month intervals. Patient demographic information and income level also will be collected at initial visit. Patients will receive standardized pharmacist counseling about their diabetes medications and lifestyle changes during these visits. Approximately 45 days after their initial and 3-month A1C measurements, patients will be contacted via telephone to assist with lifestyle changes and medication understanding and adherence, and address any questions or concerns. This study will be approved by the university institutional review board, and informed consent will be obtained for all patients enrolled in the study. To maintain patient confidentiality, all data will be de-identified. Results: Research in progress. 74—IMPACT OF PHARMACIST INTERVENTION ON DIABETES CARE AT A FEDERALLY QUALIFIED HEALTH CENTER. Jackson A, Sullivan University College of Pharmacy, E-mail: [email protected] Objective: This study aims to assess the impact of pharmacist intervention on diabetes-related outcomes compared with those of patients receiving usual care. Methods: Pharmacists provided comprehensive clinical services for patients with uncontrolled diabetes at a federally qualified health center through a diabetes management program. Patients with A1C >9% were enrolled in the program by physician referral. Upon enrollment in the program, patients were eligible to receive free diabetic testing supplies. Patients included in the study were ≥18 years of age with type 2 diabetes who had completed >2 clinic visits. Pharmacists provided patient education, clinical assessment, drug therapy management, and follow-up care. Intervention patients were compared with patients having similar baseline demographics receiving diabetes care solely from their primary care provider. Primary outcomes include changes in A1C from baseline and achievement of treatment goals. Secondary parameters include changes in baseline lipid levels, blood pressure, and body mass index. Data will be derived from retrospective chart reviews of selected patients. Data will then be evaluated using descriptive statistics. Results: Research in progress. 75—IMPACT OF A POSTGRADUATE YEAR 1 COMMUNITY PHARMACY RESIDENCY ON TYPE 2 DIABETES OUTCOMES IN A PRIMARY CARE PRACTICE. Toale A, University of North Texas System College of Pharmacy, Giaccotto M, O’Connor K, University at Buffalo School of Pharmacy and Pharmaceutical Sciences, Perna A, Internal Medicine Practice, Monte S, Brody Jr. P, University at Buffalo School of Pharmacy and Pharmaceutical Sciences, E-mail: [email protected] Objective: The primary objective of this study was to determine the change in A1C from baseline to 3, 6, and 12 months in type 2 diabetics seen by a postgraduate year 1 (PGY1) community pharmacy resident within a primary care private physician practice. Secondary objectives were to assess changes in prescribing practices, blood pressure, cholesterol, body mass index (BMI), fasting glucose, and hepatic and renal function. Methods: The PGY1 community pharmacy resident met independently with patients referred by the physician or nurse practitioners from January 2011 through December 2012 (n = 129) to provide ongoing disease state and medication education, self-management techniques, and diet and exercise counseling. The resident made medication recommendations to the providers based on patients’ medical and social history, laboratory and at-home glucose levels, and subjective patient data. Data were collected retrospectively at baseline (first Journal of the American Pharmacists Association Downloaded From: http://mustafa.japha.org/ on 06/09/2014 j apha.org appointment with resident), 3, 6, and 12 months and statistical analysis was conducted using Student t test and descriptive statistics with significance defined as P<0.05. Results: Patients’ A1C decreased from 8.4 ± 2.1% at baseline to 7.2 ± 1.3% (P<0.001) at 3 months, 7.4 ± 1.9% (P = 0.002) at 6 months, and 7.4 ± 1.5% (P<0.001) at 12 months. Prescribing practices at 12 months revealed a decrease in sulfonylurea use by 15.1% (26.5 vs. 11.4%), increase in incretin mimetic use by 32.7% (12.7 vs. 45.5%), increase in basal insulin use by 27.7% (38.2 vs. 65.9%), and increase in statin use by 11.9% (67.6 vs. 79.5%). Significant changes in BMI were observed at 6 months (34.5 ± 7.9 kg/m2 vs. 32.4 ± 6.89 kg/m2, P = 0.005). Significant changes in low-density lipoprotein were seen at 12 months (96 ± 34 mg/dL vs. 81 ± 31 mg/dL, P = 0.034). Conclusion: This study demonstrates improvement in clinical outcomes of patients referred to the PGY1 community pharmacy resident for diabetes management. Integrating community pharmacy residents into primary care providers’ practices provides improved patient care, value to the practice, and training experience for the resident. 76—IMPLEMENTATION OF AN INSULIN PROTOCOL TO REDUCE HYPOGLYCEMIC EVENTS AND IMPROVE SAFETY. Bittner A, Hertig J, Purdue University College of Pharmacy, E-mail: [email protected] Objective: The objective of this study is to evaluate the efficacy of an insulin protocol used in an ambulatory setting to reduce the rate of hypoglycemic events in patients with diabetes mellitus. Methods: The study protocol was submitted to the institutional review board in October 2013; data collection will commence with approval. A community pharmacy–based diabetes center has established a collaborative practice insulin management protocol with primary care physicians and endocrinologists in the southern Indiana region. A pharmacist implements the protocol on an individual referral basis. Insulin dose adjustments are made according to the patient’s self-monitoring of blood MA R /APR 2014 | 54:2 | JAPhA e103 APhA2014 ABSTRACTS glucose (SMBG) results. The study will compare the total number of hypoglycemic events in patients on the protocol to insulin-dependent patients not on protocol. Additionally, the total percent of time each patient was hypoglycemic will be calculated. Retrospective data collection will include a sample size of 100 to 150 patients from October 1, 2008 through October 1, 2013. Parametric or nonparametric statistics will be used as appropriate to analyze SMBG data. Results: Research in progress. 77—INTERPROFESSIONAL COMMUNITY-BASED DIABETES SCREENINGS AS A RECRUITMENT MEDIUM FOR PATIENT ENROLLMENT INTO STUDENT PHARMACIST–FACILITATED DIABETES EDUCATION. Liu R, Jung E, Creighton University School of Pharmacy and Health Professions, E-mail: RogerLiu@ creighton.edu Objective: The goal of this study was to determine whether community diabetes screenings were effective for recruiting patients to attend group diabetes education sessions. The study also aimed to determine whether patients receiving abnormal results at a community screening received follow-up care from their health care provider. Methods: Free health screenings were provided to community residents at 7 community pharmacies by 72 pharmacy and 13 physical therapy students. After each screening, students offered diabetes education counseling and encouraged participants to follow up and/ or share their screening results with their health care provider. Additionally, all high-risk participants could provide their contact information in preparation for enrollment into the study. Participants were considered high risk with a fasting blood glucose >100 mg/dL or non-fasting blood glucose >200 mg/dL. One month after screenings concluded, participants who provided contact information were invited to attend a free, student pharmacist–run, group diabetes education session utilizing U.S. Diabetes Conversation Maps. Study enrollees who did not attend were considered lost to follow-up. e104 JAPhA | 5 4:2 | M AR/AP R 2014 Downloaded From: http://mustafa.japha.org/ on 06/09/2014 Results: Of 244 participants screened, 38 (15.57%) were identified as high risk. Of the 38 high-risk participants, 17 (44.74%) provided contact information and were offered enrollment into the study. All 17 participants asked to join the group diabetes education sessions were ultimately lost to follow-up. Of the 17 participants, 8 (47.06%) did not respond to contact attempts. Of the 9 participants (52.94%) who responded, 4 (44.44%) followed up and/or shared their screening results with their health care provider. High-risk participants who did not consent to study enrollment were encouraged to do so as well. Conclusion: Community-based diabetes screenings are not an effective recruitment medium for participant enrollment into additional diabetes education sessions. However, these screenings may be useful in identifying high-risk patients and recommending those patients to follow up with their health care provider. Q 78—LONG-TERM RETROSPECTIVE CASE-CONTROL STUDY COMPARING TWICE DAILY INSULIN GLARGINE TO TWICE DAILY INSULIN DETEMIR IN PATIENTS WITH TYPE 2 DIABETES AT A VETERANS ADMINISTRATION MEDICAL CENTER. Harmon T, Worrall T, Ralph H. Johnson Veterans Affairs Medical Center, E-mail: thomas.worrall@ va.gov Objective: The purpose of this study is to determine the efficacy and tolerability of insulin glargine and insulin detemir administered twice daily over a 12-month period in veterans with type 2 diabetes and an A1C ≤9%. Methods: A retrospective case-control study of patients prescribed either twice daily insulin detemir or glargine was conducted. The insulin detemir and glargine groups were matched on age, baseline A1C, and daily basal insulin dose. The primary aim was to determine whether there was a difference in A1C between the groups at time 0 and 12 months. The secondary aim was to determine whether there was a difference in the daily dose of basal insulin between the groups at time 0 and at 12 months. ja p h a .org A descriptive analysis of the patients requiring a change in basal insulin was completed. The mean difference in treatment cost was evaluated at 12 months. Results: Baseline characteristics were similar. The median A1C at 12 months was 8.3 and 8.7 in the insulin detemir and glargine groups, respectively (P = 0.73), with no difference in the insulin detemir group and a 0.3% increase in the insulin glargine group. The median daily basal insulin use was 0.93 units/kg and 0.95 units/kg in the insulin detemir and glargine groups, respectively (P = 0.8), with a difference of +0.3 units/kg and +0.5 units/kg in the insulin detemir and glargine groups. There was an estimated cost savings of $266.30 per patient in the insulin detemir group. Conclusion: Glycemic control in this study did not differ from previously published studies that compared insulin detemir and glargine. Of note, this study did show a daily dose of insulin detemir that was less than insulin glargine, but the results were not statistically significant. There was not a difference in efficacy or tolerability between the insulin detemir and glargine groups when administered twice daily. Original Citation: Retrospective Case-Control Study Comparing Twice-Daily Insulin Glargine and Insulin Detemir in Veteran Patients with Type 2 Diabetes. Timothy Harmon, Pharm.D., Thomas J. Worrall, Pharm.D., BS(Pharm); Ralph H. Johnson VAMC, Charleston, SC. 79—PROJECT IMPACT DIABETES: MAKING HEALTHY CONNECTIONS IN A U.S.–MEXICO BORDER COMMUNITY HEALTH CENTER. Sias J, University of Texas at El Paso, Castrellon J, Lucero A, Kelly J, Centro de Salud Familiar La Fe Inc., Morton K, Southwest CARE Center, E-mail: jjsias@ utep.edu Objective: The objectives of this study are to: (1) create healthy connections for patients with diabetes using an interdisciplinary approach for a predominantly Spanish-speaking population served by a community health center (CHC) on the U.S.–Mexico border; and (2) document clinical changes and con- Journal of the American Pharmacists Association APhA2014 ABSTRACTS nections to health services made to improve care for these patients. Methods: The pharmacy leadership created an interdisciplinary team representing dental, health education, medical, nursing, pharmacy, and social work departments. During monthly meetings, the team took steps to improve clinical outcomes and health behavior interventions for patients with diabetes in a culturally and linguistically appropriate manner. The team developed an inter-department referral system with specific efforts to increase clinical pharmacy appointments and participation in health education classes as well as other CHC services. To capture missing A1C values, the pharmacy implemented use of an A1C point-of-care (POC) device at the counseling window. Further, pharmacists worked with health educators to design grocery store tours for patients with a limited budget. Patients were able to plan, shop for, and prepare $5 healthy meals for a family of 4 people. Results: The interdisciplinary team enhanced their internal referral system for primarily Spanish-speaking patients with diabetes. Sixty participants (with informed consent) showed an average A1C decrease of –1.4% (9.6% to 8.2%, P = 0.000) over 11 months. The community pharmacy began billing for A1C POC measurements. Through this interdisciplinary effort, patients connected to health classes and interventions related to diabetes. Twelve patients participated in six 4-hour grocery store tours. Over 600 encounters among recruited participants occurred across pharmacy, health education, dental, social, and immunization services. Conclusion: The interdisciplinary team improved clinical markers while making new healthy connections for patients served by this border CHC. Other clinics and community pharmacies may benefit from this model to improve diabetes management by strengthening interdisciplinary teams, improving referral systems, and encouraging multiple connections with patients. 80—PROJECT IMPACT DIABETES: OUTCOMES OF DIABETES AWARENESS TO REACH EXCELLENCE— MAKING A DIFFERENCE IN THE HOMELESS. Stevens L, The Daily Planet, Goode J, Gatewood S, Moczygemba L, Virginia Commonwealth University, E-mail: [email protected] Objective: The objectives of this study are to: (1) develop an innovative interprofessional diabetes program in a patient-centered medical home (PCMH) for the homeless or those at risk for homelessness; and (2) evaluate the impact of Diabetes Awareness to Reach Excellence (DARE) on clinical and preventive diabetes health-related outcomes. Methods: DARE–Making a Difference in the Homeless was implemented in September 2011 in a federally qualified health center for the Homeless Clinic. Patients were enrolled in the program if they had an A1C >7.0. A weekly diabetes day was created, which included group education and joint patient appointments with the physician and pharmacist. Patients participated as often as necessary and could attend the group sessions without an appointment. The interprofessional program includes a physician, pharmacist, nurse, dietitian, health educator, optometrist, and case manager. The team worked with patients to help overcome barriers associated with diabetes care and homelessness. Patients were helped with payment for medications (if needed), testing supplies, and bus passes, and they received special incentives such as healthful snacks during group classes. Outcome measures evaluated were A1C, body mass index (BMI), blood pressure (BP), lipid panel, foot exams, eye exams, smoking status, and influenza vaccine. Results: Sixty-four patients participated in the program for 12 months; there was an average of 9 visits per patient. Mean age was 52.8 years and 73.4% were men. Mean A1C decreased 0.5% (P = 0.049), while mean baseline BP started at goal and remained stable. BMI increased slightly from 31.8 to 32 (P = 0.0195). Baseline total cholesterol, highdensity lipoprotein cholesterol, and lowdensity lipoprotein cholesterol started at goal with triglycerides significantly decreasing from 183.5 to 147.2 (P = 0.012). Smoking status decreased from 48.3% to 46.8%, eye exam status increased from Journal of the American Pharmacists Association Downloaded From: http://mustafa.japha.org/ on 06/09/2014 j apha.org 7% to 14%, foot exams increased from 95% to 96.7%, and no significant change in influenza vaccines. Conclusion: An interprofessional diabetes program can help patients who are homeless or those at risk for homelessness maintain and improve clinical and preventive diabetes health-related outcomes. Q 81—PROJECT IMPACT DIABETES: PATIENT SELF-MANAGEMENT KNOWLEDGE OF DIABETES AFTER PARTICIPATION IN DIABETES AWARENESS TO REACH EXCELLENCE—MAKING A DIFFERENCE IN THE HOMELESS. Goode J, Virginia Commonwealth University, Stevens L, The Daily Planet, Gatewood S, Moczygemba L, Virginia Commonwealth University, E-mail: jrgoode@vcu. edu Objective: The purpose of this study is to evaluate the impact of Diabetes Awareness to Reach Excellence (DARE) on diabetes patient self-management knowledge. Methods: DARE–Making a Difference in the Homeless is an interprofessional diabetes education and management program within a patient-centered medical home. It was implemented in September 2011 at a federally qualified health center for the homeless persons. Homeless persons or those persons at risk for homelessness with diabetes mellitus and who have an A1C >7 were enrolled in DARE. The American Pharmacists Association Foundation’s Patient Knowledge Assessment was used to assess diabetes knowledge. Patients completed a baseline diabetes self-management knowledge assessment and completed the same assessment 1 year after participation in the program. Selfmanagement knowledge scores were categorized as beginner, proficient, and advanced. The raw scores and proficiency assessment were evaluated. Results: Forty-two patients completed both the baseline and final knowledge assessment. Mean score increased to 26.62 from a baseline of 23.55. Selfmanagement proficiency at baseline: beginner 50%, proficient 42.9%, advanced 7.1%. At the end of 1 year self-manageMA R /APR 2014 | 54:2 | JAPhA e105 APhA2014 ABSTRACTS ment proficiency improved: beginner 19%, proficient 66.7%, and advanced 14.3%. Conclusion: An interprofessional diabetes education and management program can improve diabetes self-management knowledge in patients who are homeless or at risk for homelessness. Original Citation: ADA Disparities Conference 2013 Educating the Educators 82—ASSESSING THE IMPACT OF PHARMACIST-PROVIDED FITNESS, NUTRITION, AND WEIGHT MANAGEMENT COACHING CLASSES ON BIOMETRIC OUTCOMES. Huffman K, Bourg C, Young H, University of Georgia, Grubbs K, Kroger Pharmacy, E-mail: ket986@ gmail.com Objective: The objective of this study is to examine the impact of community pharmacist–led coaching program on patient biometric outcomes. Methods: A retrospective chart review of patients who have completed a pharmacist-led coaching program will be conducted. The program consists of 13 visits and focuses on fitness, nutrition, and weight management. Data will be obtained from 35 patient care centers across 4 states. Outcomes collected include the following biometric markers: blood pressure, body mass index, cholesterol, and weight. Bivariate and multivariate analyses will be conducted to examine pre- and post-program differences in biometric outcomes. Results: Research in progress. An anticipated result from this research is that the majority of patients benefit from the program, which would be supported by the improvement in biometric markers from baseline to post-program. Obesity is a prevalent condition associated with greater morbidity. Findings from this study may encourage the use of community pharmacist programs to help improve patients’ fitness, nutrition, and weight management which in turn would reduce cost for third-party payers. Pharmacists who provide coaching undergo specific training to become a patient care specialist with the pharmacy. e106 JAPhA | 5 4:2 | M AR/AP R 2014 Downloaded From: http://mustafa.japha.org/ on 06/09/2014 This study holds significance for patients due to increased access to nutritional resources and services in the community. In addition, the implementation of such programs may benefit society by helping to reduce the problem of obesity and associated negative outcomes. 83—EVALUATING PROFESSIONAL ENGAGEMENT: DEVELOPMENT AND PILOT TESTING OF THE STUDENT PHARMACIST INVENTORY OF PROFESSIONAL ENGAGEMENT. Aronson B, Smith R, University of Minnesota, E-mail: [email protected]. edu Objective: The aim of this study is to describe the development and initial psychometric testing of a novel instrument, the Student Pharmacist Inventory of Professional Engagement (S-PIPE), to assess professional engagement. Methods: A 21-item instrument was developed from prior qualitative work that gathered students’ perceptions of professional engagement. A paper survey was offered to all third-year student pharmacists at a college of pharmacy. Exploratory factor analysis was performed using a principal component analysis (PCA) extraction. One item with low item-item correlation (<0.3) was removed after the initial extraction. After subsequent extraction with oblimin rotation, 1 item with weak loadings (<0.3) on all factors was removed. Another PCA extraction with oblimin rotation was performed. Three items with strong loadings (>0.4) on multiple factors were evaluated and placed in the best fitting conceptual factor. The internal consistency of the items within each factor was evaluated using Cronbach alpha. Results: A 5-factor solution emerged based upon eigenvalues >1, describing 70.34% of the variance in the data. The Kaiser-Meyer-Olkin value was 0.849, demonstrating “meritorious” sampling adequacy. Bartlett’s test of sphericity was significant (P<0.001), indicating the data were factorable. Factors were named based upon the content of the items that comprised the factors. The 5 factors and their internal reliabilities are: belonging (alpha = 0.878, 6 items); professional impact (alpha = 0.750, 3 items); prepared for ja p h a .org profession (alpha = 0.917, 2 items); educational impact (alpha = 0.788, 4 items); and growth (alpha = 0.745, 4 items). Conclusion: Professional engagement is an attribute vital to the professional membership of pharmacy. This research describes the development of a novel instrument to assess professional engagement in student pharmacists. The S-PIPE is composed of 5 factors with high internal reliability. Future research will involve expanding the question bank to cover all factors of professional engagement, and assessing validity and reliability of the complete instrument. 84—EVALUATION OF THE RETURN ON INVESTMENT OF A COMMUNITY PHARMACY RESIDENT IN AN INDEPENDENT PHARMACY IN RURAL MISSISSIPPI. Brown M, Warrington L, Cannon E, Latendresse E, Ross L, Bloodworth L, University of Mississippi School of Pharmacy, Mosby W, Mosby’s Drugstore, E-mail: mminor@ umc.edu Objective: The objective of this study is to evaluate the return on investment of integrating a community pharmacy resident into an independent community pharmacy. Community pharmacies are one of the most accessible health care settings. They also serve as a rich environment for student pharmacists and residents to participate in establishing and expanding pharmacy services to improve patients’ medication use and quality of care. The purpose of this study is to evaluate the impact of service implementation and enhancement in an independent community pharmacy in rural Mississippi, serving as a new residency preceptor site with limited existing clinical services. Methods: This study is institutional review board approved. It is a prospective evaluation of primary and secondary economic outcomes related to new service implementation over a 1-year period. A community pharmacy resident provides services 1 day each week in the pharmacy. Services evaluated in this study include medication therapy management (MTM) visits, point-of-care (POC) screenings, and immunization programs. The primary outcome is to Journal of the American Pharmacists Association APhA2014 ABSTRACTS evaluate the cost-to-benefit ratio for the pharmacy with the implementation and enhancement of services. The financial impact of MTM services will be evaluated using an online MTM billing system. Secondary outcomes include number of patients receiving immunizations, type of immunization administered, number of MTM visits, number of POC screenings, and impact on prescription volume. Results: Research in progress. The preceptor and resident began providing services in September 2013. To date, the following have been completed: 4 MTM visits; 9 blood glucose POC screenings; and 38 influenza, 6 pneumococcal, and 4 herpes zoster vaccinations. 85—IMPACT OF DELIVERING TOBACCO-PREVENTION PRESENTATIONS ON STUDENT PHARMACISTS. Prudencio J, Batz F, Savona N, University of Hawaii at Hilo, The Daniel K. Inouye College of Pharmacy, E-mail: [email protected] Objective: The purpose of this study is to determine the effects of delivering tobacco-prevention presentations to elementary school students by student pharmacists. Methods: In March 2012, a grant was awarded to develop and deliver a 1-hour tobacco prevention presentation for fourth-grade students presented by student pharmacists. Student pharmacist presenters underwent formal training before delivering presentations at local elementary schools. Prior to training, student pharmacist presenters were administered a 23-question survey, provided by the funding agency, inquiring into their personal health choices (e.g., diet, exercise, tobacco use) and participation in tobacco-prevention and cessation programs. Pairs of student pharmacists presented 2 to 6 presentations to classes of fourth graders during the fall 2012 semester. The same survey was readministered after the student pharmacists completed their last fourth-grade presentation. Data were entered into SurveyMonkey and analyzed using descriptive statistics. Results: Thirty-one pre-presentation and 30 post-presentation surveys were collected and analyzed. None of the student pharmacists reported current tobacco use in the pre- or post-surveys. No significant differences were found in personal health choices before training and after delivering tobacco prevention presentations. Before training to deliver presentations, 12.9% of student pharmacists reported participating in community activities to discourage others their age from using tobacco-related products, while 70% reported participation in such activities after delivering presentations to fourth graders. Conclusion: Training for and delivering tobacco prevention presentations to elementary students was associated with increased student pharmacist participation in tobacco avoidance activities involving peers. Involving student pharmacists in health-related elementary school presentations may be an effective way to increase their involvement in other community health-related activities. 86—INCREASING THE CONFIDENCE OF GROCERY STORE– BASED COMMUNITY PHARMACISTS IN PROVIDING DIET AND NUTRITIONAL COUNSELING. Redding J, Pope N, The University of Texas at Austin, Leckbee G, Bentley K, Montemayor D, H-E-B, Lawson K, The University of Texas at Austin, E-mail: [email protected] Objective: Grocery store chains are striving to integrate pharmacists and other health care professionals into a team that provides the best patient care and makes the stores centers for health and wellness. Grocery store–based community pharmacists are easily accessible to patients with questions regarding their medications or disease; however, patients also often have questions about nutritional items and foods sold in the store. The purpose of this study is to prepare pharmacists to answer patient questions regarding nutrition and supplements and ensure patient safety by assessing interactions of these items with a patient’s drugs or disease states. Methods: This study will be submitted to the institutional review board for approval. Pharmacists practicing in a regional grocery store–based community pharmacy will be surveyed to Journal of the American Pharmacists Association Downloaded From: http://mustafa.japha.org/ on 06/09/2014 j apha.org assess their confidence, knowledge, and frequency of recommending nutritional products, supplements, healthful foods, recipes, and determining drug or disease state interactions with these items. An educational module will be prepared by a pharmacist and registered dietitian. Another survey will be given to the pharmacists after completion of the education module. The results of the 2 surveys will be compared. The analysis will determine whether the education was effective by assessing the changes in scores on the survey and the frequency of recommendations made regarding nutrition and supplement products. Results: Research in progress. 87—PHARMACIST-LED EDUCATIONAL INTERVENTION ON PRESCRIBING FOR FAMILY NURSE PRACTITIONER STUDENTS. Flavin J, Pruchnicki M, The Ohio State University College of Pharmacy, Barker E, The Ohio State University, Sevin A, The Ohio State University College of Pharmacy, Green C, Porter K, The Ohio State University, E-mail: [email protected] Objective: The objective of this study is to assess the impact of a pharmacist-driven educational intervention on family nurse practitioner students’ prescribing skills. Methods: This is a prospective preand post-assessment of 14-week educational intervention designed to improve clinical and procedural aspects of prescribing in a family nurse practitioner (NP) program. NP students enrolled in Clinical Practicum, a blended course combining didactic learning and clinical rotations, will participate in an online prescribing module. All students will have received didactic instruction on prescription writing prior to the course, with this activity providing additional practice consisting of weekly patient cases with formative feedback. For each patient case, students are asked to review a corresponding prescription or to generate a prescription for the patient. The weekly activities will emphasize legal requirements, accuracy of the prescription, and appropriateness of therapy based on patient-related factors, including patient safety considerations. The pharmacist MA R /APR 2014 | 54:2 | JAPhA e107 APhA2014 ABSTRACTS facilitator will provide feedback on the students’ submissions. Before and after completion of the module, participants will complete a graded assessment on prescription writing skills. The pre-assessment also will collect demographic information. The post-assessment will include a retrospective pre- then postsurvey to collect students’ perceptions of how preparedness to prescribe changed with the practice opportunities, as well as their perceptions regarding pharmacist collaboration. Change from pre- to post-module will be evaluated by t tests or signed-rank tests, as appropriate. Associations with demographic factors will be assessed using t tests, rank-sum tests, or Jonckheere-Terpstra tests, as appropriate. Results: Research in progress. Results are expected to demonstrate the impact of pharmacist expertise on NP students’ understanding of safe and effective medication prescribing. Formative education on appropriate prescribing could enhance preparedness of future prescribers, thereby improving the medication use process and reducing errors and delays in initiating and optimizing drug therapy. Exposure of the NP students to pharmacist expertise in this area during training also may encourage future collaboration in practice. 88—A PILOT PROJECT IN THE PHARMD CURRICULUM TO ENHANCE STUDENT PHARMACIST CONFIDENCE IN APPLICATION OF EVIDENCE-BASED GUIDELINES AND MAKING PHYSICIAN RECOMMENDATIONS. Jakubek J, Konopka C, Sulkowski K, McConaha J, Lassila H, Duquesne University, E-mail: [email protected] Objective: The purpose of this study is to investigate the learning of third-professional year (PY3) student pharmacists through the application of evidencebased guidelines in making recommendations to physicians in response to care alerts issued by third-party payers. Methods: PY3 student pharmacists participated in a pilot project to determine their level of confidence and degree of learning through application of evidence-based guidelines to real-life clini- e108 JAPhA | 5 4:2 | M AR/AP R 2014 Downloaded From: http://mustafa.japha.org/ on 06/09/2014 cal scenarios. Student participants evaluated weekly care management alert letters sent to a primary care physician group. These letters included recommendations for gaps in care according to published guidelines, medication adherence issues, and potential drug-drug or drug-disease interactions. Students analyzed each letter using knowledge of disease-specific clinical guidelines learned through their didactic curriculum to determine whether the proposed intervention was appropriate and necessary. Students then prepared and submitted evidence-based recommendations to a pharmacist faculty preceptor at the physician’s office for evaluation. Recommendations deemed appropriate by the preceptor were forwarded to the physician for consideration. Those not accepted by the preceptor were sent back to the student with feedback. Student confidence level with providing clinical recommendations was evaluated pre and post data collection through a written survey. Collected data included the categorization of the types of recommendation letters, the number of student recommendations that were sent for physician consideration, and number of accepted physician recommendations. A paired t test on student pre- and post-confidence surveys will be performed along with qualitative analysis of student comments on the confidence survey. Descriptive statistics will be used which include cumulative percentages for the types of the requests, the percent of student recommendations that were sent for physician consideration, and the percent of accepted physician recommendations. Results: Research in progress. Expected results will illustrate increased confidence of the student pharmacists as a result of the application of previously acquired knowledge of current clinical guidelines. 89—STUDENT READINESS TO PROVIDE PATIENT SCREENING AND EDUCATION IN A NATIONWIDE HEALTH AWARENESS CAMPAIGN. Layson-Wolf C, Eisenschmid A, University of Maryland School of Pharmacy, E-mail: [email protected] Objective: The purpose of this study ja p h a .org is to evaluate student perceptions regarding their readiness to participate in patient screening and education events during a nationwide health awareness campaign. Methods: Student participants in this study were identified by their placement at particular rotation sites recruited for the Team Up Pressure Down campaign, which focuses on identification of patients with hypertension, referral of patients for follow up, and provision of education related to high blood pressure. Students were invited to participate in a pre-rotation education session about the campaign and were e-mailed a survey to evaluate their readiness to provide screenings to patients at their community rotation site and communicate to patients and health care providers about their screening results. The university’s terminal performance outcomes statements relevant to this activity were used to garner their readiness for the campaign. Data will be evaluated and reported utilizing descriptive statistics. A follow-up survey with the students after the campaign is also planned. Results: Research in progress. The data will be utilized to structure and design training sessions for students to help strengthen skills in screening and education programs provided in the community setting. 90—TEACHING STUDENT PHARMACISTS THE IMPLICATIONS OF ORAL HEALTH ON CHRONIC DISEASE STATE MANAGEMENT. Mazzarisi C, Bastin M, Steel E, Primley C, Gersten J, Jonkman L, The University of Pittsburgh, E-mail: caramazzarisi@ gmail.com Objective: Student pharmacists receive little instruction on oral health considerations in chronic disease management. The goal of this project was to teach student pharmacists basic information about oral health issues that arise from certain disease states or as complications of uncontrolled disease states. The skills learned during this session could then be applied at a free clinic where these students complete their service learning requirements. Methods: Pharmacy and dental stu- Journal of the American Pharmacists Association APhA2014 ABSTRACTS dents created a teaching intervention to increase pharmacy student knowledge of and comfort with oral health complications of chronic diseases. Immediately prior to the lecture, participants completed a pre-test to evaluate comfort and knowledge. After the lecture by dental students, the participants immediately completed a post-test to assess improvement in knowledge and comfort. As part of a required service learning experience, some of the participants will have an experience at a free clinic before the end of the semester. Participants will be asked to complete the post-test again at the end of the semester to assess retention. In addition, those participants who had a free clinic experience will complete information on how they used the material while at the free clinic. Improvement in knowledge and retention of knowledge will be evaluated at the end of the study. The institutional review board approved this protocol. Results: Research in progress. A total of 18 student pharmacists participated in the intervention. At baseline, students scored an average of 57% (standard deviation [SD] 19%) on the knowledge test. After the intervention, knowledge increased by 25% (P<0.05). Additionally, students’ comfort level discussing oral health with patients increased from 2.78/10 (SD 1.56) to 4.89/10 (SD 1.60) after the presentation (P<0.0001). An additional presentation will be held later in the semester to enroll more participants. The results of the third test will be analyzed at the end of the semester. Geriatrics and Long-Term Care 91—CONCORDANCE BETWEEN MEASURES OF POLYPHARMACY. Goedken A, Li C, Cook E, University of Iowa, Brooks J, University of South Carolina, E-mail: amber-goedken@uiowa. edu Objective: This study aims to: (1) assess the prevalence of polypharmacy (i.e., ≥5 medications) among elderly individuals hospitalized for acute myocardial infarction using different combinations of medication definition, categorization, and time frame; and (2) measure the concordance between different mea- sures of polypharmacy. Methods: This is a retrospective study using Medicare claims and Part D prescription drug event files of Medicare beneficiaries ≥66 years of age hospitalized with acute myocardial infarction in 2007. Part D events were linked to records in the Multum Lexicon Access database via National Drug Code (NDC) to identify the corresponding drug and active ingredients. Only linkable Part D events that were not medical supplies were included. There were 3 definitions, 3 categorizations, and 3 time frames used. The definitions were: (1) all medications; (2) prescription medications; and (3) oral medications. Nine binary measures of polypharmacy were created under each medication definition using different combinations of medication categorization and time frame. The categorizations were: (1) 9-digit NDC; (2) drug; and (3) active ingredient. The time frames were: (1) at the time of admission; (2) 90 days prior to admission; and (3) 180 days prior to admission. The prevalence of polypharmacy using each of 27 measures was calculated. Unweighted kappa statistics were used to measure agreement between measures. Results: Using all medications available at admission, 44% to 48% had polypharmacy depending on the categorization. When the time frame was extended to fills 90 and 180 days prior to admission, 65% to 69% and 74% to 77% had polypharmacy, respectively. The kappa statistics for a given categorization ranged from 0.39 to 0.79, depending on the time frame. The range was similar for alternative medication definitions. Conclusion: The time frame used to measure medication use has a greater impact on who has polypharmacy than how medications are categorized. Variation in polypharmacy prevalence between studies is likely a function of the period over which medication use is measured. 92—THE EFFECT OF HOSPITALIZATION AND REGIONAL GEOGRAPHY ON THE USE OF POTENTIALLY INAPPROPRIATE MEDICATIONS IN OLDER ADULTS. Middendorff G, University of Iowa, Lund B, Iowa City Journal of the American Pharmacists Association Downloaded From: http://mustafa.japha.org/ on 06/09/2014 j apha.org VA Health Care System, Schroeder M, Brooks J, University of Iowa, E-mail: [email protected] Objective: Potentially inappropriate medications (PIMs) are an important cause of adverse outcomes in older adults. The objectives of this study were to: (1) describe geographic variation in PIM use among older adults hospitalized for acute myocardial infarction (AMI); and (2) assess the impact of hospitalization on PIM prescribing. Methods: Participants were selected from a 100% sample of Medicare beneficiaries admitted for AMI during 2007–2008. Medicare Part D claims were used to characterize PIM exposure during the 6 months prior to hospitalization and 6 months following discharge, and to identify PIMs discontinued or initiated around the time of admission. PIM use was defined by the High-Risk Medications in the Elderly quality indicator from the Healthcare Effectiveness Data and Information Set. Results: Of 124,051 patients hospitalized for AMI, 28,097 (22.6%) had a PIM dispensed during the 6 months prior to hospitalization, which varied from 16.3% in the Northeast to 28.3% in the South. At the time of admission, 9,607 patients had an active PIM, of which 3,682 (38.3%) were discontinued prior to discharge. Discontinuation rates varied from 43.4% in the Northeast to 37.2% in the South. PIM initiation during hospitalization occurred in 4,666 (3.8%) patients and ranged from 2.2% in the Northeast to 5.1% in the South. The overall 6-month PIM prevalence following discharge was 24.6%. Conclusion: This study showed significant regional variation in health care quality among older adults admitted for AMI. Consistent with prior outpatient studies, PIM use was lowest in the Northeast and highest in the South. Contrary to the study hypothesis, acute hospitalization yielded a net increase in PIM use, both during admission and in the 6 months following discharge. These findings suggest that acute hospitalizations are a missed opportunity to improve prescribing quality, where patients have access to clinical pharmacists and other services that may not be available in the MA R /APR 2014 | 54:2 | JAPhA e109 APhA2014 ABSTRACTS community setting. Health Disparities and Cultural Issues 93—EVALUATION OF COMMUNITY PHARMACIST–MANAGED TRANSITIONS OF CARE ON HOSPITAL READMISSION RATES IN A MEDICALLY UNDERSERVED COMMUNITY HEALTH CENTER. Smith R, Rickertsen H, Smith J, Doucette W, Catney C, Veach S, University of Iowa College of Pharmacy, E-mail: rickerth@ mercyhealth.com Objective: The purpose of this study is to evaluate the effect of community pharmacist–managed transitions of care on 30-day readmission rates for patients receiving primary care at a collaborative community health center for the medically underserved. Methods: This is a longitudinal study examining a local hospital’s 30-day readmission rates over a 3-month period before and after an enhanced community pharmacist–managed transition of care model is implemented. Those rates also will be compared with statewide Medicare hospital readmission data. Study participants include adults ≥18 years of age who have been admitted to a local hospital and receive post-discharge primary care at a 340B-qualified community health center in a mid-sized city in the Midwest. Community health center patients will be identified upon admission to the hospital through a form faxed to the 340B medication access pharmacy to obtain prescription histories. The community pharmacist will follow patients by attending inpatient care conferences and accessing community health center and hospital electronic health records from hospital admission through their first appointment with their primary care provider post-hospital discharge. Pharmacist interventions will include reconciling medication and diagnosis, handling gaps in knowledge concerning patient information, ensuring patients follow up at the community health center within 3 days of hospital discharge, and increasing access to chronic medications by utilizing 340B formulary. The primary end point will be 30-day e110 JAPhA | 5 4:2 | M AR/AP R 2014 Downloaded From: http://mustafa.japha.org/ on 06/09/2014 hospital readmission rates of participating community health center patients. The secondary end point will be time to see primary care provider after hospital discharge. The 30-day readmission rates during the 3-month service period will be compared with those from the 3-month baseline period and a matching period using the statewide Medicare hospital readmission data. Results: Research in progress. 94—THE IMPACT OF MEDICARE PART D ON RACIAL/ETHNIC DISPARITIES IN THE USE OF CARDIOPROTECTIVE MEDICATIONS AMONG MEDICARE SENIORS. Hussein M, Waters T, University of Tennessee Health Science Center, E-mail: [email protected] Objective: The objective of this study is to evaluate the impact of Medicare Part D introduction on the racial/ethnic disparities in the use of beta-blockers, angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, or statins (collectively referred to as cardioprotective medications) among seniors with cardiovascular diseases. Methods: This is a quasi-experimental difference-in-differences analysis of the Medical Expenditure Panel Survey (MEPS 2002–2010). The treatment group includes Medicare seniors. The control group includes the near-elderly (60–64 years of age) non-Medicare respondents, who had at least 1 of 6 ambulatory care– sensitive cardiovascular conditions; selfreported being white, black, or Hispanic; and were continuously eligible for MEPS data collection. Periods 2002–2005 and 2007–2010 were designated as pre- and post–Part D periods, respectively. The main outcome was any refill during survey year of a cardioprotective medication. In primary analyses, survey-adjusted logistic regression was used to model this binary outcome. A distinction was made between differences and disparities in drug use, following the Institute of Medicine’s 2002 framework. Minority distributions of demographics, health status, and beliefs were replaced by the corresponding white distributions to selectively adjust for these covariates, while allowing measures of social disja p h a .org advantage (e.g., socioeconomic status) to contribute to estimated disparities. A secondary analysis using the generalized changes-in-changes (CIC) estimator assessed the heterogeneity of Part D’s effect across the outcome distribution. Results: A sample of 17,087 respondents, nationally representing 24,237,118, was analyzed. Part D was found to have reduced the white-black disparity in the probability of drug use by 12 points (95% confidence interval [CI] –16.00, –8.00; P = 0.000), while it has reduced the white-Hispanic disparity by 5.5 points (95% CI –10.00, –1.00; P = 0.001). CIC models suggest that Part D’s effect was driven by significant improvements in the lower quantiles of the distribution. Conclusion: By netting out relevant secular trends in disparities, this analysis suggests that Medicare Part D has improved elderly minorities’ access to essential cardiovascular drugs. There remain, however, significant disparities deserving further investigation in drug use in the post–Part D era. 95—MISSION OF MERCY HEALTH LITERACY AND QUALITY OF LIFE ASSESSMENT. Lindsay D, Webb T, Bloodworth L, Brown M, Davis C, Fleming J, Harrell K, University of Mississippi School of Pharmacy, E-mail: lindsdyl@ gmail.com Objective: The aim of this study was to assess health literacy and quality of life of participants in the state’s Dental Association 2013 Mission of Mercy clinic who received free dental and pharmacy services. Methods: Questions from the Centers for Disease Control and Prevention’s Quality of Life survey as well as the health screening tool, Newest Vital Sign, were compiled into a single survey and administered verbally to study participants. The survey was administered in conjunction with the state’s Dental Association 2013 Mission of Mercy clinic, which took place April 26 and 27, 2013. This study was approved by the institutional review board. Results: There were 242 participants in the survey. The majority were female (69.8%) and African American (71.7%), Journal of the American Pharmacists Association APhA2014 ABSTRACTS with a mean age of 40.8 years (range 18–80 years). A lack of medical insurance coverage was reported by 64% of participants; a majority (41%) reported their general health as “good,” but 28% reported limited ability to perform usual daily activities over the past month due to physical or mental health problems. The Newest Vital Sign component of the survey was completed by 232 participants, with an average health literacy score of 2.6 ± 1.8 (mean ± standard deviation). Only 34% had what is considered to be “adequate” health literacy; 31% scored ≤1, which indicates a high likelihood of limited health literacy. Conclusion: Although a majority of study participants reported their health as “good,” a large percentage also reported mental and physical health problems that were significant enough to hinder their usual daily activities. These problems may be related to the large number of participants who indicated a lack of medical insurance coverage, although a causative relationship cannot be shown based on the data at this time. A majority of study participants also exhibited a lack of adequate health literacy, which may contribute to the health concerns of the local patient population. Health Literacy 96—ANTIBIOTIC USE AND PERCEPTION AMONG JORDANIAN PARENTS. Athamneh L, University of Houston, El-Mughrabi M, The Ministry of Health, Athamneh M, Ramtha Hospital, Essien E, Abughosh S, University of Houston, E-mail: smabugho@Central. UH.EDU Objective: The purpose of this study is to explore parents’ patterns of antibiotics use for children aged 6 weeks to 6 years in Jordan, a small Middle Eastern country. Methods: An observational, surveybased, cross-sectional study in a convenient sample of 419 Jordanian adult parents in Irbid governorate area, Jordan. The questionnaire consisted of 32 yes/ no and multiple-choice questions in 4 major categories that capture sociodemographic information in 1 section and elicit information about the parent’s knowledge, beliefs, and practices in fever management and antibiotics use in the remaining sections. Descriptive statistics were presented. Results: More than half of parents (56%) surveyed reported giving antibiotics to their children without a pediatrician’s advice. Reasons cited include suspecting an infection (31%) or just having a fever (21%). Thirty percent of parents reported having obtained an antibiotic for their child from a pharmacy without a prescription. In this study, 14% of parents used antibiotics to treat fever in children. The study indicated that 23% of parents think antibiotics should be prescribed to all children who develop fever. Of the participant parents, 38% reported using antibiotics for their unwell child without a consultation from a physician, 67% would use antibiotics based on a pharmacist’s consultation, and 17% would insist on receiving an antibiotic prescription even when not considered necessary by their pediatrician. Conclusion: Findings indicate that parents in Jordan often have false beliefs, wrong practices, and misuse antibiotics for their children. These results highlight the need to develop reliable evidencebased educational programs to educate the parents about potential harms of misuse and ultimately control inappropriate use. 97—CORRELATION BETWEEN HEALTH LITERACY AND MEDICATION ADHERENCE IN INFECTIOUS DISEASE CLINIC. Turner B, Metzger A, University of Cincinnati, Email: [email protected] Objective: The purpose of this study is to determine the correlation between health literacy and medication adherence. Methods: Patients in an infectious disease clinic were asked 2 sets of questions at their visit; the first set of questions relates to health literacy and the second set relates to adherence. The first set, “The Newest Vital Sign,” is a series of 6 questions used to determine the health literacy of the patient. The second set of questions was developed based on existing literature on adherence and was scored on a scale of 0 to 11. Both scales Journal of the American Pharmacists Association Downloaded From: http://mustafa.japha.org/ on 06/09/2014 j apha.org were collected as part of the standard of care for the patients at their clinic visits. These scores were compared to meet the stated objectives. Results: The results showed a higher correlation between medication adherence and health literacy in patients with high health literacy (R2 = 0.8027). Patients with moderate to low health literacy had a lower correlation between health literacy and medication adherence (R2 = 0.6566 and R2 = 0.7424). These correlations show expected results. Since medication adherence can be attributed to a number of different factors (e.g., mental health, financial status), health literacy represents only part of the picture. Conclusion: Medication adherence, while important in all pharmacotherapy, has an increased importance in infectious disease, especially in patients with human immunodeficiency virus infection due to the risk of developing resistance. For this reason, medication adherence is essential to monitor in patients with chronic infectious disease. Furthermore, ways to improve medication adherence in this population as well as all others should be sought. Health care providers should take the time to help improve their patients’ medication adherence and their health literacy. Patients with lower health literacy may need extra time to go over their medication directions and additional tools (e.g., reminders, pillboxes) to achieve the same level of adherence as patients with higher health literacy. 98—EFFECT OF FOCUSED EDUCATION ON FUNCTIONAL HEALTH LITERACY AND PRESCRIPTION LABEL COMPREHENSION: A RANDOMIZED CONTROLLED TRIAL. Tai B, Law A, Western University of Health Sciences, LaRue C, Metro North Adult Education, E-mail: btai@westernu. edu Objective: The objectives of this study are to: (1) assess change in functional health literacy (FHL) and prescription (Rx) label comprehension of English-speaking older adults after a focused educational intervention; (2) examine the correlation between FHL and Rx label comprehension; and (3) examine factors that may predict FHL and Rx label comMA R /APR 2014 | 54:2 | JAPhA e111 APhA2014 ABSTRACTS prehension. Methods: A randomized, controlled, single-blinded trial was conducted at 3 senior centers. Inclusion criteria were: English-speaking older adults, ≥55 years of age; currently taking ≥2 Rx medications; and without visual, hearing, or cognitive impairment. The 107 recruited individuals were randomized to control (n = 47) or intervention group (n = 60). Pre- and post-intervention FHL levels were measured by a validated and widely used instrument, Short Test of Functional Health Literacy in Adults (STOFHLA). Rx label comprehension levels were measured using a 25-item instrument (with established face and content validity), based on labels for 4 common chronic conditions. Intervention group received focused education (individual counseling and printed material) on Rx labels during the 1-month study period. Data were analyzed using IBM SPSS version 21. Results: Majority of the sample (mean age, 76.7 years) was female (59.8%), white (56.1%), completed some college education or above (63.6%), with annual household income <$50,000 (58.9%). No significant differences were found between the intervention and control groups in demographics, baseline FHL, and Rx label comprehension levels. Reliability (internal consistency) of the label instrument scale was at Cronbach alpha of 0.87. Significant improvement was seen in STOFHLA (27.5 to 31.4) and label comprehension scores (22.8 to 24.0) from baseline (both P<0.01), compared with the control group. STOFHLA and label instrument scores were significantly correlated (r = 0.628, P<0.01). Age and education level were significant predictors for both measures. Conclusion: A significant improvement in FHL and Rx label comprehension was observed after educational intervention. Improving Rx label comprehension may be an avenue for improving FHL. 99—THE EFFECT OF USING PICTOGRAMS ON COMPREHENSION OF MEDICAL INFORMATION: A META-ANALYSIS. Ghura S, Chewning B, University of Wisconsin–Madison, E- e112 JAPhA | 5 4:2 | M AR/AP R 2014 Downloaded From: http://mustafa.japha.org/ on 06/09/2014 mail: [email protected] Objective: Health literacy is a growing concern among health care systems globally. Research has demonstrated that people with low levels of literacy have less knowledge about their disease and medication instructions, potentially increasing risk of nonadherence and poorer health outcomes. Although pictograms have been recommended to enhance health literacy, the field lacks a published meta-analysis of the impact of pictograms on patient comprehension. This meta-analysis aimed to synthesize and analyze data from published studies of the effect of pictorial aids on medication comprehension. The intention is to identify avenues for further research that can aid patient understanding of medical information through use of visual aids. Methods: Studies of patient comprehension included in this analysis used a specific treatment intervention composed of medical information provided as pictograms and text and compared this combination with a text-only intervention, which was treated as the control. All patients in these studies were provided medical information in the form of a patient label, patient information leaflets, or consultation by a health care provider. Data sets searched included Cochrane Library, EBSCO, and PubMed. Meta-analysis was performed using a random effects model. Results: Out of the 139 published studies, 12 studies were screened for data and 9 studies were used in the analysis. Results supported the primary hypothesis that pictograms aid medical comprehension (P<0.0001). The summary effect size was found to be g = 0.5 (0.19, 0.8). The I2 value for this omnibus test was almost 88%, implying large heterogeneity in the sample. Among the moderators tested, a patient’s number of years of education was close to significance (P = 0.09). Conclusion: This analysis suggests that pictograms should be integrated more often into educational materials, particularly for lower education populations. Further, there is a need to explore the relationship of medical comprehension with other outcomes such as medication adherence and health outcomes. ja p h a .org 100—HEALTH LITERACY, MEDICATION ADHERENCE, AND PATIENT SATISFACTION IN COMMUNITY PHARMACY. Anderson S, Chen A, Cedarville University, E-mail: sanderson@ cedarville.edu Objective: The objectives of this study are to: (1) determine whether pharmacists’ perception of patient health literacy and actual patient health literacy align; (2) assess the relationship between health literacy and medication adherence in patients who visit independent community pharmacies; and (3) evaluate patients’ satisfaction with their pharmacists’ patient counseling. Methods: Inadequate health literacy has been shown to result in negative outcomes, including poor medication adherence. Bridging the gap between the pharmacists’ communication and patients’ level of understanding is crucial in improving patients’ overall care. At every refill, pharmacists have an opportunity to break the health literacy barrier, therefore, improving medication adherence. However, there may be a disconnect in the pharmacists’ opinion of their patients’ health literacy and satisfaction with counseling. Local, independent pharmacies were recruited using convenience sampling. Patients who are ≥18 years of age, speak English, and are obtaining a refill for a chronic condition will be asked to complete several instruments to assess health literacy (Newest Vital Sign), medication adherence (8-item Morisky Medication Adherence Scale), and patient satisfaction with counseling (Likert-type, 5-point agreement scale). Pharmacists will complete an instrument assessing their perceptions of patient health literacy, medication adherence, and counseling satisfaction. The patient satisfaction and the pharmacist perceptions surveys were created from an indepth literature review and underwent non-expert, peer, and expert review to establish face and content validity. Survey results will be analyzed in SPSS with alpha = 0.05. To achieve beta = 0.2, approximately 60 patients will be recruited per site. Results: Research in progress. Thus far, 6 independent community pharmacies have been recruited in both un- Journal of the American Pharmacists Association APhA2014 ABSTRACTS derserved urban and rural areas. Data collection is currently underway with anticipated completion by the end of December 2013. Results from this project can be utilized to educate these and other pharmacists on possible ways to improve patient care by counseling in a way all patients can understand. Q 101—IMPACT OF HEALTH LITERACY IN A DIABETES SELFMANAGEMENT EDUCATION PROGRAM. Smith S, Shealy K, Threatt T, Presbyterian College School of Pharmacy, E-mail: [email protected] Objective: The purpose of this study was to: (1) determine whether baseline health status correlates to a patient’s health literacy level as indicated by A1C; (2) determine health literacy level correlates to health outcomes as indicated by A1C level at follow up; and (3) determine health literacy level correlates with attendance in diabetes self-management education (DSME) program. Methods: This cohort study assessed patient health literacy status using the Rapid Estimate of Adult Literacy in Medicine–Short Form (REALM-SF) and Newest Vital Sign (NVS) tools during initial consults with patients referred to a DSME program. Additional data collected included demographic information and baseline A1C. Follow-up A1C was compared with baseline. Attendance was determined by number of missed classes. Descriptive statistics were used to analyze the data collected; change in A1C was analyzed by paired Student t test and correlation coefficients (r) were calculated for attendance and A1C level by health literacy level. This study was approved by the institutional review board. Informed consent was obtained. Results: Thirty-nine patients were enrolled in the study. More patients were identified to have poor health literacy with NVS than with REALM-SF. No significant correlation was found between baseline health status and health literacy level. Significant reduction in A1C was seen in all patients; however, follow-up health status per A1C negatively correlated with NVS scores. Patients with poor health literacy missed an average of 2.4 appointments, compared with an av- erage of 1.3 missed appointments by patients with higher health literacy. Scores from REALM-SF negatively correlated with attendance and were statistically significant. Conclusion: Overall the DSME program successfully improves patients’ health, and health literacy level seems to affect attendance to DSME sessions. More research is needed to determine the optimal tools for assessing health literacy level and subsequent interventions to achieve health outcomes success in a DSME program. Original Citation: Smith S, Shealy KM, Threatt T. Impact of health literacy in a diabetes self management education program administered through a school of pharmacy. Presented at 19th Annual Diabetes Fall Symposium for Primary Health Care Professionals, Charleston, SC 102—THE INFLUENCE OF FUNCTIONAL HEALTH LITERACY ON QUALITY PATIENT-PHARMACIST COMMUNICATION. King S, Union University, Rogers E, Methodist Healthcare, Null K, University of Mississippi, E-mail: [email protected] Objective: The purpose of this study was to examine the relationship between functional health literacy (FHL) and quality patient-pharmacist communication among patients receiving anticoagulation therapy. Additionally, this study assessed whether the time patients spent within optimal therapeutic range differed by level of FHL. Methods: In this study, 232 patients from 2 rural, pharmacist-staffed anticoagulation clinics were asked to participate in detailed telephone interviews concerning their interactions with clinic pharmacists. A validated, 1-item screening question was used to classify patients as possessing either adequate or inadequate FHL. Patients’ perceptions regarding general communication with pharmacists were elicited using 6 domains from the Interpersonal Process of Care (IPC) questionnaire. Indication, target range, time in range of anticoagulation, and race/ethnicity were retrieved from the database of the respective clinic. Independent t tests were used to assess Journal of the American Pharmacists Association Downloaded From: http://mustafa.japha.org/ on 06/09/2014 j apha.org for differences between FHL groups on each of the 6 IPC domains. Logistic regression was used to measure the association between inadequate FHL and the IPC domains. Results: Telephone interviews were completed by 220 patients. Patients possessing inadequate FHL reported significantly worse ratings to the quality of pharmacist communication than did those possessing adequate FHL on 4 of the 6 IPC domains (P≤0.05). The odds of reporting poorer quality interpersonal processes of care across these 4 domains were significantly greater for those possessing inadequate FHL (P≤0.05). Patients with inadequate FHL did not differ significantly from those with adequate FHL in terms of time within therapeutic international normalized ratio (INR) range or percent of INRs in therapeutic range over the previous 12 months. Conclusion: Patients receiving anticoagulation therapy also possessing inadequate FHL appear more likely to experience poorer communication with pharmacists than patients possessing adequate FHL. Pharmacists may be failing to adequately determine the extent to which educational efforts for these patients leads to intended consequences. Educational efforts may be needed to improve pharmacists’ communication skills in these areas. 103—READERSHIP AND PERCEPTION OF MEDICATION GUIDES AND PATIENT PACKAGE INSERTS AT A STUDENT HEALTH PHARMACY. Buchman C, Boyce B, Muravez S, Oregon State University, E-mail: christina. [email protected] Objective: The printed Medication Guide (MedGuide) and Patient Package Insert (PPI) that are required with prescription drugs outline the risks of taking the medication in language that is patient-friendly and relatively easy to read. The aim of this study is to evaluate how often patients of a student health pharmacy read the MedGuides/PPIs of prescription medications and how useful they have found the information provided. The unique patient population of a university setting eliminates some potential confounders because it can be MA R /APR 2014 | 54:2 | JAPhA e113 APhA2014 ABSTRACTS assumed that students, staff, and faculty who make up the patient base will have a high enough level of education to be able to read and comprehend the handouts. Based on pre-study observation, it is proposed that patients may read the information when first presented, but not when they receive it with refills of the same medication. If this study shows low readership of MedGuides/PPIs, then pharmacists will need to be more vigilant about counseling regarding the purpose of the handouts as well as watching for adverse effects and drug-drug interactions. Methods: The study plans to enroll the first 1,500 patients who present to the student health pharmacy for a refill of a medication that requires a MedGuide or contains a PPI. Patients who are ≥18 years of age and are requesting a refill of a medication that has been previously filled at the student health pharmacy and requires a MedGuide or contains a PPI will be handed a survey to fill out while they wait for their prescription. The survey will evaluate whether they recall receiving a MedGuide or PPI with their last prescription and whether they read it. The survey also will attempt to evaluate their perception of the information by asking about understandability, usefulness, length, and how confident they are about the information in the handout. Data from the survey will be compiled and reported in aggregate form using a descriptive statistical analysis. Results: Research in progress. Immunizations 104—ADDRESSING BARRIERS TO PNEUMOCOCCAL VACCINATION: TRAINING PHARMACY TECHNICIANS FOR ROLES IN VACCINE ADVOCACY. Humphries C, University of North Carolina at Chapel Hill Eshelman School of Pharmacy, Gatton O, Cates L, Kroger, Ferreri S, Marciniak M, University of North Carolina at Chapel Hill Eshelman School of Pharmacy, Email: [email protected] Objective: According to the Centers for Disease Control and Prevention, approximately 70 million people have indications for pneumococcal vaccine e114 JAPhA | 5 4:2 | M AR/AP R 2014 Downloaded From: http://mustafa.japha.org/ on 06/09/2014 but remain unvaccinated. Patient understanding of pneumococcal vaccine recommendations is likely a large barrier to vaccination. Due to their significant role in the medication use system, pharmacy technicians may be a valuable resource to facilitate communication about pneumococcal vaccine. However, pharmacy technicians ability to initiate vaccine conversations with patients also may be a barrier to increasing vaccination rates. The purpose of this study is to determine the impact of involving pharmacy technicians on vaccination rates. Methods: This prospective cohort study will take place in a grocery store pharmacy chain. Four pharmacy technicians at the intervention store will take part in a 1-hour educational session about pneumococcal disease and vaccine. Resources will be created for the technicians to support patient encounters, including a flowchart for flagging potential vaccine candidates, a handout with educational points (“script”) for initiating discussion with the patients, and bag stuffers to inform patients about vaccine eligibility. Technicians will be trained to target the following individuals: patients ≥65 years or patients ≥18 years with asthma, cardiovascular disease, chronic obstructive pulmonary disease, or diabetes mellitus. Technicians will track the number of pneumococcal vaccination encounters each week and the number of bag stuffers distributed. A store with the same number of technicians and similar patient demographics will serve as the comparison site. Paired Student t test will be used to compare pneumococcal vaccine rates prior to and following technician training for both stores; t test will be used to compare pneumococcal vaccine rates between the intervention and control stores at the end of the study. Results: Research in progress. Institutional review board approval is anticipated in October 2013. Pharmacy technicians will be trained in November 2013 and data collected through February 2014. 105—ASSESSING PATIENT PREFERENCES FOR INFLUENZA VACCINE DOSAGE FORMS. Bailey J, Choi ja p h a .org J, Higginbotham S, Duquesne University, Skomo M, Duquesne University Mylan School of Pharmacy, E-mail: [email protected] Objective: The objectives of this study are to: (1) evaluate patient preferences related to the administration of available influenza vaccine dosage forms among subsets of the population as defined by sex, age, race, socioeconomic status, and education; (2) analyze the potential influence on dosage form selection from contributing factors such as pre-administration anxiety, perceived post-administration side effects, variable cost, and response to previous dosage forms received; and (3) assess post-administration patient response to the dosage form chosen and its effect on future dosage form selection. Methods: The study is a non-experimental descriptive exploratory study that seeks to survey patient preferences with an anticipated sample size of 500 participants. This study will survey patients scheduled to receive the seasonal influenza vaccine through the Center for Pharmacy Services, the Center for Pharmacy Care, Spirit of Health mobile unit, and related vaccination community events throughout the Pittsburgh area that are coordinated through these organizations. Participants will include adults 18 to 80 years of age in accordance with the collaborative agreement regarding who are eligible to receive the seasonal influenza vaccine (per Centers for Disease Control and Prevention guidelines). The questionnaires developed include a written pre-vaccination patient preferences survey and a follow-up survey assessing post-vaccination satisfaction given orally via telephone interview 1 week after vaccination. Completed questionnaire data and type of vaccine delivery used will be collected and collated by category. Results: Research in progress. Participants are currently being recruited. Descriptive and inferential statistics including chi-square will be employed to analyze respective data collected as related to sex, age, race, socioeconomic status, factors that influence pre-administration dosage form selection, post-administration response to the dosage form Journal of the American Pharmacists Association APhA2014 ABSTRACTS received, and patient preferences for future dosage form selection. 106—COMMUNITY PHARMACIST IMPACT ON HEPATITIS B VACCINATION RATE IN PATIENTS WITH DIABETES. Strain J, Virginia Commonwealth University, Harrison A, Kroger Pharmacy, Moczygemba L, Goode J, Virginia Commonwealth University, Email: [email protected] Objective: The objectives of this study are to: (1) determine the hepatitis B vaccination rate of patients with diabetes before and after community pharmacist education and intervention; and (2) assess patients’ awareness of the recommendation that adults aged 19 to 59 years with diabetes receive the hepatitis B vaccine. Methods: Providers and patients may still be unaware of the 2011 Advisory Committee on Immunization Practices (ACIP) recommendation that unvaccinated patients with diabetes receive the hepatitis B vaccine. Pharmacists have an opportunity to intervene and educate these patients. Approximately 300 patients, aged 19 to 59 years with diabetes, will enroll in this prospective study. The intervention will be conducted at 10 locations of a national supermarket chain pharmacy in the Richmond, Virginia, area over a 3-month period. Patients will be identified for recruitment if they filled a diabetes medication in the last 90 days. The pharmacist will provide verbal and written education to the eligible patient. Patients will complete a 1-page survey to determine demographics, baseline hepatitis B vaccination status, awareness of the recommendation, and interest in receiving the hepatitis B vaccine. Baseline hepatitis B vaccination rate will be determined by the number of patients who self-report any doses of hepatitis B vaccine. Final vaccination rate will be determined by adding the number of patients who were vaccinated at baseline to the number of patients who received at least 1 dose of vaccine during the study. Baseline and final vaccination rates will be compared among groups based on demographic factors, prior knowledge about the vaccine, and willingness to receive the vaccine at a pharmacy. Descrip- tive (means, frequencies, and standard deviations), bivariate (chi-square), and multivariate (logistic regression) statistics will be used for the data analysis in this study. Results: Research in progress. 107—EVALUATING THE IMPACT OF A PHARMACY-BASED INTERVENTION ON ELDERLY PATIENTS’ VACCINATION RATES IN A STATE THAT REQUIRES A PRESCRIPTION FOR VACCINE ADMINISTRATION. McCoy L, University of Georgia, Howell L, Village Drug Shop, Bourg C, Young H, University of Georgia, E-mail: mccoyrx@ gmail.com Objective: The objective of this study is to evaluate the impact of a pharmacy-based intervention on pneumococcal and zoster vaccination rates in elderly patients in a state that requires a prescription for pharmacists to administer vaccines other than influenza. Methods: This study will use a between-subjects experimental design. Study inclusion criteria include patient age ≥65 years and eligibility for pneumococcal or zoster vaccinations. Participants will be randomized into 1 of 3 groups. Group 1 participants will receive education (from a pharmacist or pharmacy intern) about the vaccine they are eligible to obtain, and their physicians will be contacted for a prescription to authorize administration of the recommended vaccine at the pharmacy. Group 2 participants will be mailed information (Vaccine Information Statements provided by the Centers for Disease Control and Prevention) about recommended vaccines and prompted to speak with their physician about receiving the vaccine. Group 3 will serve as a control. Pre- and post-intervention telephone surveys will be conducted. The pre-intervention surveys will assess vaccination history and barriers to receiving vaccinations. Postintervention surveys will be conducted 3 months after the intervention to assess whether vaccinations were received, the location where vaccines were received (pharmacy, physician’s office, or other), and if vaccination was not received, the barriers encountered. An analysis of variance test will be conducted to exam- Journal of the American Pharmacists Association Downloaded From: http://mustafa.japha.org/ on 06/09/2014 j apha.org ine the difference in vaccinations across the 3 experimental groups and post-hoc tests to evaluate the differences between the individual groups. Results: Research in progress. Approximately 340 patients have been identified as potential study participants, allowing for approximately 113 subjects randomized into each of the 3 groups. Additional results are in progress. 108—EVALUATING THE MOTIVATION OF PATIENTS TO BE VACCINATED AFTER A COMMUNITY PHARMACIST’S RECOMMENDATION. Choi J, Machado M, Mistry A, Massachusetts College of Pharmacy and Health Sciences University–Boston, Email: [email protected] Objective: The purpose of this study is to evaluate the motivation of community patients to receive or not receive Advisory Committee on Immunization Practices (ACIP)-recommended adult vaccinations after being screened by a community pharmacist. Methods: A community pharmacist will screen patients coming to the community pharmacy to receive ACIP vaccinations for which they are eligible. Patients will be required to complete a vaccination administration record form and a comprehensive vaccination screening sheet. Based on both forms, the pharmacist will make the recommendation for the necessary vaccinations. If the patient requires additional vaccinations, the patient will be asked to participate in the study. If the patient consents, he or she will be asked to fill out Questionnaire #1 (will participate in study, not receive vaccination) or Questionnaire #2 (will participate in study, receive vaccination). After completion of Part 1 of Questionnaire #2, the community pharmacist will counsel the patient on the vaccination(s) that will be given. After the vaccination is given, the patient will be asked to complete Part 2 of Questionnaire #2. Patients will be followed up 1 month after receiving their vaccination to assess basic vaccination knowledge via a true-or-false questionnaire created by the researcher. Patients will be called or followed at the pharmacy to obtain this information. After 3 attempts of calling the patient and MA R /APR 2014 | 54:2 | JAPhA e115 APhA2014 ABSTRACTS after 2 months of tracking the patient at the pharmacy, patient data will be lost. Results: Research in progress. 109—EVALUATION OF A VACCINATION EDUCATION PRESENTATION IN THE AGING POPULATION. Truong J, Wilhelm M, Kerr T, Southern Illinois University Edwardsville, E-mail: [email protected] Objective: There is a lack of data that details the knowledge of the aging population’s understanding of vaccination requirements and the indication of each vaccine. The objectives of this study are to determine older adults’ knowledge of common vaccines needed for the aging population and evaluate a vaccination education presentation provided to older adults. Methods: A vaccination presentation targeted toward older adults (aged ≥65 years old) was developed. An 11-question data collection tool was developed to administer an anonymous written pre- and post-vaccination knowledge quiz. The knowledge quiz contained questions related to the patient’s familiarity with influenza; tetanus, diphtheria, acellular pertussis; herpes zoster; and pneumococcal vaccinations. Age of the subject was the only demographic data collected. Knowledge quizzes were distributed to subjects at a vaccination education presentation at various senior centers and assisted living facilities. The study was approved as exempt research by the institutional review board. Results: A total of 6 vaccination education presentations were given. Eighty-two out of 144 subjects completed the pre- and post-knowledge quiz for a response rate of 56.9%. Mean quiz scores on the pre- and post-knowledge quiz was 6.7 ± 2.0 and 8.2 ± 2.0 out of 10, respectively. Forty-one of the 82 subjects (50%) stated that the vaccination education presentation increased their knowledge of vaccinations, 34 subjects (41.5%) stated that their knowledge was unchanged, and 7 subjects (0.1%) chose not to answer. Conclusion: Implementation of a vaccination education presentation in the aging population increased subjects’ overall knowledge of vaccinations. e116 JAPhA | 5 4:2 | M AR/AP R 2014 Downloaded From: http://mustafa.japha.org/ on 06/09/2014 110—EXAMINING THE ASSOCIATION BETWEEN RISK-TAKING BEHAVIOR AND HUMAN PAPILLOMA VIRUS VACCINATION STATUS. Rivera D, Eworuke E, Hartzema A, University of Florida, E-mail: drsimpson@ ufl.edu Objective: The human papillomavirus (HPV) vaccine is a relatively new treatment for the prevention of cervical cancer. The high prevalence of HPV is a public health concern and data on vaccination rates indicate a recent decline. Understanding the factors associated with not receiving the vaccine are key to targeting the at-risk population. The objective of this study is to understand the relationship between risk-taking behaviors and HPV vaccination status, with the potential to define characteristics of the population not being vaccinated. This can provide greater understanding, awareness, and ability to reduce the burden of various cancers caused by HPV. Methods: The data utilized is from the National Health and Nutrition Examination Survey for 2009–2010 administered by the Centers for Disease Control and Prevention. A multivariate logistic regression model is planned including multiple imputation for missing data to ensure proper analysis. Complete case analysis and imputation are will be included in the results. Variables include condom use, number of partners, drug use, insurance, and other health behaviors. Results: Research in progress. A detailed analysis is going to be conducted in SAS 9.3. The data are already available. The study is pending institutional review board approval. 111—EXPANDING VACCINE SERVICES IN THE COMMUNITY: PATIENT PERCEPTIONS AND THE IMPACT OF PHARMACISTS PROVIDING VACCINATION RECOMMENDATIONS. Varner E, LaysonWolf C, University of Maryland School of Pharmacy, Healy M, Keeley D, Cary R, Leikach N, Catonsville Pharmacy, Email: [email protected] Objective: The purpose of the study is to assess the impact of pharmacists actively screening patients and providja p h a .org ing recommendations on vaccine administration rates. The objectives of this study are to: (1) determine patient and physician acceptance rates of pharmacist vaccine recommendations; (2) describe patient perceptions of pharmacists as vaccination providers; and (3) identify missed vaccination opportunities. Methods: The study is designed as a prospective, descriptive survey study that will be conducted at 2 independent community pharmacies. Both pharmacies are currently participating in a vaccination initiative that involves screening adults who receive a 2013–14 influenza vaccine for herpes zoster and/or pneumococcal eligibility, providing counseling and recommendations to the patients, and communicating those recommendations with the patient’s provider to obtain a prescription and administer the vaccines. Data used for the study will be collected using 2 forms: a screening/consent form and a vaccine eligibility questionnaire (VEQ). The VEQ also surveys patients on their perceptions of pharmacists as vaccine providers and sources of vaccine information. For the study, acceptance of pharmacist recommendations for vaccinations will be measured. The number of herpes zoster and pneumococcal vaccines administered during the study will be compared with the number of each vaccine administered during the same time period last flu season in order to determine if the active screening and providing recommendations improved vaccine administration. Data collected will be evaluated using descriptive statistics. Results: Research in progress. The data collected from this study will help improve immunization practices at the community pharmacy sites and will help evaluate the effectiveness of pharmacist immunization recommendations in growing immunization rates at the practice sites. 112—FACTORS ASSOCIATED WITH VACCINATION STATUS AND LIKELIHOOD TO ACCEPT VACCINE RECOMMENDATION ON ZOSTER VACCINE IN COMMUNITY PHARMACIES. Teeter B, Westrick S, Garza K, Stevenson L, Williamson M, Journal of the American Pharmacists Association APhA2014 ABSTRACTS Auburn University, Harrison School of Pharmacy, E-mail: [email protected] Objective: The objectives of this study are to: (1) describe patient awareness of shingles, its vaccine, and vaccination status; (2) identify factors associated with vaccination status; and (3) determine the likelihood of being vaccinated after the educational session. Methods: A cross-sectional design with a convenient sample of participants aged ≥60 years in 50 community pharmacies in Alabama and Florida was utilized. During the introductory pharmacy practice experience in summer 2013, 137 immunization-certified student pharmacists interviewed participants about shingles and provided brief education on shingles and its vaccine to unvaccinated participants. A structured interviewer-administered questionnaire and Vaccine Information Statement were used. Descriptive statistics were used to describe patient awareness and vaccination status. Logistic regression identified awareness and demographic factors associated with vaccination status. Lastly, percent of unvaccinated patients who were likely to obtain vaccination after the educational session was reported. Results: Of the 688 participants, the majority were female (57.4%) and white (84.3%). Many heard of shingles (93.9%) and the vaccine (81.8%). While 68% knew that zoster vaccine was recommended for people aged ≥60 years, only approximately one-quarter (26.2%) were vaccinated. In the logistic regression, patients 65 to 74 years of age (compared with the group 60 to 64 years of age), those who received influenza vaccine, those who heard of the vaccine, and those who were aware of the recommendation were more likely to be vaccinated. Lastly, after the educational session, 358 (71.5%) of 501 unvaccinated patients said they would “definitely” or “probably” speak with their physician or pharmacist about getting vaccinated. Of those 358, 96 (26.8%) said they would like to speak with the pharmacist about receiving the vaccine that day. Conclusion: Although the majority of participants had heard of shingles and the vaccine, very few were vaccinated for this disease. Speaking to someone about shingles and the zoster vaccine may increase interest in receiving the vaccine. 113—HEALTHY PEOPLE 2020: IMPACT OF SCREENING AND IMMUNIZATION SERVICES ON PATIENTS WITH DIABETES IN THE COMMUNITY PHARMACY SETTING. Rood J, University of Iowa, Osterhaus M, Osterhaus Pharmacy, Polgreen L, University of Iowa, Farris K, University of Michigan, Veach S, University of Iowa, E-mail: [email protected] Objective: The objectives of this study are to demonstrate the ability of community pharmacists, using Advisory Committee on Immunization Practices (ACIP) recommendations, to: (1) identify patients with diabetes who are not up to date with immunizations; (2) bring up to date those patients with diabetes who are not up to date either through pharmacy services or referral to physician services; and (3) identify barriers when pharmacist intervention is unsuccessful. Methods: This will be a prospective, single group project implemented at an independent community pharmacy in a rural Midwest town. Patients flagged for participation will be ≥18 years of age who are either documented in the pharmacy processing system as having diabetes or fill any Food and Drug Administration–labeled diabetic medications. An ACIP-based screening tool was developed to determine which vaccinations each patient with diabetes requires. The Iowa Immunization Registry Information System, with supplementary data from physicians or patient report, will be used for screening. During dispensing, flagged patients will be targeted by pharmacists for any recommended vaccinations. Patients who do not visit the pharmacy directly or often will be mailed letters to market services. Any patients who do not respond to letters will be contacted by phone. All patients who agree will be immunized in the pharmacy or referred to physician care if necessary. Patients will be categorized and documented as: (1) up to date on ACIPrecommended immunizations; (2) not up to date on ACIP-recommended immunizations and (a) brought up to date Journal of the American Pharmacists Association Downloaded From: http://mustafa.japha.org/ on 06/09/2014 j apha.org through pharmacy services, (b) brought up to date through pharmacist referral to physician services, or (c) not brought up to date. Reasons for referral to physician services and any preventative barriers will be documented. Descriptive statistics will be reported. Results: Research in progress. Approximately 340 patients with diabetes have been identified. 114—IDENTIFYING BARRIERS TO HEPATITIS B VACCINATION IN PATIENTS WITH HIV. James A, Schnucks Specialty Pharmacy, Gattas N, St. Louis College of Pharmacy, Ring J, Schnucks Specialty Pharmacy, E-mail: [email protected] Objective: A vaccine is available to prevent infection with hepatitis B virus (HBV), however despite this major advancement, liver disease has become one of the leading causes of deaths unrelated to acquired immunodeficiency syndrome in patients with human immunodeficiency virus (HIV) infection. The objective of this study is to identify barriers to HIV-positive patients receiving hepatitis B vaccine. Methods: Barriers to vaccination will be investigated from the patient and provider perspectives. Patients will be identified via chart review at the time of their visit with their primary care provider and will complete a verbal questionnaire from the investigator. Patients are considered eligible if they are >18 years of age, HIV-positive, have not completed the HBV vaccination series, and do not have immunity against HBV. Eligible providers include nurse practitioners, physician assistants, pharmacists, and physicians who work with HIV-positive patients. The investigator will complete a key informant interview with providers. Barriers will be categorized and reported. Descriptive statistics will be used to quantitatively summarize the data collected. Identified barriers will be compared between the 2 groups. Results: Research in progress. Results are pending institutional review board approval. Previous studies have identified barriers to vaccination in the general population, however limited studies have specifically investigated paMA R /APR 2014 | 54:2 | JAPhA e117 APhA2014 ABSTRACTS tients with HIV. These patients are at an increased risk of transmission and complications from HBV. Once barriers are identified, the process of breaking them down can begin. Increased vaccination for HBV in this subpopulation can help decrease the spread of the virus with the hope of eradicating it in years to come. Data collected from this study also may identify barriers to other subpopulations as well as other vaccinations. 115—IMMUNIZATION RATES AND BARRIERS TO INFLUENZA VACCINE ACCESS IN THE COMMUNITY PHARMACY. Rodriguez N, Nova Southeastern University College of Pharmacy, E-mail: [email protected] Objective: Healthy People 2020 objectives include increasing the percentage of children and adults who are vaccinated annually against seasonal influenza. In Puerto Rico, 1.6 million people have the health plan provided by the government. Government health insurance provides coverage for influenza vaccine with a $0 copayment. However, during the 2012–13 influenza season, only 10% of the government health insurance population was vaccinated. During the 2013–14 influenza season the goal of the Department of Health is to vaccinate 200,000 people against influenza before December 2013. The aim of this study is to determine the influenza immunization rate of the government health insurance population in a community pharmacy. A secondary outcome is to assess the factors that influence access to the influenza vaccine in Puerto Rico. Methods: This descriptive study will be conducted in the community pharmacy setting. A sample of patients who visit the community pharmacy and are beneficiaries of the government health insurance (Mi Salud) will be assessed. Data will be collected using a structured questionnaire based on patients’ selfreported information. The information provided by patients will be confirmed using the Puerto Rico Immunization Registry. Age, sex, socioeconomic status, highest scholarly degree reached, and previous influenza immunization experience will be assessed variables. The primary outcome is influenza immuni- e118 JAPhA | 5 4:2 | M AR/AP R 2014 Downloaded From: http://mustafa.japha.org/ on 06/09/2014 zation for current season. The secondary outcome to be evaluated will be reasons for not becoming immunized against influenza this season such as: allergy to chicken eggs, history of Guillain-Barré syndrome, moderate to severe illness with fever, a history of severe reaction to flu vaccine, cost, fear of needles, beliefs, adverse effects, and other reasons that patients report. Data analysis will be using descriptive statistics. Results: Research in progress. 116—THE IMPACT OF AN IMMUNIZATION NEEDS ASSESSMENT TOOL IN A COMMUNITY PHARMACY SETTING ON ADULT NONINFLUENZA IMMUNIZATION RATES. Focht J, Ray L, Kroger Co., Snyder M, Purdue University College of Pharmacy, E-mail: jennifer.focht@ kroger.com Objective: The objectives of this study are to: (1) evaluate the impact of an adult immunization needs assessment on adult vaccination rates; and (2) identify patterns in types of non-influenza vaccinations administered to adults in the community pharmacy setting. Methods: Using the Advisory Committee on Immunization Practices current recommendations, an adult immunization needs assessment (AINA) was created to be utilized in the community pharmacy setting. Twenty-nine community pharmacy locations within a large, national grocery store chain were randomized to either usual care or to use of the AINA during the study period. While dropping off prescriptions at intervention pharmacies, adult patients will be asked a series of questions based on the AINA to identify potential vaccination needs. The pharmacist will discuss the identified needs with the patient during prescription pickup. Following the conversation, the pharmacist will fill out a short questionnaire regarding the interaction with the patient, including any subsequent vaccines administered. The number of non-influenza immunizations administered over a 4-month period will be compared with the number of immunizations administered during the same time frame in 2012–2013. A percentage change in non-influenza imja p h a .org munizations administered will be calculated and compared between control and intervention pharmacies. The questionnaire regarding the pharmacist’s interaction with the patient will be analyzed to identify patterns in patient acceptance or declination. Additionally, pharmacy associates participating in the intervention will be asked to complete a survey regarding their experience with the implementation of the AINA into workflow. Parametric and nonparametric analysis will be used as appropriate, with institutional review board approval. Results: Research in progress. 117—IMPACT OF A TARGETED INTERVENTION PROGRAM ON THE TETANUS TOXOID, REDUCED DIPHTHERIA TOXOID, AND ACELLULAR PERTUSSIS (TDAP) VACCINATION RATE IN THE COMMUNITY PHARMACY SETTING. Link S, The Ohio State University, Green T, Kroger Co., Woods J, Rodis J, The Ohio State University, E-mail: link.197@osu. edu Objective: The primary objective of this study is to determine the effect of a targeted intervention program on the number of patients who receive a tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine. Secondary objectives are to: (1) compare the effectiveness of telephonic and faceto-face interventions on the number of patients receiving Tdap vaccines; and (2) identify which patient population (e.g., parents, grandparents, siblings, caregivers) is more likely to receive the Tdap vaccination following the educational intervention. Methods: Over the past year, the number of pertussis cases and pertussisrelated deaths in the United States has almost doubled. Multiple opportunities exist for community pharmacists to improve awareness and impact vaccination rates. For this targeted intervention program, reports are generated from a community pharmacy computer system for women who filled a prescription for prenatal vitamins or folic acid supplements within the past 21 months and children ≤12 months of age. The reports will identify pregnant women and indi- Journal of the American Pharmacists Association APhA2014 ABSTRACTS viduals in close contact with children ≤12 months of age for whom the Tdap vaccine is indicated. A telephonic or face-toface intervention is performed for each identified patient or legal guardian in order to: (1) educate about pertussis and the Tdap vaccine; (2) assess interest in receiving the Tdap vaccine; and (3) identify additional family members, caregivers, or close contacts who are indicated to receive the Tdap vaccine. Two follow-up telephonic surveys are conducted 1 and 2 months after the initial intervention to assess stated objectives. Data from this institutional review board–approved study is analyzed using descriptive statistics. Results: Research in progress. Data will report the effect of telephonic and face-to-face interventions on Tdap vaccination rates in a community pharmacy. The results of this study will describe the impact of community pharmacy–based targeted intervention programs on public awareness of pertussis and the Tdap vaccine as well as guide future initiatives to improve vaccination rates. 118—PALIVIZUMAB PERFORMANCE IMPROVEMENT INITIATIVE IN A NEONATAL INTENSIVE CARE UNIT SETTING. Guerra J, Ligniti E, Rumore M, Cohen Children’s Medical Center, E-mail: [email protected] Objective: The palivizumab program goals are to streamline efficacy and reduce costs for the inpatient neonatal intensive care unit population at a level 3 regional neonatal center in New York. Palivizumab is a monoclonal antibody used to prevent respiratory syncytial virus (RSV) in high-risk infants and children <2 years of age at a dose of 15 mg/ kg intramuscular injection once monthly for 3 to 5 doses. Costs are approximately $1,200 and approximately $2,200 per 50 and 100 mg vial, respectively; unused portions must be discarded after 6 hours. Methods: A protocol was developed for order cutoff times and batch production 3 times weekly (Mondays, Wednesdays, and Fridays). Inventory and budgetary control were initiated. Tracking methods for palivizumab use were instituted. A signature log increased accountability for doses dispensed. A policy for eligibility criteria for prophylaxis (i.e., compliance with the latest American Academy of Pediatrics [AAP] Guidelines) was developed and strictly enforced by pharmacy clinical coordinators and lead pharmacists. A Pediatric Pharmacy Bulletin was distributed to clinicians regarding the initiative. Pharmacy staff was in-serviced regarding operational and clinical issues. A medication utilization evaluation was conducted from November 2011 through April 2013 on policy adherence and syringe cost savings. Results: Through pharmacy interventions, 100% compliance with the policy was achieved. The policy requirement for approval by infectious disease attending for palivizumab orders outside AAP-recommended indications virtually eliminated inappropriate usage and ensured eligible candidates received 1 dose prior to discharge only. The average monthly compliance with the batching protocol was 90.3%; 304 doses were dispensed for the 2 RSV seasons studied resulting in a cost savings of $82,623. Conclusion: The program resulted in less waste and improved accountability with fewer missing doses. Patient safety was improved in the process by dispensing patient-specific syringes instead of vials. This successful pharmacy initiative will be continued annually during RSV season. Future expansion to outpatient clinics is planned. 119—PERCEPTIONS AND BARRIERS TO ADULT IMMUNIZATIONS: A STUDY ON A DIVERSE, MULTILINGUAL, URBAN COMMUNITY. Rodis J, Sevin A, Gagne B, The Ohio State University College of Pharmacy, Arradaza N, The Ohio State University Center for Biostatistics, Romeo C, The Ohio State University College of Pharmacy, Email: [email protected] Objective: The aim of this study is to reduce barriers to immunization rates in a diverse, multilingual, urban community by identifying perceptions about immunizations and determining barriers to receiving immunizations. Methods: Low immunization rates are a widespread problem. According to the Centers for Disease Control and Pre- Journal of the American Pharmacists Association Downloaded From: http://mustafa.japha.org/ on 06/09/2014 j apha.org vention, grave disparities exist for both influenza and non-influenza immunizations. Higher socioeconomic status and being born in the United States correlate with increased immunization rates. There also are racial disparities; specifically, immunization against influenza is consistently lower for non-Hispanic blacks and Hispanics compared with non-Hispanic whites. Previous studies have addressed perceptions and barriers to specific vaccines within focused age groups. This institutional review board–approved study involves paper surveys to assess perceptions and barriers regarding immunizations for all adult immunizations and patients >18 years of age in a multilingual, urban setting. Surveys are conducted in 4 urban federally qualified health centers and 4 grocery stores with 340B pharmacy affiliations with those clinics. Patients are invited to complete the survey in English or their native language of Spanish or Somali by trained surveyors. Surveys gather demographic data, self-reported receipt of immunizations, knowledge about indications for immunizations, knowledge about access to immunizations, and perceptions of immunization safety and effectiveness. The data will be analyzed using descriptive statistics. Results: Research in progress. Reported results will include aggregate survey responses addressing study objectives. Conclusion: Survey results will guide education and programming aimed at removing barriers and improving immunization rates in this urban community and others like it in the United States. This study may generate the need for future studies to address individual immunization barriers. 120—THE PHARMACIST’S ROLE IN WORKSITE IMMUNIZATION SERVICES: ASSESSING KNOWLEDGE, PERCEPTIONS, AND BARRIERS IN PHARMACIST-DELIVERED WORKSITE VACCINATIONS. New M, University of Kentucky College of Pharmacy, Grise W, Hudspeth B, Kroger Pharmacy, Divine H, University of Kentucky College of Pharmacy, E-mail: meghann. [email protected] MA R /APR 2014 | 54:2 | JAPhA e119 APhA2014 ABSTRACTS Objective: Currently, pharmacists at the supermarket chain pharmacy deliver company employee health and wellness services and annual influenza vaccines at the employees’ worksite. Protocols for immunization delivery now include 10 different vaccinations, which could be offered and provided by pharmacists to employees during routine visits at the worksite. Worksite influenza immunization delivery services have been previously reported in the literature; however, descriptions of other adult immunization delivery services at the worksite are lacking. The objectives of this study are to: (1) assess vaccination knowledge in worksite employees receiving pharmacist-delivered health and wellness services; (2) evaluate patient perceptions of the pharmacist’s role in delivering worksite vaccinations; and (3) identify perceived barriers to vaccine delivery at the worksite. Methods: Approximately 150 employees at the supermarket chain dairy who have current insurance coverage for pharmacy services were selected to participate. Surveys and a cover letter approved by the university’s institutional review board will be distributed to employees at the worksite by pharmacists. Employees will complete the survey anonymously and return to a secure centrally located drop box to maintain anonymity. Employees will be asked to complete the survey within 4 weeks and will be reminded weekly of survey completion during employee meetings. The survey will be developed to collect demographic information, knowledge of current recommended adult vaccinations, perceptions of the pharmacist’s role in immunization delivery, and perceived barriers to worksite immunization services. Results will be analyzed using descriptive statistics. Results: Research in progress. Results will be used to design and implement a comprehensive adult immunization delivery service. Q 121—PHARMACY STUDENTS’ CONFIDENCE WITH AND ATTITUDES ABOUT VACCINE ADMINISTRATION. Allen S, Martin M, Goliak K, University of Illinois at Chicago Col- e120 JAPhA | 5 4:2 | M AR/AP R 2014 Downloaded From: http://mustafa.japha.org/ on 06/09/2014 lege of Pharmacy, E-mail: sallen7@uic. edu Objective: The University of Illinois at Chicago College of Pharmacy requires all third-year students to participate in an immunization training program as part of the curriculum. The purpose of this study was to assess student pharmacists’ confidence level with and attitudes about vaccine administration after training. Methods: A 31-item anonymous and voluntary survey was administered to the class of 2012 at mandatory class meetings during their last year of school. The research was approved by the institutional review board. Descriptive statistics were used to analyze the survey data. Results: One hundred sixty surveys were administered with a response rate >85%. Survey results show that 6% of the students had administered >40 intramuscular injections 2 months after training compared with 44% after the completion of their advanced pharmacy practice experience (APPE) rotations. The number of students who were confident or extremely confident in administering intramuscular injections increased from 59% 2 months after training to 90% at the completion of their APPEs. Eighty-five percent of the students agree or strongly agree to being comfortable administering vaccines to patients 2 months after training, whereas 98% report being comfortable after the completion of APPE rotations. Conclusion: Overall, results showed an increase in confidence and comfort with vaccine administration based on the number of vaccines administered. This study led to the question of whether the curriculum should require students to administer a specific number of vaccines above current training requirements prior to graduation to aid in the development of confidence and comfort with vaccine administration. Original Citation: Allen S, Martin M, Goliak K. “Pharmacy Students’ Confidence with and Attitudes about Vaccine Administration,” presented at the AACP Annual Meeting: Chicago, Illinois. Poster Presentation. 122—A PILOT ja p h a .org EXPLORATION STUDY TO IMPLEMENT MOTIVATIONAL INTERVIEWING IN THE COMMUNITY PHARMACY TO INCREASE ADULT IMMUNIZATION RATES. Brackett A, Mercer University, Chapman L, Kroger Pharmacy, Butler M, Mercer University, E-mail: butler_mb@ mercer.edu Objective: The purpose of this study is to evaluate whether the use of motivational interviewing in community pharmacy could improve immunization rates with shingles, hepatitis B, hepatitis A/B combination, pneumonia, and tetanus/diphtheria/pertussis combination (Tdap) vaccines. Methods: This institutional review board–approved study will be conducted at 2 locations of a community pharmacy chain in Georgia. One location will be the experimental arm and the other will be the control arm of the study. Both pharmacies have similar patient demographics and have immunization brochures available in waiting areas. The control pharmacy will use no special technique to discuss immunizations. The pharmacy serving as the experimental arm will use motivational interviewing with patients for the shingles, hepatitis B, hepatitis A/B combination, pneumonia, and Tdap immunizations. Pharmacy staff in the experimental arm will receive training on motivational interviewing and will be provided with informational pocket cards. Patients will be identified by disease states, age, and other characteristics that make them candidates to receive the immunizations being assessed. The staff will assess the patient’s immunization status and guide a conversation to determine whether the patient is ready to receive immunization(s) they are lacking. If a patient is not ready to receive the immunization(s) he or she lacks, the pharmacy staff will follow-up by letter or phone. If the patient is ready to receive the immunization(s) he or she lacks, the patient’s primary care physician will be contacted to request a prescription for the immunization(s). The pharmacist will record all motivational interviewing encounters on a data collection form. Results: Data collection begins October 2013. Conclusion: Research in progress. Journal of the American Pharmacists Association APhA2014 ABSTRACTS This study is expected to show the integral role pharmacists can play in improving immunization rates by introducing a different technique to discuss immunizations. 123—A RETROSPECTIVE STUDY OF PHARMACIST-RECOMMENDED VACCINATIONS DURING COMPREHENSIVE MEDICATION REVIEWS. Berkemeyer T, Fisher C, Kroger Co., E-mail: [email protected] Objective: The objectives of this study are to: (1) determine pharmacist impact on preventive health, specifically immunization rates during comprehensive medication reviews (CMRs) with patients, and (2) explore patients’ response to pharmacist-recommended vaccinations during CMRs. Methods: A retrospective profile review encompassing claims over 2 years will be conducted for each patient who is identified by the pharmacist during a CMR as needing an immunization. The immunizations to be evaluated are influenza; pneumococcal; herpes zoster; and tetanus, diphtheria, and pertussis (Tdap). The percent of vaccines administered will be calculated from the total number of vaccines that were recommended to patients during CMRs. Patients’ prescription profiles will be reviewed for 3 months past the CMR to identify the vaccines that were given shortly after the pharmacist recommendation. Additionally, the number of vaccinations declined will be evaluated from this percent. Secondarily, the responsiveness to the individual vaccinations recommended by the pharmacist during the CMR will be evaluated by calculating the percent of patient acceptance for each vaccination. Results: Research in progress. 124—A STUDENT-LED INITIATIVE TO IMMUNIZE PHARMACY AND MEDICAL STUDENTS AGAINST THE INFLUENZA VIRUS. Arvay B, Bachmann D, Krinsky D, Ulbrich T, Northeast Ohio Medical University, Email: [email protected] Objective: The purpose of this study is to describe a student-led initiative to immunize pharmacy and medical stu- dents against the influenza virus. Methods: In an effort to promote interprofessional collaboration, increase student access to the influenza vaccine, and provide student pharmacists with experience providing vaccines, student pharmacists were given the opportunity to provide the influenza vaccine to their medical and pharmacy colleagues starting in 2011 when the university began requiring all students to receive the vaccine prior to attending rotations. To provide vaccines, student pharmacists are required to complete the American Pharmacists Association immunization certificate training program and be up to date with their basic life support training. The clinics were 1 hour and 30 minutes long, available for students only, scheduled within a 1-week time frame in September and were scheduled outside class times in the evening and at lunch. Marketing and sign-ups were completed via e-mail by the coordinator of student health records. The university partnered with a local pharmacy to obtain the vaccine. The cost was $20 with students contributing $12 and the university contributing $8. Two pharmacy practice faculty members who are certified to provide immunizations precepted the clinics. Results: In September 2013, 3 oncampus immunization clinics were completed. Thirty student pharmacists administered 388 influenza vaccinations; this included 284 vaccines for medical students and 104 for pharmacy students. Fifty-three percent (284/534) of all medical students and 39% (104/267) of all pharmacy students were vaccinated. Conclusion: Offering a student-run immunization clinic provides student pharmacists with a chance to gain confidence in providing immunizations. It also provides an opportunity for medical students to observe first-hand the evolving scope of practice of pharmacists. Further study in this area is needed to measure student confidence and obtain medical student feedback. 125—SURVEY TO DETERMINE TRAVEL MEDICINE AND IMMUNIZATION CONTENT IN PHARMACY SCHOOL CURRICULA. Dang R, Goad J, University of Southern California, Hess Journal of the American Pharmacists Association Downloaded From: http://mustafa.japha.org/ on 06/09/2014 j apha.org K, Western University of Health Sciences, Zeind C, Machado M, Massachusetts College of Pharmacy and Health Sciences University, Luo S, Law A, Western University of Health Sciences, E-mail: [email protected] Objective: This study aims to: (1) describe the extent to which travel medicine and immunization content is integrated into U.S. pharmacy school curricula; and (2) determine whether there is a correlation between states that allow all travel vaccines to be administered by pharmacists versus those that do not with regard to curricular integration. Methods: Travel medicine is focused on the health of travelers and involves patient education, vaccination, and medication provision. It is well documented in the literature that travelers often do not seek travel medicine providers before departure, likely due to lack of awareness of risk or lack of enough providers, resulting in significant morbidity and mortality. The International Society of Travel Medicine endorses a multi-specialty approach to the provision of travel medicine and has established the body of knowledge as a basis for educational curriculum development. This study is a web-based cross-section survey of faculty and administrators at U.S. schools of pharmacy to be administered during November and December 2013. Elements of the survey will include respondent familiarity with travel medicine and immunizations; where and to what extent travel medicine and immunization content exists within the curriculum; and the role of the respondent at their institution. Data will be analyzed using descriptive and inferential statistics. Results: Research in progress. Law and Regulations 126—ANALYSIS OF THE EFFECTIVE PATENT LIFE OF NEW PHARMACEUTICALS APPROVED BY THE U.S. FOOD AND DRUG ADMINISTRATION IN THE PERIOD 1985–2012. Bin Sawad A, Alshahrani A, Seoane-Vazquez E, Massachusetts College of Pharmacy and Health Sciences University, Rodriguez-Monguio R, University of Massachusetts, E-mail: MA R /APR 2014 | 54:2 | JAPhA e121 APhA2014 ABSTRACTS [email protected] Objective: This study assessed the patent life of new molecular entities (NMEs) and new biologics (NBs) that had a patent extension in the period 1985–2012. Methods: Data were collected from the U.S. Food and Drug Administration (FDA), the U.S. Patent and Trademark Office (USPTO), and the U.S. Federal Register websites for all new drugs approved by the FDA in the period 1985–2012. Descriptive analysis was performed for all variables. Results: The USPTO listed 499 NMEs/NBs with patent extensions, representing 51.9% of NMEs/NBs approved in the study period. Complete drug regulatory and patent information was available for 283 pharmaceuticals. The average patent extension was 2.72 ± 1.39 years. The patent extension was longest for drugs in the Anatomical Therapeutic Chemical (ATC) classes alimentary tract and metabolism (3.36 ± 1.39 years), systemic hormonal preparations, excluding sex hormones and insulins (3.03 ± 1.48 years), and nervous system (3.03 ± 1.53 years). The shortest patent extensions were granted to antiinfectives for systemic use (2.47 ± 1.22 years), sensory organs (2.47 ± 1.09 years), and musculoskeletal system (2.34 ± 1.32 years). The average duration of the clinical trial period was 5.52 ± 3.41 years. The longest clinical trial periods corresponded to musculoskeletal system (8.45 ± 5.38 years) and the shortest was for sensory organs (4.31 ± 1.77 years). The average FDA review time was 1.65 ± 1.31 years; it was highest for respiratory system (3.22 ± 2.34 years) and lowest for systemic hormonal preparations (0.98 ± 0.56 years). The overall effective patent life without patent extensions was 8.70 ± 7.01 years, whereas the effective patent life with patent extensions increased to 11.71 ± 6.78 years. The longest effective patent life corresponded to dermatologicals (13.59 ± 1.03 years); and the shortest patent life corresponded to cardiovascular agents (6.56 ± 23.21 years). Conclusion: There were significant differences in the clinical trial periods, FDA review time, and effective patent life among the different ATC classes of e122 JAPhA | 5 4:2 | M AR/AP R 2014 Downloaded From: http://mustafa.japha.org/ on 06/09/2014 new NMEs/NBs approved by the FDA in the study period. 127—ASSESSING DIFFERENCES IN THE CHARACTERISTICS OF THE NEW PHARMACEUTICALS APPROVED BY THE FOOD AND DRUG ADMINISTRATION AND THE EUROPEAN MEDICINES AGENCY. Badawoud E, Alshehri N, Alqahtani S, Seoane-Vazquez E, Massachusetts College of Pharmacy and Health Sciences University, Rodriguez-Monguio R, University of Massachusetts, E-mail: [email protected] Objective: This study aims to explore some areas of discrepancies between the Food and Drug Administration (FDA) and the European Medicines Agency (EMA) in approving new molecular entities (NME) and new therapeutic biologics (BLA) in the period from 1999 to 2011. Methods: FDA and EMA websites were utilized to retrieve data regarding drug applications, approvals, orphan status, and indications for new NMEs and BLAs. The 2 systems were compared using descriptive statistics and a t test was applied to assess differences in averages. Significant level was set at 0.05. Results: Both regulatory agencies approved a total of 101 drugs (82 NME and 19 BLA; all were FDA priority reviews). BLAs were submitted 1.25 ± 4.18 months later (median 0.33 months) and approved 7.14 ± 5.47 months later (median 5.75 months) by EMA compared with FDA. NMEs were submitted to EMA 1.44 ± 24.52 months later (median 0.44 months) and approved by FDA 6.67 ± 23.43 months later (median 7.49 months) than EMA. The BLA average review time was statistically significantly lower (P<0.001) for FDA 7.67 ± 2.24 months (median 6.21 months) than EMA 14.6 ± 3.33 (median 14 months). The NME average review time was statistically significantly lower (P<0.001) for FDA 9.25 ± 9.10 months (median 5.98 months) than for EMA 14.48 ± 4.09 (median 13.72 months). The number of products with orphan designation was lower in EMA (n = 33) than in FDA (n = 57). EMA granted orphan designation to 2 products that did not have orphan designation in the ja p h a .org United States. The United States granted orphan designation to 13 products that did not have orphan designation in the European Union. Differences in the indications approved in both systems were observed in 24.8% (n = 25) of the drugs. Conclusion: Significant differences exist in the time elapsed between the filing and the approval of drugs as well as in orphan designation. Harmonization of the regulatory systems could facilitate timely approval of essential pharmaceuticals. 128—COMMUNITY PHARMACISTS’ ATTITUDES TOWARD AN EXPANDED CLASS OF NONPRESCRIPTION DRUGS. Shah R, Holmes E, West-Strum D, University of Mississippi School of Pharmacy, Patel A, Medical Marketing Economics, E-mail: [email protected] Objective: There has been considerable discussion about creating a third class of drugs which would not require a prescription, but would require a pharmacist’s consultation upon purchase. Recently the Food and Drug Administration (FDA) held a hearing that repositioned a third class as an expanded nonprescription drug class termed as the “new paradigm” using innovative technologies. The objectives of this study were to: (1) measure community pharmacists’ attitudes toward the new paradigm; and (2) determine whether these attitudes differed according to practice and demographic characteristics. Methods: This cross-sectional study was conducted using a self-report, webbased survey administered to a national panel of community pharmacists. The survey items were developed based on existing scales in the literature and the FDA’s proposed guidelines for the new paradigm. A principal components analysis (PCA) with VARIMAX rotation and reliability analyses were conducted to identify the factors affecting community pharmacists’ attitudes toward the new paradigm. Descriptive statistics were used to describe pharmacists’ attitudes. Multivariate Analysis of Variance (MANOVA) was used to determine whether attitudes toward the new paradigm differed based on practice and de- Journal of the American Pharmacists Association APhA2014 ABSTRACTS mographic characteristics. Results: Completed responses were obtained from 462 respondents. PCA results suggested that respondents’ attitudes toward the new paradigm is composed of 6 factors including: patient care, workflow, patient safety, impact on non-pharmacist providers, pharmacist burden, and access. Respondents were generally positive about the provision of patient care under the new paradigm but were skeptical about workflow change, professional liability, increased workload, and reimbursement. Respondent attitudes differed based on certain practice and demographic variables. Conclusion: Respondents were positive about many respects of the new paradigm, but still hesitant about others. Arguably, community pharmacists are the most important stakeholders for expanding the current nonprescription drug class and future input should be obtained from them; their input will be critical to the FDA’s decision about the new paradigm. 129—COMMUNITY PHARMACISTS’ CLASSIFICATION OF PRESCRIPTION DRUGS INTO DISPENSING CATEGORIES UNDER THE FOOD AND DRUG ADMINISTRATION’S PROPOSED NEW PARADIGM. Shah R, Holmes E, West-Strum D, University of Mississippi School of Pharmacy, Patel A, Medical Marketing Economics, E-mail: [email protected]. edu Objective: There has been considerable discussion about creating a third class of drugs that would not require a prescription, but would require a pharmacist’s consultation upon purchase. Recently the Food and Drug Administration (FDA) held a hearing that repositioned a third class as an expanded nonprescription drug class termed the “new paradigm” using innovative technologies. The objective of this study was to determine which drugs community pharmacists believe are acceptable additions to an expanded definition of nonprescription drugs under the new paradigm. Methods: This cross-sectional study was conducted using a self-report, web- based survey administered to a national panel of community pharmacists. The survey contained a list of 24 current prescription-only drugs that may be potential candidates for the new paradigm, based on criteria outlined by the FDA, and questions related to respondent demographic and practice characteristics. The list of drugs was developed using relevant literature and content experts. Respondents were asked to indicate whether a particular drug should be marketed as a prescription drug, nonprescription drug, or as a drug under the new paradigm (i.e., expanded nonprescription drug class). Results: Investigators received 462 completed surveys. If the new paradigm drug class were implemented, the majority of respondents indicated that clopidogrel (Plavix) and zolpidem (Ambien) should still be dispensed as prescription drugs. Atorvastatin (Lipitor), metformin (Glucophage), sildenafil (Viagra), montelukast (Singulair), finasteride (Propecia), promethazine (Phenergan), and oseltamivir (Tamiflu) among others were considered appropriate to be marketed under the expanded nonprescription drug class (i.e., the new paradigm). Desloratadine (Clarinex) and prenatal vitamins were considered appropriate for nonprescription status. Conclusion: Respondents thought most drugs on the list provided can be categorized as drugs in the new paradigm class. If implemented, the new paradigm has potential to expand pharmacists’ provision of patient care. As the FDA continues to seek feedback from stakeholders, pharmacists’ feedback, especially with regard to which medications should be a part of the new paradigm class of drugs, is critical. 130—THE EFFECT OF HYDROCODONE RESCHEDULING ON A RETAIL PHARMACY CHAIN’S DISPENSING PATTERNS IN NEW YORK STATE. D’Angelo M, CVS Caremark, E-mail: [email protected] Objective: Prescription drug abuse is among the most alarming and concerning medication usage trends seen in the past decade. Rates of abuse increase Journal of the American Pharmacists Association Downloaded From: http://mustafa.japha.org/ on 06/09/2014 j apha.org each year, and as a result the health care industry has been tasked with mitigating this national crisis. Controlled medications, especially opioids, are the most widely abused drugs in the country, and many regulations are being explored to decrease these behaviors. The state of New York rescheduled hydrocodone products from schedule III to schedule II on February 23, 2013, to more closely regulate the prescribing and dispensing of these medications. The effects of rescheduling one of the most frequently dispensed medications in the country need to be explored, and this research will seek to determine this regulation’s impact on hydrocodone product dispensing, prescribing, and patient utilization. Methods: CVS Pharmacy’s dispensing data from New York state will be compared between March–August 2012 and March–August 2013 for hydrocodone product tablets. Parameters studied will include hydrocodone product prescription count, quantity filled per prescription, filling habits of chronic users, and abuse trends. Script and quantity data for New York will be compared with a state with similar hydrocodone dispensing habits in 2012. Chronic users will be identified in 2012 data, and their use of hydrocodone products in 2012 will be compared with 2013 use. This population’s filling data from 2013 also will be analyzed to find any shifts in prescribing patterns. An algorithm will be used to identify abuse patterns before and after rescheduling. Results: Research in progress. 131—THE EFFORT FOR PHARMACIST PROVIDER STATUS: A SURVEY OF STATE PHARMACY ASSOCIATIONS. Brown P, University of North Carolina at Chapel Hill Eshelman School of Pharmacy, Branham A, Moose Pharmacy, Holland W, University of North Carolina at Chapel Hill Eshelman School of Pharmacy, Dalton E, Moose J, Moose Pharmacy, Ferreri S, Marciniak M, University of North Carolina at Chapel Hill Eshelman School of Pharmacy, E-mail: patrickbrown@moosepharmacy. com Objective: The issue of obtaining MA R /APR 2014 | 54:2 | JAPhA e123 APhA2014 ABSTRACTS provider status for pharmacists has been gaining momentum within the profession. National pharmacy associations have issued statements regarding this effort, but little has been published about efforts at the state level. The aims of this study are to: (1) evaluate the current efforts of state pharmacy associations in regard to obtaining pharmacist health care provider status; and (2) determine which state association efforts align with each other and with national pharmacy associations. Methods: This cross-sectional study will be conducted via Qualtrics. Utilizing contact information provided by the National Alliance of State Pharmacy Associations (NASPA), an e-mail with a survey link will be sent to the executive director of each pharmacy association in the 50 states, District of Columbia, and Puerto Rico. Participants will be asked if their state association has passed an official resolution to support the effort for provider status, if there is any state-specific legislation pending related to provider status, what resources have been developed to support advocacy, what barriers have been encountered, and if their state association has any additional plans related to advancing provider status. The 10-item questionnaire will be pilot tested among a convenience sample of pharmacists for feedback on validity and question structure. The survey will remain open for 30 days and nonresponders will receive an e-mail reminder 3 weeks after the initial message. A follow-up telephone call may be conducted to clarify answers or prompt nonresponders. Descriptive statistics will be used to analyze survey responses. Results: Research in progress. Institutional review board approval is anticipated in October 2013. The survey will be distributed in November 2013 with data analysis conducted from December 2013 to February 2014. Upon completion, results will be distributed to state and national pharmacy associations to serve as an information source for those working toward provider status. 132—HOW DOES THE CONTROLLED SALE OF ANTIBIOTICS INFLUENCE THE BACTERIAL RE- e124 JAPhA | 5 4:2 | M AR/AP R 2014 Downloaded From: http://mustafa.japha.org/ on 06/09/2014 SISTANCE IN BRAZIL?. Mattos K, Levy C, Ambrosio R, Mazzola P, Moriel P, Faculty of Medical Sciences, Unicamp, E-mail: [email protected] Objective: In Brazil, as a consequence of the irrational use of antibiotics, resolution number 20/2011 was implemented to control the sale of antibiotics. The current study is designed to outline the profile of bacterial resistance in source communities in patients with urinary tract infection (UTI), before and after the legislation. Methods: Data collection (1 year before and 1–2 years after implementation of the resolution) with respect to bacterial resistance was accomplished by employing a computer system that analyzed all urine cultures diagnosed with UTI, as requested during the study periods in the emergency department of a university hospital. Results: Of the 361 cases of UTI that were detected over a 3-month period, urine cultures were asked in 23% cases. Ciprofloxacin and norfloxacin were the most prescribed antibiotics. Among the 597 cases studied during the period before the legislation (73% women), 352 (59%) were resistant to at least 1 group of antimicrobials analyzed. In the next year after the legislation was implemented, of the 919 patients tested (84% women), 524 (57%) were resistant to at least 1 group of antimicrobials analyzed. In the subsequent year, of the 855 patients (86% women), 493 (58%) were resistant to at least 1 group of antibiotics. Overall, among all studied cases, the highest resistance was observed for ampicillin, followed by trimethoprim-sulfamethoxazole, and ciprofloxacin, although ciprofloxacin is the first choice for the treatment of UTI. Escherichia coli is the most frequent etiological agent found. Conclusion: In the first year, a minor drop in the percentage of bacterial resistance was observed, but in the second year a significant increase was noticed. Based on these studies so far, we cannot confirm that the result is a direct reflection of the resolution because several additional factors can influence these indices. Therefore, continued study of the indices is planned. ja p h a .org 133—IMPACT OF THE QUALITY INDICATOR SURVEY NURSING HOME SURVEY PROCESS ON PROVIDER RESPONSE TO THE CMS PARTNERSHIP TO IMPROVE DEMENTIA CARE IN NURSING HOMES INITIATIVE. Urick B, Carnahan R, Kaskie B, University of Iowa, Email: [email protected] Objective: The objective of this study is to determine the association between the Quality Indicator Survey (QIS) process for surveying long-term care facilities and nursing home providers’ response to the Centers for Medicare and Medicaid Services (CMS) Partnership to Improve Dementia Care in Nursing Homes initiative (Partnership initiative). Methods: Data for this project came from a survey of nursing home surveyors conducted by the Center for Medicare Advocacy. The survey’s goal was to obtain nursing home surveyors’ attitudes, beliefs, and experiences regarding the antipsychotic use citation process. Ten purposefully selected, nationally representative states were included in the study sample. Three states used the QIS process and 7 used the Standard survey process. Surveys were sent to each nursing home surveyor in every state in the study sample. Descriptive statistics, chi-square, and logistic regression were used in this study. Results: The initial response rate was 90.5% (597/660) with 48.5% (320/660) respondents completing the entire survey. Response rates by demographic variables were only different for surveyors in QIS survey states compared with Standard survey states. The majority of nursing home surveyors reported that they had seen positive provider responses to the Partnership initiative. While fewer surveyors reported seeing questionable provider responses, 21.6% reported they observed falsification of records and 39.1% reported they had seen providers creating a new, but false, diagnosis of psychosis as a response to the Partnership initiative. Logistic regression models comparing QIS to Standard survey states controlling for surveyor demographic variables found that surveyors in QIS states reported more positive provider responses and fewer Journal of the American Pharmacists Association APhA2014 ABSTRACTS negative responses to the initiative. Conclusion: This study finds the QIS survey process may have beneficial influences on providers responding to the CMS Partnership initiative and has implications to other initiatives to reduce inappropriate antipsychotic use in nursing homes. 134—ORPHAN DRUG DESIGNATIONS AND APPROVALS BY THE U.S. FOOD AND DRUG ADMINISTRATION AND THE EUROPEAN MEDICINES AGENCY. Alghamdi A, Almutairi R, Felemban D, SeoaneVazquez E, Massachusetts College of Pharmacy and Health Sciences, Rodriguez-Monguio R, University of Massachusetts–Amherst, Szeinbach S, The Ohio State University, E-mail: enrique. [email protected] Objective: The United States and the European Union implemented regulations for encouraging the development of drugs for rare diseases. This study examined the characteristics of orphan drugs (OD) designated and approved by the U.S. Food and Drug Administration (FDA) and the European Medicines Agency (EMA) from August 2000 to September 2012. Methods: Data for orphan designations and approvals were extracted from the FDA and EMA online databases. Restrictiveness (i.e., limitations in patient population and scope of the indications) of OD designated by each regulatory agency was assessed. Descriptive statistics were performed. Results: A total of 2,802 OD were granted by both agencies in the study period. Overall, 41.6% (n = 1,166) of the designations were designated only by the FDA, 17.6% (n = 492) were designated only by the EMA, and 40.8% (n = 1,144) by both agencies. The FDA designated the orphan indications before August 2000 in 101 of the orphan indications designated by EMA. In the study period, the FDA and EMA approved a total of 179 and 88 orphan indications, respectively; 50 indications were approved by both agencies. Products designated by both agencies had larger approval rate (13.7% of the designated indications) than products designated only by the FDA (7.9%) or designated by the EMA (3.7%). The indications designated by both agencies (n = 572 indications in each agency) were the same in 79.5% of the designations; 16.3% were more restrictive in the FDA, and 4.2% were more restrictive in the EMA. Conclusion: The European Union had more restrictive criteria for orphan designation, fewer orphan designations, and fewer product approvals than the United States. Orphan indications were more restrictive in the FDA than in EMA. Harmonization of the OD regulatory processes of FDA and EMA could result in improved access to OD in the United States and the European Union. 135—PEDIATRIC SYSTEMIC ANTIBIOTIC DRUG APPROVALS IN THE UNITED STATES: ASSESSING THE IMPACT OF THE BEST PHARMACEUTICALS FOR CHILDREN ACT AND THE PEDIATRIC RESEARCH EQUITY ACT. Lindberg-Springs S, Seoane-Vazquez E, Massachusetts College of Pharmacy and Health Sciences University, Rodriguez-Monguio R, University of Massachusetts, E-mail: enrique. [email protected] Objective: This study examined the extent to which public policies and economic incentives increased pediatric drug approvals and improved pediatric drug labeling information for systemic antibiotics (ABX) marketed in the United States. In 2012, the Food and Drug Administration (FDA) Safety and Innovation Act made permanent pediatricrelated regulations directed to improve the safety and effectiveness of drugs used in children. Specifically, the Best Pharmaceuticals for Children Act of 2002 provided the regulatory framework for pediatric exclusivity, incentivizing pediatric research and development (R&D), and the Pediatric Research Equity Act of 2003 authorized the FDA to require pediatric studies of marketed drugs. Methods: Data were collected from the FDA webpage, Micromedex, and the American Hospital Formulary Service websites. Data included ABX generic name, number of FDA-approved indications, age group for each indication, and approved orphan indications for each Journal of the American Pharmacists Association Downloaded From: http://mustafa.japha.org/ on 06/09/2014 j apha.org drug. Descriptive statistics were performed and the pharmaceutical active ingredient was the unit of analysis. Results: The study included 87 FDA-approved ABX that were marketed in the United States on September 1, 2013. Overall, 77 ABX (88.5% of the marketed ABX) included ≥1 pediatric indications, 45 (51.7%) did not specify the age group for pediatric indication, 29 (33.3%) excluded neonates from the indication, and 3 (3.4%) were specifically indicated for use in neonates. Pediatric written requests were issued to 11 (12.6%) ABX. Orphan drug designation was granted to 15 (17.2%) ABX, none for pediatric use. Conclusion: Children, and especially neonates, persist as patient subpopulations that remain understudied and underserved. Despite the adoption of more robust regulatory requirements and economic incentives for pediatric research, appropriate pediatric labeling information is still lacking. The small market size of the pediatric market and heterogeneity of pediatric patients reduce incentives for private R&D. Pediatric R&D must be driven by further public regulation, incentives, and financing. 136—THE PERCEPTION OF PROVIDER STATUS: A SURVEY OF NORTH CAROLINA PHARMACISTS. Holland W, University of North Carolina at Chapel Hill Eshelman School of Pharmacy, Branham A, Moose Professional Pharmacy, Brown P, University of North Carolina at Chapel Hill Eshelman School of Pharmacy, Dalton E, Moose J, Moose Professional Pharmacy, Ferreri S, Marciniak M, University of North Carolina at Chapel Hill Eshelman School of Pharmacy, E-mail: [email protected] Objective: Pharmacists are not currently recognized as patient care providers by the federal government under the Social Security Act. As a result, pharmacists are underutilized in the health care team due to barriers such as financial compensation. A coalition of 14 national pharmacy organizations has begun working toward provider status since the beginning of 2013. The objective of this study is to determine pharmacist understanding of obtaining provider status MA R /APR 2014 | 54:2 | JAPhA e125 APhA2014 ABSTRACTS and the perceived implications of how this would impact pharmacy practice. Methods: This cross-sectional study will be conducted via Qualtrics. Utilizing contact information provided by the North Carolina Board of Pharmacy, an e-mail with a survey link will be sent to all actively licensed pharmacists. Pharmacists who practice in all settings will be included; pharmacists without a valid e-mail address will be excluded. Survey questions will address pharmacist demographics, practice setting, current services provided, compensation for these services, potential impact of pharmacist-recognized provider status, and barriers to attaining patient care provider status. The 25-item questionnaire will be pilot tested using a convenience sample of pharmacists for feedback on validity and question structure. The survey will be open for 30 days and a reminder e-mail will be sent 2 weeks after the initial message. Participants will have the option to enter an incentive drawing to receive a gift card at time of survey completion. Descriptive statistics will be used to analyze data collected. Results: Research in progress. Institutional review board approval is anticipated in October 2013. The survey will be distributed in November 2013 with data analysis conducted from December 2013 to February 2014. 137—PHARMACISTS’ KNOWLEDGE OF THE PATIENT PROTECTION AND AFFORDABLE CARE ACT. Khanna R, Mahabaleshwarkar R, Holmes E, Jariwala K, University of Mississippi School of Pharmacy, E-mail: [email protected] Objective: The Patient Protection and Affordable Care Act (PPACA) is the most comprehensive health care law enacted in the United States since the creation of Medicare and Medicaid in 1960s. The primary aim of the PPACA is to increase health insurance coverage among the U.S. population through Medicaid expansion and insurance exchanges. Other provisions of the PPACA include increased funding for medication therapy management services, funding for interdisciplinary teams involving pharmacists, and phasing out the Medicare e126 JAPhA | 5 4:2 | M AR/AP R 2014 Downloaded From: http://mustafa.japha.org/ on 06/09/2014 Part D coverage gap (donut hole). Given the profound influence of this law on the pharmacy profession, the purpose of this study was to assess pharmacists’ knowledge of and attitudes toward the PPACA. Methods: Using a cross-sectional descriptive design, an online survey was distributed to pharmacists registered in 5 states (i.e., Louisiana, Minnesota, Mississippi, Oregon, and Tennessee) using the Qualtrics software program. Descriptive analysis of study items was conducted. Results: A total of 1,217 usable responses (5.6%) were received. Threefourths of pharmacists agreed that the American health care system needs to be reformed. Approximately 36% agreed that they understood the major provisions of the PPACA. Approximately 22% of pharmacists agreed that the PPACA will improve health care quality and will contain health care costs. Just over half (approximately 51%) of pharmacists indicated that they did not support the PPACA, with approximately 48% supporting the PPACA. Roughly 46% of pharmacists supported repeal of the PPACA, roughly 33% did not support repeal, and 21% were undecided. Conclusion: Respondent pharmacists were divided in terms of their support and attitudes toward repealing the most significant health care legislation passed in the United States in over 4 decades. Given that the minority of respondents indicated understanding major provisions of the PPACA, professional pharmacy organizations and other stakeholders may consider providing continuing education and other methods to educate pharmacists about the PPACA. Marketing and Management 138—THE EFFECT OF INCORPORATING PHYSICIAN DETAILING INTO A MARKETING PLAN ON THE NUMBER OF PRESCRIPTION COMPOUNDS FILLED AT AN INDEPENDENT PHARMACY. Griggs C, Virginia Commonwealth University, Kaefer T, Bremo Pharmacy, Goode J, Virginia Commonwealth University, Email: [email protected] Objective: The objectives of this ja p h a .org study are to: (1) evaluate whether implementation of a physician detailing marketing plan that promotes compounding pharmacy services increases the number of new compounding prescriptions filled; and (2) compare the effectiveness of 3 different types of physician detailing (i.e., written materials, e-mail plus written materials, and face-to-face plus written materials). Methods: A marketing plan will be designed including physician detailing. A list of physicians currently prescribing compounded medications for an independent pharmacy in Richmond, Virginia, will be generated. Physician practice sites will be randomized into 3 groups. The first group will receive educational materials and no physician detailing. The second group will receive electronic physician detailing via e-mail in addition to educational materials. The third group will receive face-to-face physician detailing in addition to educational materials. The number of compounded prescriptions filled will be assessed for 5 months before and after implementation of the marketing plan. Results: Research in progress. 139—INCREASING OVER-THECOUNTER ANALGESIC SALES BY MEETING CUSTOMER NEEDS IN AN INDEPENDENT PHARMACY. Zecchini J, University of Pittsburgh, Vargo P, Medicap Pharmacy, Smith R, University of Pittsburgh, E-mail: [email protected] Objective: This study aims to identify and implement changes in the overthe-counter (OTC) analgesic section to increase sales based on customer feedback. Methods: This is a market research study approved by the university’s institutional review board to determine customer awareness, usage, and satisfaction with the OTC analgesic section in an independent pharmacy in eastern Pennsylvania. The goal of the study is to increase OTC sales by modifying service offerings, product presentation, and access to the pharmacist. In-store surveys were conducted by store personnel with customers >18 years of age who consented to the survey. Survey domains included Journal of the American Pharmacists Association APhA2014 ABSTRACTS OTC customer use, product layout and presentation, pricing, and pharmacist access. The survey was administered for a 2-week period. Customer responses will be tabulated and descriptive statistics used to identify changes that can be made to the OTC product section layout. Selected changes will be implemented and their effectiveness evaluated by comparing OTC analgesic sales for 3 months prior to the changes with those 3 months after the changes. Results: Research in progress. Results are pending completion of the study in November 2013. Effective capture of the customer experience is an important component of exceeding customer expectations and increasing market share. This study will provide methods that can be easily implemented by other independent pharmacies. Research findings will demonstrate whether this information can be converted to results such as increased sales. 140—MANAGERIAL SKILLS OF NEW PRACTITIONER PHARMACISTS WITHIN COMMUNITY PRACTICE. Mospan C, Sweaney A, Casper K, The Ohio State University College of Pharmacy, E-mail: sweaney.2@ osu.edu Objective: The objectives of this study are to: (1) identify managerial skills required in community pharmacy practice; (2) explore new practitioners’ previous exposure to these skills; and (3) assess new practitioners’ perceived preparedness to take on managerial responsibilities. Methods: An anonymous, online survey was developed utilizing Qualtrics. Surveys will be distributed using e-mail addresses obtained from state boards of pharmacy for pharmacists licensed by examination from January 2003 to October 2013. Pharmacists who currently do not practice within the community setting will be excluded. Participants will have 30 days to complete the survey, and will be sent weekly reminder e-mails during the data collection period. Descriptive statistics will be used to report responses. Data will be analyzed utilizing biostatistician support through the university. Results: Research in progress. Because previous literature has focused on pharmacy management skills within the health-system setting, the results of this project will be used to identify managerial skills required within community pharmacy practice. By assessing the perceived preparedness of new practitioners to take on managerial roles, continuing education can be developed to fill knowledge and skill gaps. This information also may be utilized by colleges of pharmacy for doctor of pharmacy degree curricular assessment and revision. By identifying and understanding the required managerial skills of community practitioners, educators can strive to better prepare new practitioners to take on managerial roles as part of their current or future practice. Methods: This is a retrospective study that includes approximately 30 women who have seen a practitioner who uses the OHB system. These women must have completed an initial questionnaire and serum testing within a comparable time frame. Additionally, if a patient has a follow-up questionnaire and follow-up serum level it would allow further demonstration of the relationship between the two. Using the practitioner’s login, the questionnaire and serum results will be de-identified and placed in an Excel spreadsheet for analysis. Analysis will help determine whether there is a relationship between symptoms and serum levels. This study will be submitted to the institutional review board for approval. Results: Research in progress. Maternal, Child, and Women’s Health Q 142—CHARACTERISTICS OF YOUNG WOMEN WHO DEMONSTRATED CORRECT VERSUS INCORRECT USE OF AN EMERGENCY CONTRACEPTIVE. Cwiak C, Emory University School of Medicine, Howard B, Teva Global Medical Affairs, Hsieh J, Ricciotti N, Teva Branded Pharmaceutical Products, R&D, Inc., E-mail: ccwiak@ emory.edu Objective: The objective of this study is to examine percentages and characteristics of young women who used an emergency contraceptive (EC) correctly versus incorrectly. Methods: This was a post hoc analysis of a case-series study assessing the ability of female patients, aged 11 to 17 years, to correctly use a single-dose 1.5mg levonorgestrel EC under simulated over-the-counter conditions, without provider assistance. Correct use was defined as EC use within 72 hours following unprotected sexual intercourse. A limited medical history, including allergies, ages at menarche and coitarche, previous birth control, pregnancy history, and current pregnancy status, was collected from each participant. Results: Of the 297 female patients in the treated population who used the EC, 263 (88.6%) demonstrated correct use within 72 hours after unprotected intercourse, and 34 (11.4%) reported incorrect use. Although different age groups 141—ARE HORMONAL SYMPTOMS A MATCH FOR SERUM LEVELS?. Chasse A, Moody K, Hrncir J, Las Colinas Pharmacy, E-mail: ashley.n.chasse@ gmail.com Objective: Community pharmacists assess symptoms to address the efficacy and safety of medications. Once medication-related problems are ruled out, the next step is to refer patients to a health professional who can treat the patient’s condition. Advising patients is easier when the symptoms they exhibit indicate a specific serum or clinical level. Optimum Hormone Balance (OHB) is a pharmacist-created clinical decision support system used to advance the practice of balanced bio-identical hormone and thyroid therapy through a collaborative approach. Practitioners use OHB to email a comprehensive symptoms questionnaire to their patients, input serum levels, and track changes. In addition, a practitioner has the opportunity to use the system to request a consult with the bio-identical hormone replacement therapy pharmacists. Using OHB, this study will assess the correlation of symptoms associated with hypothyroidism, hyperthyroidism, low estrogen, low progesterone, and low testosterone provided with their respective serum levels. Journal of the American Pharmacists Association Downloaded From: http://mustafa.japha.org/ on 06/09/2014 j apha.org MA R /APR 2014 | 54:2 | JAPhA e127 APhA2014 ABSTRACTS reported correct use ranging from 80.6% in the 11- to 14-year-old subgroup to 94.6% in 17-year-old participants, average ages for correct and incorrect users were similar (15.7 and 15.5 years, respectively), as were average ages at menarche (11.9 and 12.1 years, respectively) and coitarche (14.6 and 14.3 years, respectively). Reproductive histories were similar between the groups, with the majority of patients reporting never being pregnant (88.2% for correct use and 85.3% for incorrect use), never giving birth (97.0% and 97.1%, respectively), and never having an abortion (92.0% and 91.2%, respectively). Birth control histories also were similar for correct users (64.3% used condoms, 32.7% used oral contraception, and 27.8% never used birth control) and incorrect users (52.9%, 23.5%, and 35.5%, respectively). Conclusion: There were no major differences between young women who used the EC correctly versus incorrect users. Most participants could correctly use the EC, regardless of age, demonstrating a high degree of understanding of the product labeling in individuals aged ≤17 years. Further studies are needed to understand and address incorrect EC use in this population. Original Citation: Cwiak C, Howard B, Hsieh J, Ricciotti N. Characteristics of young women who demonstrated correct versus incorrect use of emergency contraception. Presented at Society of Family Planning. October 6-7, 2013. Contraception. September 2013: 88(3):471. Q 143—ECONOMIC ANALYSIS OF A PRIMARY CARE CLINICAL PHARMACY SERVICE ON POST-FRACTURE CARE IN POSTMENOPAUSAL WOMEN. Irwin A, Oregon State University, Heilmann R, Billups S, Kaiser Permanente Colorado, E-mail: adriane. [email protected] Objective: A previously completed study of women aged ≥67 years with a documented fracture showed that a Clinical Pharmacy Osteoporosis Management Service (CPOMS) was associated with a significantly greater proportion of women completing bone mineral density (BMD) testing or initiating drug therapy when compared with a similar e128 JAPhA | 5 4:2 | M AR/AP R 2014 Downloaded From: http://mustafa.japha.org/ on 06/09/2014 intervention provided by a nurse (65% vs. 46%, respectively; P< 0.001). The purpose of this study was to compare the cost inputs associated with each intervention and quantify any cost avoidance due to hip fracture prevention. Methods: This economic analysis was conducted from the health care payer’s perspective. Intervention costs included health care provider time, anti-osteoporosis medications, and BMD tests. Data from the original study was used to construct a deterministic decision-tree analysis model to compare 12-month costs that included predicted hip fractures. Results: There were 827 women managed by CPOMS and 302 women in the comparator group in the original study. The cost of provider time for CPOMS and comparator group interventions was $27.16 and $24.03 per patient evaluated, respectively. However, for those patients achieving the endpoint of completing BMD testing or initiating drug therapy, the cost was $100.75 and $138.19 per patient, respectively. Based on the decision-tree analysis model, the 1-year cost of osteoporosis care for CPOMS patients was $413,753.05 versus $506,701.21 for patients in the comparator service. Conclusion: The CPOMS resulted in a higher cost per patient evaluated, but a lower cost for patients completing BMD testing or initiating drug therapy. When including costs associated with predicted hip fractures, CPOMS was less expensive than the comparator group because more patients completed treatment recommendations. From the health care payer’s perspective, the CPOMS intervention appears to have a lower cost per patient achieving treatment outcomes while also leading to future cost savings. Original Citation: Irwin AN, Heilmann RMF, Billups SJ. Economic analysis of a primary care clinical pharmacy service on post-fracture care in postmenopausal women. American College of Clinical Pharmacy (ACCP) Annual Meeting; Albuquerque, NM, October 13–16, 2013. (poster) Q 144—INNOVATIVE METHOD TO PROVIDE BEDSIDE MEDICATION ja p h a .org DISCHARGE COUNSELING IN A RESOURCE-CONSTRAINED ENVIRONMENT: MEDICATION INFORMATION FOR NURSING MOTHERS VIDEO. Hellwig H, Gunter J, Fort Belvoir Community Hospital, E-mail: [email protected] Objective: The objective of this presentation is to describe the creation of a video that provides medication discharge counseling to patients admitted to the hospital’s Mother-Baby Unit. Methods: As part of a pharmacy discharge process improvement initiative, a multidisciplinary team of pharmacists, pharmacy technicians, nurses, and physicians determined that a gap existed in the provision of bedside discharge counseling to new mothers on the hospital’s Mother-Baby Unit. The team identified that an opportunity existed in the creation of a video that would provide discharge counseling and education about taking medications while lactating. Several factors led the team to its decision to create a video for this patient population. First, pharmacy staffing levels could not support bedside discharge counseling in this lower risk population. Next, the vast majority of patients received the same medications upon discharge. Finally, the facility has several other videos that are required for different patient populations to watch before discharge; therefore, this new video would integrate well into existing processes and technology. A multidisciplinary team wrote and developed the script for the movie, which was then reviewed by Public Affairs before submission to the Visual Information Directorate, Bureau of Medicine and Surgery, for production. Results: A 6-minute video was created using both narration and actors. Shots include pharmacy and nursing staff members and a mother taking medications and breastfeeding her baby. This video is part of the mandatory viewing list for mothers before discharge and it will be viewed by more than 1,500 patients annually. Conclusion: Use of technology is an important asset to meet patient care needs during the current resource-constrained environment within Department of Defense health care. Creation of Journal of the American Pharmacists Association APhA2014 ABSTRACTS an educational video was ideal for this low-risk, homogeneous population. Use in other populations should be explored. Original Citation: Hellwig H, Gunter A. Innovative Method to Provide Bedside Medication Discharge Counseling in a Resource-constrained Environment: Medication Information for Nursing Mothers Video. JAPhA 2013; 53:e151170. Medication Reconciliation 145—EVALUATING PHARMACISTDELIVERED TRANSITION OF CARE DISCHARGE SERVICES IN REDUCING HOSPITAL READMISSION RATES. Panofsky L, University of the Pacific, E-mail: linda.panofsky@ gmail.com Objective: The objective of this study was to analyze whether pharmacist-delivered medication review and bedside consultation significantly reduced samecause 30-day hospital readmission rates. Methods: This was a prospective study enrolling internal medicine patients discharging to home at high risk for readmission (e.g., heart failure [HF], pneumonia, diabetes). Over the 11-month study period (beginning September 2012), medication reconciliation and bedside consultation were provided to 607 patients. Additionally, medications were provided at bedside for patients eligible for copay waiver programs. All patients were to receive a 72-hour follow-up phone call with a pharmacist. Readmission rates were calculated based on diagnosis, primary language, homeless status, whether the patient received medications at bedside, or if successful follow-up was made with patient. Results: The hospital’s baseline 30day same-diagnosis readmission rate for all causes was 14.6%. Participant demographics were 11% homeless, 78% English speaking, 16% Spanish speaking, 60% male, 28% Medicaid, 16% Medicare, and 18% no insurance. Only 36% of patients were able to be reached for followup call and 76% received medications at bedside. Total readmission rate for all study participants was 10.21%, which equates to 1 readmission prevented for every 23 patients. Readmission rates by characteristics were: 14.92% homeless versus 9.63% non-homeless; 11.42% English speaking versus 5.97% non-English speaking; 7.4% follow-up completed versus 11.8% no follow-up; and 9.9% for received medications at bedside versus 11.3% no medications at bedside. Highest readmission rate (31%) was for patients with liver disorder (including alcoholic cirrhosis). Readmission rate for patients with HF was 9.5%, diabetes 13%, and pneumonia 0%. Conclusion: Approximately $245,000 in readmission costs was saved, outweighing the costs of staff providing the service. The implication of this study is that pharmacist-provided discharge services significantly reduce readmissions, especially when medications are provided at bedside and with successful follow-up. Q 146—ADVANCING THE ROLE OF THE PHARMACY TECHNICIAN: MEDICATION RECONCILIATION. Rodriguez Esquire A, Turner P, Vera D, Fort Belvoir Community Hospital, Email: antonio.h.rodriguezesquire.mil@ health.mil Objective: The primary objective of this study is to determine whether a certified pharmacy technician (CPhT) can perform admission medication reconciliation at a 90% accuracy rate compared with a pharmacist. Studies have demonstrated that medication discrepancies on admission and discharge pose an increased risk for adverse drug events (ADE). If this task can be delegated to a CPhT, pharmacists can spend more time on the clinical aspects of their jobs. Methods: A CPhT with at least 1 year of experience in the pharmacy operation was trained by a clinical pharmacist until 3 consecutive medication reconciliations were performed without errors. CPhT reviewed outpatient and inpatient medical records from 3 different databases. Medication history also was obtained by interviewing patients or their family member. All discrepancies were documented in the Medication Reconciliation Form. Providers’ medication errors on inpatient medication orders were classified Journal of the American Pharmacists Association Downloaded From: http://mustafa.japha.org/ on 06/09/2014 j apha.org as omissions, wrong medication, wrong dose, and wrong frequency. The pharmacist independently performed medication reconciliation on each patient to validate the CPhT’s data. All results were tabulated in an Excel spreadsheet and all data analysis was performed using SPSS. Results: From May 1 to July 31, the CPhT performed medication reconciliation on 64 (19%) of 336 patients admitted to family medicine. The patient ages ranged from 18 to 97 years; approximately 52% were female. CPhT identified 17 patients with a total of 28 medication discrepancies (19 omission, 3 wrong medication, 2 wrong dose, 2 wrong frequency). CPhT completed medication reconciliation incorrectly for 4 patients (3 wrong medications, 1 wrong dose). CPhT performed medication reconciliation at a 93.7% accuracy rate. Pharmacist’s time spent on medication reconciliation was reduced by 73%, allowing the pharmacist to spend more time on direct patient care. Conclusion: Results of this study demonstrated that a trained CPhT is as effective as a registered pharmacist at performing medication reconciliation and identifying medication discrepancies Original Citation: Rodriguez Esquire A, Phoung T, Vera D. Advancing the Role of the Pharmacy Technician: Medication Reconciliation. JAPhA 2013; 53:e151-170. 147—COORDINATION OF CARE IN OUTPATIENT PRACTICE SETTINGS: PREVALENCE OF MEDICATION DISCREPANCIES AND DRUG THERAPY PROBLEMS IDENTIFIED BY A COMMUNITY PHARMACIST. Smith M, University of North Carolina at Chapel Hill Eshelman School of Pharmacy, Eker A, Kerr Drug, Marciniak M, Ferreri S, University of North Carolina at Chapel Hill Eshelman School of Pharmacy, E-mail: [email protected] Objective: Studies of medication reconciliation are extensive within transitions of care between inpatient hospital settings and outpatient clinics. However, a gap in the literature exists in coordinating patient care among different outpatient settings. Medication reconciliation MA R /APR 2014 | 54:2 | JAPhA e129 APhA2014 ABSTRACTS managed by community pharmacists could meet this need and improve coordination of care. The objective of this study is to determine prevalence of medication discrepancies and drug therapy problems identified by a community pharmacist utilizing patient medication lists from all ambulatory care providers, specialists, and pharmacies. Methods: This cross-sectional descriptive study will be conducted within 1 store of a regional pharmacy chain. Patients taking ≥5 medications filled from January 1 through October 1, 2013 and who see ≥2 providers will be included in the study. Patients <18 years of age or patients with a “do not call” status will be excluded. A community pharmacist will request medication lists from each provider of eligible patients and will reconcile medications with pharmacy dispensing records and patient-reported medication lists. Patients will be contacted by phone to ensure all prescribers and medications are included. Medication discrepancies and drug therapy problems will be recorded using a standardized medication reconciliation form developed by the investigators. Notifications of discrepancies found and recommendations to resolve drug therapy problems will be faxed to all providers. The number of medication discrepancies and drug therapy problems will be analyzed using linear regression to control for age, total number of providers, recent hospitalization or emergency room visit, and total number of medications. Results: Research in progress. Institutional review board approval anticipated in October 2013. A total of 100 patient profiles will be reviewed. Data analysis will occur from October 2013 through January 2014, with results available in March 2014. 148—AN EVALUATION OF A PHARMACIST’S IMPACT ON 30-DAY READMISSION RATES COMPARED WITH THE CURRENT STANDARD OF CARE. Tedesco G, McConaha J, Higginbotham S, Skomo M, Duquesne University, E-mail: [email protected] Objective: This study seeks to evaluate the effect transition of care follow-up and counseling performed by a phar- e130 JAPhA | 5 4:2 | M AR/AP R 2014 Downloaded From: http://mustafa.japha.org/ on 06/09/2014 macist, within a physician’s practice, can have on 30-day hospital readmission among Medicare participants when compared with the current standard of care in a similar practice. Methods: Patients aged ≥65 years, with Medicare insurance, who were recently discharged from a local hospital will be contacted by a pharmacist or student pharmacist via phone within 3 business days after discharge. It is estimated that in a 24-week period, approximately 220 patients in the pharmacist intervention group and 220 patients in the standard of care group will be eligible for the study (n = 440). During the call, the pharmacist will perform a medication reconciliation, review instructions given at discharge, and schedule the patient for a follow-up physician appointment in conjunction with a face-to-face pharmacist-provided medication therapy management. A pharmacist also will review the patient’s electronic medical record and communicate recommendations to the physician to address any gaps or issues identified. The current standard of care, which does not involve a pharmacist, at a similar local physician practice will be used as a comparative group. The 30-day readmission rates for both physician practices will be compared at the conclusion of the study through the use of chi-square test to determine statistical significance. Results: Research in progress. 149—HOSPITAL TO HOME: A COORDINATED EFFORT BETWEEN A RURAL HOSPITAL AND COMMUNITY PHARMACY TO REDUCE READMISSION RATES FOR HIGHRISK PATIENTS. Frye C, University of North Carolina at Chapel Hill Eshelman School of Pharmacy, Huie C, Roark A, Chapman A, Ferguson L, Brame Huie Pharmacy, Marciniak M, Ferreri S, University of North Carolina at Chapel Hill Eshelman School of Pharmacy, E-mail: [email protected] Objective: Patients with certain disease states are frequently readmitted to the hospital. This undesirable outcome increases health care costs. The Centers for Medicare and Medicaid Services reduces reimbursement to hospitals with ja p h a .org high readmission rates. The purpose of this study is to reduce 30-day and 90-day hospital readmission rates for high-risk patients. Secondary analyses will include cost savings to the hospital. Methods: This is a prospective cohort study. A community pharmacist will be stationed in a local hospital for 3 hours each weekday to provide services to patients with heart failure, myocardial infarction, pneumonia, or chronic obstructive pulmonary disease. Patients will be identified by case managers and referred to the pharmacist. The pharmacist will have access to patients’ medical records at the hospital and will be able to communicate directly with hospitalists. Pharmacist-provided services for participating patients will include discharge medication reconciliation, medication and disease state education, delivery of a personal medication record, and discharge summaries sent to the patient’s primary care provider and community pharmacy. Pharmacists will follow up with patients days 1, 7, 28, and 84 post-discharge. A helpline also will be available to patients at any time. Readmissions within the 30-day and 90-day period will be identified by the case managers. Statistical analysis to compare readmission rates for patients participating in the program with nonparticipants will be performed using 2 sample independent t tests. For a secondary outcome, the hospital will provide estimated cost savings for patients who participate in the program. Results: Research in progress. Institutional review board approval is anticipated October 2013. 150—IDENTIFICATION OF MEDICATION DISCREPANCIES BY COMMUNITY PHARMACISTS DURING A COMPREHENSIVE MEDICATION REVIEW IN PATIENTS 1 WEEK POST HOSPITALIZATION. Took R, Balls Foods Stores, Liu Y, Kuehl P, University of Missouri–Kansas City, E-mail: [email protected] Objective: The study site is a selfinsured regional grocery store chain with 2,626 covered lives. The company provides many employee wellness services including disease state management for Journal of the American Pharmacists Association APhA2014 ABSTRACTS diabetes, hypertension, and hyperlipidemia (6 to 8 pharmacist-led sessions per year); smoking cessation classes; health screenings; and immunizations. The most recent service added is for pharmacists to provide a comprehensive medication review (CMR) to employees within 1 week of being discharged from a hospital or intermediate level of care. The purpose of this study is to determine the number of medication discrepancies and severity of drug-related problems resolved when performing a CMR for these employees. Methods: Pharmacists began providing CMRs to discharged employees in October 2013. This study is a retrospective review of the CMR records to assess the data collected for employees seen from October 1, 2013 to March 31, 2014. Discrepancies will be identified among employees’ medication regimens before admission, after discharge, and actual medications taking post discharge. Medication-related problems will be placed into the following categories: (1) additional drug therapy; (2) unnecessary drug therapy; (3) wrong drug; (4) dosage too low; (5) dosage too high; (6) adverse drug reaction/drug interaction; and (7) adherence. Interventions will be categorized using the severity scale employed by OutcomesMTM. This project will be submitted to the University of Missouri– Kansas City Adult Health institutional review board as exempt research. Chisquare and Wilcoxon rank-sum tests will be used to compare data. Results: Research in progress. By assessing the types of discrepancies found and assigning value to the severity of medication-related problems resolved, this project aims to determine whether this service results in positive outcomes for the company’s employees who are hospitalized. 151— PH A R M AC IST-PROV I DED MEDICATION RECONCILIATION TO IDENTIFY MEDICATION-RELATED PROBLEMS IN A COMMUNITY SETTING. Jacquez M, Moorman K, Owen D, McAdam-Marx C, Jennings B, University of Utah, E-mail: macheala. [email protected] Objective: Performing medication reconciliation is important in the care of patients to reduce the risk of medicationrelated problems (MRPs) and is a national patient safety goal. With limited health-system resources, it is important to assess the impact of medication reconciliation and to target these services to patients at greatest risk of MRPs. The objectives of this study are to: (1) measure the quantity and type of MRPs encountered during pharmacist-performed medication reconciliations in the community setting; and (2) identify patient factors associated with the highest risk of having MRPs. Methods: This study is a descriptive cross-sectional analysis of a current quality improvement program underway at a university health system. Investigators will collect information from pharmacist-performed medication reconciliations in patients who are taking ≥7 medications, have ≥2 disease states, and are currently receiving care at a university health center. Descriptive statistics will be used to describe identified MRPs, potential adverse events avoided, and patient characteristics that are associated with MRPs. Recommendations will be made to providers to resolve the MRPs identified. Provider response will be captured by whether or not they are fully accepted, partially accepted, or denied. Results: Research in progress. Mental Health 152—ASSESSING THE MECHANISM OF ACTION OF PHARMACEUTICALS FOR PSYCHIATRIC AND NEUROLOGICAL DISORDERS APPROVED IN THE UNITED STATES, 1980–2012. Montagne M, Araujo-Lama L, Kwon S, SeoaneVazquez E, Massachusetts College of Pharmacy and Health Sciences University, E-mail: michael.montagne@mcphs. edu Objective: The purpose of this study was to assess the mechanisms of action (MOA) of pharmaceutical products approved for psychiatric and neurological disorders from 1980 through 2012. Methods: The MOA description in the Clinical Pharmacology section of the Food and Drug Administration (FDA)– Journal of the American Pharmacists Association Downloaded From: http://mustafa.japha.org/ on 06/09/2014 j apha.org approved product label of new molecular entities from 1980 through 2012 was collected from FDA and National Institutes of Health websites. Classifying the status of a drug’s MOA was performed by 3 researchers, based on exact wording, into the following 3 categories: known, unknown, and hypothesized. Based on the World Health Organization’ s Anatomical Therapeutic Chemical (ATC) classification system, analysis was at the level of the therapeutic-pharmacological group (ATC-3). Results: Of a total 902 pharmaceutical products approved during this time frame, 110 (12.2%) psychiatric and neurological product MOAs were assessed. MOAs are known for 11.8% of these products, unknown for 16.4%, and hypothesized for 71.8%. Categories with highest proportion of known MOAs were parasympathomimetics (100%, n = 1) and drugs used in addictive disorders (50%, n = 6). Categories with the lowest proportion of known MOAs were general anesthetics (11%, n = 9), dopaminergic agents (10%, n = 10), and antipsychotics (9%, n = 11). In 7 of 16 categories, all products (n = 49) had no known MOA. The proportion of products with a known MOA has fluctuated over the past 3 decades. Bivariate analysis did not find a statistically significant difference in proportion of known MOAs for orphan drug status and for market discontinuation. Results show lack of consistency in describing MOAs in product labeling and limited compliance with FDA guidelines. Conclusion: Most nervous system drugs did not have a confirmed MOA. Policy recommendations for the FDA include: develop a standardized template for the product label with regard to MOA; require compliance with its guidelines and template; require clear hypothesis of MOA with supporting evidence when definitive MOA is not known; and encourage manufacturers to continue post-marketing research to confirm hypothetical MOAs. 153—BUPROPION FOR THE TREATMENT OF ATTENTION-DEFICIT/ HYPERACTIVITY DISORDER IN CHILDREN AND ADOLESCENTS. MA R /APR 2014 | 54:2 | JAPhA e131 APhA2014 ABSTRACTS Shah B, Penaloza J, Medina M, Palm Beach Atlantic University, E-mail: [email protected] Objective: The purpose of this study is to observe the effects of bupropion versus methylphenidate for the treatment of attention-deficit/hyperactivity disorder (ADHD) in adults and children. Methods: Three randomized, double-blind, intent to treat, placebo and non-placebo controlled trials were studied. First trial: Patients received bupropion XL 150 mg QAM for the first week, bupropion XL 300 mg QAM for weeks 2–4 (if not indicated to increase dose then stayed at 300 mg for the remaining 4 weeks), and bupropion 450 mg for weeks 5–8 (increased dose if: score >2 on the Clinical Global Impressions (CGI) scale, had an improvement in the ADHD Rating Scale (ADHD-RS) of <30%, or did not experience any bothersome adverse events). The primary outcome was the percentage of subjects with at least a 30% reduction in the investigator-rated ADHD-RS score from randomization to week 8 or on premature discontinuation from the study. Second trial: Bupropion was started at 50 mg for patients <30 kg and 75 mg for patients >30 kg and then titrated up to 100–150 mg/day (100 mg/ day for <30 kg and 150 mg/day for >30 kg) or methylphenidate 20–30 mg/day (20 mg/day for <30 kg and 30 mg/day for >30 kg). The primary outcome was the change in scores of the parent version of ADHD-RS-IV from baseline to week 6 in each group. Third trial: There was a 7-day placebo lead-in. Patients were then randomized into bupropion, methylphenidate, or placebo for the next 7 weeks. Results: The results of the first trial showed that bupropion significantly showed a reduction in the ADHD-RS score. The results of the second trial showed that there was no significant difference in the change in parent ADHDRS-IV score between bupropion and methylphenidate. The results of the third trial showed that bupropion had a greater response on the CGI scale. Conclusion: Bupropion can be considered as an alternative treatment for ADHD based on clinical trials. It is an effective nonstimulant for patients unable to tolerate stimulants such as methylphe- e132 JAPhA | 5 4:2 | M AR/AP R 2014 Downloaded From: http://mustafa.japha.org/ on 06/09/2014 nidate. 154—COMPARISON OF HEALTH CARE UTILIZATION AND COSTS ASSOCIATED WITH PATIENTS WITH ATTENTION-DEFICIT/HYPERACTIVITY DISORDER INITIATED ON DIFFERENT STIMULANTS. Desai P, Lawson K, The University of Texas at Austin, E-mail: [email protected] Objective: The objective of this study is to compare health care costs and utilization in attention-deficit/hyperactivity disorder (ADHD) patients initiated on immediate- and extended-release amphetamine and methylphenidate using a propensity score (PS) matching technique. Methods: This was a retrospective database analysis using Texas Medicaid data. Patients initiated on immediaterelease amphetamine (IR-A), extended-release amphetamine (ER-A) and immediate-release methylphenidate (IR-M) were matched to those initiated on extended-release methylphenidate (ER-M) (reference group) using a PS caliper matching algorithm. Bivariate analyses were conducted to compare demographic and clinical characteristics before and after matching. The primary outcome measures were all-cause health care resource utilization and costs and ADHD-related drug and medical costs. Logistic regressions, generalized linear models regressions, and 2-part models were used to compare health care utilization and costs post matching. Results: Of the 15,055 patients included in the study, 64.7% were prescribed ER-M, 6.4% IR-M, 25.4% ER-A, and 3.5% IR-A. Patients prescribed IR-M had higher mean (95% confidence interval) ADHD-related drug costs compared with the ER-M group ($405 [$398, $413] vs. $389 [$381, $396]), while those in the ER-A group had higher ADHDrelated drug costs compared with the ER-M group ($405 [$397, $413] vs. $381 [$381, $396]) but patients prescribed IRA had lower ADHD-related drug costs ($206 [$187, $226] vs. $388 [$366, $410]) compared with those prescribed ER-M. ER-A initiators had significantly higher emergency room (ER) costs compared ja p h a .org with the ER-M group ($59 [$52, $66] vs. $49 [$43, $55]) and were 1.14 times more likely to have an ER visit (1.14 [1.01, 1.29], P = 0.0330). Patients prescribed IR-A had higher post-index office visit costs ($434 [$388, $480] vs. $362 [$325, $399]) compared with the ER-M group. None of the other differences were statistically significant. Conclusion: Results of this study might help guide decisions regarding initial drug therapy for patients newly diagnosed with ADHD and help Pharmacy and Therapeutics Committees in making formulary decisions. 155—CORRELATION AMONG STROKE OCCURRENCE, DEMENTIA, AND ATYPICAL ANTIPSYCHOTIC. Chen K, LeBlanc B, Pansawira C, University of California–San Francisco, E-mail: [email protected] Objective: This study aims to find the risk ratio between the occurrence of stroke and the administration of atypical antipsychotics in patients with dementia. Methods: This retrospective cohort study is awaiting final approval from a Northern California HMO institutional review board, after local facility approval had recently been granted. Electronic medical records for 2,400 patients with an International Classification of Diseases–9th revision code of dementia will be reviewed to determine the rate of stroke among patients who have used atypical antipsychotic. This review will look at prescription records from 1990 to 2013 for atypical antipsychotic prescription fills as well as the diagnosis codes indicating stroke. All data were de-identified and kept confidential during analysis. Included patients are men and women aged ≥50 years. This review also will examine comorbidities in the patient population (e.g., diabetes, hypertension, hyperlipidemia) for potential contributory factors in stroke occurrence. Upon completion of the records review, analysis will be completed to determine the rate of stroke occurrence in dementia patients who had received atypical antipsychotic medication therapy, as well as the risk ratio due to such therapy. Results: Research in progress. Pre- Journal of the American Pharmacists Association APhA2014 ABSTRACTS liminary result conducted on 100 of 2,400 patients revealed no difference in stroke occurrence between dementia patients on atypical antipsychotics and those not taking atypical antipsychotics. 156—CORRELATION BETWEEN MEDICATION REGIMEN COMPLEXITY AND REHOSPITALIZATION RATES IN SCHIZOPHRENIC PATIENTS. Mathis S, University of Mississippi School of Pharmacy, Bell A, University of Mississippi Medical Center, E-mail: [email protected] Objective: The purpose of this study was to use the Medication Regimen Complexity Index (MRCI) to determine whether there is an association between medication regimen complexity (MRC) and time to rehospitalization in schizophrenic patients. Fifty percent of schizophrenic patients are nonadherent to prescribed regimens, and this can lead to increased rehospitalization rates. Many studies have examined reasons for poor adherence to medications in schizophrenic patients, but few studies have measured MRC as a predictor of rehospitalization in this population. The MRCI is a validated tool used to quantify MRC. Methods: Patient charts were identified using International Classification of Diseases–9th revision diagnosis codes for schizophrenia. Charts were narrowed down to patients hospitalized for psychiatric purposes. Inclusion criteria were as follows: aged 18 to 65 years, hospitalized at least twice between January 1, 2008 and May 31, 2012, and having diagnosis codes of 295.XX (schizophrenic disorders) on discharge. Patient charts were excluded if no discharge medications were listed. Lengths of time between previous hospitalization and rehospitalization were measured in days and compared with correlating MRCI scores from discharge medication lists using descriptive statistics and scatterplot analysis (coefficient of determination and P values). Results: In this study, 209 charts were reviewed; 96 were excluded and 113 were included. Median MRCI scores were 11 for all discharge medications and 7 for psychiatric medications only. Median days to rehospitalization was 187. Results from analysis of scatterplots were as follows: all discharge medications, R2 = 0.0047 (P = 0.384); psychiatric medications only, R2 = 0.0085 (P = 0.244). No significant correlation was shown between MRCI scores for all discharge medications or for psychiatric medications only and time to rehospitalization. Conclusion: It cannot be concluded that MRCI scores and time to reshospitalization for schizophrenic patients are directly correlated. It is likely that a large number of factors interplay to lead to rehospitalization in this patient population. 157—HEALTH CARE PROFESSIONAL AND PATIENT KNOWLEDGE OF PHARMACIST-ADMINISTERED LONG-ACTING INJECTABLE ATYPICAL ANTIPSYCHOTICS IN INDEPENDENT PHARMACIES. Mercadel C, Samford University/FMS Pharmacy, Elmore L, Samford University, E-mail: [email protected] Objective: The purpose of this project is to assess health care professional and patient knowledge of pharmacistadministered long-acting injectable (LAI) atypical antipsychotics. The prescriber survey also aims to promote collaboration between physicians and pharmacists and to improve patient care. This study has the potential to inform independent pharmacists, patients, and health care professionals about best practices of pharmacists who administer LAI atypical antipsychotic medications. It also may help improve collaboration with physicians in the nearby geographic area. Methods: Following institutional review board approval, this qualitative study will be completed in 2 parts. Part 1: Following informed consent, a survey will be administered orally to health care professionals and will assess knowledge of pharmacist-administered LAI atypical antipsychotic medications in an independent pharmacy. The survey consists of multiple-choice questions and shortanswer questions. Health care professionals, including physicians, residents, and/or nurse practitioners who currently prescribe any antipsychotic drug (oral or LAI) will be identified utilizing Journal of the American Pharmacists Association Downloaded From: http://mustafa.japha.org/ on 06/09/2014 j apha.org pharmacy dispensing software (McKesson Pharmacy Rx database). Fifteenminute appointments in medical offices surrounding 3 independent pharmacies will be set up for interviewing purposes. Part 2: A paper survey will be administered to any patient at checkout from the pharmacy to assess knowledge of pharmacist-administered LAI atypical antipsychotic medications in the independent pharmacy. Upon completion, results will be dropped anonymously into a manila envelope to protect patient identities. This survey consists of several multiple-choice questions. Qualitative analysis will be used to evaluate both sets of data to identify common themes among prescribers and patients. Results: Research in progress. 158—IDENTIFYING PHARMACISTS’ PERCEPTION, KNOWLEDGE, AND PERCEIVED BARRIERS TOWARD PROVIDING CARE TO PATIENTS TAKING ANTIPSYCHOTICS. Gangal N, Holiday-Goodman M, Vaidya V, Bechtol R, University of Toledo, E-mail: [email protected] Objective: The purpose of this study is to: (1) assess pharmacists’ attitudes, subjective norms, self-efficacy, and intention toward providing additional care to mental health patients; (2) determine pharmacists’ knowledge of antipsychotics; (3) determine the best predictor of intent for providing care considering knowledge, attitude, self-efficacy, and subjective norms; and (4) evaluate the barriers in providing care to patients taking antipsychotics. Methods: This was a prospective study design using pharmacists working in Ohio. Data were collected and analyzed using an online survey and SPSS, respectively. Questions focused on following constructs of a modified Theory of Planned Behavior: attitude, subjective norm, knowledge, self-efficacy, and intention. Descriptive statistics and multiple regression were used. Results: Nearly 10% of the pharmacists responded. Approximately 95% of the respondents had positive attitudes toward providing additional care to mental health patients. Approximately MA R /APR 2014 | 54:2 | JAPhA e133 APhA2014 ABSTRACTS 89% had positive subjective norm. Pharmacists felt motivated to provide counseling depending on pharmacists’ desire and patients’ needs. Almost 68% had high perceived self-efficacy in providing care to patients taking antipsychotics. Approximately 90% of pharmacists intended to provide additional care to patients taking antipsychotics. Descriptive statistics showed that only 20% of pharmacists had high scores on the knowledge section (40% or higher points). Regression showed the factors that significantly predicted intention to counsel were attitude (beta = 0.188; P<0.05) and subjective norm (beta= 0.144; P<0.05). Lack of time to individual attention and lack of knowledge were the top 2 barriers perceived by 90% and 80% of the pharmacists, respectively. Conclusion: Overall, pharmacists had a positive attitude and strong intention toward providing additional care to mental health patients. A majority of pharmacists surveyed showed limited knowledge on 7 questions related to proper use of antipsychotics. Therefore, it is important to raise knowledge among pharmacists on antipsychotics. Continuing education programs could be helpful to pharmacists in this process. 159—PERCEPTIONS OF THE USE OF ALTERNATIVE THERAPIES FOR ATTENTION-DEFICIT/HYPERACTIVITY DISORDER AND THE PHARMACIST’S ROLE IN THE INITIATION OF TREATMENT. Andanar D, Gatewood S, Moczygemba L, Virginia Commonwealth University, Carson R, Martin’s Food Stores, Goode J, Virginia Commonwealth University, E-mail: [email protected] Objective: This study aims to: (1) identify caregiver or patient perceptions of the pharmacist’s role in the initiation of treatment of attention-deficit/hyperactivity disorder (ADHD); and (2) identify perceptions of the use of alternative therapies for the treatment of ADHD. Methods: This is a cross-sectional survey. The participants will be patients >18 years of age and caregivers of children who have participated in a pharmacy-based ADHD service in the Richmond, Virginia, area. The ADHD service e134 JAPhA | 5 4:2 | M AR/AP R 2014 Downloaded From: http://mustafa.japha.org/ on 06/09/2014 is a pharmacist-physician collaboration to determine the best initial treatment option for a patient with ADHD. The survey will assess patient or caregiver perceptions of the pharmacist’s role in this service, comfort with pharmacist’s involvement in the service, and confidence in the pharmacist’s knowledge about ADHD medications. The survey also will assess patient and caregiver perceptions on herbal and dietary supplements for the treatment of ADHD. The survey will be pre-tested and revised based on feedback for content and clarity. Descriptive statistics will be used for data analysis in this study. Results: Research in progress. 160—STIMULANT MEDICATION UTILIZATION IN FOSTER AND NON–FOSTER MEDICAID CHILDREN 3 YEARS OF AGE OR YOUNGER. Kim-Romo D, Rascati K, The University of Texas at Austin, E-mail: [email protected] Objective: Current practice guidelines do not provide recommendations for the evaluation of attention-deficit/ hyperactivity disorder in children before the age of 4 years. While 1 study has evaluated the use of stimulants in children aged 3 to 5.5 years, there is a dearth of data evaluating the use of stimulants in children aged 3 years and younger and especially in children in foster care who are at a higher risk for mental health disorders. The objective of this study was to assess the use of stimulant medications in foster care and non–foster care Medicaid patients aged 3 years or younger. Methods: Texas Medicaid patient and prescription claims data were analyzed for patients who were 0 to 3 years of age at any time during the 2012 fiscal year to determine stimulant medication utilization and foster care status. Results: A total of 1,130,260 patients were 0 to 3 years of age, and 0.10% (n = 1,168) had at least 1 prescription claim for a stimulant medication. Approximately 3.22% (51/1,585) of foster care children were stimulant users compared with only 0.10% (1,117/1,128,675) of non–foster care children. A logistic regression analysis adjusting for demographic variables (sex and race/ethnicity) significantly ja p h a .org showed that patients in the foster care cohort were over 30 times more likely to receive at least 1 prescription for a stimulant medication compared with patients not in foster care (odds ratio [OR] = 30.93, 95% confidence interval [CI] 23.21–41.23, P<.001). Of the other demographic variables, sex was the only significant predictor of stimulant medication usage, where male patients were over 2 times more likely to receive a stimulant medication compared with female patients (OR = 2.69, 95% CI 2.36–3.07, P<0.001). Conclusion: Overall, less than onetenth of 1% of Texas Medicaid patients aged 3 years or younger utilized stimulants. Male patients and patients in the foster care system had a significantly higher likelihood of stimulant medication use compared with female patients and non–foster care children, respectively. Medication Therapy Management 161—ACHIEVING DESIRED HEALTH OUTCOMES IN THE REAL WORLD THROUGH ASSESSING AND INTERVENING TO IMPROVE MEDICATION ADHERENCE: ADHERE. Bateman Jr. M, McConaha J, Greco A, Duquesne University Mylan School of Pharmacy, Lynch K, Pfizer Inc., E-mail: [email protected] Objective: The objectives of this study are to: (1) describe medicationtaking behaviors in patients seen in the high-volume, grocery store chain pharmacy setting; and (2) identify barriers that deter patients from adhering to their medication regimens. Methods: Medication nonadherence is a significant health care issue among patients being treated for chronic conditions, resulting in poorer medical outcomes, higher hospitalization rates, and increased health care costs. The goal of this project is to collect information about patients’ barriers to medication adherence in addition to information about patients’ sources and content of medication knowledge. Results of this study will better equip pharmacists for the customization of patient counseling in the grocery store, community Journal of the American Pharmacists Association APhA2014 ABSTRACTS pharmacy setting. This project will use a cross-sectional survey design to evaluate patients’ medication-taking behaviors and related parameters. Information collected from the self-administered, written survey will include patient demographics, chronic conditions for which they are currently being treated, and an assessment of medication adherence. This written survey also includes questions from the Morisky scale with additional questions to evaluate patients’ medication-taking behaviors and related parameters. Technicians, student pharmacists, and pharmacists will distribute and collect the surveys and consent forms at the pharmacy counter. The survey will be offered to patients of the study pharmacy locations who are >18 years of age and these patients may decline taking the survey at any time. Descriptive statistics will be reported for each variable. Correlation analyses may be conducted for the various clinical, demographic, and patient perception variables and the overall Morisky results. Each variable may be entered into a regression model with the key outcome variable being the Morisky score. Results: Research in progress. Results may provide explanations for contributing factors leading to medication nonadherence, allowing pharmacists to offer more personalized patient counseling. 162—BRIDGING THE GAP BETWEEN CLINIC AND PHARMACY: DEFINING THE ROLE OF THE COMMUNITY PHARMACIST IN TRANSITIONS OF CARE WITH HEART FAILURE PATIENTS. Wingen H, University of Minnesota, Holtan H, Fischer K, Hennepin County Medical Center, Aytay M, Walgreens, E-mail: wing0125@ umn.edu Objective: The objective of the study is to evaluate the role of the transitional care pharmacist in the care of patients with congestive heart failure (CHF) when given access to the patient’s electronic health record (EHR) in the community pharmacy setting. CHF is a leading cause for hospital readmission, with 50% of the 5.7 million American patients living with CHF having a readmission within the first 6 months following discharge. Admission related costs total approximately $34.4 billion each year, a significant amount. The emerging role of a transitional care pharmacist attempts to fill the gap in the continuum of care that occurs between inpatient discharge and the following readmission. Access to the patient chart is key; without access the community pharmacist is limited in the involvement to help patients achieve their health goals. Access to the patient chart allows for the pharmacist to gain insight into patients’ medical history, including the inpatient admissions related to CHF, and the treatment plan. Methods: This study will be submitted to the institutional review board for approval. The large metropolitan healthsystem EHR will be used to identify recently discharged CHF patients with at least 1 CHF-related hospital admission and use specific Walgreens community pharmacies near the health system clinic to fill prescriptions. Approximately 5 Walgreens pharmacies will be utilized for on-site in-person patient encounters and these encounters will occur at baseline, which is within 2 weeks of discharge, 1 month post baseline encounter, and 3 months post baseline. Identified patients are given the choice to opt in or out of the study. Patients will be randomly selected from the same list of identified potential participants to serve as the control group. A protocol consisting of vitals, medication adherence questions, and screens for worsening CHF will be used to ensure consistency of each patient-pharmacist encounter. The pharmacist conducting the interventions will be a resident pharmacist with access to ambulatory care pharmacists for advising and will communicate with the provider to initiate any interventions involving medication changes. The pharmacist will primarily provide adherence support, assistance in medication management, continued education related to CHF with the ultimate goal to prevent exacerbation that may lead to admission. The data to be tracked is being determined. Results: Research in progress. 163—CAN Journal of the American Pharmacists Association Downloaded From: http://mustafa.japha.org/ on 06/09/2014 COMPONENTS OF j apha.org MEDICATION THERAPY MANAGEMENT SERVICES BE INCORPORATED INTO ROUTINE PATIENT COUNSELING?. Lester C, Chui M, University of Wisconsin–Madison, Helmke J, Kaefer T, Bremo Pharmacy, Moczygemba L, Goode J, Virginia Commonwealth University, E-mail: calester@ wisc.edu Objective: The objective of this study is to develop and evaluate a process for integrating components of medication therapy management (MTM) services into a community pharmacy workflow. Methods: This prospective, 3-month observational study took place in an independent community pharmacy. The intervention was a redesigned workflow that included a seated private counseling area and focus on the pharmacist, rather than the technician, being the first contact when patients came into the pharmacy. Process outcomes included time spent with the patient; the number of medication-related problems identified and recommendations made; and disease education, immunizations, and health monitoring tests provided. Satisfaction with the service was solicited via a survey to patients and a focus group with pharmacists. Results: A total of 56 patients were enrolled in the study resulting in 82 encounters. Forty medication-related problems, including experiencing adverse drug event and ineffective therapy, were identified with recommendations made to patients or prescribers. Disease education, such as goals of therapy, was provided 46 times. Health monitoring tests, such as blood pressure, were performed 16 times and 8 immunizations were given. The revised workflow incorporating components of MTM services into patient counseling was successful in that 39% of encounters were <2 minutes and 49% of encounters were 2 to 5 minutes in length. Only 12% of encounters were >5 five minutes. Overall, patients were very satisfied with the intervention. Pharmacists responded positively, but expressed concern that the new workflow prevented them from overseeing technician functions. Conclusion: For pharmacists to proMA R /APR 2014 | 54:2 | JAPhA e135 APhA2014 ABSTRACTS vide MTM services, they need to be able to incorporate it into their typical workflow. Unlike previous studies that have required lengthy interaction, this study may provide evidence that pharmacists can expand their routine patient counseling to include components of MTM services in <5 minutes of direct interaction with patients. 164—COLLABORATION TO IMPROVE OUTCOMES IN AN INTEGRATED MEDICARE MEDICATION THERAPY MANAGEMENT PROGRAM. Jeong E, Kaiser Permanente Southern California, E-mail: [email protected] Objective: The purpose of this project is to describe outcomes achieved from a Medicare medication therapy management (MTM) model involving ambulatory care pharmacists and support staff working under collaborative practice agreements with physicians. Methods: A large integrated health care delivery system that provides medical services and prescription drugs to both Medicare and non-Medicare members throughout the state of California developed a Medicare MTM program for eligible Medicare Part D patients. The majority of the patient management was conducted over the phone and consisted of medication reconciliation, development of an action plan or recommendations, and generation of a current medication list for the patient. The pharmacists worked collaboratively with the physicians who allowed for initiation, titration, and discontinuation of drug therapy under pharmacist protocol to improve various clinical and medication safety outcomes. Results: During the 2012 program year, the program performed 30,772 comprehensive medication reviews (CMRs) out of 40,233 patients who met the program’s description. Clinical outcomes that were measured included low-density lipoprotein (LDL) cholesterol control, A1C control, and medication adherence. The percent of Medicare MTM patients achieving LDL <100 mg/ dL was 83% for patients with diabetes and 82% for patients with coronary artery disease. Patients with diabetes with e136 JAPhA | 5 4:2 | M AR/AP R 2014 Downloaded From: http://mustafa.japha.org/ on 06/09/2014 A1C <9% was 89% and the adherence rate (measured by proportion of days covered) for biguanides, sulfonylureas, and thiazolidinediones was 90%, 89%, 79%, respectively. Patients taking statins had an adherence rate of 92%. The safety outcome that was measured assessed the percentage of patients that filled ≥1 prescriptions for a high-risk medication (HRM). The percentage of Medicare MTM patients who filled a HRM was 9%. Patients who received a CMR were 23% and 38% less likely to be hospitalized in the 2010 and 2011 program years, respectively. Conclusion: Collaboration with physicians within a large integrated health care system resulted in positive outcomes that improved the quality of care of Medicare MTM patients. 165—COMPARING THE COMPLEXITY OF PATIENTS SEEN FOR MEDICATION THERAPY MANAGEMENT IN VARIOUS PRACTICE SETTINGS. Smith K, University of Minnesota College of Pharmacy, Karg R, Supervalu Inc., Knutson A, Park Nicollet, Riss J, Brands M, Supervalu Inc., E-mail: [email protected] Objective: The objective of this study is to compare the complexity of the patients seen for medication therapy management (MTM) services in a community pharmacy setting with the complexity of the patients seen for MTM services in a clinic setting. Methods: Records of patients seen for MTM over a 6-month period at a group of grocery store–based community pharmacies will be reviewed for the age of the patient, the number of medications, number of medical conditions, and number of drug therapy problems identified during the visit. The data will be compiled and averages calculated. The same data will be complied from data collected via a “smart form” in the electronic medical record of a large clinic group in the same geographic area for the same time period for patients who had been seen by a pharmacist for MTM in the clinic setting. Results will be compared and statistical significance will be determined using a t test. Results: Research in progress. The ja p h a .org implications for practice are that by understanding the complexity of the patients seen by pharmacists in various settings, pharmacists can ensure their MTM services are meeting the needs of the patients they serve and that the services they offer are meeting the highest standards of patient care. This research will be used to prove the value of clinical services offered in the community pharmacy setting and to advocate for easier access to patient medical records for pharmacists offering these services. 166—COMPARISON OF THE NUMBER OF PATIENTS WITH MEDICATION CHANGES FOLLOWING COMPREHENSIVE VERSUS TARGETED MEDICATION REVIEWS IN A MEDICATION THERAPY MANAGEMENT PROGRAM. Buhl A, Augustine J, Chinthammit C, Boesen K, University of Arizona, E-mail: kboesen@ pharmacy.arizona.edu Objective: The objective of this project is to determine whether targeted medication reviews (TMRs) or comprehensive medication reviews (CMRs) resulted in more medication changes in the interest of improving patient outcomes. Methods: This cross-sectional quality improvement (QI) project compared the number of patients with positive medication changes in CMR and TMRonly patients who qualified for the Medication Management Center’s pharmacist-driven medication therapy management (MTM) program in 2012. The addition of an appropriate medication or the removal of an inappropriate medication was considered a positive medication change. Changes were verified by prescription claims 120 days post-intervention. Odds ratios (OR) were calculated using Wilcoxon rank-sum. This was a QI project, therefore it did not meet the federal definition of research and institutional review board approval was not required. Results: A total of 418,649 qualified patients were included in this project. The CMR group consisted of 43,490 patients (10%) and the TMR-only group consisted of 375,159 patients (90%) who did not receive a CMR. Fifty-six percent (n = 24,231) of CMR recipients and 47% Journal of the American Pharmacists Association APhA2014 ABSTRACTS of TMR-only recipients (n = 176,016) had a pharmacist-initiated recommendation sent to their prescriber (P<0.001). Thirty percent (n = 7,369) of CMR recipients and 35% (n = 61,969) of TMR-only recipients had a medication change following a prescriber intervention (P<0.001). CMR recipients were more likely to receive a recommendation (OR 0.70, 95% confidence interval [CI] 0.69–0.72). TMR-only recipients were more likely to have a recommendation result in a medication change (OR 1.24, 95% CI 1.21–1.28). Conclusion: The TMR-only group represented the majority of patients in this project. While the percentage of patients who received a recommendation in the TMR-only group was lower, a greater percentage of these patients received a medication change. This indicates that TMRs may be more effective in producing a positive medication change compared with CMRs. 167—COMPARISON OF THE PHARMACOKINETICS OF USL255, AN EXTENDED-RELEASE TOPIRAMATE, WHEN SPRINKLED ONTO SOFT FOOD OR SWALLOWED INTACT. Clark A, Anders B, Upsher-Smith Laboratories Inc., E-mail: [email protected] Objective: The objective of this study is to evaluate bioequivalence between USL255 beads sprinkled onto soft food compared with the intact USL255 capsule. USL255 is a once-daily extended-release formulation of topiramate developed for the treatment of epilepsy. Because some patients with epilepsy may have difficulty swallowing tablets or capsules, USL255 was formulated to allow the capsule to be opened and the beads sprinkled onto soft foods. Methods: This was a phase 1, randomized, open-label, single-dose, crossover study of 36 healthy adult volunteers who received 200 mg USL255 administered as an intact capsule or sprinkled onto 1 tablespoonful of applesauce. Blood samples were collected for 14 days post-dose and pharmacokinetic parameters were calculated, including area under the plasma concentration–time curve (AUC0–∞, AUC0–t), maximum concentration (Cmax), time to Cmax (Tmax), and termi- nal elimination half-life (t1/2). AUC and Cmax were considered bioequivalent if the 90% confidence intervals (CI) for the ratio of geometric least-squares means (GLSM) were contained between 0.80– 1.25. Tolerability was evaluated through adverse event (AE) monitoring, vital sign measurements, and clinical laboratory evaluations. Results: AUC and Cmax were bioequivalent between USL255 200 mg administered as an intact capsule and sprinkled onto soft food (GLSM [90% CI]: AUC0–t 1.01 [0.97–1.04]; AUC0–∞ 1.02 [0.98–1.05]; Cmax1.09 [1.03–1.14]). Median Tmax was 10 to 14 hours and t1/2 was similar for both administration methods (81.5 hour intact; 83.6 hour sprinkled). USL255 was generally well tolerated, with similar types and numbers of AEs reported in both groups. Conclusion: USL255 beads sprinkled onto soft food demonstrated bioequivalence for AUC and Cmax compared with the intact capsule. Therefore, USL255 can be a useful treatment option for individuals with difficulty swallowing. 168—COST OF INTERMITTENT PARTICIPATION IN MEDICATION THERAPY MANAGEMENT. Pinto S, Bechtol R, Conner T, The University of Toledo, E-mail: tessa.conner@rockets. utoledo.edu Objective: The purpose of this study is to examine the cost spending associated with intermittent participation in an employer-sponsored medication therapy management (MTM) program. Methods: This is a prospective, longitudinal, multi-site study conducted at 7 community pharmacies across Northwest Ohio beginning in 2005. Pharmacists counseled patients at 3-month intervals. Eligible patients had to have primary medical insurance and prescription coverage through the employer and a primary diagnosis for diabetes with or without other comorbid conditions. Of the 650 participants enrolled in the study, 310 were identified as intermittent participants. For this study, intermittent participants were defined as those patients who enrolled in the program for 2 years, dropped out for a 2-year period, and then returned. Retrospective data for Journal of the American Pharmacists Association Downloaded From: http://mustafa.japha.org/ on 06/09/2014 j apha.org 2 years prior to entering the program was obtained and participants were tracked for a total of 5 years following enrollment. Costs for physician office visits, emergency department visits, hospitalization, and total health care costs were examined. Results: Cost spending for the time period participants received MTM was observed to be less than pre-intervention. After 2 years in the program, participants who dropped out saw an increase in cost spending comparable to the preintervention period. Upon returning to the program, a decrease in cost spending was observed. For example, the average cost to the employer per patient per year (PPPY) was approximately $390 prior to enrollment. After 2 years in the program, the cost PPPY was observed to decrease to $175. Following a 2-year drop out, cost increased to $350 PPPY. Costs decreased to $200 during the rejoined year. This trend was observed for all 4 variables included in this study. Conclusion: This study attempted to capture cost spending when patients drop out of the MTM program. Results indicate a rise in spending during the post-participation dropout period. Employers and payers should encourage participants to continually stay enrolled in MTM programs to realize sustained cost savings. 169—DEVELOPING AND IMPLEMENTING AN INTERDISCIPLINARY TRANSITION OF CARE PROGRAM UTILIZING MEDICATION THERAPY MANAGEMENT AND THE PATIENT-CENTERED MEDICAL HOME MODEL ALONG THE U.S.–MEXICO BORDER. Gomez J, University of Texas El Paso/UT Austin and Centro San Vicente, Padilla M, University of Texas El Paso/UT Austin, Email: [email protected] Objective: The objectives of this innovative practice are to: (1) develop and establish an interdisciplinary transition of care (ITC) program; (2) integrate ITC into medication therapy management (MTM): (3) create a therapeutic interchange program (TIP) protocol and implement it with ITC; (4) categorize the adverse events (AEs) avoided; and (5) MA R /APR 2014 | 54:2 | JAPhA e137 APhA2014 ABSTRACTS measure patient satisfaction. Methods: This is a descriptive, prospective study that will occur from July 2013 through 2014. A pilot group (5–10 patients) will be used to test the transition of care program from a hospital to a federally qualified community health center. The target population will include patients without insurance who are frequent users of the emergency department and high-risk patients with Medicare who have had a hospitalization within 12 months of the study. The program will use pharmacists to conduct MTM prior to the first provider visit. This service may occur at the hospital upon discharge, as a home visit, or at the clinic. During the MTM visit, pharmacists will complete a comprehensive medication review, medication reconciliation, provide a medication action plan and personal medication list, and utilize the TIP protocol to substitute medications given at discharge to clinic formulary agents. Pharmacists will track the AEs avoided at each visit. In addition, pharmacists will empower patients to be active participants in their health care through promotion of healthy behaviors and preventative care. At the first provider visit, the electronic medical record will reflect active regimens, which will allow the provider to address more acute concerns. A validated patient satisfaction survey (in English or Spanish) will be given after the MTM visit to assess the patient experience for quality improvement. This project serves as an example of how pharmacists can contribute to the patient-centered medical home model and help alleviate access barriers in underserved populations. Results: Research in progress. 170—EVALUATING THE IMPLEMENTATION OF A PHARMACISTLED TRANSITION OF CARE MEDICATION THERAPY MANAGEMENT SERVICE IN AN UNDERSERVED POPULATION. Stone N, Ulbrich T, Awad M, Northeast Ohio Medical University, Kelling S, University of Michigan, E-mail: [email protected] Objective: Medication therapy management (MTM) can decrease medication discrepancies after hospital e138 JAPhA | 5 4:2 | M AR/AP R 2014 Downloaded From: http://mustafa.japha.org/ on 06/09/2014 discharge and is a tool used to improve patient outcomes. The primary objective of this study is to measure the impact of a transition of care MTM service between local area hospitals and a federally qualified health center (FQHC). Measures of service impact will include 30-day hospital readmission rates and number of drug therapy problems identified and resolved. The secondary objective is to evaluate the service process measures including patient participation rates, usual time to conduct the visit, and average number of disease states and medications per patient. Methods: All current adult patients of the FQHC discharged from local area hospitals from January 1, 2014 through March 1, 2014 will be eligible for participation. The FQHC will use discharge summaries received from local area hospitals to identify qualifying patients. Based on a standing order at the FQHC, the patient will be contacted to schedule a face-to-face pharmacy visit within 14 days of hospital discharge. Patient participation will be measured by the number of appointments scheduled, no-show rates, and percent who decline the service. Potential and actual drug therapy problems will be documented and forwarded to the patient’s provider via the electronic medical record at the FQHC. Directly following the encounter, time to conduct the visit, number of disease states, and number of medications will be recorded. The medical record will be reviewed 14 days after the encounter to determine the number of recommendations accepted. Readmission within 30 days of hospital discharge will be determined if the FQHC receives 2 separate discharge summaries within a 30-day period. Descriptive statistics will be used to report the data. Results: Research in progress. 171—EVALUATION OF ECONOMIC OUTCOMES FROM A PHARMACIST-PROVIDED MEDICATION THERAPY MANAGEMENT CLINIC OVER 4 YEARS. Groves C, University of Maryland–Baltimore, Truong H, University of Maryland–Eastern Shore, Congdon H, University of Maryland, Botchway R, Dang T, Primary Care Coja p h a .org alition of Montgomery County, E-mail: [email protected] Objective: The objective of this study is to evaluate economic outcomes of medication therapy management (MTM) services delivered in safety-net clinics over a 4-year period. Methods: High-risk patients with multiple medications and chronic conditions were referred to an MTM clinic in a Health Resources and Services Administration (HRSA) Patient Safety and Clinical Pharmacy Services Collaborative (PSPC) for comprehensive medication therapy review. Pharmacists identified, prevented, and resolved medicationrelated problems (MRPs) including actual or potential adverse drug events as a focus of the HRSA PSPC initiative. Pharmacists’ recommendations were reviewed and adopted by the collaborating physicians. The time spent during face-to-face encounters with patients was tracked utilizing the 3 MTM billing codes: 99605 for the first 15 minutes of the initial visit; 99606 for the first 15 minutes for a follow-up visit; and 99607 for additional 15-minute increments of initial or follow-up visits. A literature review was conducted to extrapolate and quantify the MRPs. Expense of MTM services, primarily pharmacists’ salary over 4 years, also was calculated. All MRPs and pharmacists’ expenditure were determined and used to evaluate the estimated cost savings and return on investment (ROI) to assess the potential economic outcomes for the health care system over a 4-year period. Results: Research in progress. Over a 4-year period, 246 patients were provided MTM services yielding 566 30-minute encounters, which occurred once weekly. Among those encounters, billing code 99605 was utilized 245 times, 99606 was utilized 302 times, and 99607 was utilized 585 times. The amount of pharmacists’ expense for all encounters were calculated based on $2.70 per minute with 25% fringe benefits, providing a total expenditure of $57,307.50 for 16,980 minutes. The estimated ROI is being determined pending data analysis of the identified MRPs. 172—FALL RISK POTENTIAL AND Journal of the American Pharmacists Association APhA2014 ABSTRACTS THE BEERS CRITERIA ADDRESSED BY FOURTH-YEAR STUDENT PHARMACISTS COMPLETING MEDICATION THERAPY MANAGEMENT ACTIVITIES DURING REQUIRED COMMUNITY ADVANCED PHARMACY PRACTICE EXPERIENCES. Hale K, Brown S, University of Montana Skaggs School of Pharmacy, E-mail: katherine.hale@ umontana.edu Objective: The purpose of this study is to determine whether fourth-year student pharmacists address potential fall risk and use of medications meeting the Beers criteria when completing medication therapy management (MTM) activities during required community advanced pharmacy practice experiences (APPEs). Methods: Students completing required community APPEs at the University of Montana Skaggs School of Pharmacy must complete a minimum of 1 MTM case during the 4-week rotation. Care plans were included for analysis if they were submitted during academic year 2012–13 and involved patients who were ≥65 years of age. Each care plan was evaluated to determine if the student addressed fall risk and the use of medications included in the 2012 American Geriatrics Society Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. Patient demographics including age, sex, and number and type of medications meeting the Beers criteria were gathered. Results: Eighty care plans were submitted, and 33 met criteria for inclusion in this review. Of the 33 patients, 18 were female (55%) and 15 were male (45%). The average patient was 75 years of age, had 8 chronic disease states, and took 11 prescription medications and 4 overthe-counter medications. Four (12%) students addressed potential fall risk, and 2 (6%) students addressed the Beers criteria in the assessment/plan. Ten patients did not take any medications meeting the Beers criteria, while the remaining 23 took an average of 2 (range 1–4). Aspirin use, sliding-scale insulin, benzodiazepine and non-benzodiazepine hypnotics, alpha-1 blockers, and tricyclic antidepressants were the most common medications meeting Beers criteria used by the 23 patients. Conclusion: In patient care plans by fourth-year student pharmacists, potential fall risk and potentially inappropriate medication use in the elderly is rarely addressed. This illustrates the need to educate students on the importance of assessing and managing issues specific to geriatric patients. 173—FINAL RESULTS OF STUDENT SELF-ASSESSMENT OF MEDICATION THERAPY MANAGEMENT ACTIVITIES IN REQUIRED COMMUNITY ADVANCED PHARMACY PRACTICE EXPERIENCES. Hale K, Brown S, University of Montana Skaggs School of Pharmacy, E-mail: katherine. [email protected] Objective: The purpose of this study is to evaluate the change in student knowledge, skills, and ability to identify, assess, and resolve drug-related problems in medication therapy management (MTM) encounters during a required community advanced pharmacy practice experience (APPE). Methods: Student pharmacists participating in required community APPEs must perform the core elements of an MTM encounter with a minimum of 1 patient. A survey administered at the end of the 4-week APPE evaluated student self-assessment of pre- and postAPPE knowledge, skills, and ability to perform an MTM encounter based on 13 defined competencies. The survey also collected information on student MTM encounters, such as number and type of encounters as well as time spent on each encounter. Surveys were administered over a 2-year period from May 2010 through May 2012. Results: Over 2 years, 229 MTM encounters were completed by 95 student pharmacists. Most students (43%) spent 5 to 8 hours on a single encounter. The activity was rated as effective to very effective by 94% of students. Self-assessment scores improved significantly from baseline for all items (P<0.05), with the highest change in communication with primary care providers. Students rating their ability as medium-high to high increased by 62% following the completion Journal of the American Pharmacists Association Downloaded From: http://mustafa.japha.org/ on 06/09/2014 j apha.org of the community APPE. Conclusion: Implementation of MTM activities in a required community APPE significantly increased student pharmacists’ knowledge, skills, and ability to perform an MTM encounter. 174—IDENTIFICATION AND RESOLUTION OF DRUG THERAPY PROBLEMS BY COMMUNITY PHARMACISTS THROUGH TELEPHONE FOLLOW-UP AFTER CARE TRANSITIONS. Cross C, Patel D, New Albertsons Inc., Winkler S, Midwestern University Chicago College of Pharmacy, Wagner M, New Albertsons Inc., E-mail: [email protected] Objective: The purpose of this study is to describe the drug therapy problems identified and resolved by community pharmacists at 3 to 5 days and at 30 days post-hospital discharge. Methods: This is a single-center, prospective, descriptive study. Eligible subjects will be identified upon the presentation of a written or computer-generated prescription on a hospital-affiliated prescription blank to the community pharmacy. Subjects will be included if they meet 1 of the following criteria: discharged from hospital stay of ≥1 night, discharged from a visit to the emergency department, or discharged from a hospital-based outpatient procedure. A pharmacist will call study subjects at 3 to 5 days post-discharge and at 30 days post-discharge. During each phone call, the pharmacist will assess for drug therapy problems and resolve them by means of education and/or follow-up with the primary care physician. All drug therapy problems identified will be categorized and documented according to a modified classification system outlined by Cipolle et al. Descriptive statistics will be used to report the drug therapy problems identified and resolved by pharmacists at each intervention. An algorithm also will be applied to compiled drug therapy problems to determine cost savings associated with pharmacist interventions. Results: Research in progress. Reimbursement provisions put forth in the Affordable Care Act and current trends of high hospital readmission rates have made care transition interventions viMA R /APR 2014 | 54:2 | JAPhA e139 APhA2014 ABSTRACTS tal to the sustainability of hospitals and improvement of patient outcomes. It is anticipated that this research will demonstrate the significant role community pharmacists play in optimizing care transitions through necessary drug therapy interventions. 175—THE IMPACT OF COMPREHENSIVE MEDICATION REVIEWS PERFORMED BY COMMUNITY PHARMACISTS IN COLLABORATION WITH EMERGENCY MEDICINE PHARMACISTS POST EMERGENCY DEPARTMENT OBSERVATION UNIT DISCHARGE: A TRANSITION OF CARE PILOT STUDY. Long B, The Ohio State University, Kuhn C, The Kroger Co., McAuley J, Shirk M, Wehr A, Bennett M, The Ohio State University, E-mail: [email protected] Objective: The purpose of this study is to identify the impact of comprehensive medication reviews (CMR) performed by community pharmacists in collaboration with emergency medicine (EM) pharmacists for patients discharged from an emergency department (ED) observation unit (OU). Objectives of the study are to: (1) compare the modified Care Transition Measure (CTM-15) Medication Section results after OU discharge to after community pharmacistperformed CMR; and (2) identify and quantify drug-related problems (DRP) from the CMR. Methods: The pilot study will occur with patients discharged from an academic medical center ED OU, who participate in a CMR at a grocery store chain community pharmacy. Patients will be admitted to the OU per established protocol. Eligible patients include those >18 years of age with a specific Ohio Managed Medicaid insurance plan and diagnoses of cardiovascular disease (hypertension and congestive heart failure), diabetes, and/or respiratory disease (asthma and chronic obstructive pulmonary disorder). EM pharmacists will enroll the patients, create a discharge summary, and fax the summary to the community pharmacist. The community pharmacist will schedule and conduct a CMR in accordance with the Medication Therapy Management Core Elements e140 JAPhA | 5 4:2 | M AR/AP R 2014 Downloaded From: http://mustafa.japha.org/ on 06/09/2014 within 14 days of OU discharge. After the CMR, the patient will be asked to complete the survey instrument. A retrospective post-then-pre survey methodology will be used to identify the impact of a CMR delivered by a community pharmacist after a patient experiences this transition of care. This methodology will be utilized to decrease response shift bias, which can be an issue when assessing self-reported change. Additionally, the community pharmacist will collect data to quantify and describe DRP from the CMR. Descriptive statistics will be used to characterize the pilot study’s data. Results: Research in progress. 176—THE IMPACT OF COORDINATION OF CARE IN COMMUNITY PHARMACIST–DELIVERED MEDICATION THERAPY MANAGEMENT. Kleyman S, Snyder M, Purdue University College of Pharmacy, E-mail: [email protected] Objective: This study aims to determine whether pharmacists identify more health-related problems during medication therapy management (MTM) when they engage in care coordination, defined as having access to health records from a patient’s prescriber, in comparison with not having access. This study also seeks to describe parts of the health record used by pharmacists to identify health-related problems and explore whether care coordination during MTM prevents hospital or emergency department utilization at 90 days post MTM. Methods: After institutional review board approval, community pharmacies that deliver MTM without care coordination will be randomized to deliver either usual MTM care or MTM with care coordination. A target of 150 patients eligible for MTM through their Medicare Part D plan will be enrolled. Pharmacists in the care coordination arm will attain and review a target of the previous 6 months of the patient’s health records. Pharmacists in both arms will contact the patient 90 days post MTM and inquire on hospital or emergency department utilization and will record: patient demographics, number and types of health problems discovered, which parts of the patient’s health records were used to discover ja p h a .org health problems, and rates of hospitalization or emergency department utilization. Data will be analyzed using parametric and nonparametric statistics, as appropriate. Results: Research in progress. This study will determine whether pharmacists who engage in care coordination during MTM delivery discover more health-related problems and, subsequently, whether their patients utilize emergency departments and hospitals less often. 177—IMPACT OF DELAYED-DOSE ADMINISTRATION OF USL255, AN EXTENDED-RELEASE TOPIRAMATE FORMULATION. Anders B, Clark A, Upsher-Smith Laboratories Inc., E-mail: [email protected] Objective: The objective of this study is to gain an understanding of pharmacokinetic effects associated with delayed administration of USL255. USL255, a once-daily, extended-release formulation of topiramate, was developed for the treatment of epilepsy. While once-daily formulations may improve patient compliance, delayed dosing may cause steady-state plasma concentrations to decrease below minimum therapeutic concentrations. Methods: Nonparametric superpositioning was used to simulate steadystate pharmacokinetic profiles from single-dose USL255 200 mg data. A 14day dose administration (200 mg/day) to achieve steady-state conditions was simulated (full compliance), followed by a 6-, 12-, 18-, and 24-hour (double dose) simulated delay in dosing, with oncedaily dosing resuming after the late dose. Mean-predicted topiramate concentrations were calculated for each delayeddose scenario and compared with full compliance. Simulated minimum (Cmin) and maximum concentrations (Cmax) were evaluated for 96 hours following the late dose. Results: Mean predicted plasma concentrations prior to the next scheduled dose decreased incrementally as the time delay increased. However, within 24 hours after late-dose administration (followed by compliant dosing), topiramate concentrations for all delayed-dose Journal of the American Pharmacists Association APhA2014 ABSTRACTS scenarios were similar by visual comparison to simulated full-compliance concentrations. Concentrations were generally highest 2 days after a USL255 dose was administered 6, 12, 18, or 24 hours late; mean Cmax values were 2.09%, 4.25%, 6.79%, and 11.85% higher than steady-state concentrations, and corresponding Cmin values increased by 2.55%, 5.12%, 7.67%, and 10.23%. Three days after delayed-dose administration, Cmax and Cmin values were 1.14–7.03% and 1.33–5.31% higher, respectively, compared with compliant dosing. Conclusion: After a USL255 dose was administered up to 24 hours late, simulated topiramate concentrations returned to near steady state within one 24-hour interval. These data demonstrate dosing USL255, up to 18 hours after a missed dose (i.e., 6 hours before the next scheduled dose), minimizes the time that topiramate concentrations may be below minimum therapeutic concentrations without significant risk of increased (>10%) Cmax. 178—IMPACT OF AN INPATIENT MEDICATION THERAPY MANAGEMENT REFERRAL PROGRAM IN AN INTEGRATED CARE DELIVERY SYSTEM. Born M, Carlson M, Ferkul K, Fairview Health Services, E-mail: [email protected] Objective: The objectives of this study are to: (1) evaluate a tool used to identify patients to be referred for medication therapy management (MTM) services; and (2) compare the number of MTM referrals pre- and post-implementation. Methods: Much attention has been given to the use of MTM services in the care transition period after a patient discharges from the hospital. Presently, health-system infrastructure precludes referring every patient to an MTM provider, so a focus on how to refer and which patients to refer to MTM providers is important. In this health system, approximately 10% of hospital discharges could feasibly be seen by current MTM pharmacy staff. This study is an evaluation of an electronic best practice alert (BPA,) which was developed with pharmacist input as part of a system-wide care coordination team. The purpose of the tool is to identify patients in an academic medical center who may benefit most from an MTM visit (i.e., high-risk patients). The study will be approved the University of Minnesota institutional review board. During a 4-week trial period, the tool will be evaluated for its efficacy in identifying high-risk patients. Manual review of patient charts will be performed to ensure the tool is working properly. The total number of BPAs will be recorded and evaluated as percentage of all hospital discharges. During the study period, a hospital pharmacist will use the BPA to identify and refer patients for an outpatient pharmacist-provided MTM visit. The hospital pharmacist also will visit the patient while admitted to encourage follow-up with the MTM visit. The BPA tool will retrospectively be applied to patients from a similar time frame 1 year previous to be used as a control. Descriptive statistics will be used to evaluate the pre- and post-implementation data. Results: Research in progress. 179—IMPACT OF A NATIONWIDE MEDICATION THERAPY MANAGEMENT PROGRAM ON DRUGRELATED PROBLEMS AT THE MEDICATION MANAGEMENT CENTER IN 2012. Tse B, Augustine J, University of Arizona College of Pharmacy, Boesen K, University of Arizona, E-mail: kevin. [email protected] Objective: The objective of this project is to compare provider acceptance rates of medication therapy management (MTM) interventions initiated by an MTM center for potential drugrelated problems in 2012. Interventions included cost savings to patients, adherence to clinical guidelines, medication adherence, and safety initiatives. Methods: This retrospective crosssectional project measured the provider acceptance rates of MTM interventions for Medicare Part D beneficiaries. Intervention count and acceptance rates were analyzed from the center’s MTM software and database that utilizes prescription claims analysis post-intervention to determine intervention success. A chi-square test was used to assess the Journal of the American Pharmacists Association Downloaded From: http://mustafa.japha.org/ on 06/09/2014 j apha.org statistical significance between the interventions. An alpha level of 0.5 was determined a priori. This was a quality improvement project, and institutional review board approved this project as exempt status. Results: Thirty-five percent of recommendations were accepted (159,795/455,898). The rate of acceptance was highest for safety interventions (51%), followed by cost (35%), adherence (12%), and guidelines (8%). The acceptance rates for the 4 intervention types were statistically different from each other (P<0.0001). Within each intervention type, the most frequently accepted interventions were: removal of medications from the Beers criteria (8% of safety-related changes); changes from a brand name, non-oral medication such as eye drops and nasal sprays, to a generic within the same class (15% of cost saving–related changes); improved adherence to hypertension and diabetic medications (29% of adherence-related changes); and adding an antihypertensive agent to diabetic patients (62% of clinical guideline–related changes). Conclusion: Safety initiatives had the highest acceptance percentage of all 4 intervention types. Approving more safety interventions with medication use may reduce the risk of morbidity and mortality. Pharmacists providing MTM services may want to increase focus on drug safety as providers are accepting more safety interventions. More research is needed to determine why providers approve the other recommendations at lower rates. 180—IMPACT OF USING A PHARMACY RESIDENT TO TRAIN COMMUNITY PHARMACISTS ON A WEB-BASED PROGRAM TO PROVIDE MEDICATION THERAPY MANAGEMENT SERVICES. Kang S, Schnucks Specialty Pharmacy, E-mail: [email protected] Objective: The purpose of this study is to determine the effectiveness of using a postgraduate year 1 (PGY1) community pharmacy resident in training pharmacy managers and staff pharmacists of a retail pharmacy on using a web-based program to provide medication therapy MA R /APR 2014 | 54:2 | JAPhA e141 APhA2014 ABSTRACTS management (MTM) services to eligible patients. Methods: The PGY1 pharmacy resident had introduced OutcomesMTM, a web-based MTM program to 100 pharmacy managers of a privately owned chain pharmacy in a short presentation during the annual pharmacy managers’ meeting. Pharmacy managers were given time to register to set up an account, complete the online training, and start making MTM claims through the webbased program. All pharmacists were encouraged to ask questions regarding making claims to the pharmacy resident via e-mail or phone. After at least 1 pharmacist at each store pharmacy had been registered and approved to make MTM claims by OutcomesMTM, the resident traveled to each store pharmacy for a 15-minute live training session to reinforce the process of using the program. Overall effectiveness will be determined by comparing the total number of MTM service claims made through the webbased program prior to the training session and at 30 days and 60 days posttraining. Results: Research in progress. Registration of all pharmacists has not yet been completed. 181—IMPLEMENTATION AND EVALUATION OF SPECIALIZED WORKFLOW FOR TARGETED INTERVENTIONS IN A GROCERY STORE CHAIN PHARMACY. Yacko C, Andring T, McGivney M, University of Pittsburgh, E-mail: [email protected] Objective: The purpose of this project is to implement and evaluate the effect of a specified workflow on completion rate and financial metrics of OutcomesMTM Target Intervention Programs (TIPs) and Encounters. Methods: The study was conducted in 2 high-volume grocery store chain community pharmacies serving a significant portion of OutcomesMTM eligible patients. Implementation of TIPs into the workflow design was completed through intern-led training on how to identify eligible patients, complete reimbursable medication therapy management (MTM) services, and complete documentation and billing. Chain lead- e142 JAPhA | 5 4:2 | M AR/AP R 2014 Downloaded From: http://mustafa.japha.org/ on 06/09/2014 ership accompanied the intern during training and 40 additional pharmacist hours for service implementation. The intern partnered with the pharmacist manager and staff to provide ongoing support via phone. The ongoing analysis of this implementation includes: comparing MTM completion rates for 6 months before and after the training and an evaluation of revenue generated from the OutcomesMTM service and costs associated with its operation. This study was determined exempt from informed consent by the university’s institutional review board. Results: Research in progress. Preliminary results show intern-led implementation, coupled with corporate support, provided the staff with the tools necessary to begin providing reimbursable MTM services to eligible patients. Additionally, the pharmacists at both locations utilized the intern for mentoring and real-time problem solving. MTM completion rate comparison and financial analysis are ongoing. This project will provide insight on how an MTM service can be implemented in workflow of a high-volume grocery store chain community pharmacy. Q 182—IMPLEMENTATION OF CLINICAL PHARMACIST IN THE MEDICAL HOME MODEL. Ball H, Fort Belvoir Community Hospital, Email: [email protected] Objective: The purpose of this study is to assess the impact of a clinical pharmacist on Healthcare Effectiveness Data and Information Set (HEDIS) measures when providing disease management services to the patient-centered medical home (PCMH) model. Methods: In this study, 127 diabetic patients and 130 hyperlipidemia patients were followed over a 12-month period by the clinical pharmacist within the family medicine residency clinic. Disease management services provided included medication education, medication adjustments, follow-up lab orders, and follow-up visits via phone call or clinic visits. The primary study endpoints were changes in low-density lipoprotein (LDL) cholesterol and A1C from baseline to 15 months. ja p h a .org Results: Over the 12-month followup period, average A1C levels decreased from 8.59% to 7.34% (P<0.0001). Average LDL levels decreased from 111.83 mg/ dL to 90.48 mg/dL (P<0.0001). Average blood pressure at the end of the study period was <130/80 mmHg. Conclusion: Implementation of a clinical pharmacist within the PCMH model improves HEDIS measures of patients with diabetes and hyperlipidemia. Original Citation: Joint Forces Abstract #32 183—IMPLEMENTATION OF CLINICAL PHARMACY SERVICE FOR PREVENTING PRESCRIPTION ERRORS IN A WOMEN’S HEALTH INTENSIVE CARE UNIT. Costa L, Ferracini A, Rodrigues A, Cruz A, Barros A, Silva N, Carvalho R, Moriel P, University of Campinas, Mazzola P, pmazzola@ fcm.unicamp.br, Department of Clinical Pathology , E-mail: [email protected] Objective: The aim of this study is to evaluate the impact of clinical pharmacy implementation in patient safety of a specialized women’s health intensive care unit (ICU) through quantification and assessment of the clinical significance of pharmacy interventions and prescription errors. Methods: The study was conducted from February 2012 to February 2013 in the ICU of a university women’s hospital. The pharmacist analyzed prescriptions of patients >18 years of age, admitted to ICU for >24 hours and performed interventions during bedside visits, quantifying and dividing them into accepted or not by the medical team. Prevented prescription errors also were quantified, and clinical significance of the errors and the interventions were assessed. Drugs most commonly involved in prevented errors were quantified and classified by ATC classification. Statistical analysis was performed using the Fisher exact test to assess the association between drug classes and clinical significance of errors. Results: There were 224 patients monitored (110 obstetrics, 96 oncological, and 18 gynecological); mean age was 44.4 ± 18.1 years (mean ± standard deviation). A total of 1,259 prescriptions Journal of the American Pharmacists Association APhA2014 ABSTRACTS were evaluated, in which 104 prescription errors were identified; of these 90 prescription errors were prevented. The most common prescription errors were dosage higher than correct (n = 17) and unsafe medication due to drug interaction (n = 17). Among the 130 interventions performed, 116 were accepted, 4 partially accepted, and 10 not accepted. The most common were dosage (n = 30) and drug information (n = 17). Drugs to digestive tract (n = 43) and nervous system (n = 20) were the most involved in the errors. There was statistical association between involved drug classes and the clinical significance of errors (P = 0.0359). Most prevented errors were significant (n = 74) and serious (n = 18); most of interventions were significant (n = 67) and somewhat significant (n = 18). Conclusion: Clinical pharmacy implementation contributed to patient safety by preventing prescription errors and reducing risks from drug therapy. 184—IMPLEMENTATION OF A MARKETING STRATEGY TO INCREASE PATIENT PARTICIPATION IN MEDICATION THERAPY MANAGEMENT IN A COMMUNITY SETTING. Kosloski K, Steber S, Charles M, Simenson S, Goodrich Pharmacy, Email: [email protected] Objective: The primary objective of this study was to determine whether implementing a marketing strategy that focused on increasing patient awareness and knowledge by providing patients informational packets would increase patient participation in a community medication therapy management (MTM) practice setting. The secondary objective was to determine whether the inclusion of a primary care provider (PCP)–endorsed recruitment letter in the informational packet would further increase patient participation compared with generic recruitment letters. Methods: This was a quasi-experimental, randomized, controlled study with 155 patients targeted for MTM services at a community-based clinical pharmacy practice. Informational packets about MTM services, which included an MTM informational brochure, along with either a generic recruitment letter or a PCP-endorsed recruitment letter were mailed to each patient in the intervention groups. Recruitment phone calls were conducted within 14 days of mailings. The main outcome measure was patient participation in clinical MTM services. Results: A total of 155 patients were enrolled in this study. The control group had 17% participation in MTM services (n = 13) compared with 33% participation (n = 26) with the intervention group. The intervention group had a statistically significant (P = 0.006) 16% increase in patient participation. There was no statistical difference between using a generic recruitment letter versus a PCP endorsed letter. Conclusion: Use of a marketing strategy that included an informational packet sent to patients resulted in increased patient participation in community MTM. This increase in participation may be related to the increased awareness that these informational packet conveyed to patients. 185—IMPROVEMENT OF UTILIZATION OF CLINICAL SERVICES IN COMMUNITY PHARMACY USING MEDICATION SYNCHRONIZATION AND THE APPOINTMENTBASED MODEL. Butler S, Stafford R, University of Arkansas for Medical Sciences, E-mail: [email protected] Objective: The objectives of this study are to: (1) determine the impact of medication synchronization (MS) and appointment-based model (ABM) on revenue from prescription and clinical sales; and (2) explore the effects of these models on pharmacists’ workflow, with the intention of freeing up time to perform more clinical actions such as medication therapy management (MTM) and immunizations, by measuring the reallocation of time spent per patient on a monthly basis using company standard measurements of workflow functions. Methods: A convenience sample of 10 to 20 patients per pharmacy eligible for MTM services and ≥18 years of age will be selected from 2 supermarket pharmacies. The patient’s medication profile will be analyzed to determine the appropriate MS schedule. All medications requested by the patient will be Journal of the American Pharmacists Association Downloaded From: http://mustafa.japha.org/ on 06/09/2014 j apha.org synchronized to the specified appointment date. Expected study duration is 4 to 6 months. Objectives will be measured by comparing the sample’s averages for 6 months prior to the study and during each month of the study. Descriptive statistics will be used to analyze the data. Results: Research in progress. Some pharmacies employ clinical pharmacists, outside the normal workflow, to provide clinical services. Demonstrating the impact of utilizing MS and ABM to allow pharmacists to use time efficiently and to generate revenue could imply that clinical services should be included in normal workflow provided by all community pharmacists. Clinical service success may increase when the pharmacists providing the services are those assigned to workflow in the same store daily, which have a relationship with the patients, rather than clinical pharmacists who float to stores as needed. Showing positive outcomes in this patient sample could lead to expansion of the models in more stores where greater results and further conclusions could be generated. 186—THE INFLUENCE OF COMMUNITY PHARMACISTS ON STAR RATINGS: FOCUS ON DIABETES MEDICATION ADHERENCE. Berenbrok L, University of North Carolina at Chapel Hill Eshelman School of Pharmacy, Michaels N, Lee J, Petri D, Kerr Drug Inc., Marciniak M, Ferreri S, University of North Carolina at Chapel Hill Eshelman School of Pharmacy, E-mail: [email protected] Objective: With pay-for-performance models gaining ground in the United States, the role and impact of pharmacists on value-based health care are becoming increasingly important to patients and to third-party payers. Star ratings, designed to encourage value by the Centers for Medicare and Medicaid Services (CMS), guide patient selection of Medicare Prescription Drug Plans by rating each plan on quality and performance using a scale of 1 to 5 stars. Plans may achieve a 5-star rating by meeting benchmarks for several predetermined measures of quality. One such measure that pharmacists can impact is proportion of days covered (PDC) for diabetes MA R /APR 2014 | 54:2 | JAPhA e143 APhA2014 ABSTRACTS medications. This study aims to evaluate to what extent community pharmacists can impact star ratings by initiating targeted underuse interventions. Methods: This retrospective study includes data obtained from OutcomesMTM documented by pharmacists of a regional pharmacy chain. Claims billed using OutcomesMTM as metformin underuse with a status of approved/paid from January through December 2012 will be included for analysis. For each claim identified, the pharmacy dispensing software will be utilized to calculate the PDC for each underuse claim 6 months prior and 6 months following the pharmacist’s intervention. A paired Student t test will be used to evaluate a change in pre- and post-intervention PDC for patients underusing metformin to represent a chainwide impact on star ratings. Results: Research in progress. Institutional review board approval is anticipated in November 2013. Data analysis will occur December 2013 through January 2014, with results available in March 2014. Preliminary reports indicate that over 300 claims are eligible for analysis. 187—MEASURING THE IMPACT OF AN INTERDISCIPLINARY POLYPHARMACY CLINIC WITHIN A PATIENT-CENTERED MEDICAL HOME. LaBella S, Li G, Barnes K, Matthews D, Beatty S, The Ohio State University, E-mail: [email protected] Objective: The primary objective of this project is to track the types of interventions made in an interdisciplinary polypharmacy clinic to improve medication regimens and medication burden. Polypharmacy has been well documented in the literature as a risk for medication errors, adverse drug events, and morbidity. Team visits, including complete medication reviews, by pharmacists and physicians within a National Committee for Quality Assurance (NCQA) tier 3 patient-centered medical home (PCMH) at an academic medical center, can improve medication regimens. Secondary objectives include: (1) measuring each patient’s quality of life at baseline and 1 month post-intervention and (2) tracking the cost of medication e144 JAPhA | 5 4:2 | M AR/AP R 2014 Downloaded From: http://mustafa.japha.org/ on 06/09/2014 additions and discontinuations. Methods: Patients taking ≥10 chronic medications will be identified for referral to the polypharmacy clinic from a report generated from the electronic medical record. The polypharmacy clinic will be staffed by a pharmacist and medical resident with oversight from an attending physician who specializes in geriatrics. Drug-related problems identified during the visit will be resolved and categorized based on indication, efficacy, cost, safety, and compliance. The numbers and types of interventions made, both during the primary visit and anticipated in the future, will be tracked. The 12-item short form (SF-12) survey also will be administered at baseline and 1 month post intervention. The increase or decrease in cost for medications added and removed during these visits will be captured using the average wholesale prices. Results: Research in progress. Using descriptive statistics, the types of drugrelated problems identified and interventions made will be reported. Changes in quality of life and monthly medication costs will be described. 188—PATIENTS’ KNOWLEDGE AND PERCEIVED VALUE OF A COMMUNITY PHARMACY MEDICATION THERAPY MANAGEMENT PROGRAM. Mobley-Bukstein W, Ulrich E, Aldrich C, Drake University, E-mail: wendy.mobley-bukstein@ drake.edu Objective: The objective of this study is to determine patients’ knowledge and perceived value of a community pharmacy–based medication therapy management (MTM) program. Methods: This study consists of a cross-sectional 10-item survey distributed to patients of 15 franchise community pharmacy locations, owned by a single company, in a large Midwestern city. Individuals who are eligible to receive MTM services were included in this study; patients must be diagnosed with ≥5 comorbidities and/or taking ≥10 prescription medications. A computer-generated random sample of 100 subjects was created from the pool of all patients who meet this requirement from all 15 pharmacies. An online survey was ja p h a .org sent to those subjects who had an e-mail address and a paper copy of the survey was mailed to those without an e-mail address. Measures of interest include: demographics, type of prescription drug coverage, awareness of MTM service being offered at the pharmacy, perceived value of an MTM service, willingness to pay for an MTM service, and preference of setting to receive an MTM service. After 2 weeks, follow-up postcard and/or phone call reminders were conducted. The survey respondents were given 4 weeks to respond. At this time, data are being collected. Descriptives and frequencies will be conducted for all survey items. Chi-square and Spearman correlations will be conducted to determine the relationships between subjects’ perceived value of an MTM service, willingness to pay, preferred setting to receive an MTM service, and demographic and type of prescription drug coverage. These analyses may characterize different subgroups of patients. It is expected that there will be a correlation between patients who perceive value in the MTM service and patients who are willing to pay for an MTM service. Results: Research in progress. There are no results available because the survey is still active. 189—PHARMACOTHERAPY AND MANAGEMENT OF ASTHMA AMONG CHILDREN AND YOUNG ADULTS IN AN OFFICE-BASED AMBULATORY CARE SETTING. Lam A, Rhiel T, Maneno M, Howard University College of Pharmacy, E-mail: [email protected] Objective: The objective of this study was to evaluate the pharmacotherapy and management of asthma among children and young adults in an officebased ambulatory care setting. Methods: A cross-sectional study of ambulatory care visits in the National Ambulatory Care Survey from 2000 to 2010 was conducted. Included in this study were patient visits of persons who were ≤17 years of age with an associated International Classification of Diseases– 9th revision diagnosis of asthma. Descriptive statistics including means and frequency distributions were estimated Journal of the American Pharmacists Association APhA2014 ABSTRACTS for patient characteristics and types of asthma related therapy. Trends in asthma-related therapy and asthma education before and after the 2007 Expert Panel Report 3 (EPR3) were evaluated using the chi-square test. All analyses in this study were conducted using SPSS version 19 at an alpha of 0.05. Results: There were 1,970 visits from persons ≤17 years of age included in the study. The majority were male (60.7%), white (76.5%), and managed by pediatricians (71.9%). Overall, short-acting betaagonists (SABA) were the most common asthma-related therapy prescribed for those aged 0 to 4 years (67.4%), 5 to 11 years (63.8%), and 12 to 17 years (62.8%). Leukotriene modifiers were more frequently prescribed among those aged 5 to 11 years (25.7%) and those aged 12 to 17 years (20.0%) versus those aged 0 to 4 years (15%). Overall, asthma education decreased from 53.3% before 2007 to 41.2% after 2007 guidelines (P<0.05). Prescribing differences before 2007 and after 2007 guidelines were noted for long-acting beta-agonists(LABA)/inhaled glucocorticoids combination therapy products, with increases observed among visits of those aged 0 to 4 years, 5 to 11 years, and 12 to 17 years (P<0.05). Few visits were associated with LABA alone across all age groups after 2007 (<1%). Conclusion: This study shows changes in prescription drug asthmarelated therapy, with fewer LABA-only regimens which shows adherence to EPR3 guidelines. Decrease in asthma education shows need for improvement. therapy management (MTM) communication in the community pharmacy setting; (2) identify physicians’ perceived barriers to communicating with a pharmacist regarding MTM; and (3) determine whether Missouri physicians believe MTM is beneficial for their patients. Methods: A cross-sectional, prospective survey study will be conducted using mail-in surveys. Surveys will be mailed on January 2, 2014 and responses accepted until March 1, 2014. The survey contains items that address physicians’ experience with MTM, physicians’ preferences regarding MTM communication, physicians’ perceived barriers to communicating with pharmacists regarding MTM, and whether or not physicians believe that MTM is beneficial for their patients. The survey also will collect the following demographic data: sex, age, years in practice, and practice specialty. All questions are multiple-choice, yes/no, or short-answer format. All survey responses will be anonymous. Physicians’ mailing addresses will be obtained from the MO HealthNet provider listing. Surveys will be mailed to the 2,576 general and family practice physicians registered with MO HealthNet. Included in each mailing will be a 1-page introduction letter, a 1-page survey, and a postage-paid business reply envelope. Descriptive statistics will be used to analyze the demographic information. Nominal data will be evaluated utilizing chi-square analysis. Data points will be analyzed using the SPSS statistical software program. Results: Research in progress. 190—PHYSICIANS’ PREFERENCES FOR COMMUNICATION REGARDING PHARMACIST-PROVIDED MEDICATION THERAPY MANAGEMENT IN THE COMMUNITY PHARMACY SETTING. Shackles K, Stoner S, University of Missouri–Kansas City School of Pharmacy, Hartwig D, May J, Nicolaus S, Schramm A, Red Cross Pharmacy Inc., DiDonato K, University of Missouri–Kansas City School of Pharmacy, E-mail: shacklesk@umkc. edu Objective: This study aims to: (1) identify physicians’ preferences regarding pharmacist-provided medication 191—A RETROSPECTIVE ANALYSIS ON THE IMPACT OF A STUDENT PHARMACIST–RUN TARGETED INTERVENTION PROGRAM. Melody K, Shah C, Patel J, Willey V, University of the Sciences, E-mail: k.melody@ usciences.edu Objective: The purpose of this study is to evaluate the impact of a student pharmacist–run targeted intervention program. Methods: OutcomesMTM connects insurance companies with local pharmacies to provide medication therapy management. One of these services is a targeted intervention program (TIP), re- Journal of the American Pharmacists Association Downloaded From: http://mustafa.japha.org/ on 06/09/2014 j apha.org quiring a physician consultation (needs additional therapy and cost efficacy) or a patient consultation (underuse, new therapy monitoring, and administration/technique) to resolve. Beginning in August 2013, a new model was started in which student pharmacists work under the supervision of a pharmacist to resolve TIPs. In this retrospective analysis, data from August 1, 2013 to December 31, 2013 will be examined from a report of TIPs claims generated from OutcomesMTM and pharmacy records. The impact of this model will be evaluated using descriptive analysis techniques such as means, standard deviations, medians, frequencies, and percentiles of the TIPs regarding reimbursement, estimated cost avoidances (ECA), patient satisfaction, TIP acceptance rates, and types of TIPs completed. Reimbursement and ECA rates are set by OutcomesMTM. Patient satisfaction is obtained using a Likert scale during patient follow-up. Results: Out of 159 total TIPs available, 31 (19.5%) have been attempted and 10 (6%) have been completed (3 accepted, 6 rejected, 1 invalid). Based on preliminary data, reimbursement for the completed tips was $83 and students and pharmacists spent a total of 84 minutes and 2 minutes, respectively, completing these TIPs, earning the pharmacy $59/ hour. Two of the accepted TIPs were needs additional therapy and the third was new therapy monitoring. The ECAs for the accepted TIPs submitted included a hospitalization, an emergency room visit, and adherence support, which totaled approximately $27,050. Preliminary data show that this is a successful and innovative model to complete TIPs that could be implemented in other community pharmacies to improve patient outcomes, lower health care costs for patient, and increase revenue in a costeffective way for the provider of these services. 192—RETURN ON INVESTMENT OF USING PHARMACY TECHNICIANS TO AID IN THE COMPLETION OF COMPREHENSIVE MEDICATION REVIEWS. Stafford R, University of Arkansas for Medical Sciences College of Pharmacy, E-mail: rastafMA R /APR 2014 | 54:2 | JAPhA e145 APhA2014 ABSTRACTS [email protected] Objective: This study aims to determine the return on investment of using a technician to perform the nonprofessional tasks needed to complete comprehensive medication reviews (CMRs) for medication therapy management (MTM) services. Methods: A pharmacy technician at a supermarket pharmacy was trained on the OutcomesMTM platform to identify eligible patients, schedule CMR appointments, and enter medication lists. Ten hours per week were earmarked for the technician to perform duties related to MTM for 6 weeks. A report was generated to determine the number and types of claims billed and refused and fees collected. Results: During the project, 89 claims generated fees of $2,454. Twentyseven claims were for a completed CMR visit; 1 claim was a CMR refusal. The remaining 61 claims were intervention claims resulting from a CMR. On average, $91 fees were collected per CMR performed. This does not include additional claims that were still pending follow-up at the time of abstract submission. For each hour of technician time invested, $40.90 of MTM fees were collected. Conclusion: Using technicians to complete nonprofessional tasks related to MTM can increase the number of successful CMRs completed, decrease refusal rates, and further streamline pharmacists’ time. For pharmacies implementing MTM services or for pharmacies that already provide MTM services, it is crucial to include technicians in the MTM workflow. 193—STUDENT PHARMACIST IMPACT ON MEDICATION THERAPY MANAGEMENT SERVICES IN A HIGH-VOLUME COMMUNITY PHARMACY. Hestin J, Greco A, McConaha J, Duquesne University, E-mail: [email protected] Objective: The purpose of this study is to determine the success of incorporating student pharmacists into the implementation of medication therapy management (MTM) programs within a high-volume community pharmacy by evaluating the types of MTM inter- e146 JAPhA | 5 4:2 | M AR/AP R 2014 Downloaded From: http://mustafa.japha.org/ on 06/09/2014 ventions performed, MTM completion rates, and the amount of revenue generated. MTM platforms, such as Outcomes and SOCRxATES, allow pharmacists to conduct complete medication reviews (CMRs), targeted intervention programs (TIPs), and gap-in-care alerts. However, lack of pharmacist time, insufficient staffing, and high prescription volume make incorporating these MTM programs into workflow a challenging task. Student pharmacists can help alleviate these barriers by completing the preparation and follow-up components of MTM and by assisting pharmacists during the patient consultation. The goal of this study is to assess the effectiveness of incorporating student pharmacists into the MTM process of a high-volume community pharmacy by determining the overall MTM completion rates and generated revenue. Methods: This prospective study will pilot 2 MTM platforms in 4 highvolume community pharmacies. These locations will have a lead student pharmacist and pharmacist managing the MTM services. The student pharmacists will assist with calling and scheduling patients for the MTM consultation, completing the consultation preparation, and documenting the intervention. The pharmacists will conduct the consultation interviews and submit for billing. Specific data that will be collected includes the number of CMRs, TIPs, and gap-in-care alerts completed (completion rate), and the total amount of revenue generated from these MTM services. Data will be collected for 3 months and compared with the previous completion rates and generated revenue for the 3 months prior to incorporating student pharmacists. Increased completion rates and generated revenue will indicate the success of incorporating student pharmacists into the MTM process. Institutional review board approval has been granted. Results: Research in progress. 194—TARGETING TRANSITION IN CARE PATIENTS IN A COMMUNITY PHARMACY TO DECREASE HOSPITAL READMISSION RATES. Neltner A, Kroger Pharmacy Cincinnati–Dayton KMA, Luder H, University of Cincinnati, Frede S, Pleiman M, Rosser ja p h a .org S, Kroger Pharmacy Cincinnati–Dayton KMA, E-mail: shelly.rosser@stores. kroger.com Objective: The aim of this study is to implement a systematic approach in a community pharmacy that targets transition in care patients post hospital discharge to measure 30-day hospital readmission rates, participation, pharmacist interventions, and patient satisfaction. Methods: Pharmacists impact care transitions, however it is unknown if identifying patients post hospital discharge at the community pharmacy decreases hospital readmission rates and further improves transitional care in the outpatient setting. This prospective study will take place at 2 locations of a large grocery store chain pharmacy in Cincinnati, Ohio. Inclusion criteria are English-speaking patients >18 years of age who have been hospitalized within the past 10 days. Transition in care patients will be targeted at prescription drop off by pharmacy technicians who will ask a standardized question assessing recent hospitalization. Patients who meet the inclusion criteria will have a transition in care comprehensive medication review (CMR) explained and offered to them by a pharmacist. If the patient agrees, a face-to-face or telephonic CMR will be conducted by a pharmacist within 10 days from hospital discharge as appropriate. If the patient declines, baseline data will be collected and will serve as the control group. All eligible patients will be provided with a calendar that projects 30 days past their most recent hospital discharge and will be educated to document any days they are readmitted to the hospital. Follow-up will be completed 30 days post discharge to determine whether the patients have been readmitted by assessing their calendars. Hospital readmission data from the patients who received the CMR will be compared with patients who declined a CMR. For those who received a CMR, the acceptance and success of pharmacist interventions will be assessed and a satisfaction survey will be administered at follow-up. Results: Research in progress. 195—UTILIZATION OF PHAR- Journal of the American Pharmacists Association APhA2014 ABSTRACTS MACY INTERNS AND AUXILIARY STAFF IN PROVIDING MEDICATION THERAPY MANAGEMENT SERVICES. Avena-Woods C, Mantione M, St. John’s University, E-mail: avenac@ stjohns.edu Objective: The objective of this survey is to identify how pharmacists providing medication therapy management (MTM) services are utilizing the assistance of interns and auxiliary staff. Results will be used to identify best practices and major challenges affecting a pharmacist’s success in providing MTM. This information will help identify focus areas for training and ways to best support pharmacists providing MTM. Methods: In collaboration with OutcomesMTM, a survey link was e-mailed to a randomized group of pharmacists enrolled as providers in their system. Pharmacists answer a series of questions related to their practice setting, characteristics of their MTM provision, allocation of their time during MTM consults, and utilization of auxiliary staff such as pharmacy technicians and student pharmacists. Data are being collected regarding how auxiliary staff is being used in each step of the MTM process as well as challenges and opinions on future needs for increased support. Descriptive statistics will be provided. Results: Research in progress. To date, 90 responses have been collected. The survey link will remain active until the end of 2013, and several other rounds of pharmacists will receive the link and request prior to that date. Of the responses collected so far, the majority of respondents practice in a chain or independent community pharmacy and they process 500 to 2,000 prescription per week. Ninety-four percent of respondents provide MTM services in a location where they are also responsible for dispensing prescriptions. Forty-five percent report having 1 to 5 hours per week designated by their employer to perform MTM consults exclusively, but 44% report not receiving any time to devote solely to MTM. Sixty-seven percent state that the time required to provide the MTM service is the most significant barrier, followed by inadequate access to patient information. The majority of pharmacists (>90% in each category) report that they are solely responsible for tasks such as offering MTM, scheduling patients, and follow-up visits and that they strongly agree with statements indicating they would be more successful in providing MTM consults with more assistance from interns and technicians. 196—UTILIZATION OF STANDARDIZED OPERATING PROCEDURES IN IMPLEMENTATION OF A MEDICATION THERAPY MANAGEMENT PLATFORM. Bateman M, Greco A, McConaha J, Duquesne University, DeJames J, Krasnow D, Giant Eagle Pharmacy, E-mail: batemanm@ duq.edu Objective: The objectives of this study are to evaluate the impact and pharmacist receptivity of standardized operating procedures (SOPs) when implementing a new medication therapy management (MTM) platform in highvolume, grocery store pharmacies. Methods: The pharmacies in this study follow a structured work design and require specific SOPs, allowing for high volumes of prescriptions to be filled daily. This model is successful for driving distributive pharmacy services, but creates a challenge when attempting to incorporate clinical services such as MTM. SOCRxATES is an MTM platform recently adopted by the study pharmacies and focuses on addressing adherence and omission gaps in care. SOPs may support the study pharmacies in implementing this program properly and efficiently. This project will use a mixed-methods, observational, prospective design. At least 5 pharmacies that dispense >300 prescriptions each day and have ≥20 SOCRxATES gap in care alerts prior to the start of this project will be included. The SOPs will be created by the study investigators to assist pharmacists in utilizing SOCRxATES to address the adherence and omission gap in care alerts. Quantitative data that will be measured include the percentage of gaps completed and the counseling revenue earned. Pharmacist feedback of the SOPs will be collected and analyzed as qualitative data. Results: Research in progress. This Journal of the American Pharmacists Association Downloaded From: http://mustafa.japha.org/ on 06/09/2014 j apha.org data will help to improve the implementation of future MTM platforms in highvolume, grocery store pharmacies. Nuclear Pharmacy 197—ANALYSIS OF RADIOPHARMACEUTICAL KIT BASED COMPOUNDING USING 68GA SUPPLIED BY A 68GE/ 68GA GENERATOR IN A NUCLEAR PHARMACY SETTING. January S, Galbraith W, University of Oklahoma College of Pharmacy, E-mail: [email protected] Objective: Current positron emission tomography (PET) radioisotopes must be produced in a cyclotron causing the availability of PET imaging agents to be limited by the proximity of the cyclotron to the imaging facility. The 68 Ge/68Ga generator provides a PET radioisotope within a nuclear pharmacy or imaging facility and has the potential to expand PET imaging as a whole. The overall objective of this study is to analyze the adaptability of a 68Ge/68Ga generator to a nuclear pharmacy practice setting. Analysis will include 4 parameters: preparation of eluate, kit compounding, cost effectiveness, and radiation safety issues. Methods: The study is taking place in a nuclear pharmacy working with a researcher utilizing a 68Ge/68Ga generator. The concentration and radionuclide purity of the 68Ga eluate using highest fraction elution method is being compared with that of the eluate using a cation exchange cartridge. The steps required for labeling 68Ga compounds in current clinical trials will be reviewed. Cost analysis will include elution processing and efficiency, as well as a comparison between 68 Ga-DOTATOC and 111In pentetreotide. Since DOTATOC and pentetreotide are used for the same indication, a comparison will provide relative cost effectiveness of a 68Ga labeled compound. Radiation exposure will be measured during generator setup and elution processing. Results: Research in progress. Currently, the commercially available 68 Ge/68Ga generators are not yet approved by the Food and Drug Administration. The cartridge preparation appears to offer a way to buffer the eluMA R /APR 2014 | 54:2 | JAPhA e147 APhA2014 ABSTRACTS ate, minimizing exposure during eluate processing. Radiolabeling for most 68Ga compounds is a single-step method. The end product testing includes solvent impurity testing with gas chromatography and 68Ge breakthrough testing. Due to elution yield and half-life, each elution is able to produce 1 patient dose. Preliminary work delineates the needed modifications, expenses, and identifies barriers to using a 68Ge/68Ga generator within a nuclear pharmacy. Findings during this simulation process will be valuable in assessing the utility of 68Ga as a viable delivery method of PET radiopharmaceuticals for patient care, ahead of the anticipated approval of a pharmaceutical grade 68Ge/68Ga generator. 198—ASSESSMENT OF TECHNETIUM-99M SUCCIMER RESIDUAL ACTIVITY USING INERT NONREACTIVE SYRINGE. Chen X, Galbraith W, University of Oklahoma, Talley K, University of Oklahoma Medical Center, Grantham V, University of Oklahoma, Email: [email protected] Objective: It has been widely reported that technetium-99m (Tc99m) succimer adsorbs to plastic syringes significantly (up to 50%), often resulting in a lower administered dose than intended or inaccurate dosing. This is especially problematic in the pediatric population. To improve Tc99m succimer dosing, this study compared the adsorption of Tc99m succimer with 2 types of syringes: silicone-coated syringes with non-latex rubber on the plunger, and inert nonreactive syringes with no silicone coating and no rubber on the plunger. Methods: Tc99m succimer kits were compounded according to manufacturer’s instructions. A series of Tc99m succimer doses (0.03–0.14 MBq) were drawn into 3-mL (silicone-coated or inert nonreactive) syringes in 1 mL volume. Thirty minutes, 1 hour, 2 hours, and 4 hours later, the syringes were assayed in a dose calibrator, and assayed again after being emptied and rinsed with saline. In addition, the data collected were examined from 129 Tc99m succimer doses administered in a pediatric department, in which 52 were dispensed in siliconecoated syringes and 77 were dispensed e148 JAPhA | 5 4:2 | M AR/AP R 2014 Downloaded From: http://mustafa.japha.org/ on 06/09/2014 in inert nonreactive syringes. The doses were assayed immediately before and after injection followed by flushing with saline. Results: The labeling efficiency of the Tc99m succimer kits was more than 95%. Residual activity left in the inert nonreactive syringes was 0.73% (standard deviation [SD] ± 0.18%), which is significantly lower than the activity left in the silicone-coated syringes (P<0.0001), which was 20.9% (SD ± 5.6%). The extent of adsorption did not change significantly between 30 minutes and 4 hours of incubation. The clinical data showed that the residual activity was 30.6% (SD ± 12.5%) from doses dispensed in siliconecoated syringes and 6.38% (SD ± 2.95%) from doses dispensed in inert nonreactive syringes (P<0.001). Conclusion: The inert nonreactive syringes retained less than 1% of the activity of the Tc99m succimer, making it possible to accurately administer desired doses to pediatric patients. 199—MODIFIED METHOD FOR ADMINISTRATION OF LU-177 PEPTIDE. Ponto J, University of Iowa, Smith J, Bricker J, University of Iowa Hospitals and Clinics, E-mail: james-ponto@ uiowa.edu Objective: Peptides radiolabeled with lutetium Lu-177 are being used investigationally to treat receptor-expressing tumors. Previous investigators have used the Flebo infusion method or the Rotterdam method for administration of the radiopharmaceutical. The objective of this study was to establish a modified administration method that is simple and efficient, while also affording a high level of radiation protection. Methods: An old generator elution lead vial shield was repurposed to hold the 30 mL glass vial containing the radiopharmaceutical and an old chemistry ring stand flask clamp was repurposed to secure the vial/shield assembly to an intravenous (IV) pole. The radiopharmaceutical vial septum was punctured with a vented IV spike infusion set, attached upside down to an IV pole, and the contents infused with an IV pump. Results: Unlike the Flebo method, the method used in this study allowed ja p h a .org efficient infusion of the radiopharmaceutical without being diluted with normal saline. Unlike the Rotterdam method, this study used a lead vial shield to provide radiation protection. The dose-rate from 200 mCi Lu-177 unshielded is 5.6 mrem/hour at 1 meter; placed into the 8 mm lead vial shield (~13 half-value layers), the dose-rate at 1 meter was undetectable. Using the IV spike infusion set, nearly all of the radiopharmaceutical (initial volume of 23–25 mL) was removed from the vial. The mean ± SD volume remaining in the vial was 0.42 ± 0.5 mL, or 1.7% ± 0.2%. This small fractional retention is acceptable within the protocol and regulatory allowances, and hence avoids the need for flushing of the vial to rinse out residual contents. Conclusion: This modified method for administration of Lu-177 peptide allows simple and efficient infusion of radiopharmaceutical while providing desired radiation protection. 200—PRACTICE EXPERIENCE WITH THE FIRST FOOD AND DRUG ADMINISTRATION–APPROVED ALPHA-EMITTING RADIOPHARMACEUTICAL. Tan X, Galbraith W, University of Oklahoma College of Pharmacy, Ponto J, University of Iowa College of Pharmacy, E-mail: [email protected] Objective: The objective of this project is to describe the implementation of radium-223 dichloride therapy in a hospital setting. Methods: A review of the process involving radium-223 dichloride, an alpha-emitting radiopharmaceutical, was conducted. Therapy was administered at an academic hospital with a patient population that fit the treatment parameters. Data were collected from interviews with the pharmacist participating in therapy management. Survey questions ranged from the steps required to bring the radiopharmaceutical into the hospital formulary to administering the dose to patients. Data were then assessed for the ease of implementation to other facilities. Results: From August 2013 to October 2013, radium-223 dichloride has been administered to 10 male patients aged Journal of the American Pharmacists Association APhA2014 ABSTRACTS 57 to 90 years. To date, 4 patients have completed the first cycle of treatment, 3 patients have completed second cycle, and 3 patients have completed the third cycle. Barriers such as proper facility licensing, verification of the compounding pharmacy, therapeutic necessity, and medication reimbursement were found. One such example is that the drug is manufactured in a vial, but dispensed from a pharmacy in a unit-dose syringe from 1 location in the United States. This combines the process of assuring the pharmacy compounding status from 2 boards of pharmacy. The facility’s standard operating procedures (SOP) for the alpha radiopharmaceutical were developed. SOPs included communication with oncology throughout the 6-month treatment cycle, nuclear medicine department’s modification of radiopharmaceutical delivery schedule from an out of state pharmacy, syringe assay when patient dose was provided in more than one 10-mL syringe, dose calibrator accuracy when verifying the administered dose, contamination detection efficiencies, and decontamination procedures. Product was added to the formulary after providing these additional supporting documents to the Pharmacy and Therapeutics Committee. Conclusion: Similar procedures can be adapted by other facilities with a patient population that will benefit from radium-223 dichloride treatment. OTC, Self-Care, and CAM 201—ASSESSING THE ROLE OF A PHARMACIST ON THE SELECTION AND KNOWLEDGE OF NONPRESCRIPTION MEDICATIONS PROVIDED TO PATIENTS THROUGH POINT-OF-CARE CONSULTATIONS. Patel P, Walgreens/Massachusetts College of Pharmacy and Health Sciences University-Boston, Machado M, Mistry A, Massachusetts College of Pharmacy and Health Sciences University, E-mail: [email protected] Objective: The primary objective of this study is to assess the role a pharmacist plays on the selection of nonprescription medications during a point-of-care consultation. The secondary objective is to assess the patient’s knowledge on the specific nonprescription medication. As the role of a pharmacist has evolved in the past decade, it is a pharmacist’s responsibility to educate and counsel patients regarding not only prescription medications but also nonprescription medications. Having the most direct relationship with their patients, community pharmacists have the potential to make a dramatic difference in their patients’ overall health status. Methods: This study will be submitted to the institutional review board for approval. The point-of-care service will occur in 2 community pharmacies within the same community chain in Massachusetts. Patients for inclusion in the study will be individuals found in the front store viewing any nonprescription medication including over-the-counter products, herbal and dietary supplements; patients who present themselves to the patient consultation room or the dropoff, pick-up, and pharmacy consultation windows at the pharmacy; and patients eligible for medication therapy management services. A thorough consultation will include collecting information on a patient’s age, sex, allergies, current disease states and medications, as well as chief complaint after informed consent is documented. Additional information such as a patient’s current knowledge of the selected product’s active ingredients, warnings, side effects, and directions for use will be gathered. All data will be recorded without patient identifiers and confidentiality will be maintained. Data from each patient will be evaluated to be included in the study’s descriptive analysis. The reviewers will assess how many patients were receptive to a pharmacist’s consultation, how many interventions were made, how many patients changed their intended purchases after the consultation, and how many patients did or did not have previous knowledge of their intended purchase. Results: Research in progress. Q 202—A CONSUMER SURVEY OF HERBAL PRODUCT AND DIETARY SUPPLEMENT AWARENESS IN IDAHO. Toone T, Owens C, Steed M, Idaho State University, E-mail: ctow- Journal of the American Pharmacists Association Downloaded From: http://mustafa.japha.org/ on 06/09/2014 j apha.org [email protected] Objective: The purpose of this study is to assess consumers’ knowledge, practices, and attitudes regarding herbal products and dietary supplements. Although used by millions of Americans, several potential safety concerns have been noted with these products, including misconceptions on the part of consumers, potential for adverse effects and/or supplement-drug interactions, and a lack of consistent efficacy data from randomized, controlled clinical trials. Methods: The university’s institutional review board approved this survey. A convenience sample of adult Idaho residents who reported use of an herbal product or dietary supplement for a health-related reason in the past year were asked to complete a brief, paper survey at local pharmacies, gyms, and community events. The survey included demographic information and assessed type and frequency of herbal product and dietary supplement use. A 5-point Likert scale was used (0 = strongly disagree; 5 = strongly agree) to assess attitudes related to perceived safety and efficacy of these products. Concomitant prescription and over-the-counter (OTC) medication use also was queried. Respondents were asked about their familiarity with the Dietary Supplement Health and Education Act and the role of the United States Pharmacopeia and Consumer Lab in testing these products. Results: A total of 526 surveys were completed and analyzed. The majority of respondents (71.5%) preferred dietary supplements over prescription or OTC medications for treating disease or maintaining health. Most respondents agreed that dietary supplements could interact with prescription medication (Likert scale score 3.94); there was somewhat less agreement that these products have the potential for adverse effects (average score 3.39). Conclusion: Herbal products and dietary supplements are commonly taken on a daily basis concomitantly with prescription medication and patients may underestimate the potential for adverse effects. Clinicians should regularly assess use of these products and provide MA R /APR 2014 | 54:2 | JAPhA e149 APhA2014 ABSTRACTS education regarding risks and benefits, including the potential for adverse effects and interactions. Original Citation: Poster previously presented at: Idaho State University Research Day, Idaho State University; ISHP-Local State Chapter, Sun Valley, ID; ASHP Midyear Clinical Meeting, Orlando, FL. 203—EVALUATION OF STUDENT SELF-CARE CONFIDENCE IN TWO TEAM-BASED LEARNING FORMATS. Todt A, Kiersma M, Manchester University, Frame T, Chen A, Gryka R, Cailor S, Cedarville University, E-mail: [email protected] Objective: The purpose of this study was to evaluate student perceptions and confidence of self-care concepts using a team-based learning (TBL) format at 2 universities. Methods: TBL has been increasingly utilized in higher education because active learning aids in promoting self-directed learning and adaptability in problem-solving situations while improving student performance and increasing active learning time. A 32-item instrument was administered at the beginning and conclusion of a self-care course at 2 universities. The instrument examined student perceptions of self-care utilizing the theory of planned behavior (TPB) domains of perceived behavioral control, subjective norm, and attitude (13 questions, 7-point, Likert-type, [1 = strongly agree; 7 = strongly disagree]), and confidence in learning self-care concepts using Bandura’s Social Cognitive Theory (19 questions, 5-point, Likert-type, “not at all confident” to “extremely confident”). Pre- and post-assessments were evaluated using paired t tests and differences between universities using independent t tests since the data were normally distributed. Instrument reliability was measured using Cronbach alpha. Results: A total of 117 students were assigned to TBL teams. Cedarville (N = 53, 100% response) and Manchester (N = 58, 92% response) students completed both instruments. Student self-care perceptions with TPB improved significantly on 8 of 13 questions for Cedarville (P<0.05) and 1 of 13 questions for Man- e150 JAPhA | 5 4:2 | M AR/AP R 2014 Downloaded From: http://mustafa.japha.org/ on 06/09/2014 chester (P<0.05). Student confidence in learning self-care concepts improved significantly on all questions for both universities (P<0.001). Combined analyses of both schools showed significant results on 5 of 13 perceptions and all 19 confidence questions (P<0.05). Scale reliability indicated the instrument subscales (TPB and confidence) were reliable measures of student intention regarding learning and utilization of self-care concepts (alpha >0.8, respectively). Conclusion: Data indicate TBL was effective in improving student confidence in self-care concepts. Since pharmacists must utilize self-directed learning to continually expand their knowledge of pharmacy and be adaptable in problem-solving situations, it is important to establish these skill sets prior to entering the profession. 204—FACTORS INFLUENCING COMMUNITY PHARMACISTS’ OVER-THE-COUNTER ORAL ANALGESIC DRUG RECOMMENDATIONS FOR PATIENTS. Kanani K, Volino L, Rutgers University, Patel V, Bayer HealthCare, Toscani M, Rutgers University, E-mail: [email protected] Objective: The objective of this study is to assess potential factors influencing pharmacists’ decisions to select and/or recommend over-the-counter (OTC) systemic analgesic drug products in the United States. One of the major roles of a community pharmacist in providing patient-focused care is as a selfcare consultant. As self-care consultants, community-based pharmacists interface with patients requesting health information, which includes assisting patients in selecting OTC products, counseling, and addressing health-related questions. However, little research has been done on factors that influence OTC drug product recommendations by the pharmacist. Methods: A 20-question online survey assessing potential factors influencing pharmacists’ decisions to select and/ or recommend OTC systemic analgesics will be distributed to approximately 3,100 community pharmacists in all regions throughout the United States. Pharmacists will be selected via a database maintained by a market research ja p h a .org organization and encompasses various practice types (i.e., independent, chain/ mass merchandiser, and grocery store) and areas (i.e., urban, rural, and suburban). The sample size represents the maximum number of community practicing pharmacists maintained in the database. A response rate of 20% to 30% is expected based on market research reports. Survey questions will evaluate forces such as medical (e.g., primary and secondary literature, pharmacy school instruction, product safety profile), social (e.g., personal, patient, colleague, and health care professional feedback; product cost) and marketing (e.g., television, Internet, mail, and store advertising; brand reputation). In addition, area and number of years of practice will be collected. The survey instrument was developed based on comprehensive literature review and professional expertise and is not validated. Factors will be analyzed individually using overall and subgroup analysis. Only descriptive statistics including frequencies and mean scores will be used to analyze data and identify trends. An application for exemption from full institutional review board was submitted and is pending approval. Results: Research in progress. 205—FACTORS INFLUENCING CONSUMERS TO PURCHASE OVER-THE-COUNTER DRUGS IN AMERICAN SAMOA. Amoa F, Daniel K. Inouye College of Pharmacy University of Hawaii at Hilo, Tufa A, University of Hawaii at Manoa, Ma C, Wongwiwatthananukit S, Daniel K. Inouye College of Pharmacy University of Hawaii at Hilo, E-mail: [email protected] Objective: American Samoa is a U.S. territory with a population of 55,000. There are currently only 2 U.S. registered pharmacists working in the hospital and none available in retail pharmacies. With the growing number of over-the-counter (OTC) drugs being sold in local grocery stores, the objective of the study was to determine factors that influence consumers to purchase OTC drugs. Methods: A convenience sample of 350 participants aged ≥18 years with prior OTC purchase and use for ≥3 Journal of the American Pharmacists Association APhA2014 ABSTRACTS months were recruited from 6 different public locations across Tutuila island. A cross-sectional face-to-face survey with structured interview questions was developed and conducted by well-trained interviewers to gather sociodemographic information, OTC use, knowledge of effectiveness and safety, and factors influencing utilization of OTC drugs. Data were analyzed using descriptive statistics. Results: Of the 350 people surveyed, 325 surveys were completed and usable (60% women, 40% men; age range 18 to ≥60 years). Local grocery stores were the main source to purchase OTC drugs (51%). Familiarity with brand name, perceived effectiveness, safety, and minor sickness were major factors related to purchasing decision (≥62% of participants responding “very often” or “always”). The majority of participants (68%) reported that knowledge of effectiveness was based on previous use and they knew what OTC drug to buy by reading the label. Purchasing OTC drugs for others in the household was reported by 75% of participants and 87% would ask a pharmacist when a pharmacist was available to offer an opinion at the time the participant was purchasing OTC drugs. Conclusion: Results indicate several factors influence consumers to purchase OTC drugs. Although participants reported reading the label when deciding to purchase, previous use and familiarity with brand name and/or minor sickness were more influential. Results suggest an opportunity for pharmacist involvement in expanding roles and counseling services to stores that sell OTC drugs. 206—HERBAL MEDICATION USE IN THE GUJARATI POPULATION AND ITS IMPACT ON MEDICATION COMPLIANCE. Patel Y, Hilas O, St. John’s University, E-mail: yesha. [email protected] Objective: The purpose of this study is to: (1) identify cultural beliefs and influences contributing to the use of Ayurvedic practices; (2) observe a change in perception between early and recent immigrants in the use of Ayurveda; and (3) determine if noncompliance exists secondary to the use of Ayurveda. Methods: A qualitative study design was conducted using focus groups organized in Gujarati-dense locations at a community center in New York predominantly consisting of the firstwave immigrants (1970s), and a temple in New Jersey predominately consisting of recent immigrants (1990–2000s). Participants were recruited from the community center by word of mouth and participants from the temple were recruited by the use of a suggested representative sample. Participants were required to have prior or current experience with Ayurveda, be ≥18 years of age, and Gujarati. Discussions were carried out in native language, tape recorded, transcribed, and analyzed. Participants were asked various questions to gauge perceptions and use of Ayurvedic medicine. A literature search was performed for articles studying the Gujarati population and Ayurveda. Currently, no analyses of medication compliance and use of Ayurvedic practices in the Gujarati population have been performed. Results: The literature review consisted of 2 relevant articles. The first study indicated 63.2% of Asian Indians utilize complementary and alternative medicine. The second study suggested that 20% of the Gujarati population reported using traditional medicine. Both groups agreed, Ayurveda along with diet and lifestyle modifications aided in prevention or cure of disease states. A difference in perception of Ayurvedic practices was observed between early and recent immigrants. The study population is likely to use Ayurvedic medicine resulting in noncompliance to prescription medications. Conclusion: The implications and extent of Ayurvedic practices in the Gujarati population is unknown and requires further study. A better understanding may aid in counseling and educating patients in medication management. 207—PHARMACIST INTERVENTION IN PATIENT SELECTION OF SELF-CARE PRODUCTS. Schimmelfing J, Virginia Commonwealth University, Brookhart A, Fountain K, The Kroger Journal of the American Pharmacists Association Downloaded From: http://mustafa.japha.org/ on 06/09/2014 j apha.org Co., Goode J, Virginia Commonwealth University, E-mail: schimmelfinjt@vcu. edu Objective: The purpose of this study is to: (1) evaluate the outcomes of a pharmacist intervention on patient selection of nonprescription and self-care products; and (2) evaluate patient confidence with future self-treatment and satisfaction with the assistance of the pharmacist. Methods: A prospective study will be conducted in 2 national supermarket chain pharmacies located in the Charlottesville, Virginia, area; 150 adult patients aged ≥18 years will be eligible to participate in the study. The study will occur over 4 months. Patients will be identified as needing assistance in choosing a nonprescription or self-care product and will self-select into the study by agreeing to participate in the study intervention. The study intervention is the pharmacist consultation with the patient to assess the self-care complaint and to make an appropriate recommendation for care. The pharmacist conducting the intervention will use a standardized method of approaching self-care recommendations (i.e., SCHOLAR-MAC: symptoms, characteristics, history, onset, location, aggravating factors, remitting factors and other medications, allergies, and conditions). Each intervention will be document the patient’s sex, age, and chief complaint; medication patient initially selected; pharmacist recommendation after intervention; and outcome of intervention and associated reasoning. Patients will be asked about their confidence in future self-treatment, their satisfaction with the intervention, and whether they are more willing to ask the pharmacist for future self-care assistance. The duration of the encounter also will be recorded. Results: Research in progress. 208—PREVALENCE OF PATIENT SELF-CARE ERRORS ASSOCIATED WITH OVER-THE-COUNTER CALCIUM SUPPLEMENTS. Gandhi J, Malone C, Jewel-Osco, Winkler S, Midwestern University Chicago College of Pharmacy, Wagner M, Jewel-Osco, Email: [email protected] MA R /APR 2014 | 54:2 | JAPhA e151 APhA2014 ABSTRACTS Objective: The goal of this study is to determine the prevalence of patient errors associated with the use of over-thecounter (OTC) calcium supplements. Methods: A multicenter, prospective, survey-based study will be performed. Eligible participants will include female participants ≥19 years of age receiving a prescription oral bisphosphonate from 1 of 3 community grocery store pharmacies in Naperville, Illinois. Participants will be asked to complete a multiple-choice survey regarding their calcium supplement use to determine the presence of dosing and administration drug therapy problems. Additional items will identify demographic factors that may impact self-care errors in certain populations. Surveys will be administered for a period of 20 weeks during participant interaction at the pharmacy pick-up window. Eligible participants will complete the survey before leaving the pharmacy. If the individual is not present, the representative will be asked to have the participant complete the survey at home and return it to the pharmacy within 1 week using a self-addressed stamped envelope. Data will be collected and analyzed with SPSS computer software. Results: Research in progress. An estimated 43% of Americans use calcium supplements. Evidence has shown the prevalence of adverse events associated with use of calcium supplements, but few data have reported the prevalence of supplement dosing and administration errors. It is anticipated that data gathered from this research will identify the need for pharmacists to proactively counsel patients on choice and use of OTC calcium supplements in order to reduce selfcare errors. Furthermore, pharmacist intervention can lead to appropriate use by patients, ultimately reducing adverse events, the risk of complications and disease progression, and health care costs. Pain Management 209—DEMOGRAPHICS AND CLINICAL CHARACTERISTICS OF PATIENTS HOSPITALIZED WITH PRESCRIPTION OPIOID-RELATED OVERDOSE. Liu C, Jennings B, Uni- e152 JAPhA | 5 4:2 | M AR/AP R 2014 Downloaded From: http://mustafa.japha.org/ on 06/09/2014 versity of Utah Hospitals and Clinics, Stevens V, University of Utah, Murnin K, University of Utah Health Center, Email: [email protected] Objective: Prescription medication abuse and overdose is a rising national problem. Among prescription drugs, prescription opioid analgesics account for more deaths than heroin and cocaine combined. Ranked fourth nationally for opioid-related deaths, Utah had an incidence rate 56% higher than the national rate. The objective of this descriptive study is to determine the demographics and clinical characteristics of patients who present for emergency department (ED) visit or hospitalization for opioid overdoses. This study may help identify characteristics associated with patients with opioid overdose and identify targets for future research. Methods: This is a retrospective, case-series study examining the demographics and clinical characteristics of patients who were prescribed opioids by a University of Utah outpatient clinic provider and were hospitalized for opioid overdose. The study will identify patients with ED visits or hospitalizations for opioid overdose in the past 5 years using International Classification of Diseases–9th revision diagnosis and E codes related to opioid and substance abuses. Patients who had at least 1 prescription for opioids written by a University of Utah outpatient clinic provider will be selected for study inclusion. Various patient characteristics and clinical history will be collected using a standard data collection sheet to ensure consistency and completeness. Results: Research in progress. Q 210—DOSE PROPORTIONALITY AND LINEARITY OF ACETAMINOPHEN AFTER SINGLE OR MULTIPLE ORAL DOSES OF MNK-795 OXYCODONE/ACETAMINOPHEN EXTENDED-RELEASE TABLETS. Morton T, Brunelle R, Devarakonda K, Mallinckrodt Inc., E-mail: [email protected] Objective: The purpose of this analysis was to evaluate the dose proportionality and linearity of the acetaminophen (APAP) component of oxycodone/ ja p h a .org acetaminophen extended-release (OC/ APAP ER) when administered as 1, 2, or 4 tablets (325 mg, 650 mg, or 1300 mg APAP). Methods: Data were pooled from randomized, single- and multiple-dose crossover studies conducted in healthy adults. Single oral doses of OC/APAP ER (7.5 mg OC/325 mg APAP) were administered as 1, 2, or 4 tablets (325 mg, 650 mg, or 1300 mg APAP) in 3 separate studies. Multiple doses of 1 or 2 tablets of OC/APAP ER (325 mg or 650 mg APAP) were administered every 12 hours for 4.5 days (9 doses) in 2 separate studies. Individual plasma concentration versus actual time data were used to estimate the pharmacokinetic parameters of APAP by standard non-compartmental methods. Dose normalization (calculated as plasma concentration divided by dose) was utilized to compare concentrations across different dosage strengths. Dose linearity and proportionality were determined using linear regression of nontransformed data, including 95% confidence intervals. Safety and tolerability were monitored. Results: Data from 119 adults were included in the single-dose studies and 57 adults in the multiple-dose studies. After a single dose of OC/APAP ER, both maximum concentration (Cmax) and area under the plasma concentration– time curve(AUC0-∞) for APAP were linear and dose proportional with respect to dose, with dose-normalized slopes approximately equal to zero (–0.001 and –0.007, respectively). In the multipledose study, Cmax and AUC0-∞ of APAP at steady state were also linear and proportional with respect to dose (slopes of –0.004 and –0.011, respectively). The most frequently reported treatmentemergent adverse events included nausea, vomiting, pruritus, dizziness, somnolence, and headache. Conclusion: This pooled pharmacokinetic analysis demonstrates dose proportionality and dose linearity of the APAP component of OC/APAP ER up to 1300 mg. Original Citation: Morton T, Brunelle R, Devarakonda K. Dose proportionality and linearity of acetaminophen after single or multiple oral doses Journal of the American Pharmacists Association APhA2014 ABSTRACTS of MNK-795 controlled-release oxycodone/acetaminophen (CR OC/APAP) tablets. Presented at: PAINWeek 2013; September 4-7, 2013; Las Vegas, NV. Q 211—DOSE PROPORTIONALITY AND LINEARITY OF OXYCODONE AFTER SINGLE OR MULTIPLE ORAL DOSES OF MNK-795 OXYCODONE/ACETAMINOPHEN EXTENDED-RELEASE TABLETS. Morton T, Brunelle R, Devarakonda K, Mallinckrodt Inc., E-mail: [email protected] Objective: The purpose of this analysis was to evaluate the dose proportionality and linearity of the oxycodone component of oxycodone/acetaminophen extended-release (OC/APAP ER) tablets when administered as 1, 2, or 4 tablets (7.5 mg, 15 mg, or 30 mg oxycodone). Methods: Data were pooled from randomized, single- and multiple-dose crossover studies conducted in healthy adults. Single oral doses of OC/APAP ER (7.5 mg OC/325 mg APAP) were administered as 1, 2, or 4 tablets (7.5 mg, 15 mg, or 30 mg oxycodone) in 3 separate studies. Multiple doses of 1 or 2 tablets of OC/APAP ER (7.5 mg or 15 mg oxycodone) were administered every 12 hours for 4.5 days (9 doses) in 2 separate studies. Individual plasma concentration versus actual time data were used to estimate the pharmacokinetic parameters of oxycodone by standard non-compartmental methods. Dose normalization (calculated as plasma concentration divided by dose) was utilized to compare concentrations across different dosage strengths. Dose linearity and proportionality were determined using linear regression of non-transformed data, including 95% confidence intervals. Safety and tolerability were monitored. Results: Data from 119 adults were included in the single-dose studies and 57 adults in the multiple-dose studies. After a single dose of OC/APAP ER, both maximum concentration (Cmax) and area under the plasma concentration– time curve (AUC0-∞) for oxycodone were linear and proportional with respect to dose, with dose-normalized slopes approximately equal to zero (–0.001 and –0.024, respectively). In the multiple- dose study, Cmax and AUC0-∞ of oxycodone at steady state were also linear and proportional with respect to dose (slopes were –0.003 and 0.033, respectively). The most frequently reported treatmentemergent adverse events included nausea, vomiting, pruritus, dizziness, somnolence, and headache. Conclusion: This pooled pharmacokinetic analysis demonstrates dose proportionality and dose linearity of the oxycodone component of OC/APAP ER up to 30 mg. Original Citation: Morton T, Brunelle R, Devarakonda K. Dose proportionality and linearity of oxycodone after single or multiple oral doses of MNK-795 controlled-release oxycodone/acetaminophen (CR OC/APAP) tablets. Presented at: PAINWeek 2013; September 4-7, 2013; Las Vegas, NV. 212—EVALUATION OF A COMPOUNDED PAIN MANAGEMENT MEDICATION SERVICE IN AN INDEPENDENT COMMUNITY PHARMACY. Houmes S, Layson-Wolf C, University of Maryland School of Pharmacy, Klempay J, Zaremba S, Van Wie W, Professional Pharmacy, E-mail: cwolf@ rx.umaryland.edu Objective: The objectives of this survey are to: (1) evaluate patient satisfaction with pain management compounded prescriptions; and (2) evaluate patient satisfaction with the follow-up service related to the prescription. Methods: Participants are included if they are ≥18 years of age and received a compound at the pharmacy or via mail. Patients receive a call at 1 week for initial counseling and a call at week 3 to assess efficacy. A voluntary, anonymous, 14-item survey, cover letter, and raffle slip are mailed to patients at week 3. The survey lists statements about satisfaction with compounds and the follow-up service. Patients respond using a Likert scale (1 = strongly disagree; 5 = strongly agree). Participants are asked to circle the group of symptoms that best describes their pain. A comment box will be included for participants to write in comments. Participants will be entered into a raffle for gift cards. A reminder postcard is mailed at week 5. The surveys will be Journal of the American Pharmacists Association Downloaded From: http://mustafa.japha.org/ on 06/09/2014 j apha.org mailed from and returned to the university to further prevent bias. Results: Research in progress. Data collection will begin October 1, 2013 and continue until February 1, 2014; surveys returned after the end date will not be included for analysis. Statement response, inferred pain management compound (based on symptom group), and total responses will be reported using descriptive statistics. The estimated sample size is 300 based on dispensing trends. The data from this survey will be used to evaluate whether changes are needed to improve patient satisfaction with the compounds and follow-up service. Other pharmacies implementing a compound follow-up service could utilize the data to assist with service design. 213—EVALUATION OF OPIATE REDUCTION PROTOCOL IN PAIN MANAGEMENT PATIENTS AT A COMMUNITY HEALTH CENTER. Kafader S, Fred Meyer Pharmacy, Ramirez S, Oregon State University, Davis J, Fred Meyer Pharmacy, E-mail: [email protected] Objective: The objective of this project was to evaluate the effectiveness of an opiate reduction protocol, involving a controlled substance committee, in pain management patients at a community health center. Patients with chronic pain were referred to the controlled substance committee which provided a recommendation to the provider for reducing opiate pain medication use. The protocol was designed to achieve a safe level of opiate pain medications in patients with chronic pain and to reduce the risk of adverse drug events in these patients. Methods: The project was a retrospective, case-control chart review involving patients from a community health center. A group of 100 chronic pain patients were selected from a 6-month period before the creation of the opiate reduction protocol to serve as a control group, while the experimental group was composed of 100 chronic pain patients selected from a 6-month period after the creation of the protocol. Patients were eligible for inclusion if they were: >18 years of age; being treated for chronic, non-cancer pain at the commuMA R /APR 2014 | 54:2 | JAPhA e153 APhA2014 ABSTRACTS nity health center; and receiving opiate pain medications at a level of ≥120 mg morphine dose equivalents. Data were collected from chart review that included level of opiate pain medication on day 1 of study period and 6 months later, percent reduction from baseline of opiate pain medication, and evidence that protocol was followed by practitioners. Data analysis included the percentage of patients reaching the primary endpoint of <120 mg morphine dose equivalents as well as secondary endpoints of percent reduction from baseline of opiate medication, and percent of providers who followed recommendations. Data were analyzed using descriptive statistics and the control and experimental groups were compared using a t test and a chisquare test. Results: Research in progress. Q 214—HALF-VALUE DURATION ANALYSIS FOR ACETAMINOPHEN AFTER SINGLE AND MULTIPLE DOSES OF ORAL MNK-795 OXYCODONE/ACETAMINOPHEN EXTENDED-RELEASE TABLETS. Ping H, Brunelle R, Morton T, Devarakonda K, Mallinckrodt Inc., E-mail: [email protected] Objective: This analysis examines the half-value duration (HVD) of the APAP component of oxycodone/acetaminophen extended-release (OC/ APAP ER) after single and multiple doses compared with the HVD of immediate-release (IR) OC/APAP. HVD is defined as the time during a dosing cycle when plasma concentrations are at least half of the maximum concentration (50% Cmax) and can help describe the pharmacokinetic (PK) performance of extendedrelease products. Methods: HVD and conventional PK measures (Cmax, Tmax, area under the plasma concentration time curve [AUC]) for APAP from OC/APAP ER (2 tablets [15 mg/650 mg] administered once [single dose] or q12h over 4.5 days [multiple dose]) were compared with values from IR OC/APAP (7.5 mg/325 mg; 1 tablet twice, 6 hours apart [single dose, 15 mg/650 mg total] or q6h for 4.5 days [multiple dose]) using data from 2 randomized, open-label, crossover studies e154 JAPhA | 5 4:2 | M AR/AP R 2014 Downloaded From: http://mustafa.japha.org/ on 06/09/2014 (single dose [n = 29], multiple dose [n = 24]) in healthy adults. Blood samples for bioanalysis were collected up to 36 hours (single-dose study) or up to 132 hours (multiple-dose study). Safety and tolerability were monitored. Results: Conventional PK measures (Cmax, Tmax, and AUC) for APAP were similar for OC/APAP ER and IR OC/ APAP in both studies. The mean HVD of APAP was not significantly different for OC/APAP ER versus IR OC/APAP after single doses. During steady state, however, the mean HVD of APAP with OC/APAP ER was significantly longer versus IR OC/APAP (4.24 h vs. 3.11 h; P = 0.024). OC/APAP ER was generally well tolerated. Conclusion: In this analysis, the Cmax, Tmax, and AUC of APAP following single and multiple doses of OC/APAP ER (2 tablets, 15 mg/650 mg) were consistent with IR OC/APAP (1 tablet, 7.5 mg/325 mg) taken q6h; however, the HVD for APAP of OC/APAP ER was significantly longer than the HVD for IR OC/APAP with steady-state dosing. Original Citation: Ping H, Brunelle R, Morton T, Devarakonda K. Half-value duration analysis for acetaminophen after single and multiple doses of oral MNK-795 controlled-release oxycodone/acetaminophen (CR OC/APAP) tablets. Presented at: PAINWeek 2013; September 4-7, 2013; Las Vegas, NV. Q 215—HALF-VALUE DURATION ANALYSIS FOR OXYCODONE AFTER SINGLE AND MULTIPLE DOSES OF ORAL MNK-795 OXYCODONE/ACETAMINOPHEN EXTENDED-RELEASE TABLETS. Ping H, Brunelle R, Morton T, Devarakonda K, Mallinckrodt Inc., E-mail: [email protected] Objective: This analysis examines the half-value duration (HVD) of oxycodone from oxycodone/acetaminophen extended-release (OC/APAP ER) after single and multiple doses compared with immediate-release (IR) OC/APAP. HVD is a complementary measure of the pharmacokinetic (PK) performance of extended-release products, and is defined as the time during a dosing cycle when plasma concentrations are at least ja p h a .org half of the maximum concentration (50% Cmax). Methods: HVD and conventional PK measures (Cmax, Tmax, and area under the plasma concentration time curve [AUC]) for oxycodone from OC/APAP ER (2 tablets [15 mg/650 mg] administered once [single dose] or q12h over 4.5 days [multiple dose]) were compared with values from IR OC/APAP (7.5 mg/325 mg; 1 tablet twice, 6 hours apart [single dose, 15 mg/650 mg total] or q6h for 4.5 days [multiple dose]) using data from 2 randomized, open-label, crossover studies in healthy adults (single dose [n = 29], multiple dose [n = 24]). Blood samples for bioanalysis were collected up to 36 hours (single-dose study) or up to 132 hours (multiple-dose study). Safety and tolerability were monitored. Results: In both single- and multiple-dose studies, the mean Cmax of oxycodone was lower for OC/APAP ER compared with IR OC/APAP, whereas AUC measurements were similar. The mean HVD of oxycodone was significantly longer for OC/APAP ER compared with IR OC/APAP after initial administration (single dose, 9.65 h vs. 5.94 h; P<0.0001) and at steady state (multiple dose, 7.85 h vs. 5.79 h; P<0.001). OC/APAP ER was generally well tolerated. Conclusion: HVD indicates a longer time above 50% of the Cmax for oxycodone plasma concentrations with OC/ APAP ER administered every 12 hours compared with IR OC/APAP administered every 6 hours. These findings support administration of OC/APAP ER every 12 hours to manage moderate to severe acute pain. Original Citation: Ping H, Brunelle R, Morton T, Devarakonda K. Half-value duration analysis for oxycodone after single and multiple doses of oral MNK795 controlled-release oxycodone/acetaminophen (CR OC/APAP) tablets. Presented at: PAINWeek 2013; September 4-7, 2013; Las Vegas, NV. 216—WITHDRAWN. Q 217— A NOVEL FORMULATION OF IBUPROFEN SODIUM HAS A FASTER ONSET OF ANALGESIA THAN STANDARD IBUPROFEN Journal of the American Pharmacists Association APhA2014 ABSTRACTS TABLETS IN THE TREATMENT OF POSTOPERATIVE DENTAL PAIN. Brain P, Jean Brown Research, Leyva R, Pfizer Consumer Healthcare, Doyle G, Independent Consultant, Kellstein D, Pfizer Consumer Healthcare, E-mail: [email protected] Objective: This study was conducted to test the clinical relevance of faster ibuprofen (IBU) absorption observed with Advil film-coated tablets (IBUNa), a newly available IBU sodium formulation, compared with standard IBU tablets to onset of analgesia and overall analgesic efficacy. Methods: This randomized, doubleblind, single-center, 8-hour inpatient study employed the third molar extraction model of dental pain in 316 subjects with at least moderate postsurgical baseline pain. Subjects were randomized 2:2:2:1 to receive a single dose of IBUNa (2x256 mg; equivalent to 400 mg IBU; n = 95), Advil (IBUAdv; 2x200 mg; n = 86), Motrin (IBUMot; 2x200 mg; n = 87), or placebo tablets (n = 48). Primary endpoints were time-weighted sum of pain relief and pain intensity differences over 8 hours (SPRID 0–8) and time to meaningful pain relief (TMPR), assessed using the double-stopwatch method. Results: Mean SPRID 0–8 scores were significantly greater for IBUNa and the other active treatments versus placebo (P<0.001). The IBUNa group reported TMPR significantly earlier (median 42.4 minutes) than placebo (>8 hours), pooled IBUAdv/IBUMot (median 55.3 minutes), and IBUMot (median 60.7 minutes) (all P<0.001) and marginally faster than IBUAdv (median 52.0 minutes; P = 0.075). By study end, 95.8%, 88.4%, 94.2%, 82.8%, and 22.9% of subjects in the IBUNa, pooled IBUAdv/IBUMot, IBUAdv, IBUMot, and placebo groups, respectively, achieved meaningful pain relief. Secondary endpoint comparisons of IBUNa versus placebo, including time to first perceptible pain relief; SPRID 0–2,–3, and –6 scores; time to treatment failure; and global evaluation of treatment, were consistent with the primary findings. Nausea and vomiting were the most common adverse events; all were mildly or moderately severe and similar across treatment groups. No serious adverse events or discontinuations due to adverse events occurred. Conclusion: IBUNa provides more rapid onset of analgesia than standard IBU tablets and placebo and represents a new treatment option for rapid relief of acute pain. Funded by Pfizer Consumer Healthcare. Original Citation: 32nd Annual Scientific Meeting of the American Pain Society, May 8–11, 2013, New Orleans, LA; PAINWeek 2013, September 4–7, 2013, Las Vegas, NV; 2013 Annual Meeting of the American College of Clinical Pharmacy, October 13–16, 2013, Albuquerque, NM Q 218—A NOVEL FORMULATION OF IBUPROFEN SODIUM IS ABSORBED FASTER THAN STANDARD IBUPROFEN TABLETS. Legg T, CoxHealth, Leyva R, Kellstein D, Pfizer Consumer Healthcare, E-mail: david. [email protected] Objective: These studies were conducted to determine the pharmacokinetic profile of Advil film-coated tablets (IBUNa) containing ibuprofen sodium, a newly available formulation developed for fast absorption. Methods: Two randomized, openlabel, 5-way crossover, pharmacokinetic studies were conducted to evaluate the rate (maximum concentration) and extent (area under the concentration-time curve to last measurement) of IBU absorption after single doses of IBUNa tablets compared with other marketed IBU formulations. Results: The 2 studies were completed by 71 healthy adults (N=36 and N=35, respectively). IBUNa (2x256 mg; equivalent to 400 mg IBU free acid) was bioequivalent to other fast-absorbed IBU formulations—Advil Liqui-Gels (IBULG; 2x200 mg) in the fasted and fed states and Advil FastGel (IBUFG; 2x200 mg) and Nurofen Express (IBU lysine [IBULys]; 2x342 mg; equivalent to 400 mg IBU free acid) in the fasted state—for rate and extent of IBU absorption. In the fasted state, IBUNa was bioequivalent to Motrin IB (IBUMot), Advil (IBUAdv), and Nurofen (IBUNur) (each 2x200 mg) tablets for extent of absorption, but was absorbed significantly Journal of the American Pharmacists Association Downloaded From: http://mustafa.japha.org/ on 06/09/2014 j apha.org faster than all 3 standard ibuprofen tablet formulations. The median IBUNa time to maximum concentration (Tmax) was 30 to 35 minutes, comparable to IBULG, IBUFG, and IBULys (median Tmax = 40, 40, and 35 minutes, respectively), but much faster than IBUMot, IBUNur, and IBUAdv (median Tmax = 120, 120, and 82 minutes, respectively). In the fed state, IBUNa and IBULG had the same median Tmax (90 minutes). Adverse events (AEs) were balanced across treatments and mostly mild in severity; the most common AEs were headache and dizziness. Conclusion: These data demonstrate that IBUNa is absorbed at a faster rate than, but to a similar extent as, standard ibuprofen tablets. Moreover, IBUNa reaches peak concentrations in 30 to 35 minutes, comparable to other fast-absorbed ibuprofen formulations and >45 minutes faster than standard formulations. Funded by Pfizer Consumer Healthcare. Original Citation: 32nd Annual Scientific Meeting of the American Pain Society, May 8–11, 2013, New Orleans, LA; PAINWeek 2013, September 4–7, 2013, Las Vegas, NV; 2013 Annual Meeting of the American College of Clinical Pharmacy, October 13–16, 2013, Albuquerque, NM Q 219—OPEN-LABEL SAFETY OF MNK-795, OXYCODONE/ACETAMINOPHEN EXTENDED-RELEASE TABLETS, IN PATIENTS WITH OSTEOARTHRITIS OR CHRONIC LOW BACK PAIN. Nalamachu S, International Clinical Research Institute Inc., Barrett T, Kostenbader K, Young J, Mallinckrodt Inc., Email: [email protected] Objective: The primary objective of this study was to demonstrate the safety and tolerability of oxycodone/acetaminophen extended-release tablets (OC/ APAP ER) with up to 35 days of use. Methods: This multicenter, phase 3, open-label study included adult patients who had been diagnosed with osteoarthritis (OA) of the knee or hip with moderate to severe pain despite the use of nonopioid or opioid analgesics, or moderate to severe chronic low back MA R /APR 2014 | 54:2 | JAPhA e155 APhA2014 ABSTRACTS pain (CLBP) present for several hours per day for at least 3 months. Study medication was OC/APAP ER (2 tablets [15 mg OC/650 mg APAP] q12h) for up to 35 days. The primary endpoint was measured by time to discontinuation, change from baseline physical examination findings, vital signs, pulse oximetry, clinical laboratory tests, liver function test results, and treatment-emergent adverse events. Descriptive statistics included mean, standard deviation, median, minimum, and maximum, and all categorical/qualitative data are presented using frequency counts and percentages. Results: Of 376 patients enrolled (n = 141 OA, n = 235 CLBP), 75.8% completed the study (69.5% OA, 79.6% CLBP). Treatment-emergent adverse events that occurred in >5% of patients were nausea (23.1%), vomiting (15.2%), dizziness (14.9%), somnolence (11.4%), constipation (11.2%), pruritus (7.2%), and headache (5.1%). Liver function tests shifted from normal at baseline to elevated at study end in 0.3% to 6.9% of patients, depending on the measure. Ten patients had liver function test results deemed clinically significant; this resulted in study discontinuation for 5 patients (with subsequent resolution). Changes in physical examination findings, vital signs, and oxygen saturation were not clinically significant, with the exception of 1 patient who experienced treatmentrelated hypopnea and discontinued the study. Substantial decreases in pain intensity were observed for both patient groups. Conclusion: In this study, OC/ APAP ER was generally well tolerated for up to 35 days in patients with OA and CLBP who had moderate to severe pain. Original Citation: Nalamachu SR, Barrett T, Ward J, Giuliani M, Kostenbader K, Young J. Open-label safety of MNK-795, controlled-release oxycodone/acetaminophen tablets (CR OC/ APAP), in patients with osteoarthritis or chronic low back pain. Presented at: PAINWeek 2013; September 4-7, 2013; Las Vegas, NV. 220—STUDENT SATISFACTION WITH PAIN MANAGEMENT IN PHARMACY SCHOOL: A SURVEY e156 JAPhA | 5 4:2 | M AR/AP R 2014 Downloaded From: http://mustafa.japha.org/ on 06/09/2014 OF THREE PHARMACY CLASSES AT A NEW SCHOOL OF PHARMACY SCHOOL. Troccia A, Wegmans School of Pharmacy at St. John Fisher College, Email: [email protected] Objective: The purpose of this study was to elicit student pharmacists’ perceptions and knowledge of pain management. The Institute of Medicine has noted that pain management is inadequate in the United States and many patients will seek self-care first. Pharmacists and pharmacy schools are well positioned to address this important public health problem, but little is known about satisfaction with training. Methods: In April 2013, students (N = 255) in 3 pharmacy school graduate classes (P1, P2, and P3) were surveyed with questions that assessed both their personal perception and clinical opinion on pain management as an entity. The topic of questions covered were addressed with the following subsets: etiology of pain, knowledge of pain medications, assessment of pain management implementation into doctor of pharmacy programs, motivation to manage pain in a clinical setting, assessment for the difference between diversion and a true need for management, and the impact of expanded pain management techniques. Results: P3 students were more confident in their knowledge of pain etiology and management than others. Perception of pain being a manageable and true issue had gone from a state of uncertainty or strongly disagreeing to a more agreeing and accepting nature. Responses to the question “I feel that managing a patient’s pain in the pharmacy is a pharmacist’s responsibility” were as follows: P1 (n = 72) disagree 23%; P2 (n = 70) disagree 13%; P3 (n = 60) disagree 7%. As students were early on in their didactic studies, their baseline knowledge of pain and its management was significantly lower than those students who had progressed further in the program. Conclusion: Professional pharmacy students were shown to have a gradually increased knowledge of pain management and recognition of pain as an issue that is more than just a patient complaint to obtain unnecessary medications and attempt diversion. ja p h a .org 221—TOPICAL KETAMINE IN THE TREATMENT OF COMPLEX REGIONAL PAIN SYNDROME. Mekhjian H, Goad J, Durham M, University of Southern California, E-mail: mekhjian@ usc.edu Objective: The objectives of this study are to: (1) assess changes in numeric pain intensity scores after using topical ketamine in the treatment of complex regional pain syndrome (CRPS); and (2) assess adverse effects associated with topical ketamine. Methods: Ketamine is a general anesthetic and a noncompetitive Nmethyl-D-aspartate (NMDA) receptor antagonist with opioid activity. Ketamine hydrochloride is approved for intravenous and intramuscular use and is available in a bulk powder. Parental and oral forms of ketamine have shown some promise for treating the burning pain and exquisite skin hypersensitivity, allodynia, of CRPS and other chronic pain states associated with nerve injury. Several randomized, double-blind, placebo-controlled studies have reported on the reduction of allodynia following intravenous administration of ketamine, but central nervous system (CNS) adverse effects may limit use. Topical formulations of ketamine can be compounded to reduce CNS adverse effects and increase patient acceptance. There are limited data on the use of topical ketamine to treat CRPS. This is a retrospective chart review of pain center patients who have used topical ketamine during the study period of April 2010 to April 2013. Patients will be followed up to the point of discontinuation of therapy or the end of the study period. Inclusion criteria consist of patients seen at this pain center and have received compounded topical ketamine according to pharmacy records. Patients will be excluded if they have been prescribed topical ketamine for pain syndromes other than CRPS, if they have started other pain medications concurrently with topical ketamine, if they picked up a prescription for topical ketamine but never used it, or if they are <18 years of age. Data collected will include dose and duration of topical ketamine use, pain scores, adverse effects, comorbid conditions, and basic demo- Journal of the American Pharmacists Association APhA2014 ABSTRACTS graphics. Data will be analyzed using descriptive statistics. Results: Research in progress. Q 222—TREATMENT OF EPISODIC TENSION-TYPE HEADACHE WITH A NOVEL FORMULATION OF IBUPROFEN SODIUM. Packman E, Institute for Applied Pharmaceutical Research, Leyva R, Kellstein D, Pfizer Consumer Healthcare, E-mail: david. [email protected] Objective: This study was conducted to test the clinical relevance of faster ibuprofen (IBU) absorption observed with Advil film-coated tablets (IBUNa), a newly available ibuprofen sodium formulation, compared with standard IBU tablets in the treatment of episodic tension-type headache (ETTH). Methods: This randomized, double-blind, single-center, parallel-group study included subjects aged 18 to 65 years with a history of ≥4 ETTH attacks per month for the past 6 months. Subjects reporting at least moderately severe baseline headache pain were randomized 2:2:1 to single-dose IBUNa (2x256 mg; equivalent to 400 mg standard IBU), Motrin (IBUMot; 2x200 mg), or placebo. Primary endpoints were time-weighted sum of pain relief rating (PRR) and pain intensity difference (PID) scores over 3 hours (SPRID 0–3) and time to meaningful pain relief (TMPR), assessed using the double-stopwatch method. Secondary endpoints included time to first perceptible pain relief (TFPR) confirmed by TMPR; sum of PRR and PID scores (PRID) at 1, 2, and 3 hours postdose; and time-weighted sum of PRR, PID, and PRID scores over 2 and 3 hours. Results: Eligible subjects (N = 226) were randomized to IBUNa (n = 91), IBU(n = 89), and placebo (n = 46). IBUNa Mot and IBUMot had significantly better mean SPRID 0–3 scores than placebo (P<0.001), but were not significantly different from each other. Summed secondary endpoints revealed similar results. Median TMPR was significantly faster in both active treatment groups (IBUNa = 40.6 min; IBUMot = 48.5 min) versus placebo (>180 min; P<0.001). The prespecified TMPR analysis showed no difference between IBUNa and IBUMot (P = 0.253); however, a post-hoc analysis assigning higher weight to earlier time points indicated that IBUNa provided faster TMPR and TFPR than IBUMot (P = 0.022 and 0.018, respectively). No adverse events were reported. Conclusion: IBUNa is effective and safe in the treatment of ETTH. A posthoc analysis indicates that IBUNa provides an appreciably faster onset of analgesia than standard IBU tablets. Funded by Pfizer Consumer Healthcare. Original Citation: 55th Annual Meeting of the American Headache Society (AHS), held in conjunction with the 16th Biennial Congress of the International Headache Society (IHS), June 27– 30, 2013, Boston, MA; PAINWeek 2013, September 4–7, 2013, Las Vegas, NV; 2013; Annual Meeting of the American College of Clinical Pharmacy, October 13–16, 2013, Albuquerque, NM Patient Attitudes and Behavior 223—ARE CHILDREN WITH ASTHMA OVERCONFIDENT THAT THEY ARE USING THEIR INHALERS CORRECTLY?. Carpenter D, Geryk L, University of North Carolina at Chapel Hill Eshelman School of Pharmacy, Weaver M, University of North Carolina at Chapel Hill, DeWalt D, University of North Carolina at Chapel Hill School of Medicine, Sleath B, University of North Carolina at Chapel Hill Eshelman School of Pharmacy, E-mail: dmcarpenter@unc. edu Objective: Prior research has shown that most children with asthma have suboptimal inhaler technique. A potential reason children may have poor technique is because they are unaware that they are using their inhaler incorrectly. The objective of this study is to document the extent to which children with asthma are overconfident that they are using their inhalers correctly. Methods: Children (n = 91) aged 7 to 17 years with persistent asthma were recruited at 2 nonurban pediatric practices in North Carolina. Eligible children demonstrated their inhaler technique for metered-dose inhalers either with or without a spacer at an office visit and Journal of the American Pharmacists Association Downloaded From: http://mustafa.japha.org/ on 06/09/2014 j apha.org again 1 month later. Children were dichotomized into 2 groups based on their level of inhaler self-efficacy: either “completely sure” or “not completely sure” they were using their inhaler correctly. The mean number of inhaler steps (out of 8) children performed incorrectly for the 2 groups was examined. A linear mixed model was run for children in the “completely sure” group to determine whether demographic factors predicted their overconfidence, defined as the number of inhaler steps they missed. Results: Children were primarily male (56%) and non-white (60%). Sixtyeight (75%) children were completely sure they used their inhalers correctly at the office visit. Children in the “completely sure” group missed an average of 1.5 steps whereas children in the “not completely sure” group missed an average of 1.8 steps. There was no evidence found that demographic characteristics were associated with the number of steps that the “completely sure” group missed. Conclusion: In this study, children who were completely sure that they used their inhalers correctly still missed an average of 1.5 steps. Simply asking children about correct inhaler use is unlikely to identify children who do not use their inhalers correctly. Pharmacists should ask children to demonstrate inhaler technique so they can instruct children in proper technique. 224—ASSESSMENT OF PATIENT PERCEPTIONS REGARDING PHARMACISTS AS PROVIDERS IN COLLABORATIVE MODELS OF CARE. Grimshaw S, Cost M, Black B, Tennessee Pharmacists Association, Email: [email protected] Objective: As Tennessee and other states implement and update laws, regulations, and practice acts to reflect current collaborative models of care involving pharmacists, all stakeholder groups, including prescribers, pharmacists, other providers, patients, and the general public, should be knowledgeable regarding the purpose for these models of care and the growing need for pharmacists in our health care system. Although recent research has demonstrated positive prescriber and pharmacist perceptions MA R /APR 2014 | 54:2 | JAPhA e157 APhA2014 ABSTRACTS regarding the inclusion of pharmacists in collaborative models of care, very few studies exist that assess patients’ perceptions. Thus, this research study seeks to assess patients’ perceptions of pharmacists as providers and pharmacists’ roles in collaborative models of care. This study further seeks to analyze and evaluate participants’ responses to assist in the future development and implementation of collaborative models of care. Methods: This research study will utilize a prospective, web-based survey to assess patient perceptions. The survey will be disseminated to patients through the Tennessee Pharmacists Association (TPA) membership using multiple methods of delivery, including electronic devices and web-based methods. The survey link will be open for 60 days, after which time the survey data will be analyzed. Patient participation will be voluntary, and responses will be collected anonymously. Patients will be asked to provide demographic information and will be eligible to complete the survey if they are ≥18 years old, either live or work in Tennessee, and have sought or received information or services from a pharmacist or student pharmacist. Instructions for accessing the online survey will be distributed to patients through communications with TPA members, which includes pharmacists and student pharmacists in multiple direct patient care settings, such as community and health-system pharmacy practices, colleges of pharmacy, student pharmacist– organized patient care events, and other public outreach and awareness events. Results: Research in progress. 225—LIGHTS, CAMERA, ACTION: EVALUATING THE PORTRAYAL OF PHARMACISTS IN FILM AND TELEVISION. Yanicak A, Monterroyo P, Chappell A, Tavassoli S, Furgiuele G, Waddington L, South Carolina College of Pharmacy, Willliams J, University of South Carolina, Bookstaver P, South Carolina College of Pharmacy, E-mail: [email protected] Objective: Media portrayals of pharmacists may represent the public’s view of the profession and may influence viewer perception. The purpose of this e158 JAPhA | 5 4:2 | M AR/AP R 2014 Downloaded From: http://mustafa.japha.org/ on 06/09/2014 study was to characterize the portrayal of pharmacists appearing in movies and television shows since 1970 and assesses trends over time. Methods: This was a retrospective study of all references to pharmacists in movies and television available in the United States from January 1970 to July 2013. A comprehensive search of the Internet Movie Database, including characters, summaries, and scripts was conducted. Internet searches using Bing and Google search engines also were used to identify additional data. Electronic inquiries requesting input of known pharmacist portrayals were distributed to pharmacy professionals in national, regional, and state pharmacy organizations. The study team viewed all identified references, primarily to evaluate the portrayal of pharmacist characters as positive, negative, or neutral as determined by an algorithm developed by study investigators. A 20% random sampling was viewed by a second investigator. Year and genre of media, demographic information of pharmacist, and victim, hero, or villain status were recorded if available. Data also were analyzed for trends over decades and compared with actual pharmacist demographics. Results: Based on 274 nonduplicate submissions, 205 unique portrayals of pharmacists in film and television were identified, viewed and evaluated after removing exclusions. Pharmacists were primarily portrayed as white (75%), male (75%), younger than the age of 50 years (57%), working in a community pharmacy setting. The majority of portrayals were characterized as negative (62%) while 21% were determined to be neutral. There were 2.9 times as many pharmacists portrayed as victims compared with portrayals as heroes. Pharmacists mostly played minor character roles with single appearances. Conclusion: These results highlight a potential concern in the public’s view and lack of knowledge of the changing dynamics in the profession. 226—PATIENT PERCEPTIONS OF PHARMACOGENOMIC TESTING IN A COMMUNITY PHARMACY ja p h a .org SETTING. Dorosti Y, Goad J, University of Southern California School of Pharmacy, Sarino L, Ralphs Pharmacy, E-mail: [email protected] Objective: The objectives of this study are to: (1) assess patient knowledge, attitudes, beliefs, and practices (KABP) regarding pharmacogenomics after a genetic risk test; (2) compare attitudes and beliefs among people with no risk versus any percent of risk on the genetic risk test; and (3) determine whether there is a linear correlation between KABP and the genetic risk assessment score. Methods: Community pharmacists play a key role in reducing adverse drug events and improving the efficacy of treatment by identifying key interactions in a patient’s medication profile. Personalized medicine uses pharmacogenomic markers to determine optimal drug doses for certain medications and to predict safety issues related to metabolism and drug interactions. These biomarkers require a blood test and are approved by the Food and Drug Administration and included in certain drug labels. While the benefits may seem to clear to clinicians, literature indicates patients are unclear about the risks and benefits of pharmacogenomics. This study is a prospective survey of patients presenting to the community pharmacy for a proprietary web-based genetic risk assessment test from November 2013 to March 2014. An anonymous paper-based KABP survey will be administered in conjunction with the web-based genetic risk test, which calculates a genetic risk score using patient medication profiles and population statistics. The knowledge part of the survey will be administered before the genetic risk test and the remainder of the questions administered following the standard post-test result counseling. The calculated genetic risk score, medication list, age, and sex will be recorded on the survey. To be included in the study, subjects must be ≥18 years of age and take ≥2 medications. Data will be analyzed using descriptive and inferential statistics. Results: Research in progress. 227—PATIENT OF PRIMARY PERCEPTIONS NONADHERENCE Journal of the American Pharmacists Association APhA2014 ABSTRACTS BASED ON UNCLAIMED PRESCRIPTIONS AT A COMMUNITY PHARMACY. Iskanian R, University of Southern California, E-mail: riskanian@ westernu.edu Objective: This study seeks to: (1) determine patient-stated reasons for not claiming new prescriptions; (2) evaluate the types of prescriptions not claimed by patients; and (3) determine if there is a correlation with chronic medication refill pattern and primary nonadherence. Methods: Poor adherence to prescribed drug therapies is dangerous to patients and costly to the health care system. Primary nonadherence results when a patient is prescribed a medication, but fails to start it. In the pharmacy, unclaimed medications may account for $150 billion annually in treatment failures and wasted resources. While studies showing nonadherence to medications and poor clinical outcomes have been reported, those on patient perceptions on claim status have not been reported. This is a phone-based survey study of patients who fail to claim a prescribed medication within 14 days during November 2013 to April 2014. Patients will be excluded from the survey if they are <18 years of age, not receiving a new medication, or the patient or caregiver cannot be reached. Other data collected from pharmacy records will include name and class of medication, insurance type, refill pattern of other medications on profile, and age. Data will be evaluated with descriptive and inferential statistics. Results: Research in progress. 228—PATIENT PERSPECTIVE ON THE UTILIZATION OF COMMUNITY PHARMACISTS AS TRAVEL HEALTH CONSULTANTS. Tran A, University of Illinois Chicago College of Pharmacy, Sommers-Hanson J, Walgreens, Allen S, University of Illinois Chicago College of Pharmacy, MalikIsmail I, Walgreens, E-mail: atran013@ gmail.com Objective: The purpose of this study is to assess patients’ needs and perceptions on travel health services provided by community pharmacists in order to gain insight for the implementation of these services. Methods: A cross-sectional study will be conducted using a voluntary, anonymous survey instrument and offered to participants who have traveled internationally in the past or will be traveling within the next year. Participants will be excluded if they are <18 years of age or are unable to read and write in English. The survey will ask a series of questions that assesses participants’ needs for travel health care services and their perceptions on how knowledgeable and skilled community pharmacists are in providing travel health consultation regarding travel immunizations, medications, and supplies. The questions also will provide insight on the participants’ likelihood of seeking those products and services through a community pharmacy, as well as the willingness to compensate a pharmacist for the travel health consultation. Participants will have the option of completing the survey on paper at the pharmacy where offered or electronically, both of which are preceded with an informed consent clause. Survey responses will be transcribed by the principal investigator into a secure, password-protected spreadsheet that can then be utilized for data analysis and the study presentation. Statistical analyses will include calculations for overall frequencies and measures of central tendency. Results: Research in progress. Release of the surveys is scheduled for October 15. It is important to understand not only the patients’ needs and expectations for travel health services, but also to recognize their perceptions on the capabilities of community pharmacists in providing comprehensive pre-travel health care. The information uncovered by this research will help in establishing a successful and effective travel health program within a community pharmacy. 229—PATIENT SATISFACTION WITH A COMMUNITY-BASED MEDICATION SYNCHRONIZATION PROGRAM. Butler K, Price Chopper, Ruisinger J, University of Kansas School of Pharmacy, Vink J, Price Chopper, Melton B, University of Kansas School of Pharmacy, E-mail: [email protected] Journal of the American Pharmacists Association Downloaded From: http://mustafa.japha.org/ on 06/09/2014 j apha.org Objective: This study seeks to determine satisfaction with a community pharmacy–based medication synchronization program. Improving medication adherence plays a crucial role in optimizing patient care and increasing pharmacy revenue. Methods: A pharmacy chain in the Kansas City metropolitan area currently offers a medication synchronization program to patients at 1 location. The program, Time My Meds (TMM), launched July 2013, allows medications to be synchronized on a 30- or 90-day basis. Currently, approximately 70 patients are enrolled. This study is a cross-sectional survey, which will be administered to patients after 3 months of program participation, to determine patient satisfaction with the program. The survey will collect demographic information along with satisfaction questions modified from the diabetes disease state management questionnaire (DDSM-Q) using a 5-point Likert scale (1 = strongly disagree; 5 = strongly agree). Program participants include patients or caregivers ≥18 years of age, picking up at least 3 months of synchronized fills. Those with refills only occurring every 90 days will be excluded from the study. Study eligibility will be determined using refill history extracted from pharmacy and TMM software. Printed surveys will be distributed to participants when they pick up medications at the pharmacy. Participants will place completed surveys in a sealed box. Descriptive statistics will be used to evaluate patient demographics. Program satisfaction will be evaluated using chi-square with an a priori alpha of 0.05. Results: Research in progress. Results are expected to provide insight into satisfaction with a medication synchronization program. If participants are satisfied with the program, then expansion of the program would be justified and it may improve medication adherence and pharmacy workflow. 230—PATIENT SATISFACTION WITH PHARMACIST-LED CHRONIC DISEASE STATE MANAGEMENT PROGRAMS. Schuessler T, Hen House, Ruisinger J, University of Kansas School MA R /APR 2014 | 54:2 | JAPhA e159 APhA2014 ABSTRACTS of Pharmacy, Hare S, Balls Food Stores, Melton B, University of Kansas School of Pharmacy, E-mail: tyler.schuessler@ ballsfoods.com Objective: As patients begin to realize the value of pharmacist contributions to patient care, the number of patients participating in pharmacist-led disease state management (DSM) programs will likely increase. Therefore, understanding patient needs will be central to the success of these programs. The objective of this study is to assess patient satisfaction with 2 pharmacist-led chronic DSM programs. Methods: A self-insured company, which operates a chain of pharmacies in the Kansas City metropolitan area, administers its own diabetes and cardiovascular DSM programs for employees and their dependents through the company’s health insurance plan. These pharmacist-led programs work with patients to improve cardiovascular and diabetes outcomes through education, improved medication adherence, and drug therapy optimization. Patients are given incentives to participate, such as discounts on health insurance and prescription medications. This study is a cross-sectional survey that will collect demographic information and assess patient satisfaction with the chronic DSM programs through a modified version of the validated diabetes disease state management questionnaire (DDSM-Q) using a 5-point Likert scale. Study participants must be ≥18 years of age, an employee or dependent utilizing company health insurance, have participated in 1 or both of the chronic DSM programs for ≥6 months, and have either hypertension, hyperlipidemia, or diabetes. Clinical pharmacists who administer the program will provide a survey to program participants with a return envelope included to be anonymously completed at the end of the pharmacist visit. Descriptive statistics will be used to assess patient demographics. Program satisfaction will be evaluated using chi-square with an a priori alpha of 0.05. Results: Research in progress. Results from this study could influence future consideration for starting or continuing pharmacist-led chronic DSM e160 JAPhA | 5 4:2 | M AR/AP R 2014 Downloaded From: http://mustafa.japha.org/ on 06/09/2014 programs. Further, current programs may use the data to improve patient satisfaction. 231—PSYCHOMETRIC EVALUATION OF AN INFORMATION SEEKING AND PROCESSING INSTRUMENT: MEDICATION RISK MESSAGES IN THE MEDIA. Williams C, Huston S, University of Georgia, Sarpong D, Xavier University of Louisiana, E-mail: [email protected] Objective: The objective of this study is to examine the psychometric properties of an instrument developed to test the Risk Information Seeking and Processing (RISP) Model. For this study, rosiglitazone cardiovascular risk was used as the exemplar. Methods: The 44-item survey comprised: (1) health history information (physician-diagnosed diabetes, cardiovascular disease, diabetes [type 1 or 2], diabetes medication use); (2) information channels used for health-related information; (3) risk information seeking and processing variables (current knowledge of rosiglitazone cardiovascular risk, information sufficiency threshold, channel beliefs, perceived information gathering capacity, and seeking and processing behaviors); and (4) demographic variables. The survey, administered via Qualtrics online survey software tool, took approximately 30 minutes to complete. In the development process, the survey was pilot tested in two stages: (1) Delphi method was used to revise the initial constructed instrument; and (2) the revised survey was tested in 10% of the target population. The 5-response option Likert-like scale responses to channel belief items was 1 (most negative) to 5 (most positive); and the scale of Current Knowledge and Information Sufficiency (knowledge needed) was 0 to 100. Descriptive statistics, factor analysis, and reliability analysis (Cronbach alpha) were performed to determine the psychometric properties of the subscales of the instrument. Results: The 15 channel belief items, with responses ranging from 2 to 5, had Cronbach alpha scores ranging from 0.598 to 0.829. Of the 3 media channels, magazines had the highest (alpha ja p h a .org 0.818–0.821); followed by television (alpha 0.750–0.763); and newspaper (alpha 0.690–0.755). The range of alpha values for information seeking, heuristic information processing, and systematic information processing was 0.745–0.780. Conclusion: The instrument designed to assess the RISP Model for medication taking of patients is valid, reliable, and can be used to help understand factors influencing information seeking in medication risk situations. 232—WHY MEDICARE PART D BENEFICIARIES DO NOT SWITCH PLANS: TESTING A MODEL OF PART D PLAN INFORMATION PROCESSING. Han J, Urmie J, University of Iowa, E-mail: [email protected] Objective: Guided by the Motivation, Opportunity, and Ability (MOA) model, the objective of this study was to describe Medicare Part D plan information processing. Methods: This study used focus groups and individual interviews to obtain qualitative data. Stratified purposeful sampling was used to recruit participants. Medicare Part D beneficiaries were recruited from a church, an independent living facility, an assisted living facility, and a senior center in 2 Iowa cities. The 2 selected areas represent higher and lower education attainment compared with the Iowa statewide average. In total, 17 individuals participated in the study. Written transcripts were made from audio-recorded discussions and coded using the MOA model as a guide. Results: A total of 18 themes were identified. Information processing (low, medium, high); perceived risk (fear of making changes, losing coverage, choosing wrong plan); needs (product differentiation, product importance); opportunity (access to helper, access to helper with medical knowledge, social interaction, information, choices); self-efficacy; and ability (knowledge, literacy) matched constructs from MOA model. Delegation of information processing (delegation of initiating information processing, delegation of some information processing after self-initiation) was a newly identified theme that was not included in the MOA model. Participants Journal of the American Pharmacists Association APhA2014 ABSTRACTS from the church or senior center tended to do nothing before receiving help with information processing whereas those from independent and assisted living facilities tended to initiate information processing. Although none of participants switched Part D plans last year, their level of information processing was varied; for example, some read through plan information whereas some threw it away. Conclusion: The results of this study suggest that Medicare Part D beneficiaries process plan information in various degrees even though they made the same decision to stay with their current Part D plan. These results will help policy makers develop strategies to improve beneficiaries’ non-switching behaviors. 233—YOUTHS’ DIABETES EMOTIONS, EMOTION PROCESSING, AND COMFORT IN ADJUSTING FOR DIABETES IN PUBLIC. Huston S, Kim C, Rathbun S, Blount R, Murray D, University of Georgia, Heidesch T, Brenau University, Southwood R, University of Georgia, E-mail: hustonsal@ gmail.com Objective: This study was conducted to: (1) develop scales for measuring (a) adaptive and negative diabetes-related emotions of adolescents with diabetes, (b) their emotion expression and processing, and (c) their comfort in adjusting for diabetes in public; and (2) investigate the relationships among the 3 sets of variables. Methods: Scales were tested and validated via cross-sectional survey administration to 308 youths from 8 to 17 years of age attending a summer diabetes camp. Results: Principal components factor analysis resulted in the following scales: negative diabetes-related emotions, confidence, feeling normal, personal growth, and comfort with adjusting. Emotion expression was significantly associated with confidence, personal growth, and comfort. Talking with friends and dad, but not with mom, was associated with feeling normal. Emotion processing was significantly and positively correlated with confidence, feeling normal, personal growth, and comfort with adjusting for diabetes in public. Self-identifying as African American was significantly and positively correlated with more negative diabetes emotions, and lower scores on confidence, feeling normal, and comfort in adjusting for diabetes in public. Being a previous camper was significantly correlated with more comfort in adjusting for diabetes in public and higher confidence and personal growth. Conclusion: Constructs of both negative and adaptive diabetes related emotions were identified. Adaptive emotions appear to be positively associated with comfort in adjusting for diabetes in public. African Americans appear to experience lower levels of adaptive emotion and higher levels of negative emotions, while camping was associated with improvements in adaptive emotions. Age was not correlated with negative or adaptive emotions. Interventions, such as diabetes camps, which foster emotion expression and processing (e.g., diabetes-related emotion discussion with friends), have the potential to improve adaptive emotions and behaviors in youths with diabetes. African American youths with diabetes may especially benefit from such interventions. Patient Care Services group sessions at a community pharmacy. Visits occur weekly for the first month and every other week during months 2 to 6. Patients’ weights are measured at every visit and a total body composition is performed at the first and last visits. Patients are provided with behavioral, dietary, and nutritional education during these visits. Furthermore, patients are encouraged to make goals during each visit regarding the provided educational content. The primary outcome is the mean weight loss at 6 months compared with baseline. A 6-month follow-up also will be performed with those who have completed the program to assess the weight loss maintenance achieved. Results: Research in progress. The pharmacist-led weight loss program is currently ongoing. To date, 11 participants have completed the study with an additional 22 currently enrolled. For those who have completed the program, all participated in individual sessions and the mean weight loss at 6 months compared with baseline was 5 kg (95% CI 3–6.9 kg, P<0.001). Results of the 6-month follow-up are in progress. A pharmacist-led intensive behavioral therapy program can effectively assist patients in losing weight in a manner consistent with the guidelines set forth by CMS. 234—EVALUATION OF A PHARMACIST-LED 6-MONTH WEIGHT LOSS PROGRAM IN OVERWEIGHT PATIENTS. Ching K, Boomershine V, Walgreens, Pogge E, Midwestern University College of Pharmacy–Glendale, E-mail: [email protected] Objective: The purpose of this study is to evaluate the efficacy of a pharmacist-led weight loss program that is based on the general requirements set forth by the Centers for Medicare and Medicaid Services (CMS) November 2011 Decision Memo for Intensive Behavioral Therapy for Obesity. Methods: This study is a pilot weight loss program following the CMS guidelines. Individuals with a body mass index (BMI) >30 kg/m2 or >27 kg/m2 with an additional comorbidity are eligible for participation in the study. Participants are to attend 14 face-to-face individual or 235—ADVANCING THE ROLE OF PHARMACY TECHNICIANS: TELEPHONE HOSPITAL DISCHARGE FOLLOW-UP. Turner P, Rodriguez Esquire A, Vera D, Fort Belvoir Community Hospital, E-mail: David.A.Vera.mil@ health.mil Objective: This study aims to determine the feasibility of a certified pharmacy technician (CPhT) to perform telephone hospital discharge follow-up. Recently hospitalized patients are at high risk for adverse drug events (ADEs). It is estimated that 20% to 30% of all patients are readmitted, of which 66% are attributable to ADEs. Telephone hospital discharge follow-up has been reported to reduce emergency department (ED) visits and hospital readmissions. Hospitals are challenged to reduce readmissions by providing safe inpatient care and to minimize post-discharge complications Journal of the American Pharmacists Association Downloaded From: http://mustafa.japha.org/ on 06/09/2014 j apha.org MA R /APR 2014 | 54:2 | JAPhA e161 APhA2014 ABSTRACTS with limited resources. Methods: Adults aged >18 years discharged from the general medicine ward from May 1 to July 31, 2013 were contacted by a CPhT within 7 days via telephone using a scripted medication assessment questionnaire. Patients who self-reported an ADE were referred to a clinical pharmacist for evaluation and triage. Patients were classified as “lost to follow-up” if they did not receive a follow-up call or telephone number was invalid. Data collected included baseline demographics, health care utilization, number of patients referred to clinical pharmacist, post-discharge ADE, CPhT interventions, and time spent. Thirtyday readmissions and ED visits were obtained from Tricare claims data. Results: Fifty-two patients met the inclusion criteria for post-discharge telephone follow-up. The CPhT successfully contacted 19 patients and completed 3 interventions (i.e., 1 booked appointment and 2 medication refills). Telephone calls lasted 2 to 7 minutes. Two patients were referred to a clinical pharmacist; both patients experienced an ADE (i.e., diarrhea attributed to new antibiotic). One patient was readmitted for treatment of infection. Two readmissions in the “not contacted” arm occurred <7 and 29 days post-discharge. In the “lost to followup,” 2 ED visits occurred 29 days postdischarge. Conclusion: CPhTs are able to perform scripted telephone hospital discharge follow-up and effectively refer patients needing consultation with a clinical pharmacist. 236—ASSESSMENT OF A PHARMACIST-LED COMPREHENSIVE MEDICATION MANAGEMENT AND WELLNESS PROGRAM. Janovick D, Bright D, Ohio Northern University, Green T, Kroger Co., E-mail: d-janovick@ onu.edu Objective: Pharmacists are currently providing comprehensive medication management in the outpatient setting. However, there is little documented evidence suggesting pharmacists are providing nonpharmacologic support, such as fitness and nutrition counseling. The objective of this study is to demonstrate e162 JAPhA | 5 4:2 | M AR/AP R 2014 Downloaded From: http://mustafa.japha.org/ on 06/09/2014 a pharmacist-led wellness program with medication management and lifestyle modifications through fitness and nutrition can lead to improved biometric markers. Methods: The wellness program will target corporate employees and will be offered in a corporate headquarters setting with an on-site workout facility. The pharmacist overseeing the program will be licensed as a certified personal trainer from the National Strength and Conditioning Association for fitness program design and supervision. The program is expected to recruit approximately 40 patients into the wellness program consisting of 2 treatment arms from November 2013 to May 2014. Group A will feature nutrition-based classes, medication therapy management, and fitness education. Group B will perform the first group’s activities plus direct, supervised fitness training once weekly. Measured outcomes during the study will consist of body mass index, waist circumference, fasting blood glucose, blood pressure, heart rate, and lipid panel. Biometric markers will be assessed at baseline, 3 months, and 6 months. Comparisons will be made using Microsoft Excel 2010 and SPSS v18.0. This study will be submitted for institutional review board approval. Results: Research in progress. 237—BLOOD PRESSURE MONITORING BY ADVANCED PRACTICE STUDENT PHARMACISTS TO ASSESS PATIENTS’ GOALS OF THERAPY. Doheny S, Walgreens, Charron D, Massachusetts College of Pharmacy and Health Sciences University, Oh S, Walgreens, Lynch A, Massachusetts College of Pharmacy and Health Sciences University, E-mail: [email protected] Objective: The purpose of this study is to determine the impact of a monthly blood pressure screening protocol on student pharmacists’ knowledge of hypertension, their confidence in assessing blood pressure, and the appropriateness of their treatment plan. Methods: Advanced pharmacy practice experience (APPE) students will be assessed prior to involvement in rotation activities on their knowledge of hypertension and goals of therapy. During ja p h a .org their rotation, students will participate in a monthly blood pressure screenings at their APPE site to eligible and willing patients. Students will then assess a patient’s blood pressure and design a treatment plan (if necessary) in addition to other rotation responsibilities. Change in scores of students’ hypertension knowledge before and after the rotation will be reported as well as their perception of confidence in assessing blood pressure, and the appropriateness of their treatment plan. The students’ knowledge of hypertension and treatment guidelines, confidence in assessing blood pressure, and appropriateness of treatment recommendations will be compared with 2 cohorts: (1) APPE students on the same rotation who do not participate in the monthly blood pressure screenings and (2) APPE students on a similar rotation with a different preceptor. The appropriateness of their treatment plan will be assessed by their preceptor at the time of patient visit, and is determined on current treatment guideline recommendations and patient-specific factors. Results: Research in progress. Patient recruitment and student assessment is ongoing. Q 238—BREAKING THE TRICARE MAIL ORDER PHARMACY BARRIER WITH PATIENT EDUCATION. Weber S, Oliver D, Naval Health Clinic Charleston, E-mail: samantha.weber@ med.navy.mil Objective: The Tricare Mail Order Pharmacy (TMOP) program, administered by Express Scripts, is designed to provide beneficiaries their medications when they need them. The Naval Health Clinic Charleston (NHCC) Pharmacy Process Improvement Committee recognized a need to better serve patients who presented prescriptions that were designated non-formulary. Currently there are no copayments to beneficiaries processing prescriptions at military treatment facilities (MTFs). As of February 2013, TMOP copayments range from $0 to $43, and current retail pharmacy copayments range from $15 to $132 for a 90day supply. Seeing the need and benefit, not only for beneficiaries but also for the Department of Defense, the pharmacy Journal of the American Pharmacists Association APhA2014 ABSTRACTS team decided to educate and assist patients with the enrollment process. The objective is to enhance patient quality of care through the use of TMOP services. This is an effort to allow patients to receive the best quality of care that can be rendered by the facility for medications not available on local MTF formulary. Methods: Initial determinations were made whether the patient was currently using TMOP services for those medications not on the local MTF formulary. When patients were unaware or not currently using TMOP services, they would be counseled on the benefits and assisted with the initial enrollment process. Afterward, the patients would be asked to complete a short survey to determine if they felt TMOP was improving their quality of care. Results: Over the past 5 months, there have been 107 patients enrolled in TMOP. Of the 107 patients enrolled, 300 prescriptions have been filled through TMOP, resulting in a total cost savings of $39,447 to the government. Conclusion: Medication costs appear to be one of the most common barriers to health care. The pharmacy has stepped in and identified that TMOP education was a barrier inhibiting NHCC’s patient populations’ access to care and then provided the services necessary to overcome those barriers, which resulted in the improvement of quality of care. The NHCC pharmacy TMOP assistance program has proven to be a step in the right direction in breaking the TMOP barrier and improving patient education. This in turn leads to a better quality of care for those patients entrusted to our care. Original Citation: Breaking the tricare mail order pharmacy “TMOP” barrier with patient education. 239—COMPARISON OF TWO PHARMACIST-DRIVEN POPULATION MANAGEMENT APPROACHES TO INCREASE MONITORING OF SERUM VITAMIN B12 IN PATIENTS TAKING METFORMIN. Matthews D, Beatty S, The Ohio State University College of Pharmacy, Grever G, The Ohio State University, LaBella S, The Ohio State University College of Pharmacy, Lehman A, The Ohio State University, Barnes K, The Ohio State University College of Pharmacy, E-mail: [email protected] Objective: The primary objective of this project is to compare 2 pharmacist-driven population management approaches to improve monitoring of serum vitamin B<sub>12</sub> in patients taking metformin. Secondary objectives are to: (1) determine the number of patients on metformin with a vitamin B<sub>12</sub> deficiency; and (2) determine the number of patients on metformin with a vitamin B<sub>12</sub> deficiency and prior evidence of anemia or peripheral neuropathy. Methods: The electronic medical record will generate a list of patients on metformin who are enrolled in MyChart, a secure patient portal that allows electronic communication between health care providers and patients. Patients taking metformin for at least 1 year who have not had serum vitamin B<sub>12</sub> monitoring completed in the past year will be randomized to 1 of 2 population management interventions. For patients randomized to approach 1, the pharmacist will communicate monitoring recommendations to the primary care physician prior to a scheduled office visit. For patients randomized to approach 2, the pharmacist will communicate the need for laboratory monitoring directly to the patient using MyChart. Charts of patients in both groups will be reviewed 30 days after the initial communication to track the increase in serum vitamin B<sub>12</sub> monitoring and the number of patients with vitamin B<sub>12</sub> deficiency. Retrospective chart reviews of patients with vitamin B<sub>12</sub> deficiency will be performed to determine the number of patients with prior evidence of anemia or peripheral neuropathy. Results: Research in progress. Descriptive and inferential statistics will be used to describe the difference in the proportion of patients in each group who obtained serum vitamin B<sub>12</ sub> measurements. The number of patients with a vitamin B<sub>12</sub> deficiency who have prior evidence of anemia or peripheral neuropathy will be Journal of the American Pharmacists Association Downloaded From: http://mustafa.japha.org/ on 06/09/2014 j apha.org reported. The time spent by the pharmacist to conduct each intervention also will be reported to characterize the long-term sustainability of each approach. 240—A COMPREHENSIVE REVIEW OF CURRENT PROCEDURAL TERMINOLOGY CODES TO ASSESS PHARMACY’S CURRENT AND FUTURE ROLE IN HEALTH CARE. Kurian J, Jennings L, Asfoor F, Dichoso E, Luu D, Tabrizi P, Tasmin A, Tauscher T, University of the Pacific, Thomas J. Long School of Pharmacy and Health Sciences, E-mail: [email protected] Objective: The Current Procedural Terminology (CPT) codes were used as a model of contemporary health care to investigate which services pharmacists are licensed to perform and potentially bill for these services. Methods: The guidelines for a doctor of pharmacy degree (PharmD), according to the Accreditation Council for Pharmacy Education (ACPE), and 5 Board of Pharmacy Specialties (BPS) were reviewed and compared with each individual CPT code. The CPT codes that were represented by a guideline were compiled by 2 separate researchers. Cohen’s kappa test was utilized to determine the inter-rater reliability. Any discrepancies were then reviewed by the pair of researchers to produce a final list of codes that fell under the specified set of guidelines. Results: There are 10,962 CPT Category I codes within the 2013 CPT code list. A total of 672 CPT Category I codes were determined to be represented by the PharmD degree ACPE guidelines. The percentage of CPT Category I codes that are represented by each specialty’s guidelines, in addition to the baseline PharmD codes, are 6.90% (Psychiatry), 7.64% (Nuclear), 7.31% (Oncology) , 6.27% (Nutrition Support), 8.06% (Ambulatory Care), and 8.46% (Pharmacotherapy). The number of CPT Category I codes that are represented solely by each specialty’s guidelines are 108 (Psychiatry), 167 (Nuclear), 131 (Oncology), 76 (Nutrition Support), 424 (Ambulatory Care), and 655 (Pharmacotherapy). Conclusion: This review exemplifies the significant presence of pharmacists MA R /APR 2014 | 54:2 | JAPhA e163 APhA2014 ABSTRACTS in the current health care system beyond the 3 CPT codes designated to pharmacists, notably in Pharmacotherapy and Ambulatory Care specialties. The future of pharmacy lies in optimizing the role of the pharmacist within the patient-centered medical team. Shifting services to pharmacists can allow other health care providers to tend to additional patients whose needs are not presently met under the current health care structure, potentially reducing health care costs and optimizing quality of care. 241—COST ANALYSIS AND EVALUATION OF PATIENT AND PROVIDER SATISFACTION OF PHARMACIST-DELIVERED TRAVEL HEALTH SERVICES IN A COMMUNITY PHARMACY. Ford M, University of Iowa, Kading T, Hy-Vee, Ernst E, Veach S, University of Iowa, E-mail: [email protected] Objective: This study aims to: (1) determine whether pharmacist-delivered travel health services, excluding immunizations, would be cost-effective if reimbursed using a two-level, tripletier payment system; and (2) evaluate patient and provider satisfaction with pharmacist-delivered travel health services. Methods: This will be a prospective, observational study in a Midwest grocery store chain pharmacy. The pharmacist will document time spent gathering recommendations from the Centers for Disease Control and Prevention and counseling on general travel information for patients who present for travel health services from October 2013 through February 2014. The patient will be charged a fee similar to a physician office visit insurance copay for the consultation. For study purposes, a two-level, triple-tier system will be used for data collection. Level 1 will correspond to the number of countries visited (Tier 1 is 1–2 countries, Tier 2 is 3–4 countries, and Tier 3 is ≥5 countries). Level 2 will correspond to pharmacist time (Tier 1 is ≤30 minutes, Tier 2 is 31–60 minutes, and Tier 3 is >60 minutes). Each visit will be assigned a fee based on the highest categorized tier, whether it is Level 1 or Level 2. The dollar value assigned per tier will be $150 e164 JAPhA | 5 4:2 | M AR/AP R 2014 Downloaded From: http://mustafa.japha.org/ on 06/09/2014 for Tier 1, $175 for Tier 2, and $200 for Tier 3. A cost analysis will be done for data collected during the study period to determine whether the service is costeffective. Surveys using a 5-point Likert scale will be sent to past and current travel health patients and providers who have been contacted for prescriptions related to travel. The questions will assess overall satisfaction and perceived value of the service, areas for quality improvement, and confidence in the pharmacist’s recommendations (for providers only). Descriptive statistics will be used to report results. Results: Research in progress. 242—DEVELOPMENT OF AN INDEPENDENT THIRD-YEAR STUDENT PHARMACIST ROTATION IN PEDIATRIC ASTHMA CLINICS. Qureshi A, Kittaneh A, The Ohio State University, Laubacher C, Nationwide Children’s Hospital, Singrey A, Rodis J, The Ohio State University, E-mail: [email protected] Objective: The objectives of this study are to: (1) implement an independent, introductory pharmacy practice experience (IPPE) for third-year (P3) student pharmacists in pediatric asthma ambulatory clinics; (2) assess students’ perceptions regarding experience; and (3) assess satisfaction of families receiving education. Methods: P3 students provide asthma-focused patient education independent of a pharmacist at 3 pediatric primary care clinics 1 half day per week during the 2013–14 academic year as part of an IPPE. An ambulatory care clinical pharmacist trains students using the interactive, case-based Pharmacy Student Asthma Learning and Training manual created by the pharmacy preceptor. During 4 half-day clinics, the physician precepts the student to provide education to patients and families using materials such as an asthma education booklet, patientfriendly medication handouts, and training devices for demonstration purposes. After the visit, the family completes a written satisfaction survey, dropping the completed document at the front desk to maintain confidentiality. Student feedback regarding the IPPE is evaluated usja p h a .org ing a survey completed at training and on the last day of rotation to compare pre- and post-rotation perspectives. Information gathered evaluates students’ perceptions of the value of this learning experience, comfort working independently, confidence providing education, and areas for improvement. Information is analyzed using descriptive statistics. Results: Research in progress. Preliminary data presented will include the number of patients educated by students, patient demographics, family satisfaction with the service, and student pre- and post-rotation perceptions of the IPPE. This IPPE in pediatric ambulatory care affords P3 students a unique opportunity to improve interdisciplinary skills, develop the ability to work independently, and enhance pharmacologic and therapeutic knowledge. Investigators aim to provide a template for pharmacists in similar settings seeking to enrich students’ experiences. 243—EFFECTIVENESS OF A COMMUNITY PHARMACIST–PROVIDED WEIGHT MANAGEMENT PROGRAM. Fina P, Danaher V, New Albertsons Inc., Winkler S, Midwestern University Chicago, Wagner M, New Albertsons Inc., E-mail: [email protected] Objective: The purpose of this study is to determine the effects of a community pharmacist–provided weight management program on patient weight, waist circumference, and body mass index. Methods: A pharmacist-provided weight management program will be implemented at 3 pharmacies within a supermarket pharmacy chain. Subjects will be identified during annual employee wellness screenings. Inclusion criteria are: associate or spouse with company-provided insurance, ≥18 years of age, nonpregnant, and body mass index ≥25.0 kg/m2. Subjects will participate in a pharmacist-provided 12-week weight management program. Blood pressure, total cholesterol, highdensity lipoprotein, and random blood glucose will be measured at baseline and 12 weeks. Pharmacists will perform a targeted medication review at baseline Journal of the American Pharmacists Association APhA2014 ABSTRACTS to track and intervene on medications known to cause weight management difficulty. Subjects will meet bi-weekly with a pharmacist for a total of 7 visits, which will alternate between live and telephone consultations. Each consultation will include targeted education on selected topics, such as setting goals, reading nutrition labels, and planning meals. Every subject’s waist circumference and weight will be measured during the live consultations. Descriptive statistics will be used to assess changes in the patient population after participation in the weight management intervention. Results: Research in progress. Obesity has been increasing in prevalence in the United States from 12.8% in 1960, to 22.5% in 1994, to 35.7% in 2010, and the American Medical Association has declared it a disease. This trend is alarming, as studies have shown that obesity is a serious health condition that leads to increased morbidity and mortality. Data from this study will help to determine the effect a pharmacist can have on patient outcomes in a community pharmacist–provided weight management program. Further, the methods used may provide a foundation for future weight management programs in the community pharmacy setting. 244—EVALUATING THE EFFECT OF THE APPOINTMENT-BASED MODEL ON INCREASING MEDICATION THERAPY MANAGEMENT INTERVENTIONS AND INFLUENZA IMMUNIZATION RATE IN A COMMUNITY PHARMACY. Martin A, University of Iowa College of Pharmacy, Shepley A, Jackson A, Wilkinson K, CarePro Health Services, Tang Y, Veach S, University of Iowa College of Pharmacy, Email: [email protected] Objective: Pharmacists face many barriers to providing medication therapy management (MTM) and immunization services in a community pharmacy. The appointment-based model (ABM) is a program that allows medication synchronization to a monthly appointment date and may decrease barriers to providing those clinical services. The objectives of this study are to compare pre- and post-enrollment MTM interven- tions identified by pharmacists and rates of influenza immunization administered at the pharmacy in patients enrolled in a pharmacy’s ABM medication synchronization program. Methods: This is a prospective, pilot project being implemented at a community pharmacy in a small, rural, Midwest community. Patients with >5 medications will be flagged during the dispensing process and targeted for enrollment into the ABM synchronization program by pharmacy staff using promotional material. In order to synchronize medications to 1 monthly appointment, patients will agree to monthly prescription reminder phone calls, receipt of preliminary partial fills, and payment of corresponding copayments. Enrolled patients will be contacted by phone 1 week before the monthly appointment, using a standardized script to inquire about needed refills and scheduling an influenza vaccination. All requested medications will then be filled at a convenient time for pharmacy staff prior to the appointment. Enrolled patients’ medication profiles also will be reviewed for potential MTM interventions prior to the appointment. At the appointment, pharmacists will make and document MTM interventions as well as any required follow-up. If patients are OutcomesMTM eligible, a claim will be submitted using the OutcomesMTM online platform. MTM interventions, OutcomesMTM claims, and influenza vaccination rates for enrolled patients pre- and post-intervention will be reported using descriptive statistics. Results: Research in progress. 245—EVALUATING THE IMPLEMENTATION OF YEAR-AROUND IMMUNIZATIONS IN A GROCERY STORE CHAIN PHARMACY. Binz J, University of Arkansas for Medical Sciences, E-mail: [email protected] Objective: The objectives of this study are to: (1) evaluate the implementation of a year-around immunization program in a community pharmacy by assessing the cost of implementation and return on investment (ROI) as well as the effect on pharmacy business growth; and (2) justify the implementation of clinical services in a community pharmacy set- Journal of the American Pharmacists Association Downloaded From: http://mustafa.japha.org/ on 06/09/2014 j apha.org ting. Methods: Design: Retrospective study. Setting: Twenty-eight pharmacies in a grocery store chain in Arkansas implemented an immunization program to provide year-around immunizations (i.e., zoster [shingles], pneumococcal, and influenza vaccinations). The program’s implementation was led by the community pharmacy resident. All stores began the program on September 16, 2013. Patients: Pharmacy patients. Data: Data were collected retrospectively using the Enterprise pharmacy system to include data from the time of implementation (September 16, 2013) through February 16, 2014. Data from previous years also were obtained using the Enterprise system. Data Analysis: The cost of implementation, ROI, profit per immunization, and the service’s effect on business growth were evaluated. The cost of implementation was tabulated throughout the implementation and then calculated as the sum of all costs involved in implementing the program (cost of pharmacist training/certification, resident salary, supplies, etc.). Following the collection of data and cost of implementation, the ROI was evaluated. ROI was calculated using: ROI = (revenue from investment – cost of investment)/cost of investment. A positive number would indicate a profitable program. The average profit per immunization was determined after calculating the profit for each immunization using: profit = revenue – cost. Lastly, the service’s effect on business growth was evaluated. Each store’s growth during this time frame was compared with the growth rate in the previous 3 years. The growth rate was measured as a change in pharmacy sales between September and February of each year. Results: Research in progress. 246—EVALUATION OF COMMUNITY PHARMACIST COMMUNICATION STRATEGIES TO IMPACT BEHAVIOR CHANGE IN AN EMPLOYEE WELLNESS PROGRAM. Ventricelli D, West Virginia University, Rumbach-Austin J, Kroger, Elswick B, West Virginia University, E-mail: [email protected] Objective: The objectives of this MA R /APR 2014 | 54:2 | JAPhA e165 APhA2014 ABSTRACTS study are to: (1) determine the degree of short-term behavior change in patients who enroll in an employee wellness program; and (2) assess whether differences exist between pharmacist-provided telephone communication versus electronic mailings to employees regarding company-determined health targets. Methods: This is a prospective, open-enrollment, quasi-experimental study conducted within a grocery store chain in 22 locations. Participants who received a company-provided health screening during a 3-month period and who are >18 years of age will be included in this study. Participants who received a health screening from a health care source outside the company will be excluded. Following a pharmacist-administered comprehensive health screening program for blood pressure, blood glucose, body mass index, and cholesterol, employees who do not meet the company health targets will be identified for additional pharmacist-provided education and employee wellness programs. These participants will be randomly assigned to an intervention or control group. Participants assigned to the control group will receive standard electronic communication from the company directing them to the wellness program opportunities that are available. The intervention group will receive the same electronic communication as the control group. In addition, the intervention group will receive a personalized phone call from their pharmacist to explain the wellness program options available to them. All participants will be contacted by phone after 3 months to determine whether they made any behavior change to assist them in attaining personal health goals. Data will be analyzed to determine whether there is any difference in behavior change between the intervention group and the control group. Results: Research in progress. 247—EVALUATION OF A DISCHARGE MEDICATION BEDSIDE DELIVERY PROGRAM: THE PATIENT PERSPECTIVE. Yum C, Poliskey K, McPhillips A, Walgreen Co., Rickles N, Northeastern University, E-mail: [email protected] e166 JAPhA | 5 4:2 | M AR/AP R 2014 Downloaded From: http://mustafa.japha.org/ on 06/09/2014 Objective: A large community chain pharmacy located inside a clinic has implemented a pilot program to deliver discharge medications to patients’ bedside upon discharge from a large urban hospital. The purpose of this program is to provide patients immediate access to their discharge medications and avoid initial and medication nonadherence related to medication non-availability. Utilizing the PRECEDE-PROCEED planning model, this study aims to evaluate the pilot bedside delivery program and identify ways to make the program more efficient and effective and to maximize several patient outcomes. Methods: This study has 2 components. First, a retrospective descriptive analysis of patients enrolled in the program from January 2013 to September 2013 will be conducted. The analysis will examine patient demographics such as: age and sex, prescription insurance status, number and type of medications brought to bedside, patient’s residential distance from hospital, and whether the patient received a follow-up phone call 48 to 72 hours post discharge. The second component involves a survey given to patients enrolled within a 3-month period. At time of consent, patients will be given a choice to receive the survey via telephone, Internet, or postal mail. Patients will be contacted approximately 1 month post discharge and survey questions will explore self-reported adherence to the medications received at discharge, primary care provider follow-up, patient satisfaction and helpfulness with the existing program, and exploration of unfulfilled medication needs at discharge. Descriptive statistics will be used to analyze most patient survey items. Thematic analysis will be used to analyze open-ended items from patient surveys. Exploratory bivariate and multivariate analyses will be used to examine relationships between program characteristics and patient outcome variables. All data will be entered and analyzed using SPSS 21.0. Results: Research in progress. Institutional review board approval is pending from affiliated sites. 248—AN EVALUATION OF A PHARja p h a .org MACIST’S IMPACT ON THE AVOIDANCE OF ADVERSE DRUG EVENTS WHEN PROMPTED BY A THIRDPARTY PAYER COMMUNICATION. Grant K, Gwin R, Johnson A, Teplitskaya A, McConaha J, Lassila H, Duquesne University, E-mail: [email protected] Objective: This study aims to assess the impact of interventions made by a pharmacist embedded in a primary care physician office, when prompted by a third-party payer, on physician cost savings and satisfaction. Methods: A clinical pharmacist, based in a primary care physician office, reviewed weekly patient care communications sent by third-party payers. Medicare, Medicaid, and commercial thirdparty payers sent communications to notify physicians of potential patient medication-related issues. These alerts often included recommendations for gaps in care according to published guidelines, medication adherence issues, and potential drug-drug or drug-disease interactions. These communications were analyzed by the physician practice’s clinical pharmacist and were either resolved at the pharmacy level or a recommendation was made to the physician. Documented data from this initiative included whether or not the recommendation was accepted, how the issue was able to be resolved (by the pharmacist or physician), and physician-reported satisfaction with the service. Results: Research in progress. Preliminary results show that the majority of the care management alerts were able to be resolved by the pharmacist. Qualitative analysis of physician-reported benefits of the service in terms of satisfaction and time savings also will be analyzed. 249—EVALUATION OF STUDENT PHARMACIST AND PHARMACIST IMPACT ON DISEASE STATE MANAGEMENT AND PATIENT SATISFACTION IN ADULT PATIENTS WITH ASTHMA. Jackson B, McConaha J, Duquesne University, E-mail: [email protected] Objective: The purpose of this study was to measure the success of student pharmacist intervention, with pharmacist oversight, on improvements in dis- Journal of the American Pharmacists Association APhA2014 ABSTRACTS ease state control and patient satisfaction in an adult population with asthma. Methods: This prospective study occurred at a regional chain community pharmacy, an independent chain pharmacy, and a university campus located in Pittsburgh, Pennsylvania. Patients aged 18 to 65 years with a diagnosis of asthma on ≥1 inhaled medications were included. Three interventions were utilized: an initial face-to-face intervention, a follow-up face-to-face intervention 1 month after the initial visit, and a telephonic follow-up 6 months after the initial visit. Asthma severity and control were determined for each patient enrolled in the study through the use of multiple assessments including spirometry testing, inhaler technique reviews, validated surveys such as the Asthma Control Test (ACT), and patient satisfaction questionnaires. The main outcomes measured in this study were patient confidence level with disease state management and improvement in inhaler technique following student pharmacist intervention. Results: After 6 months of recruitment, 12 patients were enrolled and 6 completed all interventions (50%). Data measured included spirometry values, survey responses, and inhaler technique review scores and was analyzed using a repeat-measures ANOVA. An average ACT score of 19.8 (out of 25; 79.2% controlled) was noted at baseline, with 22.2 (88.9% controlled) post-intervention. Patient inhaler technique improved at 1 month, from an average technique score of 77.8% to 94.4%. Patient satisfaction with disease state control also improved post-intervention, from an average score of 92.3 to 110.2 (possible 126 points). The only area where scores remained relatively unchanged was the pulmonary function tests. Conclusion: Results of this study show improved patient confidence in asthma control after student pharmacist intervention. This type of intervention could easily be performed by a student intern or pharmacist in a community setting. 250—EXPLORING THE USE OF HEALTH INFORMATION TECH- NOLOGY IN COMMUNITY PHARMACY FOR DISSEMINATING EVIDENCED-BASED TOBACCO CESSATION SUPPORT FOR PATIENT SMOKERS. Patel S, Ogunsanya M, Ford K, College of Pharmacy, The University of Texas at Austin, E-mail: [email protected] Objective: The study was designed to explore pharmacy professionals’ perceptions of systems changes by using health information technology (HIT) for expanding the reach of tobacco cessation support for smokers. Methods: A qualitative research design was employed using a 90-minute focus group with community pharmacy professionals (CPPs) from Texas. Building from the Theory of Planned Behavior (TPB) model, participants were asked to respond to questions based on the following constructs: (1) behavioral beliefs– describe the advantages and disadvantages of HIT; (2) normative beliefs–identify individuals that would approve or disapprove of a systems change; (3) control beliefs–describe factors that would make it easy or difficult to implement this change. Two researchers independently corroborated the order and frequency of each theme to establish interrater reliability. Results: A total of 9 CPPs participated in the focus group. The majority of CPPs were female (n = 7, 78%). Participants were 25 to 65 years of age. All were board-certified CPPs practicing in Texas and 5 (56%) were pharmacy managers. They stated advantages associated with HIT as: (1) speed of use; (2) proactive disease management; and (3) information sharing. They described disadvantages as having: (1) lack of systems support; (2) lack of provider cooperation; and (3) lack of legal integration. Control beliefs were: (1) pharmacist-patient trust; (2) privacy of patient information; (3) time; and (4) reimbursement for services. Participants indicated managers, corporations, hospitals, and payers as parties that would approve or disapprove of such a systems change. Inter-rater reliability was high (95.5%) and discrepancies (4.5%) were resolved through discussion. The results of this study will help in implementing tobacco cessation support services Journal of the American Pharmacists Association Downloaded From: http://mustafa.japha.org/ on 06/09/2014 j apha.org in community pharmacies. The themes identified are important focus points for any type of pilot study that would be developed for HIT-based cessation support in a community pharmacy. 251—IDENTIFYING BARRIERS THAT PREVENT OFFICE-BASED PRACTITIONER REFERRALS FOR COMMUNITY PHARMACIST-LED DIABETES EDUCATION PROGRAMS. Mencia J, Patel C, Wagner M, Jewel-Osco, Drambarean B, University of Illinois at Chicago, E-mail: Jasmine. [email protected] Objective: The purpose of this study is to determine the barriers preventing office-based referrals for educational and clinical diabetes services provided by community pharmacists. Methods: This will be a prospective, multicenter, survey-based study. The top 100 prescribers will be identified in 3 different regions of the Chicago metropolitan area and contacted via fax to complete a survey. Data collected will include: demographics, knowledge about the role of the clinical specialist, knowledge about community pharmacist-led diabetes education programs, types of patients likely to be referred into these programs, and barriers to referrals, if applicable. The survey will be available to participants for 6 weeks and completed anonymously. Study data will be interpreted through descriptive and comparative statistics. Results: Research in progress. Conclusion: Research in progress. The results of this study will be instrumental in determining barriers that may prevent office-based practitioner referrals, which will allow pharmacists to implement methods to increase diabetes education provided to patients in the community setting. Based on the findings from this research, it is anticipated that new strategies can be developed to strengthen interprofessional relationships between community pharmacists and office-based practitioners, further enhancing patient care. 252—IMPACT OF CLINICAL PHARMACY SERVICES INTEGRATION WITHIN A PATIENT-CENTERED MA R /APR 2014 | 54:2 | JAPhA e167 APhA2014 ABSTRACTS MEDICAL HOME. Malinowski J, Wilkes University, E-mail: [email protected] Objective: The objectives of this study are to: (1) describe a potential role for pharmacists within a patientcentered medical home (PCMH) model; (2) discuss successful implementation strategies and potential barriers to pharmacist integration within a PCMH; and (3) outline the impact of a clinical pharmacy–integrated interprofessional team-based model on chronic disease outcomes. Methods: Design: Prospective, institutional review board approved. Inclusion criteria for chronic disease focused on completed outcomes include: 47 highrisk patients >75 years of age with recent blood pressure >140/90 mm Hg on 2 consecutive occasions with ≥5 chronic diagnoses and 43 high-risk patients on multiple medications aged 18 to 75 years with hemoglobin A1C >9%. Additional population of focus includes patients with heart disease and diabetes with low-density lipoprotein (LDL) concentrations >100 mg/dL. Process: The clinical pharmacy team completed medication reconciliation and medication management reviews during chronic care visits. Follow up: The clinical pharmacy team and other interprofessional team members identified monthly rapid cycle processes or Plan-Do-Study-Act cycles to enhance patient care. Medical residents, pharmacy, and nursing students supported the initiative. Results: Within 4 months, half of all patients with hypertension aged ≥75 years achieved goal blood pressure. Two-thirds of the population achieved goal blood pressure within 6 months. One-third of all patients with baseline hemoglobin A1C >9% were under 9% within 6 months. The average rate of potential and actual adverse events identified and corrected by the pharmacy team was 2.8 per patient. Intervention types will be characterized and presented. Interim LDL goal achievement and safety evaluation in the heart disease and diabetes population will be reported. Conclusion: Interprofessional team-based care with integrated clinical pharmacy services improves patient e168 JAPhA | 5 4:2 | M AR/AP R 2014 Downloaded From: http://mustafa.japha.org/ on 06/09/2014 outcomes and safety. Identification of innovative practice models that include pharmacy services is important for care transformation in the PCMH setting. 253—THE IMPACT OF IMPLEMENTING OSTEOPOROSIS SCREENING WITHIN THE COMMUNITY PHARMACY SETTING ON PATIENT EDUCATION AND RISK AWARENESS. Mwangi W, Pope N, Lawson K, Wilson J, The University of Texas at Austin College of Pharmacy, Montemayor D, Valdez G, Cervantes J, H-E-B, E-mail: [email protected] Objective: This project is designed to assess the impact of community pharmacy–based osteoporosis screening on raising awareness of risk factors, providing effective education, and enabling lifestyle modifications. Osteoporosis affects over 10 million individuals in the United States; the incidence of compromised bone strength will continue to grow as risk factors become more prevalent within the general population. The National Osteoporosis Foundation asserts that the identification and education of patients at risk for osteoporosis can lead to early treatment and prevention of disease. Screening within the community provides an ideal setting to provide individuals with accessible education and recommendations for bone health. Methods: The study will be submitted to the institutional review board for approval. Osteoporosis screening will be offered within the community pharmacy setting upon attaining informed consent from each participant. Participants will complete a questionnaire to assess modifiable and non-modifiable risk factors for osteoporosis. Based on responses to the risk assessment tool, patients will be educated on any identified risks and given suggestions for lifestyle modifications. All participants will receive education on the appropriate supplements for their respective age group and they will be encouraged to speak with their health care provider about osteoporosis at their next visit. Patients who are deemed to be at high risk for osteoporosis will be referred to their health care provider for confirmatory diagnostic testing. All participants will be contacted to complete a ja p h a .org telephone survey assessing the services provided through the screening, any resulting modifications to lifestyle, and incidence of follow-up with a health care provider. Results: Research in progress. 254—THE IMPACT OF AN INCENTIVIZED, EMPLOYER-DRIVEN, PHARMACIST-RUN, KNOW YOUR NUMBERS CLINIC. Franks K, Duquesne University Mylan School of Pharmacy, Higginbotham S, Duquesne University Center for Pharmacy Care, Email: [email protected] Objective: The purpose of this study is to demonstrate the impact of an employer-directed, incentivized, pharmacist-managed wellness program on employee total cholesterol, high-density lipoprotein (HDL) cholesterol, body mass index (BMI), and diastolic blood pressure (BP) from baseline along with health literacy and knowledge about wellness. Methods: The study is a retrospective chart review with prospective survey conducted at a pharmacist-managed ambulatory care clinic located on a university campus. Subjects will be university employees with active university health insurance who participate in the university’s Know Your Numbers Clinic. Patients must be ≥18 years of age or with a minimum of 2 years’ worth of data to provide a baseline and follow-up reading. The research is looking for an improvement in total cholesterol, HDL, BMI, and BP from baseline. The survey will collect data pertaining to current views, health literacy, and knowledge of wellness. Results: The data collected include 143 participants. The mean age was 50.7 years and 58 participants (40.5%) were also enrolled in an additional program at the clinic. The preliminary results from a repeated measures analysis of variance shows that an improvement was seen with total cholesterol (P = 0.014) and low-density lipoprotein cholesterol (P = 0.002). All other results were not statistically significant. The study aims to show the benefit of a pharmacist-run clinic on patient health awareness and health outcomes using point-of-care tests. While Journal of the American Pharmacists Association APhA2014 ABSTRACTS the results for most laboratory tests were not statistically significant, they show clinical significance. A trend was shown in improved patient outcomes which helps to show the benefit of pharmacist education on patient wellness. In addition, this study aims to show value of clinical services offered to patients without chronic conditions. 255—IMPACT OF AN ONLINE PROGRAM TO IMPROVE PHARMACISTS’ SKILLS AND CONFIDENCE IN PROVIDING PATIENT CARE. Farrell B, Archibald D, Tsang C, Bruyere Research Institute, Richardson T, Canadian Pharmacists Association, E-mail: [email protected] Objective: The purpose of this study is to examine the self-reported experience of pharmacists who have completed the online learning program Adapting Pharmacists’ Skills and Approaches to Maximize Patients’ Drug Therapy Effectiveness (ADAPT). The goal is to determine if skills and confidence gains have been maintained and translated into adoption of expanded scope of practice activities and billable patient care services, improved quality of patient care, and professional growth. ADAPT is a 5-month continuing education program consisting of 7 modules designed to enhance pharmacists’ patient care and collaborative skills. The program’s pilot results demonstrated learner satisfaction, increased confidence in performing skills, and gains in knowledge of skills along with intention to change practice. Program uptake has been significant across Canada with growing interest from the United States. Methods: The study will use a mixed-methods approach, employing a survey, complemented with telephone interviews. Participants include Canadian and American pharmacists who have completed the ADAPT program since its inception in 2011 (approximately 240 pharmacists). The survey will be analyzed using descriptive and comparative analyses with a content analysis of openended responses. Twelve to 15 interview participants will be purposively selected from survey responders. Interviews will be conducted using a semi-structured approach, audiotaped, transcribed, and analyzed using a constant comparative approach. Results: Research in progress. This study will generate knowledge about the experience of ADAPT graduates attempting to employ new patient care skills in practice. Data collection and analysis will take place from November 2013 to February 2014. The findings will provide insight into pharmacists’ ability to use new patient care knowledge and skills in adopting practice change. Barriers and other facilitators of interest to managers and policy makers may be identified. Researchers will benefit from an enhanced understanding of pharmacists’ opinions about how their gains in skills and confidence have impacted on patient care. 256—IMPACT OF STUDENT PHARMACIST INTERVENTION ON HOSPITAL CONSUMER ASSESSMENT OF HEALTH CARE PROVIDERS AND SYSTEMS COMMUNICATION ABOUT MEDICATION SCORES. D’Angelo R, Meny L, Ferris State University, E-mail: [email protected] Objective: The objective of this project is to analyze the effect of student pharmacist–provided medication education on the hospital consumer assessment of health care providers and systems (HCAHP) domain of communication about medications for patients on the medical/surgical unit at a small rural community hospital. Methods: The institutional review board determined this project to be exempt from review because it was viewed as a quality improvement initiative. Student pharmacists at a small community hospital under the supervision of the staff pharmacists identified patients whose length of stay reached a duration of 1 day by 0700 the following morning. Students reviewed patient charts and identified new medications not previously prescribed in the outpatient setting. Patients with high-risk medications and/or high-risk disease states were identified as needing medication education. Counseling points for medications and/or disease states were developed under guidance of the staff pharmacist. Journal of the American Pharmacists Association Downloaded From: http://mustafa.japha.org/ on 06/09/2014 j apha.org Student pharmacists then met each patient and communicated indication for new medication(s), side effects, monitoring parameters, and beneficial lifestyle modifications. Students documented questions from the patient and reviewed them with a pharmacist to develop answers and reported back to the patient with answers. Each month the institution released data gathered by a third-party group that administered and collected HCAHP surveys. Reports were collected during January through April 2013 to establish a baseline score for “communication about medication ” domain. Reports were collected during May through July 2013. The difference from the pre-intervention period and the intervention period will be measured to analyze the effect student pharmacists had on those scores. Results: Research in progress. The average communication about medication HCAHP score for the pre-intervention period was 68.5%. Twenty-four patients during the intervention period were identified, counseled, and educated about high-risk medications and disease states. The average HCAHP scores during the intervention period was 78.1%. 257—IMPLEMENTATION OF WHOLE BLOOD RAPID THYROID STIMULATING HORMONE SCREENING BY PHARMACISTS IN A GROCERY STORE–BASED COMMUNITY PHARMACY SETTING AS A PRIMARY INDICATOR OF HYPOTHYROIDISM. Green K, Pope N, Lawson K, Wilson J, The University of Texas at Austin, Soliz R, Montemayor D, Cervantes J, H-E-B, E-mail: npope@utexas. edu Objective: The objective of this study is to assess the effectiveness of a community pharmacist–delivered thyroid stimulating hormone (TSH) screening on detection and treatment of primary hypothyroidism. Primary hypothyroidism has an estimated prevalence of up to 4.6% in the general population, as stated by the American Association of Clinical Endocrinologists (AACE). Undiagnosed patients are at risk for certain health conditions including cardiovascular disease, osteoporosis, and infertility. According to the American Thyroid Association MA R /APR 2014 | 54:2 | JAPhA e169 APhA2014 ABSTRACTS and the AACE, measurement of TSH is the principle screening test for primary hypothyroidism and is usually the first test health care providers perform. Methods: The study will be submitted to the institutional review board for approval and informed consent will be obtained from all participants. TSH screening will be initiated in grocery store–based community pharmacies in the Austin, Texas, area using a thirdgeneration supersensitive TSH whole blood test. Participants will be pharmacy clients ≥18 years of age without a history of hypothyroidism. Educational information will be offered to all participants. Participants who test positive as indicated by a TSH level >5 µIU/mL will be referred to their general practitioner for a confirmatory test. Participants will receive a follow-up phone call to complete a verbal survey regarding the service. The primary endpoint will be the effectiveness of the service as measured by the number of patients with positive results who followed up with their physician. The secondary endpoint is patient self-reported assessment of the service. Results: Research in progress. 258—IMPROVING THE COLLABORATIVE CARE PROCESS: DEVELOPING A FRAMEWORK FOR IMPROVING PHARMACY RESIDENT TRAINING AND CLINICAL DECISION-MAKING DOCUMENTATION. Garza O, Moon J, Schweiss S, University of Minnesota, E-mail: [email protected] Objective: As pharmacists increasingly becoming integrated into the care process, it is critical that documentation of pharmacist-provided care is communicated in a consistent, accurate, and clear manner to ensure the optimization of drug therapy and avoidance of drugrelated complications. Peer-review processes have recently been used in a variety of practice settings to evaluate and monitor the performance of pharmacy practitioners; however, incorporating and evaluating it within the preparation and training protocol of future pharmacy practitioners has not been well described. The objectives of this project are to develop and implement a framework for im- e170 JAPhA | 5 4:2 | M AR/AP R 2014 Downloaded From: http://mustafa.japha.org/ on 06/09/2014 proving drug therapy decision making and communication among pharmacy residents through a SOAP note evaluation and peer-review process. Methods: A committee of resident pharmacist preceptors and primary care providers (PCP) will be convened to develop the evaluation and peerreview process and assessment criteria. Pharmacy residents will select 3 drug therapy management notes from their case record during the 2nd, 3rd, and 4th quarters of the residency training period for evaluation. The patient’s PCP will evaluate the pharmacy resident notes while an assigned pharmacist outside the residency training site will evaluate matching sets of de-identified notes. The pharmacy residents will meet with the assigned pharmacists to debrief and discuss the evaluations. Results: Research in progress. An initial review of 10 randomly selected, de-identified SOAP notes from ambulatory pharmacy residents’ patient documentation records was performed. An assessment tool was used to evaluate the accuracy, consistency, and quality of the selected SOAP notes and scored on a 5-point scale (1 = unacceptable; 2 = poor; 3 = acceptable good; 4 = very good; and 5 = exceptional). The 3 areas requiring most improvement included a Subjective (S) component (incorporating all pertinent data/facts); an Assessment (A) component (interpreting relationships/patterns among data); and a Plan (P) component (including recommendations for monitoring), with average ratings of 2.8 each. 259—THE INCIDENCE OF HYPOTENSION IN PATIENTS UNDERGOING GENERAL ANESTHESIA. Hunsicker K, Callejas B, Cook E, Roke Thomas M, Wilkes University, Saeed I, Surgical Specialists of Wyoming Valley, E-mail: [email protected] Objective: The purpose of this research is to predict the incidence of hypotension on patients undergoing surgery with the induction of propofol as general anesthesia. Studies have shown a significant association of anesthesia dose level of propofol with hypotension in patients. This study also may identify predictors ja p h a .org of hypotension to include, age, sex, medication history, and anesthesia time. Methods: Student pharmacists obtained blood pressure (BP) readings from 110 patients during a preoperative visit to the surgical office. Once the patients completed their surgical procedure, computerized anesthesia records of these patients were reviewed for total anesthesia time, blood pressure prior to surgery, and then at 10-, 20-, and 30-minute intervals following the induction of propofol. All surgeries were performed with a length of stay <24 hours. Demographic data, current medications, age, and sex were retrieved from the surgeon’s electronic health record (EHR) to determine any additional predictors for hypotension. Results: Research in progress. The blood pressure records will be analyzed using paired sample t tests to determine whether there is a significant difference in blood pressure at different time intervals following induction of propofol. Regression analysis will be used to predict hypotension based on age, sex, current medication, and anesthesia time. The results are pending completion of the research. Students became proficient in taking blood pressure readings and retrieving data from EHRs. 260—THE INCIDENCE OF POSTOPERATIVE COGNITIVE DYSFUNCTION IN THE ELDERLY POPULATION UNDERGOING SHORT-STAY SURGERY. Overfield K, Bellanco S, Maheady S, Daubert E, Elczyna S, Roke Thomas M, Wilkes University, E-mail: [email protected] Objective: The purpose of this study is to determine if there is a significant relationship between cognitive function and the administration of general anesthesia to individuals >70 years of age presenting for short-stay surgery. Patients will be evaluated prior to surgery, at 1 week postoperatively, and 6 weeks postoperatively. Methods: The intervention group consists of 104 surgical patients >70 years of age undergoing general anesthesia at a “same-day outpatient surgical center” with postoperative intervention <23 hours. The control group includes 102 Journal of the American Pharmacists Association APhA2014 ABSTRACTS individuals >70 years of age undergoing surgery under local anesthesia without general anesthesia at a local short-stay surgical office. Cognitive function was evaluated prior to the introduction of the anesthesia on the day of surgery, 1 week after surgery, and 6 weeks after surgery. Cognitive function was assessed using the Telephone Interview for Cognitive Status (TICS). The quantitative score on the TICS test will be interpreted qualitatively. Results: Research in progress. The study is currently ongoing and the results are being evaluated as received. Paired t tests will be used to determine whether there is any significant difference in cognitive function prior to and 1 week after surgery and prior to and 6 weeks after surgery. To date, there is no significant difference (P>0.05) in cognitive function at 1 or 6 weeks after surgery in the control group. Postoperative cognitive dysfunction (POCD) is defined as a change in the results of neuropsychological tests administered before and after anesthesia and surgery. POCD has the potential to affect outcomes in the elderly up to 5 years postoperatively. POCD presents as a financial and personal challenge for elderly adults because this can result in problems with commuting, shopping, meal preparation, managing finances, and medication management. Medication management postoperatively for these patients can be challenging for pharmacists. 261—INITIATION OF PHARMACEUTICAL SERVICES FOR THE MANAGEMENT OF ASTHMA AND CHRONIC OBSTRUCTIVE PULMONARY DISEASE IN A COMMUNITY PHARMACY. Bhatt V, Masilamani S, University of Houston College of Pharmacy, Hardin-Oliver C, Walgreens, Email: [email protected] Objective: The purpose of the study is to implement and assess the impact of pharmaceutical services in the management of asthma and chronic obstructive pulmonary disease (COPD). These services are provided by pharmacists in a retail pharmacy in Cleveland, Texas. In 2005, among adults aged ≥18 years, there were 15,424 hospitalizations for asthma and 26,718 hospitalizations for COPD in Texas. Liberty County, which includes the city of Cleveland, was among the top 10 counties for COPD admission rates in 2005. Methods: This study will be submitted to the institutional review board for approval. This is a unique attempt to provide pharmaceutical care for patients with asthma and COPD at a retail pharmacy in collaboration with a federally qualified health center (FQHC) in this rural city. All pharmacists at the store are trained in COPD and asthma management. Patients aged ≥18 years who are picking up any inhalers or inhalation solutions are counseled on respiratory device use technique and are asked to fill out a validated Asthma Control Test (ACT) or COPD Assessment Test (CAT) for the condition self-reported by the patient. Patients with uncontrolled asthma or COPD, as assessed by the tests, are offered an initial 30 minute appointment with a pharmacist followed by a maximum of 4 monthly 15-minute follow-up sessions as needed based on their control. Additionally, patients from the FQHC are referred to the individual sessions. For FQHC patients, initial assessment of control and counseling on device use technique is done at the first session. After 6 months, anticipated outcomes include decrease in number of emergency department visits and/or hospitalizations based on local hospital data, improvement in symptom control based on validated questionnaires, and reduced rescue inhaler use and improvement in adherence to controller medication based on fill history. Results: Research in progress. 262—NEW PHARMACIST PRACTITIONER READINESS TO PROVIDE PATIENT CARE SERVICES IN A COMMUNITY CHAIN PHARMACY SETTING. Ossman K, McGrath S, Bacci J, McCartney E, McGivney M, University of Pittsburgh School of Pharmacy, E-mail: [email protected] Objective: The objectives of this study are to: (1) assess perceived readiness of new pharmacist practitioners to provide direct patient care services; (2) identify necessary competency and Journal of the American Pharmacists Association Downloaded From: http://mustafa.japha.org/ on 06/09/2014 j apha.org skill gaps in the transition process from student pharmacist to new pharmacist practitioner; and (3) identify methods for developing new training and assessment tools within a community chain pharmacy. Methods: As community pharmacy practice moves toward increased provision of direct patient care services, it is important that community chain pharmacies train and hire new pharmacists who are most capable of providing these services. This study will utilize a mixedmethod approach to assess new pharmacist practitioner readiness to provide direct patient care services. Surveys will be distributed to approximately 2,400 new pharmacist practitioners nationwide, defined as pharmacists with 1 to 3 years of practice experience since graduation. Survey questions will be derived from the Center for the Advancement of Pharmaceutical Education’s 2013 Educational Outcomes and the National Association of Chain Drug Stores’ 2012 Entry-Level Competencies Needed for Community Pharmacy Practice. Questions will relate to pharmacist readiness in 5 domains: pharmacist-delivered patient care, public health, communication, management, and leadership. Survey results will be analyzed using descriptive statistics. A focus group will then be conducted to interpret any identified gaps in patient care skills or competencies and identify methods to further develop training for new practitioners. The focus group transcript will be analyzed using the principles of grounded theory. Results: Research in progress. Results of this study will assist in understanding new pharmacist practitioner readiness to provide necessary patient care services in a rapidly changing health care system. Perceived gaps in patient care skills, knowledge, or experience by new practitioners can be utilized for community pharmacies to develop training programs for hiring new practitioners. 263—OPTIMIZING A MEDICATION USE PROCESS TO IMPROVE SAFETY FOR A SPECIAL-NEEDS PATIENT POPULATION. Cotugno S, Saunders C, University of Pittsburgh, EMA R /APR 2014 | 54:2 | JAPhA e171 APhA2014 ABSTRACTS mail: [email protected] Objective: This study aims to identify problems and create interventions to improve medication safety for children and adults with disabilities or chronic illness in a non–health care setting. Methods: The non–health care setting, a camp, is a nonprofit organization providing fully accessible facilities to children and adults with disabilities or chronic illness. The camp provides 5-night summer programs and 2-night weekend programs housing 48 campers. Two student pharmacists were requested by the camp for an advisory/ observational role twice weekly over 12 weeks. The role included making observations at medication check-in, dispensing, storage, and administration in addition to studying the camp’s initial operational design. The identification of errors and potential medication use errors were made and discussed with the Board of the Directors. Small changes were implemented immediately while substantial policy, procedural, and education/training changes were submitted for approval. Results: Problems identified included administering medications to the incorrect patient, inappropriate administration time, medications incorrectly measured, inadequate monitoring parameters, and lack of an organizational design. A plan was implemented to correct these deficiencies, which included instituting a photographic process at check-in to ensure patient identification, creating written operational procedures for the medication management process, improving work processes for safety and efficiency, and preparing a training manual for non–medical staff on medication management and administration. Conclusion: It is anticipated that these efforts will result in a reduction in medication errors. The final assessment cannot be adequately determined until the end of the next summer program by evaluating the reported number of medication errors from before and after the interventions. Both pharmacists and student pharmacists can play an important role in assuring for safe medication use, adequate health care training, and proper dispensing techniques in non–health e172 JAPhA | 5 4:2 | M AR/AP R 2014 Downloaded From: http://mustafa.japha.org/ on 06/09/2014 care settings such as schools, camps, and day-care facilities, in addition to providing safety measures for specialized populations such as elderly adults and disabled persons. 264—ORIENTATION TO PHARMACY SERVICES: AN EDUCATIONAL PROGRAM FOR RESETTLED REFUGEES. Kim H, Kilbane G, The Ohio State University, Michaels B, Kroger Corporation, Rodis J, The Ohio State University, E-mail: [email protected] Objective: This project aims to provide an educational presentation about pharmacy services for resettled refugees to the United States. Methods: A grocery store chain pharmacy located in a diverse section of Columbus, Ohio serves many customers unaccustomed to health care in the United States. The surrounding neighborhood is a refugee resettlement area accepting 50 to 100 refugees to the United States every month. This newly resettled refugee population has limited understanding of U.S. pharmacy systems and services. To help overcome cultural barriers and better serve this population, the pharmacy implemented a new program called Orientation to Pharmacy Services. Each month, advanced practice student pharmacists conduct a 2-hour educational session for newly resettled refugees that provides information on: differences between over-the-counter and prescription medications, how to obtain a prescription, why medications have refills, and how to order refills. Resettled refugees are shown how to use the pharmacy and read a prescription label. This presentation is verbally interpreted into the refugees’ home languages and supplemented by visual aids. A translated handout is also provided to participants. This program incorporates an informal question and answer session to address misunderstandings and concerns about pharmacy services. Results: Research in progress. Pilot sessions held in July and September of 2013 educated 24 patients from 2 different language groups, Nepali and Swahili. Preliminary results will report logistics of the sessions as well as the number of sessions held and the number of paja p h a .org tients reached. Conclusion: The study describes a method for increasing newly resettled refugees’ understanding of U.S. pharmacies and available services. Enhanced understanding is expected to improve access to medications, medication management, and pharmacist care. 265—PATIENT-CENTERED MEDICAL HOME: IMPLEMENTATION OF A PHARMACY COLLABORATIVE CARE MODEL. Nagy I, Meijer Inc., Email: [email protected] Objective: The aims of this project are to: (1) implement a pharmacy collaborative care model with the intent to improve clinical outcomes and patient and physician satisfaction of care; and (2) document the impact of community pharmacy–based medication therapy management in patients with chronic disease states or in patients who are taking multiple medications being provided care through the patient-centered medical home (PCMH) model. Methods: Patients are identified following a routine physician visit at a specified medical group and have their prescriptions filled through 2 locations of a regional grocery store chain pharmacy and are participants in a cohort of Priority Health Medicare Part D program. The medical group–based pharmacist meets with patients during their routine physician visit at which time the patients are asked to participate in a comprehensive medication review (CMR) with a community pharmacist at 1 of the 2 identified pharmacy locations. Patient information is communicated to the community pharmacist via secure and protected email at which time the pharmacist schedules a CMR with the patient to assess regimen efficacy, safety, cost efficacy, and patient adherence. Details from the CMR are communicated back to the physician group–based pharmacist to be forwarded to the patient’s physician. Any changes in the patient’s treatment regimen are communicated back to the community pharmacist for follow-up with the patient. Both patients and physicians participate in satisfaction surveys at baseline and at the end of the study period. Medication adherence data are Journal of the American Pharmacists Association APhA2014 ABSTRACTS obtained at baseline, 6 months, and at the conclusion of research utilizing medication possession ratios calculated from patient refill data with a goal to determine whether community pharmacist intervention in a PCMH model impacts medication adherence or patient/prescriber satisfaction. Results: Research in progress. Anticipated results are improved rates of satisfaction and medication adherence as well as improved clinical outcomes. 266—PATIENTS’ PERCEPTIONS OF A COMMUNITY PHARMACY– BASED FRACTIONAL EXHALED NITRIC OXIDE SCREENING PROGRAM AND ITS IMPACT ON INHALED CORTICOSTEROID ADHERENCE RATES. Shah P, Hussein S, Chicago State University College of Pharmacy, Shafer E, Kshatriya S, Dominick’s Pharmacy, Mukherjee K, Chicago State University College of Pharmacy, Email: [email protected] Objective: The objectives of this study are to: (1) assess patients’ perceptions of testing fractional exhaled nitric oxide (FeNO) in a community pharmacy setting; and (2) assess patients’ adherence to prescribed inhaled corticosteroids (ICS) based on participation in the program. Methods: This survey-based, prospective, single-site (i.e., grocery store pharmacy setting) study involves the implementation of FeNO testing, which measures inflammation in the lungs. Inclusion criteria: patients ≥18 years of age, experiencing any respiratory symptoms (e.g., shortness of breath, allergy symptoms), and/or have a diagnosis of asthma or chronic obstructive pulmonary disease (COPD). Exclusion criteria: patients with allergy or intolerance to ICS or short-acting beta-agonists or unable to commit to follow-up appointments. Patients will be recruited by the pharmacy staff via advertisement of the program throughout the store. At the time of the initial screening appointment, patients will complete a pre-survey, which will gather demographic data, baseline knowledge about asthma and COPD management, and baseline status of patients’ medication adherence. The service will consist of an educational session with the pharmacist, where the relevance of FeNO testing will be covered, followed by the patient performing the FeNO test. The patient will be referred to a participating physician if evaluation, treatment, and/or change in treatment is needed based on test results. The patient will be scheduled for a follow-up FeNO testing appointment 14 days from the day the prescribed medication is picked up. After the follow-up appointment, patients will complete a post-survey, similar to the pre-survey. Descriptive analysis will be utilized to analyze the data. Results: Research in progress. Conclusion: The program aims to introduce an innovative screening device to patients in a community pharmacy setting to help improve medication adherence and manage patients’ asthma, COPD, or allergy symptoms. 267—PHARMACIST-DELIVERED MEDICARE ANNUAL WELLNESS VISITS IN A PRIMARY CARE OFFICE. Thomas M, VHQC, E-mail: [email protected] Objective: The purpose of this study is to describe the development and implementation of a pharmacist-delivered Medicare Annual Wellness Visit in a physician-owned private family practice office. Methods: A pharmacist working in a private family practice office describes the conception, development, planning, and implementation of Medicare Annual Wellness Visits for the practice. Results: From September 2012 to February 2013, 174 patients participated in the pharmacist-delivered Medicare Annual Wellness Visits. The practice income from wellness visits during this time frame was $27,880.98. Conclusion: Pharmacist-delivered Medicare Annual Wellness Visits are financially viable and allow for pharmacist participation on the primary care team. 268—PHARMACIST’S ROLE IN ENGAGING PATIENTS IN A SMOKING CESSATION PROGRAM USING HEALTH INFORMATION TECHNOLOGY WITHIN A PATIENT-CEN- Journal of the American Pharmacists Association Downloaded From: http://mustafa.japha.org/ on 06/09/2014 j apha.org TERED MEDICAL HOME. Singrey A, Mehta B, Casper K, Shaffer W, The Ohio State University College of Pharmacy, Wexler R, The Ohio State University Wexner Medical Center, Arradaza N, The Ohio State University, E-mail: [email protected] Objective: The purpose of this study is to: (1) evaluate patient engagement in a smoking cessation program through active messaging with a pharmacist using an online patient portal; and (2) assess patient satisfaction of a smoking cessation program using health information technology (HIT). Methods: The National Committee for Quality Assurance (NCQA) recognizes patient-centered medical homes (PCMH) that meet specific standards including identifying and managing patient populations through utilization of HIT. Pharmacists can help PCMHs meet those standards by engaging patients who are ready to quit smoking in a smoking cessation intervention through an online, secure patient portal. A list of documented smokers is generated using the electronic medical record, and targeted patients are telephoned to identify those reporting readiness to quit within 30 days. Patients schedule a face-to-face visit with a pharmacist to begin a 3-step smoking cessation program. At initial visit, patients enroll in the patient portal and complete Step 1 of the program including identifying reasons and motivation for quitting. One week later, they utilize the patient portal messaging system to complete Step 2, which examines behavioral techniques to curb temptations. Contact is made with the patient on quit date and then 1 week later to provide tips for staying smoke-free. One month after Step 1 completion, patients take a satisfaction survey to evaluate both their interaction with the pharmacist and the smoking cessation program. Two months after quit date, patients are contacted to determine smoking status. A pharmacist-directed patient portal smoking cessation program at a PCMH may be an effective way to identify and manage the smoker population using HIT, assisting PCMHs in meeting NCQA standards. Results: Research in progress. PreMA R /APR 2014 | 54:2 | JAPhA e173 APhA2014 ABSTRACTS liminary data presented includes patient demographics, percentage of patients actively engaged in scheduled correspondences of smoking cessation program, percentage of patients who initiate correspondence with pharmacist, quit status 2 months after quit date, and patient satisfaction. 269—PHARMACISTS’ PERCEPTIONS OF THE ROLE OF COMMUNITY PHARMACISTS IN WEIGHT MANAGEMENT. Pekny C, Walgreens/Purdue University College of Pharmacy, Sheehan A, Purdue University College of Pharmacy, Arnett S, Walgreens, Snyder M, Purdue University College of Pharmacy, E-mail: chelsea. [email protected] Objective: The purpose of this study is to determine pharmacists’ perception of the role of community pharmacists in weight management, knowledge of treatment and guidelines, and comfort level in discussing weight management with patients. Methods: Pharmacists will be contacted using a listserve of all Indiana pharmacists purchased from the Indiana Board of Pharmacy to participate in a Qualtrics electronic survey. Pharmacists will be asked about their current practice setting, and a branched survey will be used based on response. Community pharmacists will be surveyed about comfort level discussing weight management with patients, knowledge of treatment and guidelines, and the community pharmacists’ role in providing weight management services. Pharmacists in non–community settings will be surveyed about comfort level in recommending that patients discuss weight management with their community pharmacist and the need for community pharmacists to provide these services. A 5-point Likert–type scale and yes/no questions will be used to assess responses, where appropriate. Participation in the survey will be on a volunteer basis and participants will be entered in a drawing to win 1 of 5 $50 gift cards. The survey will be distributed over 2 months and data will be collected over 6 months. Data will be analyzed using appropriate parametric and non- e174 JAPhA | 5 4:2 | M AR/AP R 2014 Downloaded From: http://mustafa.japha.org/ on 06/09/2014 parametric tests. The study protocol is pending institutional review board and corporate approval; survey distribution and data collection will begin upon approval. Using results from the survey, a training program can be developed that gives community pharmacists the ability to effectively be a part of patients’ weight management. Training can include education on effective interaction with patients, over-the-counter and prescription medications, diet and exercise recommendations, and incorporation of weight management into practice based on survey results. Results: Research in progress. 270—REDUCING PREVENTABLE HOSPITAL READMISSIONS THROUGH A PHARMACIST-LED CARE TRANSITION INTERVENTION. Clark B, Cohen E, Kwasigroch D, Singer S, Hou J, Walgreen Co., E-mail: [email protected] Objective: The primary objective of this research study will be to evaluate a pharmacist-led care transition program designed to assist in reducing preventable hospital readmissions. This care transition program encompasses the retrieval of community pharmacy medication histories, the delivery of medications to the bedside at discharge, medication alignment and prescription therapy planning, and follow-up reminder calls to encourage medication adherence and to monitor health outcomes. Methods: This will be a retrospective case comparison cohort study using propensity score matching. For comparison purposes, patients enrolled in this pharmacist-led care transition program will be matched with similar patients in terms of age, sex, disease state, illness severity, comorbidities, and other pertinent predictors of hospital readmission. The first 6 to 9 months of the program’s implementation will be evaluated in 4 hospitals, and the primary outcome variable will be 30-day hospital readmission rates. Results: Research in progress. After only 6 months since the program’s implementation, preliminary results show that patients had a 37% lower unadjusted 30-day readmission rate, relative ja p h a .org to patients who were eligible for but not enrolled in the program. The estimated number of averted readmissions was 21.1, which translates into a total savings of $202,896 or $530 per engaged patient. As the data continue to accumulate, a formal research study is planned to verify these preliminary findings. 271—UNDERSTANDING EMPLOYEE PERCEPTIONS OF A PHARMACIST-PROVIDED SMOKING CESSATION SERVICE IN THE COMMUNITY PHARMACY SETTING. Caracciolo C, Thomson M, Acme Sav-on Pharmacy, Patel N, Temple University School of Pharmacy, Melissen P, Acme Sav-on Pharmacy, E-mail: [email protected] Objective: The objective of this study is to obtain the perceptions of employees of 2 regional grocery store chains on a pharmacist-provided smoking cessation service in the community pharmacy setting. Methods: This multi-site prospective study includes adults who are >18 years of age, identify themselves as active cigarette smokers or having quit within the past 6 months, and are current employees of 2 regional grocery store chains. Eligible associates will be recruited during employee health screenings and in participating regional grocery store chains. Participants meeting inclusion criteria will receive a survey with questions pertaining to demographics, smoking status, past quit attempts, and their perceptions of a pharmacist-provided smoking cessation service. Descriptive statistics will be used to analyze and compare results. Results: Research in progress. Recent health care reform has led to a greater focus on the reduction of tobacco use. The increasing adoption of workplace smoking bans and the growing number of insurers offering discounted medical premiums for nonsmokers has created a need to identify the impact that pharmacists can have in the smoking cessation process. The results of this study will identify how the needs of tobacco users, in regard to smoking cessation, can be used to identify the desired structure and support required to successfully quit Journal of the American Pharmacists Association APhA2014 ABSTRACTS smoking. This research also will determine the willingness of patients to participate in a pharmacist-provided smoking cessation service in the community setting. Identifying these critical factors will help support recognition of pharmacists as providers of smoking cessation services. 272—WHAT EFFECTS DO MEANINGFUL USE MEASURES HAVE ON TOBACCO CESSATION IN A COMMUNITY HEALTH CENTER?. Youngblood A, Ramirez S, Oregon State University, Davis J, Fred Meyer Pharmacy, E-mail: jennifer.davis@stores. fredmeyer.com Objective: The purpose of this study was to describe how often meaningful use measures around tobacco use are being asked in a community health center and whether asking these questions leads to tobacco cessation counseling. Secondarily, this study described the types of tobacco cessation education that were being provided to patients assessed as tobacco users. “Meaningful use” is the set of standards defined by the Centers of Medicare and Medicaid Services (CMS) Incentives Program that regulates the use of electronic health records (EHRs). The goal of meaningful use is to promote the adoption of EHRs across the United States to improve health care. One of the measures set forth is the assessment of tobacco use at each patient encounter. The results from this study will be used to design a targeted intervention program for tobacco cessation at this clinic. Methods: The primary outcome of this study was the percentage of visits that were applicable to asking a patient 3 questions regarding tobacco use, readiness to quit, and willingness to receive additional patient education. The secondary outcomes of this study were to determine the percentage of visits that received patient education if the patient reported being ready to quit and the type of education provided. Retrospective chart reviews were conducted on EHRs collected for over 1,000 patient visits from June 1, 2012 through May 30, 2013. Records were obtained for patients >18 years of age. Patients’ responses to the tobacco use questions were docu- mented. From this dichotomous data, the percentage of eligible visits for cessation counseling were determined and the types of patient education provided were documented. Results: Research in progress. Personalized Medicine/Pharmacogenomics 273—FROM GENES TO RNA EXPRESSION PROFILES: A SHIFT IN UNDERSTANDING BREAST CANCER DEVELOPMENT AND ITS RESPONSE TO CHEMOTHERAPY. Yao D, Ji S, Rutgers University, E-mail: sji@ rci.rutgers.edu Objective: Traditional cancer research has focused on specific oncogenes as the determinants of carcinogenesis. Using the complementarity principle prevalent in other fields, this study proposes that there is another factor contributing to cancer formation. One such factor is mRNA “copy number,” the transcript level of specific genes determined by the balance between transcription and degradation rates. This study aims to explore the correlation between mRNA copy numbers and tumor development and treatment in patients with breast cancer. Methods: Microarray data were analyzed for 4,740 genes from 20 human patients with breast cancer patients [Perou CM et al. Nature. 2000;406:747–52]. mRNA levels were measured in normal breast tissue culture and before and after doxorubicin treatment for each patient. Genes were classified as exhibiting harmful or beneficial RNA expression profiles based on mRNA changes: harmful profiles had tumor mRNA changes exacerbated by doxorubicin treatment, and beneficial profiles had tumor mRNA changes reversed by doxorubicin treatment. Results: No gene exhibited a common beneficial or harmful RNA profile in all patients. The majority of genes shared common profiles in only 1–5 patients, and many genes exhibited conflicting profiles in different patients. Poisson distributions were obtained describing the frequency of genes exhibiting either beneficial or harmful profiles, with re- Journal of the American Pharmacists Association Downloaded From: http://mustafa.japha.org/ on 06/09/2014 j apha.org spective modes of 4 and 2 patients. The beneficial:harmful mode ratio (2) can be a quantitative measure of the efficacy of doxorubicin in treating breast cancer. Conclusion: The lack of genes exhibiting a common profile suggests that viewing individual oncogenes as the sole determinants of carcinogenesis is too simplistic. These results from analyzing this gene pool suggest that sets encompassing perhaps hundreds of genes are involved in carcinogenesis. These sets may include genes that encode proteins for regulating mRNA transcription and degradation. Understanding sequence– copy number complementarity may enable development of ways to better combat cancer and further develop personalized medicine. 274—INFLUENCE OF GLUTATHIONE S-TRANSFERASE POLYMORPHISMS ON CISPLATIN KINETIC EXCRETION IN PATIENTS WITH HEAD AND NECK CANCER. Pincinato E, Mackenzie Presbyterian University, Moriel P, Lopes-Aguiar L, Costa E, Nogueira G, Lima T, Lima C, Faculty of Medical Sciences, Unicamp, E-mail: [email protected] Objective: The aim of this work was to evaluate the urinary cisplatin (CDDP) kinetic excretion associated with glutathione S-transferase (GST) polymorphisms in patients with squamous cell carcinoma of head and neck (SCCHN). Methods: At the University of Campinas, 105 patients with SCCHN received 35 sessions of radiotherapy (2 Gy per session) plus intravenous CDDP (75–100 mg/m2 on days D1, D22 and D43). Blood samples were obtained to DNA extraction and urine was obtained from 0 to 12, 12 to 24, and 24 to 48 hours after CDDP administration. Urinary CDDP was detected with HPLC-UV and GSTs genotypes were evaluated using multiplex polymerase chain reaction (PCR) and PCR and enzymatic digestion respectively. Results: GSTM1 and GSTT1 null genotypes were identified in 56.2% and 11.4% of patients, respectively; 47.6%, 44.8% and 7.6% of patients presented GSTP1 IleIle, IleVal and ValVal genotypes, respectively. Nearly 84.4% of MA R /APR 2014 | 54:2 | JAPhA e175 APhA2014 ABSTRACTS CDDP was eliminated in urine of a 0- to 12-hour period. Patients with GSTT1 null genotype eliminated less CDDP in urine than those with the genes (68.67 ± 49.94 vs. 46.29 ± 39.37 µg CDDP/mg creatinine). Patients with GSTP1 variant Val/Val genotype eliminated less CDDP in urine than those with Ile/Val and Val/Val genotypes (41.35 ± 30.20; 63.88 ± 49.53; 67.11 ± 50.94 µg CDDP/mg creatinine, respectively). Conclusion: Urinary CDDP detection by HPLC-UV is a powerful tool to analyze kinetics excretion of the drug. GSTT1 and GSTP1 Ile105Val polymorphisms alter CDDP excretion in urine. Thus, patients SCCHN patients with inherited distinct abilities for CDDP metabolism associated with these genes may exhibit distinct responses and toxicities to conventional treatment. Pharmacist Behaviors and Attitudes 275—ASSESSING PHARMACISTS’ ATTITUDES TOWARD EXPANSION OF CARE IN PHARMACY PRACTICE. Aldrich S, Sullivan D, Ohio Northern University, E-mail: s-aldrich@ onu.edu Objective: The profession of pharmacy is constantly changing. Where will we be 20 years from now? The opportunities for expansion of care in pharmacy practice are vast including limited prescriptive authority, managing acute and chronic disease states, and even interpreting pharmacogenomic data. This study assessed pharmacists’ attitudes toward potential expansion of care areas and their perceived competency and training in each area. Methods: Five hundred pharmacists from Ohio were randomly selected for inclusion in the study; 174 completed the survey (35% response). A 54-question, self-administered, mailed questionnaire was used to collect data using a Likert-type scale (1 = strongly disagree; 7 = strongly agree). Several topics were assessed including the pharmacists’ attitudes toward obtaining prescriptive authority; the ability to monitor and manage chronic diseases and acute infections, such as strep throat, urinary tract e176 JAPhA | 5 4:2 | M AR/AP R 2014 Downloaded From: http://mustafa.japha.org/ on 06/09/2014 infections, and ear infections; the ability to order and interpret lab tests; and the role of medication therapy management (MTM) programs in their practice. Demographics included sex, age, degree, and number of years and area of practice. Results: Pharmacists moderately agreed that they should have limited prescriptive authority (5.68), and moderately agreed that it should be limited to certain drugs (6.06). Pharmacists slightly to moderately agreed that they should be able to authorize a 1-month additional refill for a non-controlled prescription drug that the patient has taken for over year (5.51) and slightly disagreed they needed extensive training to do so (3.01). Participants slightly to moderately agreed that they should be able to manage diabetes using blood glucose testing (5.65), diabetes using A1C testing (5.63), hypertension using blood pressure measurements (5.51), and cholesterol using lipid panels (5.59). With appropriate training, pharmacists moderately agreed that they would feel comfortable conducting a Rapid Strep Test (5.81) and moderately agreed that based on the results they would feel comfortable prescribing a treatment (5.64). Pharmacists slightly agreed that they should be able to order and interpret pharmacogenetic testing to determine therapeutic appropriateness of drugs (4.79), however they moderately agreed that they would need extensive training to do so (5.70). Finally, pharmacists slightly agreed that MTM would become more prevalent (5.19) and beneficial (5.30) if they could adjust therapy as needed. Conclusion: Based on the results of this study, pharmacists are ready to expand their scope of care and the clinical services they could offer. 276—COMMUNITY PHARMACIST MEDICATION MONITORING: EXPERIENCES, ATTITUDES, AND BARRIERS. Witry M, Doucette W, University of Iowa College of Pharmacy, Email: [email protected] Objective: Medication monitoring is an emerging role for community pharmacists and is associated with an increasing focus on quality and outcomes. There has been little description of the associja p h a .org ated processes and factors involved with current monitoring practice. The objective of this study is to describe the attitudes, contextual factors, activities, and behaviors associated with community pharmacist medication monitoring in the dispensing process. Methods: Twelve, 45-minute, semistructured interviews were conducted in person or telephonically with community pharmacists from independent, chain, and grocery pharmacies. Participants were selected randomly from a state list or purposefully based on pharmacy reputation of providing quality cognitive services. Interviews were audiorecorded and transcribed. Transcripts were coded descriptively and interpretively, beginning with the domains of the Health Collaboration Model. Pattern codes were identified iteratively. Representative quotations were identified and theme summaries were prepared. Check coding supported the interpretations. Results: Overall, pharmacists’ medication monitoring was constrained by busyness, although interviewees were open to more monitoring interactions. Some pharmacists perceived patients as disinterested in medication monitoring, especially when busy or using the drivethrough pickup. Pharmacists were less likely to monitor medications viewed as routine. Rather, they responded to unique circumstances such as patient question-asking, prior memory of a patient interaction such as service utilization, discussion of technical issues such as medication cost, or when handing off the prescription. Pharmacists felt challenged by nonadherence monitoring because workflows generally do not make this information easily accessible and due to the high prevalence. Conclusion: Pharmacists reported numerous barriers to medication monitoring in practice including busyness, workflow issues, information inaccessibility, and patient disinterest. Barriers need to be addressed if pharmacists are to take on a greater medication monitoring role in the interest of improving quality. 277—COMMUNITY PHARMACIST QUESTION ASKING AT THE TIME Journal of the American Pharmacists Association APhA2014 ABSTRACTS OF REFILL: RESULTS OF A FACTORIAL SURVEY. Witry M, Doucette W, University of Iowa, E-mail: matthew. [email protected] Objective: Inadequate medication monitoring contributes to more medication-related problems than errors in prescribing, yet monitoring has received less attention in practice and research. Community pharmacists are well positioned to engage in medication monitoring. The objective of this study was to identify significant contextual and pharmacist-level factors associated with community pharmacist self-reported likelihood to ask medication monitoring questions at the time of refill. Methods: Surveys were mailed to 599 community pharmacists using a Dillman approach. Surveys included demographics, 6-point Likert-type attitudinal items addressing monitoring roles (internal) and environment monitoring perceptions (external), and 5 unique refill vignettes randomly populated with values for 8 contextual variables based on the Health Collaboration Model. Respondents assigned their likelihood of asking nonadherence, safety, and effectiveness questions for each vignette. Hierarchical linear modeling produced regression coefficients for pharmacistlevel and vignette-level variables. Results: There were 254 (43%) returned, usable surveys. Overall, respondents had a moderately positive internal medication monitoring attitude (4.62) and an external monitoring attitude slightly conducive to monitoring (3.87), although with appreciable variation. For nonadherence, female patients were more likely to be questioned. Being short-staffed and the prescription previously being filled more times did not decrease likelihood, unlike with side effect and effectiveness questions. Side effect and effectiveness questioning may be seen as more discretionary than nonadherence questioning. Other persons waiting decreased likelihood of asking all 3 questions. Overall, metoprolol and fluoxetine were less question worthy than warfarin and hydrocodone. Conclusion: Pharmacists reported variation in question asking likelihood based on medication, patient, and envi- ronmental characteristics. Pharmacist medication monitoring attitudes contributed more to explaining pharmacist medication monitoring attitudes than setting, suggesting there are pharmacists oriented to monitoring in multiple settings. Days late was a cue to asking for all 3 question types. Pharmacies should ensure late refill information is reaching pharmacists if increases in medication monitoring are desired. 278—EFFECTIVENESS OF AN EDUCATIONAL INTERVENTION ON THE CARING BEHAVIORS AND REFERRAL ACTIVITIES OF COMMUNITY PHARMACISTS. O’Neal K, Murray K, University of Oklahoma College of Pharmacy, Skomo M, Duquesne University Mylan School of Pharmacy, Carter S, University of Oklahoma College of Pharmacy, McConaha J, Duquesne University Mylan School of Pharmacy, E-mail: katherine-oneal@ ouhsc.edu Objective: The objectives of the study were to: (1) identify previously diagnosed migraineurs’ perceptions of care by pharmacists who have undergone specialty training in migraine versus those who have not had specialty training in migraine; (2) identify perceptions of patients with previously undiagnosed recurrent headache regarding pharmacist effectiveness and thoroughness, after specialty training, to identify a potential migraine diagnosis and referral for advanced care; and (3) identify pharmacists’ perceptions regarding (a) their interactions with migraine and recurring headache patients and (b) the migraine training program and caring for patients with recurrent headache. Methods: This study was a 2-group, multi-site, quasi-experimental, cohort design using community pharmacies from the Tulsa, Oklahoma, and Pittsburgh, Pennsylvania, greater metropolitan areas. Pharmacists from intervention pharmacies received specialty training on migraine. Approximately 1 month after the training, control and intervention pharmacists were surveyed regarding (a) their interactions with migraine and recurring headache patients and (b) their perceptions about the migraine training Journal of the American Pharmacists Association Downloaded From: http://mustafa.japha.org/ on 06/09/2014 j apha.org program and caring for patients with recurrent headache. In addition, patients from both pharmacies were surveyed to measure headache-related disability using the Migraine Disability Assessment (MIDAS) and assess pharmacists’ delivery of care as derived from the Pharmacists’ Care of Migraineurs Scale. Results: Sixteen pharmacists and 60 patients were recruited. There was no difference in patient perception of pharmacists’ care or in patient self-perception between migraineurs and patients with recurrent headache. Ninety-two percent of pharmacists agreed that the program could be transferred to an Internet-based educational program. The 14-item patient survey demonstrated good internal consistency reliability with each question having a Cronbach alpha ≥0.80. Conclusion: There are few studies evaluating the role and potential impact community pharmacists can have on patients with migraines or recurrent headaches. While no difference was found between the groups, the internal reliability of the survey questions and the need to address needs of migraineurs warrants a larger-scale study. 279—EFFECTS OF AGGRESSIVE PATIENT BEHAVIOR ON PHARMACIST JOB STRESS AND JOB SATISFACTION. Liu N, Kings Pharmacy, Lonie J, Arnold and Marie Schwartz College of Pharmacy and Health Sciences Long Island University, E-mail: [email protected] Objective: The aim of the study was to assess the effect of aggressive patient behavior on pharmacist job stress, job satisfaction, and intention to leave the profession. Methods: A purposeful sample of 40 actively practicing community pharmacists from the New York metropolitan area was selected to complete a retrospective survey in which participants were asked to recall and reflect on incidents with aggressive patients. Currently practicing community pharmacists working a minimum of 20 hours per week at an independent, chain, mass merchant, or food store pharmacy were selected for participation. Depending on the preference of the participant, surveys were MA R /APR 2014 | 54:2 | JAPhA e177 APhA2014 ABSTRACTS distributed via mail or e-mail. Data were analyzed quantitatively using SPSS software. Results: Research in progress; no results to report at this time. Pharmacist job stress and dissatisfaction due to consistent encounters with aggressive patients may lead to increased job turnover, resulting in compromised patient care. Excessive job turnover can affect the number of experienced well-trained pharmacists in community settings. If the results of this study demonstrate that pharmacist job stress and job satisfaction are negatively affected by patient aggression, implementing strategies to assist pharmacists to better deal with these encounters may be needed. Creation of educational programs focused on conflict management may be beneficial for pharmacists to overcome the impact of patient aggression on job stress and dissatisfaction. These educational programs may include techniques to recognize and mitigate potentially aggressive encounters before they arise and techniques to overcome communication barriers during incidents of aggression. 280—EVALUATION OF AN EDUCATIONAL INTERVENTION ON COMMUNITY PHARMACISTS’ CARE OF RECURRENT HEADACHE SUFFERERS. Murray K, University of Oklahoma College of Pharmacy, Skomo M, Duquesne University Mylan School of Pharmacy, Carter S, University of Oklahoma College of Pharmacy, E-mail: [email protected] Objective: The objectives of the study were to: (1) compare pharmacists’ self-assessed knowledge of migraine before and after an educational intervention; (2) compare pharmacists’ selfreported care behaviors following an educational intervention with a control group of pharmacists; and (3) identify interactions between the educational intervention and individual independent variables. Methods: The study employed a quasi-experimental, parallel design. Pharmacists were recruited from community pharmacies in a regional chain in northeastern Oklahoma. A questionnaire containing a survey assessing self- e178 JAPhA | 5 4:2 | M AR/AP R 2014 Downloaded From: http://mustafa.japha.org/ on 06/09/2014 reported care behaviors was administered to the intervention group of pharmacists at baseline just prior to their participation in a 2-hour educational course on migraines. One month later, the intervention pharmacists were asked to complete the same questionnaire. Pharmacists in the control group completed their only questionnaire at the same time the intervention pharmacists completed their follow-up questionnaire. The selfreported care behaviors assessed in the survey were: (1) perceived difficulty in providing care to patients with recurrent headaches; (2) perceived self-efficacy or level of confidence in providing care to patients with recurring headaches; (3) employer culture; (4) self-assessed knowledge of migraine; (5) actual care provided to patients with recurring headaches; and (6) ability to maintain knowledge of migraine. Descriptive and appropriate inferential statistical analyses were performed using SAS v9.3. Results: The intervention group was composed of 24 pharmacists and there were 25 pharmacists in the control group. Pharmacists’ self-assessed knowledge mean scores were significantly different pre- and post-intervention (P <0.0001). Self-assessed knowledge was higher in the intervention group postquestionnaire scores compared with the control group (P = 0.004). Intervention group pharmacists were more confident in their ability to maintain knowledge of migraine (P = 0.04). No difference was seen regarding difficulty in providing care for a migraineur (P = 0.16) or in how the pharmacists perceived employer culture (P = 0.79). Conclusion: Participating in an educational program on migraine improved pharmacists’ knowledge of migraine and their confidence providing care to migraineurs. 281—IDENTIFYING COMMUNITY PHARMACISTS’ READINESS TO PARTICIPATE IN TRANSITIONS OF CARE. Gibson N, Kebodeaux C, St. Louis College of Pharmacy, Smith D, Holtgrave K, Walgreens, Gattas N, St. Louis College of Pharmacy, E-mail: ngibson@ stlcop.edu Objective: The purpose of this study ja p h a .org is to determine the readiness of community pharmacists to participate in transitions of care and identify additional training perceived to be beneficial. Methods: Medication discrepancies, adverse effects, nonadherence, and lack of patient understanding of treatment commonly occur in the post-discharge period. These undesirable outcomes often contribute to hospital readmission that could be prevented with improved care coordination. Community pharmacists are in a unique position to widely impact patient health outcomes and decrease hospital readmission rates. Currently, community pharmacists do not formally participate in transitions of care and there is no research regarding their readiness to participate. A questionnaire will be used to identify the community pharmacists’ willingness, attitudes, and barriers to participation in transitions of care. The questionnaire will be validated by experts and piloted on select community pharmacists prior to implementation. The anonymous paper questionnaire will be distributed to approximately 250 community pharmacists. Descriptive statistics, correlations, and chi-square tests will be used to analyze demographics and determine differences in final results. Results: Research in progress. This study will provide useful information regarding community pharmacists’ readiness to participate in transitions of care and help to identity the characteristics of community pharmacists correlated with a strong desire to participate in transitions of care. The questionnaire will be beneficial in identifying potential barriers and determining additional training necessary for community pharmacists to feel confident in their ability to participate in transitions of care. 282—IMPROVING THE SELF-CONFIDENCE OF STUDENT PHARMACISTS TO SIMPLIFY COMPLICATED MEDICATION REGIMENS. Ghura S, Chewning B, University of Wisconsin–Madison, E-mail: sonalghura@ gmail.com Objective: Student pharmacists in community settings are ideally situated to help patients simplify complicated Journal of the American Pharmacists Association APhA2014 ABSTRACTS regimens, however students’ self-efficacy is not known. This study aims to: (1) test the impact of a student assignment using a structured grid to optimize patients’ regimen dose timing on a student pharmacist’s self-efficacy and the intention to do this activity as a practicing pharmacist; and (2) identify medical conditions and drugs targeted most frequently when altering patients’ regimen dose timing. Methods: A pre-post design is being used to evaluate the impact of a community pharmacy clerkship assignment for 132 fourth-year students in the doctor of pharmacy program. The assignment requires each student to optimize the daily timing of medication doses for 2 patients with ≥5 prescription medications. A structured grid will be used to record medication timing before and after the student pharmacists’ consult. The hypothesis is that the assignment will contribute to increased self-efficacy for student pharmacists and increased intention to help patients simplify complicated regimens. To explore the assignment impact, a self-reflection questionnaire measuring self-efficacy and intention is being used. Scales were adapted from reliable scales and were informed by social cognitive theory. Self-efficacy is measured by a 7-item 7-point scale and intention is measured by a 3-item 6-point scale. A frequency table will be constructed to identify the most common disease areas and drug classes where pharmacists modified the dosing schedule. Self-report of the measures in the questionnaire and a lack of random assignment are limitations to this study. Results: Research in progress. Thus far, data on 16 student pharmacists and 25 patients have been collected. Only 2 patients reported ever having a health care provider (i.e., pharmacist and physician) help them simplify and optimize their medication dose timing. Increased self-efficacy of pharmacists may promote simplifying medical regimens for patients, thereby reducing a practical barrier to adherence. 283—NEW JERSEY PRESCRIPTION MONITORING PROGRAM: PHARMACISTS’ PERCEPTIONS AND COMMENTARY. Drimalla B, Wagner A, Volino L, Toscani M, Feudo D, Yue R, Rutgers University, E-mail: [email protected] Objective: The objectives of this study are to evaluate New Jersey outpatient pharmacists’ knowledge and perceptions of the New Jersey Prescription Monitoring Program (NJPMP) and capture commentary from pharmacists. New Jersey is 1 of 44 states with an operational prescription monitoring program. The NJPMP, which was launched January 2012, tracks controlled substances (CII–V) and human growth hormone dispensed in outpatient settings in New Jersey and dispensed into New Jersey in an effort to help combat prescription drug abuse, misuse, and diversion. Methods: This is a 6-week, institutional review board-exempt, crosssectional study of New Jersey pharmacists practicing in outpatient settings. A sample of 495 licensed New Jersey pharmacists will be contacted by e-mail to participate in a voluntary, anonymous survey using SurveyMonkey. Inclusion criteria include: (1) pharmacists practicing in New Jersey; (2) pharmacists practicing in community pharmacy, mail order, and hospital/clinic outpatient settings; (3) consenting subjects. Exclusion criteria include: (1) pharmacists not licensed and/or practicing in New Jersey; (2) practicing pharmacists who are not subject to NJPMP reporting. The adaptive-design survey contains 1–17 items to assess perceptions of the NJPMP, including accessibility, benefits and challenges to use, and applicability. A percentage of responses to each survey item will be collated across the cohort. Descriptive statistics will be used to analyze the information provided. Results: Research in progress. There are currently 79 survey respondents. Preliminary results reveal that >98% of subjects are registered to use the NJPMP and 59% report accessing the NJPMP “almost daily/daily” or “multiple times daily.” The top 3 triggers for use are CII analgesics, CII stimulants, and CIII–V analgesics. A common trend with regard to commentary is for the NJPMP to be available to other health care practitioners, such as physicians and dentists. Journal of the American Pharmacists Association Downloaded From: http://mustafa.japha.org/ on 06/09/2014 j apha.org Furthermore, respondents would like to see future implementation of a linked, real-time database. 284—PHARMACISTS’ USE AND PERCEPTIONS OF A PRESCRIPTION DRUG MONITORING PROGRAM FOR CONTROLLED SUBSTANCES: A SURVEY OF CHAIN COMMUNITY PHARMACISTS IN TEXAS. Schulenberg S, H-E-B Pharmacy/The University of Texas at Austin College of Pharmacy, Pope N, Lawson K, Wilson J, The University of Texas at Austin College of Pharmacy, Weems J, Montemayor D, H-E-B Pharmacy, E-mail: [email protected] Objective: The purpose of this study is to assess community pharmacists’ opinions and utilization of the online statewide prescription drug monitoring program for controlled substances. Methods: On August 20, 2012 the Prescription Access in Texas (PAT) program went online for voluntary use by any licensed Texas pharmacist willing to enroll in the program. Once enrolled, pharmacists can search for a patient’s prescription dispensing history for Schedule II–V controlled substances during the previous 365 days. Currently, no information is available regarding pharmacists’ use of PAT and perceived benefits from the program. Data will be collected from licensed community pharmacists in Texas. Participants will complete an anonymous online survey designed specifically to assess pharmacists’ knowledge of the PAT program, frequency of use, and perceptions of its usefulness and ease of use. Data collected from this study will be analyzed to produce an estimate of pharmacists’ use and attitudes toward the PAT program. This study will be submitted to the institutional review board for approval and informed consent will be obtained from all participants. Results: Research in progress. 285—PHARMACISTS’ AWARENESS AND KNOWLEDGE OF MULTIPLE SCLEROSIS. Joshi N, Khanna R, Holmes E, University of Mississippi School of Pharmacy, E-mail: njoshi@ go.olemiss.edu MA R /APR 2014 | 54:2 | JAPhA e179 APhA2014 ABSTRACTS Objective: Although multiple sclerosis (MS) is an incurable disease, many drugs have been approved over the past 2 decades to provide symptomatic relief to patients. Pharmacists are positioned to facilitate optimal treatment of MS by effectively managing symptoms and providing recommendations to patients. This study examined pharmacists’ awareness and knowledge of core symptoms, etiology, and treatment of MS. Methods: A cross-sectional, online survey of pharmacists practicing in 7 states (i.e., Louisiana, Minnesota, Mississippi, Oregon, South Dakota, Tennessee, and Washington) was undertaken. The survey assessed pharmacists’ awareness and knowledge of core symptoms, etiology, treatment, and information resources on MS. Information on demographic and practice-based characteristics of pharmacists also was collected. Descriptive analyses were performed on survey data. Results: A total of 1,096 usable responses (3.4%) were received. Most pharmacists (86%) were not familiar with the McDonald criteria for diagnosis of MS. One-third of the pharmacists were not familiar with the side effects of MS medications. Approximately 71% of the pharmacists were unfamiliar with information resources on MS that can be used by patients and health care professionals. Approximately 28% of the pharmacists incorrectly believed that MS is a rare disease. Only 1 in 4 pharmacists indicated being confident in their ability to counsel patients about the medication profile and side effects of MS medications. A majority (91%) of the pharmacists agreed that they could benefit from a continuing education or training program on MS. Conclusion: Study results highlight significant gaps in pharmacists’ knowledge of MS. Policy makers and national MS organizations should consider offering MS-specific continuing education programs to pharmacists. 286—STALL DRUGS: ASSESSMENT OF STUDENT SATISFACTION WITH DRUG INFORMATION POSTERS IN LAVATORY STALLS. Takara L, University of Hawaii at Hilo, e180 JAPhA | 5 4:2 | M AR/AP R 2014 Downloaded From: http://mustafa.japha.org/ on 06/09/2014 E-mail: [email protected] Objective: The purpose of this study is to assess student pharmacists’ satisfaction with Stall Drugs as a tool for learning and retaining prescription drug information. Methods: Stall Drugs is a learning project which places the “Top 200” prescription drug information posters on the inside of lavatory stall doors at a college of pharmacy campus. Posters contain proprietary and generic names, common indications, dosage forms, adverse effects, contraindications, counseling tips, clinical pearls, drug images, and comics. Each week, a unique therapeutic class or indication is selected as the drug theme, with a different drug represented in each stall. Each week, a new theme poster group replaces the previous theme group. At the beginning of the fall 2013 semester, all first-, second-, and third-year doctor of pharmacy students were invited to participate in a pre-survey conducted via SurveyMonkey. The survey asked about the types of tools and satisfaction with tools used to learn about the Top 200 prescription drugs; assessment and preparedness to utilize Top 200 drug knowledge; and use of campus lavatories. At the end of the fall 2013 semester, a similar post-survey will be conducted with the same students. The survey results will be analyzed to determine students’ perceived improvement in drug information knowledge and level of satisfaction with Stall Drugs. Results: Research in progress. The pre-survey was completed by 70% of the 260 eligible students. The most popular Top 200 prescription drug learning tools were identified as tertiary drug information resources and self-made flashcards. Student pharmacists reported using the campus lavatories an average of 7 times a week. 287—STUDENT PHARMACISTS’ PERCEPTIONS OF THE QUALIFICATIONS AND RESPONSIBILITIES OF COMMUNITY PHARMACY TECHNICIANS. Conway S, Dunican K, Abel C, Seed S, Lynch A, Massachusetts College of Pharmacy and Health Sciences University, E-mail: kaelen.dunican@ mcphs.edu ja p h a .org Objective: The purpose of this study is to evaluate student pharmacists’ perception of the qualifications, responsibilities, and importance of community pharmacy technicians. Methods: An anonymous survey was administered to student pharmacists at the conclusion of their first professional (P1) year in an accelerated doctor of pharmacy program via Turningpoint technology. Survey questions assessed students’ knowledge of the qualifications and responsibilities of certified pharmacy technicians (CPhTs) in community pharmacy and the perceived value of community pharmacy technicians to the community pharmacy team. Completion of the survey was voluntary and approved by the university’s institutional review board. Data were evaluated using descriptive analyses. Results: Of the 298 surveys administered, 282 surveys were completed (94.6% response rate). The majority of the P1 students were aware that CPhTs are required to pass a licensure examination (78.4%) but only 37.2% were aware that CPhTs are required to complete continuing education. Less than 10% of students felt that CPhTs were qualified to contact prescribers regarding complex drug-related problems (DRP) and 41.5% of students felt that CPhTs were not qualified to communicate with prescribers for any DRP. The majority of students (92.2%) believed that pharmacy technicians are very important to a community pharmacy team; less than 1% felt that technicians were not important to a community pharmacy team. In comparison, only 61.7% of students thought that pharmacy interns were very important to the community pharmacy team and 8.5% felt that interns were not important to the pharmacy team. Conclusion: Student pharmacists’ view CPhTs as more important to the pharmacy team than pharmacy interns. Student pharmacists are not aware of many of the technicians’ qualifications and their ability to assist with DRPs. CPhTs play a critical role in community pharmacies, and student pharmacists should be educated about the technicians’ qualifications. Journal of the American Pharmacists Association APhA2014 ABSTRACTS 288—SURVEY TO DETERMINE PHARMACISTS’ CAPABILITIES AND PERCEIVED VALUE OF CLINICAL INTERVENTIONS DURING THE DISPENSING PROCESS. Lantaff W, University of Iowa College of Pharmacy, McDonough R, Towncrest Pharmacy, Urmie J, Catney C, Veach S, University of Iowa College of Pharmacy, E-mail: [email protected] Objective: The objectives of this study are to: (1) examine the perceived financial and clinical value community pharmacists in a Midwestern state have on clinical interventions that occur during the medication dispensing process; and (2) determine which factors may influence pharmacists’ abilities to address clinical interventions in the traditional community setting. Methods: Interventions made by pharmacists in the community setting are associated with an overall cost savings to the health system in addition to improved patient outcomes. These necessary interventions add an incremental cost to the dispensing process, which is generally not accounted for in current reimbursement model. Beyond the cost burden during the dispensing process, further evaluation is also needed to determine pharmacists’ capabilities in making these interventions, beyond those needed to properly dispense the prescription, due to influencers such as knowledge/skill, training, and work environment. An online survey to evaluate these objectives has been developed and will be administered through Qualtrics. A link to access the survey will be e-mailed to the study population with a cover letter explaining the purpose of the study. The e-mail will be sent through the state pharmacy association’s list server to pharmacists who practice within the state and who identify their practice site as the community pharmacy setting. The online survey will be open from December 2013 through February 2014. Following the closing of the survey, data analysis will occur and descriptive statistics will be used to summarize the survey results. Results: Research in progress. Pharmacoeconomics and Out- comes ries compared with 16 children (5.14%) who received medication. 289 —AT T EN T ION-DEF ICI T/ H YPERACTIVITY DISORDER MEDICATIONS AND INJURIES AMONG CHILDREN. Chen Z, Goedken A, University of Iowa, E-mail: [email protected] Objective: Children with attentiondeficit/hyperactivity disorder (ADHD) are at higher risk for accidental injuries. Though the clinical efficacy of ADHD medication on reducing ADHD symptoms is well established, there is limited knowledge of the effect of ADHD medications on injuries among children with ADHD. The objectives of this study are to: (1) estimate the association between ADHD medication and injury rate among children with ADHD; and (2) assess the types of injuries suffered by children with ADHD who receive and do not receive ADHD medication. Methods: This retrospective cohort study pools 8 panels of data from the Medical Expenditure Panel Survey spanning the years 2002 to 2010. The study sample is required to: (1) be eligible and participate in all 5 rounds of a panel; (2) be ≤18 years old at ADHD diagnosis; (3) have ADHD diagnosed in rounds 2, 3, or 4 of the survey; (4) have no exposure to ADHD medications in the round prior to ADHD diagnosis; and (5) have no injury during the round of ADHD diagnosis. The outcome variable is the injury rate during the round after a child is diagnosed with ADHD. The exposure variable is whether a child receives an ADHD medication in the round of diagnosis. The covariates include age, sex, index round, and previous injury. Descriptive statistics will characterize the demographics and injuries of the medicated and non-medicated groups. A multiple regression model will be used to examine the association between ADHD medication and injuries. Results: Research in progress. A total of 527 children are included in the study, of which 311 (59%) received ADHD medication and 216 (41%) did not receive ADHD medication. Twenty-seven children (5.1%) experienced at least 1 injury. Eleven children (5.09%) who did not receive medication experienced inju- Journal of the American Pharmacists Association Downloaded From: http://mustafa.japha.org/ on 06/09/2014 j apha.org 290—AVERAGE ANNUAL COST OF PROSTATE CANCER AND FACTORS PREDICTING THE COST. Patel P, Shah S, Tackett R, University of Georgia, E-mail: [email protected] Objective: The purpose of this study is to: (1) explore annual average prostate cancer cost per patient based on type of visit, age, and race/ethnicity; and (2) explore the significant predictors of annual cost of prostate cancer among age, race, and type of visits. Methods: This was a retrospective study involving the use of 2010 Medical Expenditure Panel Survey database. Data for patients with prostate cancer was extracted using the International Classification of Diseases–9th revision (ICD-9) code. One-way analysis of variance analyses were used to find the average annual prostate cancer–related costs, and multivariate regression was carried out to examine the impacts of age, race, and types of services on total costs in SAS software. Results: The average annual prostate cancer expenditure per patient on drug purchase, inpatient, outpatient, and office-based visits was found to be $6,177.2, $5,169.4, $3,679.71, and $1,149.86 respectively. Hispanic patients aged 45 to 64 years spend an average of $5,060.08 on prostate cancer–related expenses while in the age category of 75 to 90 years, they spend $17,220.55, which is significantly higher than any amount spent by any other ethnic background in that age category in 2010. Overall, prescription cost and outpatient visits were the statistical significant predictors of annual costs of prostate cancer. Conclusion: Drug purchase or medications were found to be most expensive while prescription cost and outpatient visits influence the cost of prostate cancer. To reduce costs associated with prostate cancer, conservative management and proper pharmacist-provided counseling to these patients are suggested as the most important strategies. 291—CAN HIGHER RATES OF CARDIOVASCULAR DRUG USE INMA R /APR 2014 | 54:2 | JAPhA e181 APhA2014 ABSTRACTS CREASE SURVIVAL FOR PATIENTS WITH END-STAGE RENAL DISEASE? AN INSTRUMENTAL VARIABLES INVESTIGATION. Tang Y, University of Iowa, Brooks J, University of South Carolina, Wetmore J, Shireman T, University of Kansas, E-mail: [email protected] Objective: Cardiovascular (CV) disease is a leading cause of death and morbidity among patients with end-stage renal disease (ESRD). However, utilization rates of CV drugs for patients with ESRD vary substantially across the United States. The objectives of this study are to examine the comparative effectiveness of CV drugs among patients with ESRD and determine whether higher utilization rates improve survival. Methods: Risk adjustment and instrumental variables models were used to estimate the comparative effectiveness of CV drugs on survival of patients with ESRD. Medicare/Medicaid dual-eligibles with ESRD who initiated dialysis during 2000–2004 were selected using U.S. Renal Data System and Medicaid Analytic eXtract data (n = 50,468). Treatments included angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, calcium channel blockers, betablockers, and HMG-CoA reductase inhibitors (i.e., statins) within 90 days post dialysis. Area treatment ratios (ATR) were instruments created for each CV drug category. Both models were adjusted for patient demographic characteristics, comorbidities, and functional status. Results: Risk adjustment estimates suggest that CV drug use provided survival benefits to ESRD patients who received them. However, ESRD patients receiving CV drugs tended to have more comorbidities, suggesting that risk adjustment estimates are biased low. Substantial variation in ATRs of CV drugs were found across the United States that are strongly related to CV drug use. Fewer clear relationships were found between measured covariates and ATR groups than treatment groups. Instrumental variables estimates suggested that higher rates of beta-blocker use statistically significantly increased 1-year survival, but no survival benefits were found in other CV drug categories. e182 JAPhA | 5 4:2 | M AR/AP R 2014 Downloaded From: http://mustafa.japha.org/ on 06/09/2014 Conclusion: Instrumental variables estimates suggest that only higher rates of beta-blocker use by ESRD patients are associated with improved survival. With limited information on comparative effectiveness found from randomized controlled trials, this study represents an important advancement in the understanding of real world CV therapeutic effectiveness and whether higher utilization rates are warranted in CV drugs. 292—COST-CONSEQUENCE ANALYSIS OF A COMMUNITY PHARMACY RESIDENT. Branson R, Kieser M, Kreling D, University of Wisconsin School of Pharmacy, E-mail: rbranson@ wisc.edu Objective: The objectives of this case study are to examine whether the value of a pharmacy resident outweighs the cost of maintaining a pharmacy resident and to explore patient interest in services offered by a pharmacy resident. Methods: A cost-consequence analysis will be used to determine the value of a community pharmacy resident to a site that had never previously had a resident. The direct and indirect costs to the site of maintaining a pharmacy resident for a period of 1 year will be examined and compared with the consequences of having a pharmacy resident present at the site. Consequences will be identified based on activities completed by the resident while at the residency site including, but not limited to, number of medication therapy management services performed, number of patients served in anticoagulation and tobacco cessation clinics, prescription volume, number of provider drug information questions answered, and increased utilization of electronic health record by pharmacy services as evidenced by number of templates generated by the resident and number of times those templates are used. Patient interest in receiving services from a pharmacist also will be measured by preand post-surveys directed toward asthma patients before and after initiation of a pharmacist-managed asthma care clinic. These surveys will examine patient perception of the care they are currently receiving, whether they feel pharmacists are qualified to provide such services, ja p h a .org and what benefits they perceive from pharmacist-managed services. Data will be collected over 2 months and extrapolated to fit the 10-month time frame of active residency. Results: Research in progress. 293—ESTIMATING THE ECONOMIC BURDEN OF TREATING INCOMPLETE MISCARRIAGE IN THE BAHAMAS. Sakharkar P, Roosevelt University College of Pharmacy, Sakharkar V, University of the West Indies School of Clinical Medicine and Research, Email: [email protected] Objective: Incomplete miscarriage is the most common gynecological problem with an estimated incidence ranging from 15% to 30% of all diagnosed pregnancies. It is one of the leading causes of emergency department visits and gynecological admissions. Incidence of incomplete miscarriage is approximately 15% of total births in the Bahamas every year. Besides hospital costs, cases of incomplete miscarriage take up hospital beds and consume operating room resources. The aim of this study was to estimate the economic burden of incomplete miscarriage on the publicly funded health care system in the Bahamas. Methods: A 5-year data collection on number of admissions, outpatient treatment, and medical and surgical management of miscarriages was reviewed from the largest hospital in the Bahamas. Cost of medical and surgical treatment was calculated separately. It included direct and indirect costs as follows: physician cost, procedure cost, cost of ultrasounds, drug cost, cost of hospital stay, costs of complications and adverse events as well as loss of wages and cost of travel. Costs were derived from annual hospital financial report, national labor and wages statistics, and the published literature. Results: Total miscarriages accounted for 15% of all gynecological admissions with an average inpatient hospital stay of 2.4 days. The majority (88%) of miscarriages were managed by surgical evacuation, of which (38%) were managed in hospital and 62% were managed on an outpatient basis. Only 12% were treated medically. The average cost of inpatient surgical treatment Journal of the American Pharmacists Association APhA2014 ABSTRACTS was $2,393 and as an outpatient $1,843. The cost of medical treatment was $926. The overall cost of treating incomplete miscarriage in the Bahamas accounts for over $1,048,460 each year, translating to $1,906 per patient. This burden can be reduced to $323,496 (31%) by maximizing outpatient surgical and medical management. Conclusion: Incomplete miscarriages are substantial burden on the publicly funded health care system in the Bahamas. Use of outpatient surgical and medical treatment can reduce this cost burden significantly. 294—EVALUATION OF RETURNTO-STOCK MEDICATIONS IN TWO COMMUNITY PHARMACIES. Jaber A, Gavin R, Coley K, University of Pittsburgh, E-mail: [email protected] Objective: The study goal is to determine trends existing among prescriptions that are “returned to stock” in community pharmacy settings in order to identify contributing factors and characteristics of prescriptions that are not picked up by patients to develop improvements in the future. Methods: This study was conducted at 2 community pharmacy locations within 2 different chains in western Pennsylvania, where the mutual need to reduce the amount of prescriptions being returned to active pharmacy stock due to patient failure to pick up was identified. Prescription medications that were returned to stock were identified through the use of automatically generated daily return to stock reports. For each medication, the following variables were collected within a span from June 1, 2013 until August 1, 2013: patient date of birth, sex, and zip code; medication name, cost, third-party information, method of prescription transmission, prescription enrollment in automatic refills, first fill or refill, site 1 or 2, and the overall number of prescriptions picked up by that patient in the previous 30 days from date of return. These data will be analyzed using SPSS software to determine trends among the returned to stock prescriptions. This study was approved by the university’s institutional review board. Results: Research in progress. Time management in community pharmacy is becoming increasingly important as focus shifts from the dispensing role of the pharmacist to the provision of patient care services. This research is intended to identify a starting point from which to develop strategies aimed at reducing the amount of medications returned to stock in community pharmacies in order to optimize use of time and resources. 295—THE IMPACT OF MEDICARE PART D COVERAGE ON HEALTH OUTCOMES IN PATIENTS WITH END-STAGE RENAL DISEASE. Park H, University of Florida, Rascati K, Lawson K, Barner J, Richards K, The University of Texas at Austin, Malone D, The University of Arizona, E-mail: hpark@ cop.ufl.edu Objective: Medicare Part D coverage gap involves substantial periods of uncovered drug use. The purpose of this study was to evaluate the impact of Medicare Part D coverage on health outcomes in patients receiving dialysis. Methods: A retrospective analysis (2006–2010) was conducted using data from the United States Renal Data System for Medicare-eligible patients receiving dialysis. Medication adherence, health care utilization and expenditures, cardiovascular disease morbidity, and mortality rates were compared, categorized based on patients’ Part D coverage in 2007 for those who: (cohort 1) did not reach the coverage gap; (cohort 2) reached the coverage gap but not catastrophic coverage; (cohort 3) reached catastrophic coverage; and (cohort 4) did not reach the coverage gap but received a low-income subsidy. Cox proportional hazard models, Kaplan-Meier methods, logistic regressions, generalized linear models, and generalized estimating equations were used. Results: A total of 11,732 patients were identified. Patients in cohort 2 were more likely to be nonadherent to medications for diabetes (relative risk [RR] = 1.71, 95% confidence interval [CI] = 1.48–1.99), hypertension (RR = 1.69; 95% CI, 1.54–1.85), hyperlipidemia (RR = 2.01, 95% CI 1.76–2.29), hyperphosphatemia (RR = 1.74, 95% CI 1.55–1.95), Journal of the American Pharmacists Association Downloaded From: http://mustafa.japha.org/ on 06/09/2014 j apha.org and hyperparathyroidism (RR = 2.08, 95% CI 1.66–2.60) after reaching the coverage gap. These patients had $2,419 lower pharmacy costs, but $3,368 higher medical service costs (P<0.001) due to increased rates of hospitalization (1.73 vs. 1.58) and outpatient visits (7.98 vs. 6.95) compared with patients in cohort 4 (P<0.05). In addition, patients in cohort 2 and cohort 3 had 42% and 38% increased risk of cardiovascular disease (odds ratio [OR] = 1.42, 95% CI 1.20–1.68 and OR = 1.38, 95% CI 1.10–1.72); and had 36% and 37% higher mortality rates compared with those in cohort 4, respectively (hazard ratio [HR] = 1.36, 95% CI 1.27–1.44 and HR = 1.37, 95% CI 1.27–1.48). These relationships remained significant for the propensity-score matched and fully adjusted models controlling for laboratory data. Conclusion: Reaching the Part D coverage gap was associated with decreased medication adherence and unfavorable clinical and economic outcomes in patients undergoing dialysis. 296—IMPACT OF PRIOR AUTHORIZATION OF MONTELUKAST ON CLINICAL OUTCOMES FOR ASTHMA AND ALLERGIC RHINITIS AMONG CHILDREN AND ADOLESCENTS IN A STATE MEDICAID PROGRAM. Keast S, Harrison D, University of Oklahoma College of Pharmacy, Thompson D, University of Oklahoma College of Public Health, Farmer K, Smith M, University of Oklahoma College of Pharmacy, Nesser N, Oklahoma Health Care Authority, Email: [email protected] Objective: As policy makers struggle with increasing membership and limited resources, restrictions are often placed on costly pharmaceuticals when more cost-effective products are available. Restrictions in fragile disease states must be reviewed to ensure unintended clinical consequences do not occur. Oklahoma Medicaid implemented such a restriction on montelukast in January 2009. The objective of this research was to evaluate potential unintended clinical consequences of the restriction on patients with asthma and allergic rhinitis. Methods: Monthly individual-level MA R /APR 2014 | 54:2 | JAPhA e183 APhA2014 ABSTRACTS data were collected from Oklahoma Medicaid paid pharmacy and medical claims from January 1, 2007 through December 31, 2010 for children and adolescent beneficiaries with asthma and/or allergic rhinitis. Continuous eligibility for the entire 48-month period was required. The effect of the prior authorization for montelukast on emergency room (ER) utilization, disease-related physician office visits (DRV), and antibiotic prescription utilization (ABX) was analyzed using segmented binomial regression. Results: For all 3 outcomes, decreases in mean number of claims per member per month were detected when comparing pre– and post–prior authorization periods for the disease states of asthma, allergic rhinitis, or both. Odds of having an outcome of interest at the point of prior authorization implementation was 0.71 (P<0.0001), 1.29 (P<0.0001), and 1.26 (P<0.0001) for ER, DRV, and ABX respectively. Overall trend in odds was 1.02 (P<0.0001), 0.93 (P<0.0001), and 0.95 (P<0.0001) for ER, DRV, and ABX, however during the post-implementation period, the odds were 0.92 (P<0.0001) for ER and 1.03 (P<0.0001) for DRV and ABX. Conclusion: While there was a point increase at implementation for DRV and ABX, the overall trend remained negative, indicating that no unexpected negative clinical outcomes occurred. Additionally, the results indicate no negative effect was detected in ER utilization after prior authorization implementation, especially in patients with asthma. 297—IMPLICATIONS OF WASHOUT PERIOD DURATION IN INCIDENT USER STUDY DESIGNS IN COMMERCIALLY INSURED POPULATIONS. Roberts A, University of North Carolina at Chapel Hill Eshelman School of Pharmacy, Dusetzina S, University of North Carolina at Chapel Hill School of Medicine, Farley J, University of North Carolina at Chapel Hill Eshelman School of Pharmacy, E-mail: [email protected] Objective: This project aims to describe the effect of “washout” period duration on the composition of retrospective incident user cohorts. Incident e184 JAPhA | 5 4:2 | M AR/AP R 2014 Downloaded From: http://mustafa.japha.org/ on 06/09/2014 user study designs reduce bias in observational studies by excluding patients with prior drug exposures. Increasing washout period duration ensures more accurate identification of incident users at the expense of generalizability and precision. Little evidence exists to guide researchers in selecting appropriate washout periods. Methods: This study used Truven Health Analytics MarketScan database from 2007 to 2010. Individuals aged 18 to 64 years with a prescription claim in calendar year 2010 for a medication approved to treat hyperlipidemia, diabetes, or depression were included. For each cohort, 5 increasingly restrictive washout periods (i.e., 3, 6, 12, 24, and 36 months) were applied to identify incident users with continuous enrollment. Changes in cohort sample size across washout durations were described. Rates of incident user misclassification for each cohort were assessed as washout duration decreased. Results: Among the 3,477,753 antihyperlipidemic, 1,445,651 antidiabetic, and 3,468,137 antidepressant users identified, a 3-month washout reduced the sample by 54%, 61%, and 56%, respectively. Twelve-month washouts reduced the antihyperlipidemic and antidiabetic cohorts by 87% and the antidepressant cohort by 83%. A 36-month washout reduced each cohort by 95%. Continuous enrollment gaps accounted for nearly half of observed sample loss in 3- to 12-month washouts and roughly 70% of observed sample loss in longer washouts. Incident user misclassification rose as washout duration decreased. Twelve-month washouts resulted in misclassification of 33%, 26%, and 32% of antihyperlipidemic, antidiabetic, and antidepressant users, respectively. Misclassification rates were 45% to 50% for 6-month washouts and 67% to 77% for 3-month washouts. Conclusion: Washout period duration significantly impacts the size and accuracy of retrospective incident user cohorts. These trends were similar for medications used for both chronic and episodic conditions. Researchers should be aware that washout periods of 6 to 12 months may be insufficient for identifyja p h a .org ing treatment-naive patients. 298—IMPROVING COST SAVINGS AND PATIENT OUTCOMES WITH HEPATITIS C TRIPLE THERAPY TREATMENT IN THE MEDICAID POPULATION. Chen Y, Carter C, Fish M, PerformRx, Mayer D, University of Pittsburgh School of Pharmacy, E-mail: [email protected] Objective: This study aims to use several simple approaches to contain rising costs and provide better care for patients with hepatitis C patients in this Medicaid population. Throughout the entire process, comparisons will include costs and member outcomes from the study approach to the baseline before these initiatives took effect. Overall, if cost control and improved member outcomes are successful with the hepatitis C population, then these processes also may be applied to other disease states, clients, and members in an effort to manage total health care costs and outcomes. Methods: For a Pennsylvania Medicaid population, more restrictive parameters were implemented on the prior authorization criteria to reflect changes in the recommended treatment regimen. In addition, this institution’s current patients with hepatitis C will be monitored throughout their entire duration of treatment starting from March 2013 until the end of treatment by obtaining their refill history, laboratory values, and prior authorization data for any hepatitis C triple therapy request. Providers and patients would be contacted if interventions are necessary. Furthermore, tablet computers will be used to give more insight into and improve adherence. These tablet computers would mainly push questions and reminders to members to take their medications and have necessary lab work drawn on time. Through an online portal, answers to the questions can be reviewed for the purpose of analyzing attitudes and adherence rates and determining necessary interventions. Results: Research in progress. 299—PATTERNS OF ADHERENCE AND HEALTH SERVICE UTILIZATION AMONG UNIVERSITY OF NORTH CAROLINA HEALTH CARE Journal of the American Pharmacists Association APhA2014 ABSTRACTS PHARMACY ASSISTANCE PROGRAM ENROLLEES WITH CHRONIC DISEASE. Roberts A, University of North Carolina at Chapel Hill Eshelman School of Pharmacy, Crisp G, University of North Carolina at Chapel Hill Hospitals and Clinics, Esserman D, Yale School of Public Health, Roth M, University of North Carolina at Chapel Hill Eshelman School of Pharmacy, Weinberger M, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Farley J, University of North Carolina at Chapel Hill Eshelman School of Pharmacy, E-mail: [email protected] Objective: The purpose of this study was to examine medication adherence and health care utilization among patients with chronic disease enrolled in a charitable pharmacy assistance program. Charitable pharmacy assistance programs are prevalent and provide medications to financially vulnerable patients, who are at greater risk of suboptimal medication adherence and health outcomes. However, little is known about the utilization patterns of program members. Methods: This study used a retrospective cohort design to investigate 6-month outcomes for new University of North Carolina Health Care Pharmacy Assistance Program (UNCH PAP) members receiving medications indicated for hypertension, diabetes, and/or hyperlipidemia during 2009 to 2011. The study describes medication adherence (measured in proportion of days covered [PDC]) and health care utilization patterns for antihypertensive, antidiabetic, and statin user cohorts. Logistic regression was used to analyze predictors of adherence and evaluate the association between adherence and emergency and inpatient care utilization, while controlling for demographic and select utilization characteristics. Results: The cohorts included 866, 265, and 455 UNCH PAP members using antihypertensive, oral antidiabetic, and statin medications, respectively. Average 6-month adherence, in PDC, for antihypertensive, oral antidiabetic, and statin user cohorts was 0.70, 0.67, and 0.60, respectively. Approximately 40% to 50% of subjects were adherent at PDC ≥0.8. Nearly 20% were hospitalized at least once and over 25% received emergency care during the observation period. Regression analyses suggested that multiple comorbidities and adherence were associated with reduced inpatient and emergency care. Conclusion: UNCH PAP was a primary source of care for many low-income, uninsured North Carolinians. The findings suggest that PAPs can provide access to consistent pharmacy care and reduce costly health care utilization, particularly among older, complex patients. The future viability of charitable PAPs to achieve positive health outcomes, particularly in states like North Carolina that are opting out of Medicaid expansion, may require further research and integration of medication therapy management services. 300—PREDICTING IMMUNOGENICITY OF INFLIXIMAB: PHARMACOECONOMIC IMPLICATIONS FOR BIOSIMILARS. Andrick B, Stroyne K, Kamal K, Meng W, Duquesne University, E-mail: [email protected] Objective: The purpose of the study was to predict immunogenicity of infliximab in the context of perceived economic benefit of biosimilars. Biosimilars are products containing the same active biologic ingredients, with similar physiochemical and clinical performance. The anticipated cost-saving has generated strong interests among third-party payers. However, manufacturing of biologics is complex; slight product deviance may result in drug-specific antibody responses. A thorough pharmacoeconomic evaluation must consider immunogenicity-related adverse drug events and not just drug acquisition costs. In the present study, the amino acid sequence of infliximab was analyzed for antigenic and aggregation potential, both factors contributing to induction of antibodies. Methods: The antigenic potential of infliximab was evaluated using the bioinformatics tool SYFPEITHI. The sequence was screened for peptides that conform to the binding motif of HLADRB1*1001, human major histocompatibility molecules (MHC) linked to rheumatoid arthritis. Aggregation propen- Journal of the American Pharmacists Association Downloaded From: http://mustafa.japha.org/ on 06/09/2014 j apha.org sity was analyzed using the prediction of amyloid-structure aggregation (PASTA) algorithm. Proteins are more likely to enter MHC pathways when aggregate. The pharmacoeconomic framework needs to address budget impact of introducing the biosimilars in the formulary. Results: Scanning infliximab for HLA-DRB1*1001 motif yielded GPIYKRVDGKWMREL (light-chain residues 94-109) as a potential ligand. This fragment resembles the influenza A virus nucleocapsid segment YKRVDGKWVRELVLYDK, also a potential ligand of HLA-DRB1*1001. The resemblance suggests patients exposed to the influenza may be sensitized toward infliximab. PASTA analysis identified several segments in infliximab that may drive beta-fibril–like aggregation. Inflectra and Remsima are 2 biosimilar products of infliximab that have been approved by the European Medicines Agency. The acquisition costs (per 100 mg) of the biosimilars are $399.99 versus Remicade (infliximab) product which is $665.65. Future pharmacoeconomic framework should weight the lower acquisition costs of the biosimilars against costs incurred from adverse events, if any. The results will help payers decide the true value of these biosimilar drugs. 301—SHORTAGES OF ONCOLOGY DRUGS IN THE UNITED STATES. Greene N, Turkistani F, Seoane-Vazquez E, Massachusetts College of Pharmacy and Health Sciences, Rodriguez-Monguio R, University of Massachusetts School of Public Health and Health Sciences, Fox E, University of Utah Hospitals and Clinics, Szeinbach S, The Ohio State University College of Pharmacy, E-mail: [email protected] Objective: Shortages of oncology products adversely impact health outcomes and health care costs. The objectives of this study were to: (1) assess the prevalence of shortages of oncology products; and (2) evaluate the characteristics of the products in short supply as reported by the American Society of Health-System Pharmacists (ASHP) in the United States on December 31, 2012. Methods: Drug approval data were collected from the U.S. Food and Drug MA R /APR 2014 | 54:2 | JAPhA e185 APhA2014 ABSTRACTS Administration (FDA) webpage. Shortage data were collected from the ASHP webpage. The unit of analysis was the active ingredient(s) and route of administration. The prevalence of shortages was estimated as a percentage of the total number of products in the U.S. market as of December 31, 2012. Results: ASHP listed a total of 435 products in shortage/discontinued (237 current shortages, 166 resolved shortages, and 32 discontinued products). This study excluded analysis of 2 devices, 3 nontherapeutic biologics, 15 vaccines, and 58 non-FDA approved products. A total of 36 of the products in shortage/ discontinued were approved by the FDA for oncology indications (20 current shortages, 14 resolved shortages, and 2 discontinued products). The prevalence of shortages/discontinuations for oncology products was estimated at 21.3% (36 shortages out of 169 FDA-approved products). The prevalence for products for all other therapeutic classes was estimated at 13.9% (321 shortages out of 2,310 FDA-approved products). Reasons for oncology drug shortages were manufacturing (64.9%), discontinuations (8.1%), business decision (5.4%), product sold to another company (2.7%), raw materials (2.7%), change in manufacturing (2.7%), and unknown reasons (13.5%). Conclusion: Over one-sixth of the oncology products available in the United States were reported in short supply/discontinuation in December 2012. Problems with manufacturing and discontinuations represented most of the reported causes of shortages. Additional research is needed to assess the risk factors, causes, and clinical and economic impact of pharmaceutical shortages in the United States. 302—TREATMENT PATTERNS AMONG PATIENTS WITH BREAST CANCER IN THE UNITED STATES DURING 2006–2010 USING TWO NATIONAL SURVEYS ON VISITS TO PHYSICIANS’ OFFICES AND HOSPITAL OUTPATIENT DEPARTMENTS. Wittayanukorn S, Qian J, Hansen R, Auburn University Harrison School of Pharmacy, E-mail: szw0022@ tigermail.auburn.edu e186 JAPhA | 5 4:2 | M AR/AP R 2014 Downloaded From: http://mustafa.japha.org/ on 06/09/2014 Objective: The purpose of this study is to: (1) estimate the patterns of antineoplastic agents prescribed to nationally representative patients with breast cancer in ambulatory settings; and (2) identify factors associated with the antineoplastic agents prescribed. Methods: A cross-sectional, retrospective analysis using the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey data for 2006–2010 was conducted. Patients with breast cancer were identified by their primary diagnosis. Breast cancer treatments were categorized by medication class and further grouped as novel, classical, and hormone agents. A visit-level descriptive analysis using visit sampling weights estimated national prescribing trends. Weighted chi-square tests examined differences in treatment pattern across patient demographic, health insurance, and setting. Multivariable logistic regression identified factors associated with antineoplastic agent use. Results: Based on 2,281 breast cancer visits (weighted n = 29,116,697), antineoplastic agents were documented in 20.52% of visits in 2006, compared with 24.53% in 2010 (P>0.05 across years). Hormones were the most commonly prescribed antineoplastic agents (54.07%) followed by mitotic inhibitors (17.74%) and HER2 inhibitors (9.79%). Logistic regression analyses found that patients with distant stage cancer were more likely than patients with other cancer types to receive anticancer agents (odds ratio [OR] = 2.88; 95% confidence interval [CI] 1.04–6.01), and in particular novel (OR = 5.87; 95% CI 1.81–8.99) and classical agents (OR = 6.34; 95% CI 1.69– 8.05). Patients with older age, comorbid depression and diabetes, and living in the Midwest were less likely to receive novel agents (P<0.05 for all). Patients having private insurance were less likely to receive classical agents, while patients seen in office-based clinics were more likely to receive classical agents (P<0.05 for all). Conclusion: The proportion of patients with breast cancer receiving ambulatory treatment is increasing over time. Factors predicting type of treatment inja p h a .org clude age, region, insurance type, certain comorbidities, and setting. These findings have implications for research on treatment access, health disparities, and comparative effectiveness research. Professional Development 303—EMPLOYER SUPPORT OF POLITICAL ADVOCACY. Woods J, Pruchnicki M, Sweaney A, The Ohio State University College of Pharmacy, Email: [email protected] Objective: Research has defined professional advocacy for pharmacy as a commitment and participation in advancing awareness of the profession to various stakeholders. Political advocacy in particular directs efforts toward influential leaders and policy makers. Pharmacists not engaged in political advocacy have reported that employer support would facilitate their participation, thus offering a potential opportunity to enhance pharmacists’ political involvement. The objectives of this study are to: (1) explain the perceived value of political advocacy from community pharmacy employers’ perspectives; (2) compare the opportunities, resources, and support employers may provide their pharmacists to engage in political advocacy; (3) and suggest a practical approach for employers to consider support of employees’ advocacy efforts. Methods: Research will be conducted using an explanatory, multiple case study approach with qualitative and quantitative data collected through structured interviews. Participants will include community pharmacy department leaders recruited through purposive sampling. After obtaining consent, subjects will participate in personal or telephonic standardized interviews. Interviews will include both focused and open-ended questions regarding beliefs and company-specific practices related to employees’ advocacy activities. Data collection and analysis will be conducted simultaneously through a standard iterative approach. This process will allow for adjustment of interview questions based on input of preceding interviews. Investigators will conduct interviews until the sample is exhausted or data sat- Journal of the American Pharmacists Association APhA2014 ABSTRACTS uration occurs. Interview transcripts will be reviewed and data reported through themes and cross-case synthesis; these will be organized to develop representative employer advocacy models. Models should describe broad, aggregate generalizations regarding advocacy practices and provide specific examples of successful engagement. Results: Research in progress. Conclusion: The models generated from this research could potentially influence employers and professional organizations to promote successful political advocacy engagement. Conclusions also could provide opportunities for pharmacists to influence the formation of corporate advocacy agendas and stimulate grassroots advocacy efforts. 304—EVALUATING THE EFFECTIVENESS OF A MEDICAL SPANISH TRAINING COURSE FOR COMMUNITY PHARMACISTS. Andres L, Purdue University College of Pharmacy, Fletcher L, Fagen Pharmacy, Gonzalvo J, Purdue University College of Pharmacy, E-mail: lindsey.andres@fagenpharmacy. com Objective: This study aims to determine the effectiveness of a medical Spanish education course for training community pharmacists. Methods: This study has been approved by the institutional review board. Data will be collected from pharmacists who will be attending a medical Spanish training session tailored toward the needs of a community pharmacist. Training modules will be developed by the research team and will be designed to be brief and available online to provide a novel, more practical training environment for today’s community pharmacist. The focus will be on basic pronunciation, pharmacy-related vocabulary, and necessary phrases for accurate dispensing of prescriptions. Prior to training sessions, pharmacists who agree to participate in the study will complete a pre-training assessment. Upon completion of the training course, a second assessment will be administered to assess objective and subjective medical Spanish language skills. The primary outcome measured will be pharmacists’ ability to recognize and use Spanish language in a pharmacy. This outcome will be assessed by comparison of pre- and post-training responses to an objective assessment of language skills. The assessment will include Spanish language necessary to perform typical pharmacy functions such as obtaining pertinent information from patients, verifying accuracy of a prescription processed in Spanish, and providing basic medication counseling. The secondary outcome will measure self-efficacy with Spanish skills. A 5-point Likert-type scale will be used to assess pharmacists’ confidence in their ability to perform typical pharmacy functions with Spanish-speaking patients. Comparison of data collected from pre- and post-training assessments will allow for evaluation of the impact of training sessions on pharmacists’ ability to utilize medical Spanish. Results: Research in progress. 305—EVALUATION OF A COMMUNITY PHARMACY SUMMER INTERN PROGRAM MANUAL. Vahle L, Wilhelm M, Southern Illinois University Edwardsville, E-mail: lvahle@siue. edu Objective: The purpose of this study is to evaluate the effectiveness of a learning tool (i.e., a program manual) for a summer intern program that provided student pharmacists with self-care topics and community pharmacy experience throughout a 10-week program. Methods: A 20-question data collection tool was developed as a pre- and post-quiz for student pharmacists completing a 10-week summer intern program. Interns were instructed to make a unique identifier to maintain anonymity but allow for pre- and post-quiz comparisons. The pre- and post-quiz consisted of 2 multiple-choice self-care–related questions taken from each week of a previously developed summer intern program manual. Interns completed the quiz on the first and last days of the 10-week summer intern program. Upon completion of the summer intern program, interns also completed a 9-question perception survey. The perception survey utilized a 5-point Likert scale with questions related to how the manual assisted with learning of self-care–re- Journal of the American Pharmacists Association Downloaded From: http://mustafa.japha.org/ on 06/09/2014 j apha.org lated topics. The study was approved by the institutional review board as exempt category of research. Results: All 4 interns (100%) participating in the summer intern program completed the pre- and post-quiz. Preand post-quiz scores were analyzed using descriptive statistics. Mean intern quiz scores improved from 20% initially to 69% after completion of the summer intern program and manual. Overall perception survey results were positive with interns consistently agreeing or strongly agreeing that the manual for the summer intern program contributed to their learning. Conclusion: Mean pre- and postquiz scores and perception survey results indicate the summer intern program manual is an effective learning tool. All interns reported they would recommend the program to other student pharmacists. 306—INTRODUCTORY LEARNING MODULES FOR DRUG DOSAGE FORMS AND DELIVERY ROUTES. Horner J, Brock T, Chen X, Ferrone M, Floren L, University of California–San Francisco, E-mail: [email protected] Objective: The goal of this project was to provide novice pharmacy students with a consolidated and technologically enhanced introduction to drug dosage forms and delivery routes to eventually apply this knowledge in further coursework and internships. Methods: The project includes 5 phases which were adapted from the Kern methodology, a validated method of curriculum development: (1) review of current practices; (2) curriculum design; (3) creation of media; (4) implementation; and (5) evaluation. Phase 1 involved a review of which topics in drug dosage forms and delivery routes were currently covered in which courses across the curriculum to identify gaps, inefficiencies, and areas of confusion. In phase 2, a curricular outline was developed for 5 audiovisual learning modules: introduction to dosage forms, oral delivery, parenteral delivery, delivery via inhalation, and topical delivery. Next, learning objectives and technical content were detailed for each module including MA R /APR 2014 | 54:2 | JAPhA e187 APhA2014 ABSTRACTS a unifying patient case, pictures, videos, and supplementary resources. In phase 3, the multimedia modules were created using Articulate Presenter. In phase 4, the modules were launched to all the first-year pharmacy students (N = 120). For phase 5, the (validated) Kirkpatrick model will be used for evaluating student reaction, learning, behaviors, and results. This includes both phased online student surveys (e.g., satisfaction, recommendations for improvement, practicality for internship) and instructor surveys (e.g., perceptions of preparedness, cohort grade comparisons). Results: Research in progress. Initial satisfaction surveys were very positive. Students appreciated the content of the modules and enjoyed the media platform used. Further evaluation next year will show if this project will have a positive effect on students’ preparation for more advanced courses and clinical internships. 307—PHARMACISTS AS CERTIFIED ASTHMA EDUCATORS (AEC): WHAT IS THE IMPACT OF THE AE-C AND WHY AREN’T MORE PHARMACISTS CERTIFIED?. Hudd T, Seoane-Vazquez E, Massachusetts College of Pharmacy and Health Sciences University, Bollmeier S, St. Louis College of Pharmacy, E-mail: tim.hudd@ mcphs.edu Objective: The purpose of this study is to gather insight from pharmacists who have successfully completed the certified asthma educator (AE-C) exam to better gauge how the National Asthma Educator Certification Board (NAECB) may further promote or recruit pharmacists to sit for this examination. Methods: A questionnaire was developed, validated, and pretested by pharmacists with expertise in asthma education. The final 20-item survey was distributed to the 224 pharmacists nationwide with an active AE-C credential using the Constant Contact Online Survey Tool on April 6, 2013. Participation was voluntary and results were reviewed using descriptive statistical analyses. Results: Of the 224 AE-C pharmacists surveyed, a total of 57 (25.4%) phar- e188 JAPhA | 5 4:2 | M AR/AP R 2014 Downloaded From: http://mustafa.japha.org/ on 06/09/2014 macists from 30 states fully completed the survey. Fourteen pharmacists not directly involved in patient care–related activities were excluded from analysis. Respondents were primarily female (83.3%); had earned a doctor of pharmacy degree (84.7%); completed a postgraduate year 1 residency (42.9%); and were practicing in an ambulatory care setting (57.1%). Respondents considered that the AE-C certification had helped advance them professionally, with 24.4% of the respondents strongly agreeing, 48.9% somewhat agreeing, 22.2% neither agreeing nor disagreeing, and 4.4% somewhat disagreeing. The majority of respondents (84.4%) indicated that they would recommend the AE-C credential to a pharmacist colleague. Conclusion: The National Asthma Education and Prevention Program has advocated for multifaceted educational programs to improve self-management skills and asthma outcomes. As the pharmacists’ role continues to evolve, the ability to demonstrate competence in specialty areas of practice will be increasingly important. As the NAECB continues to promote the AE-C certification among all eligible health care provider groups, increased efforts to raise awareness around this credential among pharmacists demands exploration. 308—STUDENT UTILIZATION OF PROFESSIONAL PHARMACY ORGANIZATIONS TO ADVANCE PROFESSIONAL CAREER DEVELOPMENT. Naik M, Kalaria S, Cintron N, Ernest Mario School of Pharmacy–Rutgers, The State University of New Jersey, E-mail: [email protected] Objective: The purpose of this study is to assess student involvement in professional pharmacy organizations and evaluate how students utilize different opportunities from their involvement to advance professional development and career goals. These organizations play a key role in developing initiatives to assist members in achieving professional growth. As a result, this information can be used by these organizations to target specific student populations. Students interested in specific career paths also will be able to identify organizations that ja p h a .org may be the most useful to them. Methods: This cross-sectional study will use anonymous paper and online surveys to gather data from pharmacy school students. It will be open to students of all years in a 0–6 doctor of pharmacy degree program as they are able to join pharmacy organizations regardless of their year. This population consists of students from 2 pre-professional and 4 professional years. Surveys will include both quantitative and qualitative questions regarding students’ intended career goals and experiences with organization involvement. Questions include identification of which organizations students are involved, extent of involvement within the organization, chapter versus national involvement, rating of quality of professional development, reasons for involvement, and relevancy of organization-held events, all with respect to predefined career goals (e.g., community, hospital staff, industry). A free text option will be included as well for career goals, which will then be further analyzed and categorized by similarity. Survey questions will consist of questions in the following formats: multiple choice, 5- and 10-point Likert scales, and open-ended responses. The collected data will be evaluated to assess student involvement and the level of career-oriented professional development offered to them. Descriptive statistics and subgroup comparisons will be used to analyze the data. Results: Research in progress. Survey has been created and data collection is currently underway. Public Health 309—IMPACT OF A FOOD AND DRUG ADMINISTRATION DRUG SAFETY COMMUNICATION ON ZOLPIDEM DOSING: AN OBSERVATIONAL RETROSPECTIVE COHORT. Harward J, Clinard V, Muzyk A, Campbell University College of Pharmacy and Health Sciences, Lingerfeldt B, Kerr Drug, E-mail: jonathanharward@ gmail.com Objective: Previous studies have been performed to analyze the effects of Food and Drug Administration (FDA) Journal of the American Pharmacists Association APhA2014 ABSTRACTS communications and health warnings on the health care system. However, no trials are published to date that have studied the effect of the FDA communication with regard to zolpidem-containing products. The primary objective of this study is to compare proportions of new prescriptions for select zolpidemcontaining products concordant with FDA-approved dosing in women before and after the original FDA drug safety communication in January 2013. The secondary objectives include describing concordance proportion based on location (urban or rural) and prescriber (midlevel or MD) after the FDA drug safety communication. Methods: This retrospective cohort will include women aged 18 to 64 years who were dispensed a new prescription for select zolpidem-containing products in a regional community pharmacy chain from April 1, 2012 to September 30, 2012, and from April 1, 2013 to September 30, 2013. Description of the secondary endpoints will serve as a demographic assessment of concordance based on the type of provider prescribing the medication in question and the location where the medication was dispensed. Patient age, drug dispensed, dose of drug, city or town in which drug was dispensed, and provider type will be obtained from a central pharmacy database. The primary objective will be analyzed using a chi-square test. Results: This study is pending institutional review board approval. 310—AN ASSESSMENT OF EDUCATION ON SECONDHAND SMOKE: ARE PATIENTS GETTING ENOUGH INFORMATION?. Squires S, Harding University, E-mail: ssquires@harding. edu Objective: The purpose of this study was to assess the knowledge of people attending a local, community festival regarding the dangers and consequences of secondhand smoke. Methods: A booth was set up at a free, local, environmentally and health conscious festival to distribute materials and educate attendees on the dangers of secondhand smoke. Attendees approached the booth and were asked to take a voluntary, anonymous survey to assess their knowledge of the harms caused by secondhand smoke. Once the survey was completed, the attendees were informed of the correct answers to help increase their working knowledge. Pamphlets, for those who prefer reading materials, and a QR code which linked to a YouTube video created for this project, for audiovisual learners, also were distributed. The data collected from the surveys included age group, race, smoking status, whether anyone in the home smoked, and a variety of true/false and multiple-choice questions. Results: This population appeared to be representative of the area in which the study was conducted. The majority of those surveyed knew secondhand smoke was harmful even if it could not be smelled and that secondhand smoke begins to affect a healthy, nonsmoker almost immediately; however, nearly one-third of the people surveyed believed airing out a room helped to avoid exposure to secondhand smoke. Furthermore, only approximately 7% of those surveyed knew that “heart attacks” was the correct answer when asked which disease or illness dropped in incidence soon after smoking was banned in many bars and restaurants. Conclusion: The assessed education of the population could be improved regarding the link between smoking or secondhand smoke and cardiac health. Improved education about these dangers and consequences could be achieved through more substantial interaction with patients in many pharmacy settings, such as ambulatory care, retail, and health fairs. 311—DEVELOPMENT OF A PHARMACIST-DRIVEN COMMUNITYBASED INITIATIVE TO REDUCE CERVICAL CANCER RATES IN A SMALL RURAL AREA: MEETING THE NEEDS OF AN UNDERSERVED POPULATION. Smith J, Story R, Jones E, Khan P, Underwood B, Jang S, Kissack J, Yates K, Harding University College of Pharmacy, E-mail: jsmith17@harding. edu Objective: Despite the availability of human papillomavirus (HPV) vac- Journal of the American Pharmacists Association Downloaded From: http://mustafa.japha.org/ on 06/09/2014 j apha.org cines, the incidence of cervical cancer in this rural, medically underserved area remains strikingly higher than the national incidence. The HPV Awareness and Vaccination Project strives to meet the needs of this population by developing educational tools to supplement current resources offered by local health officials. The overarching goal of this multi-staged, interdisciplinary project is to improve consumer knowledge about HPV-related disease and to increase vaccination rates. Methods: In 2009, student pharmacists under faculty supervision designed a survey for community leaders and health care providers to better understand perceptions of current clinical practice and behaviors of local patients/ residents. Another survey was subsequently developed targeting male patients; it was aimed at finding discrepancies in HPV knowledge. Next, the project expanded community awareness of HPV-related cervical cancer and genital warts; various outlets were used such as radio and print media, face-to-face administration of surveys, continuing education opportunities for pharmacists, and live presentations to undergraduate students. The progress of this initiative has been regularly reported to the medical community via poster presentations at state and national professional meetings. Results: Research in progress. The study surveys reveal a clear lack of knowledge regarding HPV and cervical cancer. The project has since tailored its educational initiative to provide meaningful and relevant information to the public. From the study results, it can be inferred that providing education will increase the vaccination rate, thus lowering the rate of HPV-associated cancer. The next phase of the program will incorporate new media outlets, such as television public service announcements. The final phase will be administration of HPV vaccine by student pharmacists and student physician assistants in conjunction with the Local Health Unit (LHU). This collaboration will continue to strengthen as the research team works directly with the LHU to coordinate and implement the interdisciplinary HPV MA R /APR 2014 | 54:2 | JAPhA e189 APhA2014 ABSTRACTS vaccination days. among fourth grade students. 312—IMPACT OF A TOBACCO PREVENTION PRESENTATION ON ELEMENTARY SCHOOL STUDENTS. Prudencio J, Savona N, Batz F, University of Hawaii at Hilo, The Daniel K. Inouye College of Pharmacy, E-mail: [email protected] Objective: The objective of this program is to prevent tobacco use in order to improve community health and lessen the economic burden, prior to initiation of use. Methods: In March 2012, a grant was awarded to an organization to develop and administer a 1-hour tobacco prevention education presentation, titled What About Tobacco, for fourth-grade students. The organization trained student pharmacists from a university to deliver the tobacco prevention education programs. During fall 2012, these student pharmacists delivered presentations to approximately 650 fourth graders. The program included: (1) screening of a brief, professionally produced tobacco prevention video designed for elementary school students; (2) an audience participatory activity discussing the effects of tobacco use on various body organs; and (3) a second audience participatory activity discussing the toxic chemicals found in tobacco products. Identical preand post-presentation quizzes, made up of 6 true-or-false questions and 4 multiple-choice questions, were administered to participants to assess the impact of the presentations on their knowledge and attitudes toward tobacco use. Results: After all of the presentations were completed, a total of 648 prequizzes and 649 post-quizzes were compiled and analyzed. Correct responses for 9 of the 10 questions increased from the pre-quiz to the post-quiz. Conclusion: The analysis of the quiz results and the overwhelmingly supportive feedback from the teachers of the participating students indicates the tremendous value of the What About Tobacco program. It is apparent that the What About Tobacco program is effective in increasing students’ knowledge on the harmful effects of tobacco, and should continue to be implemented 313—POINT OF DISPENSING DRILL: PREPARING STUDENT PHARMACISTS TODAY FOR THE EMERGENCY PREPAREDNESS AND RESPONSE WORKFORCE OF TOMORROW. Hogue G, Bounds R, Barbye E, Taylor D, Truong H, University of Maryland Eastern Shore School of Pharmacy, E-mail: [email protected] Objective: The objectives of this study are to: (1) provide student pharmacists with the concepts and applications of emergency preparedness and response; and (2) demonstrate the pharmacist’s role in mitigating public health threats to the community, including school, university, and health department. Methods: Students received a 1-hour instruction on emergency preparedness and response with emphasis on the Strategic National Stockpile process of delivering medications, vaccinations, and supplies from federal stockpiles to local points of dispensing (PODs) and a 30-minute quasi just-in-time-training on drill day to explain the concepts and operations of PODs in a hypothetical terrorist release of anthrax over the East Coast. Faculty members of the Maryland Board of Pharmacy Emergency Preparedness Task Force (EPTF) and previously trained students were utilized as leaders and facilitators to guide and monitor drill operations. University crisis team and local health department participated. Through-put times, accuracy rates, and an after-action review, including students’ survey, were evaluated. Results: Approximately 100 first professional year students, including 60 in pharmacy and 40 in physician assistant programs, participated along with EPTF members, physician assistant faculty, student facilitators, campus police officers, and health department personnel. Students alternated roles as patients and providers. This POD drill resulted in through-put rate of approximately 384 patients/hour with a gross error rate of 25%. Ninety-three percent of students surveyed thought that the exercise was of valuable and should be continued. After-action reviews were positive for e190 JAPhA | 5 4:2 | M AR/AP R 2014 Downloaded From: http://mustafa.japha.org/ on 06/09/2014 ja p h a .org procedures but identified some processes for improvement. Conclusion: Properly trained students can become volunteers for the emergency preparedness and response workforce in POD operations during a public health crisis. This type of drill could be expanded to other professional programs and provide actual influenza vaccinations to serve the dual purpose of training and providing an essential service. Prepared students gain a greater awareness and become more inclined to volunteer in their community. 314—THE PREVALENCE OF HYPERTENSION IN AN UNDERSERVED POPULATION: A RETROSPECTIVE STUDY COMPARING HEALTH STATUS DATA FROM A SUBSET POPULATION TO THE NATIONAL HEALTH AND NUTRITIONAL EXAMINATION SURVEY DATA. Bangura S, Lassila H, Mattei T, Kroh T, Duquesne University, E-mail: tkroh@ duqrx.org Objective: This project aims to describe the prevalence of hypertension and other risk factors from an underserved population in the surrounding areas of Pittsburgh, Pennsylvania, and comparing the data with the national averages using the National Health and Nutrition Examination Survey (NHANES) data. The Affordable Care Act created a focus on preventive health services and a National Prevention Strategy. Pharmacists are the most accessible, frontline health care providers and are able to optimize patient health through screening and prevention. The National Prevention Strategy encourages the use of clinical and community preventative services in an effort to prevent death and disability from preventable diseases and by detecting health problems early. The strategy focuses on improving cardiovascular health utilizing “highest value services that are both evidence-based and cost effective including aspirin, blood pressure control, cholesterol reduction, and smoking cessation.” NHANES identified that a majority of Americans with high cholesterol or blood pressure do not have it controlled. Based on a literature search, there Journal of the American Pharmacists Association APhA2014 ABSTRACTS has not been a study conducted in a community pharmacy setting that compares local area health screening statistics with the NHANES data. Methods: The Center for Pharmacy Services provides community-based pharmaceutical care and wellness services including a preventative care program through community health screenings. The pharmacy’s preventative care outreach program aligns with the National Prevention Strategy in an effort to prevent death and disability from preventable diseases and by detecting health problems early. This past fiscal year, 2,035 health screenings reaching 1,004 individual patients was completed. Data collected from these health screenings will be analyzed using descriptive statistics and compared with the national averages based on NHANES data. Results: Research in progress. 315—REFERRAL OF PATIENTS TO COMMUNITY-BASED HEALTH RESOURCES: EXPERIENCES OF COMMUNITY PHARMACY EMPLOYEES AND PATIENTS. Helsel N, Purdue University College of Pharmacy, Frail C, University of Minnesota College of Pharmacy, Snyder M, Purdue University College of Pharmacy, E-mail: snyderme@ purdue.edu Objective: The objective of this study is to describe community pharmacist, technician, and patient perceptions and experiences regarding patient referrals to community-based health resources as a means of health promotion. Methods: Rx-SafeNet is a community pharmacy practice-based research network administered by the Purdue University College of Pharmacy’s Center for Medication Safety Advancement. Study participants will be identified at the investigators’ visits to Rx-SafeNet pharmacies that have expressed interest in this study. Eligible participants must be ≥18 years of age; be a pharmacist, technician, or patient of the pharmacy; and give consent to participate. Semistructured interviews will be conducted, either face-to-face or over the phone, per the participant’s preference and availability. Interviews will gather information about participant experiences and opinions pertaining to the roles of community pharmacists and technicians in referring patients to community-based health resources. Community-based health resources refer to any source of assistance or information that could impact health and is located outside the pharmacy, but within the community. Semistructured interviews will enable further probing regarding referrals being made. Interviews will be audio-recorded and transcribed verbatim by a professional transcriptionist. Each participant will be offered a $25 gift card as compensation. Transcripts will be analyzed using qualitative thematic analysis supported by MaxQDA v. 10 software. Themes will be identified for each pharmacy site and summarized across sites. Results: Research in progress. To date, 1 site visit has been completed, and 13 participants have been interviewed. Site visits will continue throughout the coming months. Quality and Safety 316—ADVERSE REACTIONS AND CISPLATIN EXCRETION IN URINE OF PATIENTS WITH HEAD AND NECK CANCER UNDERGOING CHEMOTHERAPY. Visacri M, Faculty of Medical Sciences, Unicamp, Pincinato E, Mackenzie Presbyterian University, Ferrari G, Souza C, Lourenço A, Faculty of Medical Sciences, Unicamp, Pimentel R, Biology Institute, Unicamp, Tuan B, Ambrosio R, Faculty of Medical Sciences, Unicamp, Mazzola P, pmazzola@fcm. unicamp.br, Clinical Pathology Lima, Co-Author, Faculty of Medical Sciences, Unicamp Clinical Medicine, Patricia, [email protected] Faculty of Medical Sciences, Unicamp, Objective: This study was designed to investigate the adverse reactions in patients with head and neck cancer undergoing chemotherapy and to study the urinary excretion of cisplatin. Methods: This was a prospective study conducted from May 2011 to January 2013 in Brazil. Outpatients with head and neck cancer received a first course of cisplatin chemotherapy (80 or 100 mg/ m2) as therapy. Adverse reactions were classified based on severity (Common Journal of the American Pharmacists Association Downloaded From: http://mustafa.japha.org/ on 06/09/2014 j apha.org Toxicity Criteria v.4.0). Cisplatin excretion in urine was evaluated by highperformance liquid chromatography in 3 periods: 0–12, 12–24, and 24–48 hours after administration of cisplatin. Results were statistically analyzed. Results: Fifty-nine patients were analyzed (group 100 [100 mg/m2]: n = 41; group 80 [80 mg/m2]: n = 18). Their mean age was 55.6 ± 9.4 years, most were male, white, accentuated smokers and drinkers, and had pharyngeal tumors in advanced stages. The most frequently observed adverse reactions were anemia (81.4%), lymphopenia (78.0%), nausea (64.4%), and change in creatinine clearance (63.2%), with a prevalence of grades 1 and 2. Patients from both groups had significant reductions in blood cell counts and creatinine clearance, with no difference between the groups in these parameters. However, the increase in serum creatinine was significant only for group 100. Regarding severity of reactions studied, only vomiting was statistically more severe in group 100. The amount of cisplatin excreted at 0–12, 12– 24, and 24–48 hours in groups 100 and 80 was, respectively, 6.7 ± 5.3 and 7.7 ± 8.5, 0.7 ± 0.6 and 0.8 ± 0.6, and 0.5 ± 0.3 and 0.5 ± 0.3 ng of cisplatin/mg creatinine. There was no difference between groups and the amount of excreted cisplatin did not influence the severity of adverse reactions. Conclusion: The period of highest cisplatin excretion was 0–12 hours after chemotherapy, the dose of chemotherapy did not influence the severity of adverse reactions (except for vomiting and creatinine) or the amount of cisplatin excreted, and the cisplatin excretion could not predict toxicity. 317—ATTITUDES OF ARIZONA COMMUNITY PHARMACISTS ON THE MONITORING AND TRACKING OF MEDICATION ERRORS AND NEAR MISSES. Augustine J, Warholak T, University of Arizona, MacKinnon N, University of Cincinnati, E-mail: [email protected] Objective: The purpose of this study is to examine the attitudes and current behaviors of community pharmacists in Arizona about the tracking and monitorMA R /APR 2014 | 54:2 | JAPhA e191 APhA2014 ABSTRACTS ing of medication errors or quality-related events (QRE) in their primary work location. Methods: This cross-sectional study surveyed members of the Arizona Pharmacy Association who indicated community pharmacy as their primary practice site. The survey was revised from a previously published instrument used in Nova Scotia, Canada. Two-thirds of the study population received the questionnaire that asked about QRE, which includes medication errors and near misses. The remainder received a similar questionnaire about medication errors that used the language from the new Arizona legislation, which does not include near misses. Questionnaire reliability, validity, and scale and item functioning will be assessed using the Rasch rating scale model. In situations where data fit the model, ordinal data will be converted to interval level data; t tests will be completed to compare the Rasch scores on the items that are the same on both surveys. An alpha = 0.05 has been selected a priori. This study was approved by the university institutional review board. Results: Research in progress. Fifty pharmacists returned usable QRE questionnaires (response rate = 19.8%) and 35 pharmacists returned usable medication errors questionnaires (response rate = 31.8%). In both groups, the most frequent respondents were pharmacy managers (47% and 40%, respectively), who worked full time (79% and 74%) in a supermarket (42% and 37%). In both groups, the vast majority of respondents indicated that their pharmacies have a current process for reporting errors (96% and 97%). No differences were found in demographic information (i.e., job title, sex, number of hours worked per week, pharmacy type, pharmacy location, number of years practiced, and number of prescriptions processed per week) of respondents (P>0.05). Additional analysis will be conducted to allow for comparisons. 318—CEFTRIAXONE SAFETY IN THE PEDIATRIC POPULATION. Rumore M, Sussman R, Cohen Children’s Medical Center, E-mail: mrumore@nshs. edu e192 JAPhA | 5 4:2 | M AR/AP R 2014 Downloaded From: http://mustafa.japha.org/ on 06/09/2014 Objective: The objective of this study is to evaluate clinical decisions in the face of a cluster of ceftriaxone immediate hypersensitivity reactions in a pediatric population. Methods: Adverse drug reactions (ADRs) to ceftriaxone from the medical center’s computerized reporting system were evaluated using chart review from January 2012 through September 2013 (October through December 2013 data will be added to the final results to provide 2 years of data). Causality was assessed using the Naranjo ADR Probability Scale. This study included conducting a literature review, distributing a Pediatric Medication Alert, reporting to MedWatch, and changing the administration policy. Results: Research in progress. Over 22 months, ceftriaxone was responsible for more ADRs than any other medication, specifically 18% (16/89); 13.5% (12/89) involved itching, swelling, periorbital edema, hives, rash or respiratory depression. Four anaphylactic reactions, severe in nature requiring intervention to sustain life and subsequent hospitalization, 3 of which involved cardiac arrest occurred. Two patients had sickle cell disease but hemolytic anemia was ruled out. No patient had documented previous allergies to ceftriaxone. No case involved neonates. Hypersensitivity could not be tested by skin testing or ceftriaxone-specific IgE, nor were rechallenges undertaken. Anaphylaxis reactions are rare (0.0001%–0.1%) but the rate is much higher than penicillin. The literature review revealed a number of published anaphylaxis cases with ceftriaxone after a single dose. Although there was not a denominator for total ceftriaxone doses, the ADR volume indicates pediatric patients are at increased risk for ADRs from ceftriaxone. Switching to cefotaxime as a preferred agent was explored but decided against because of multiple daily dosing requirement. Safety improvement efforts included joint pharmacy and nursing education, a Pediatric Medication Alert, restriction to Food and Drug Administration–approved indications or infections that could not be treated with oral agents, and administration over approximately ja p h a .org 30 minutes. Extreme caution is exercised with ceftriaxone in pediatric patients with sickle cell anemia or patients with previous type 1 hypersensitivity to penicillin/cephalosporins. 319—DESCRIPTION AND COMPARISON OF DRUG DIVERSION IN PHARMACIES BY PHARMACISTS, INTERNS, AND PHARMACY TECHNICIANS. Draime J, Cedarville University, Anderson T, McBride Orthopedic Hospital, Anderson D, Cedarville University School of Pharmacy, E-mail: [email protected] Objective: The purpose of this study is to describe reported drug diversion within the practice of pharmacy. Methods: There is limited research that examines the nature and extent of drug diversion within the practice of pharmacy. If drug diversion is reported, state boards of pharmacy examine cases involving registered pharmacy personnel. To describe the problem of diversion, a sample of state board records were examined. First, states were classified, using U.S. Census classifications, into regions and divisions to provide a representative sample. States that did not have minutes posted online or that did not register technicians were excluded. If more than 1 state remained in a division, then a state was randomly chosen for analysis. Meeting minutes were obtained from May 2008 to May 2013. The following items were obtained for each case of drug diversion: (1) category of pharmacy employee (pharmacist, technician, intern), (2) type of substance (controlled, non-controlled, both); (3) use of diverted substance (sale, personal use, both, unknown); and (4) action taken by the board. An a priori sample size was calculated (alpha = 0.05, effect size = 0.3, n = 253 cases). Descriptive statistics were performed for all data in SPSS v.21, and chi-square tests were used to assess categorical differences. Results: A total of 811 drug diversion cases in 9 states were identified and used. Most cases were involving a pharmacy technician (71.4%), controlled substances only (94.2%), diverted for personal use (46.6%), and resulted in license revocation/surrendering (62.5%). When Journal of the American Pharmacists Association APhA2014 ABSTRACTS examining drug diversion use by type of substance, there were significant differences by pharmacy employee type (sale use P = 0.003; personal use P = 0.032; unknown use P<0.001). Conclusion: Drug diversion is prevalent, as indicated by the 811 cases examined by state boards, and many cases may be unreported. Technicians represent nearly three-fourths of diversions. It is essential that the practice of pharmacy identifies and assesses strategies to reduce drug diversion. 320—DETERMINING RATES OF INAPPROPRIATE MEDICATION DOSING FOR PATIENTS WITH RENAL DYSFUNCTION IN AN OUTPATIENT SETTING. Hovis Z, Breslow R, University of Wisconsin School of Pharmacy, Statz-Paynter J, Lisowe K, Dean Clinic, E-mail: [email protected] Objective: The purpose of this study is to quantify the rates of dosing errors for medications requiring dose adjustment based upon renal function estimates at the time of prescribing in the outpatient setting. Methods: In this retrospective study, electronic medical records from an outpatient health system will be reviewed and analyzed. Patients are required to be ≥18 years of age and must have been prescribed a medication requiring dose adjustment for renal function between September 1, 2012 and August 31, 2013 for inclusion. A medication list will be finalized based upon frequency of use, clinical relevance, as well as previous literature examining similar outcomes in the outpatient setting. An estimated creatinine clearance will be calculated using the Cockcroft-Gault equation with lab values from the date the prescription was written or the closest date prior. The prescribed dose of the target medications will be assessed for appropriateness based on the calculated creatinine clearance for each patient. The incidence of inappropriate dosing will be reported for each medication individually and in aggregate by dividing instances of inappropriate dosing by total instances requiring dose adjustment. Descriptive statistics will be used to describe population demographics. Results: Research in progress. Current error rates in this setting are unknown. The results of this research will help inform decision makers on the necessity of process improvement efforts to reduce dosing error rates in this population to ultimately decrease emergent health care expenditures from resultant adverse drug events. 321—EFFECT OF LORAZEPAM VERSUS MORPHINE ON QUALITY OF LIFE IN HOSPICE PATIENTS WITH DYSPNEA AND ANXIETY. Daubert E, Bolesta S, Wilkes University, E-mail: [email protected] Objective: The field of palliative care aims to ease the suffering of terminally ill patients. However, there is little literature that addresses how to best improve quality of life of palliative care patients with the “symptom cluster” of anxiety and dyspnea. The purpose of this study is to determine whether treatment with benzodiazepine or opiate therapy has a greater impact on improving the quality of life in terminally ill patients who are enrolled in a hospice service. Methods: This will be a prospective, randomized, double-blind, clinical trial. Patients ≥18 years of age enrolled in a hospice service, diagnosed with anxiety and dyspnea, and able to take oral medications will be eligible. Patients with a life expectancy of ≤7 days or contraindications to the study drugs will be excluded. Subjects will be randomly assigned to receive either lorazepam or morphine. Those in the morphine group will receive 5 mg oral morphine. The lorazepam group will be treated with 0.5 mg oral lorazepam. Additional doses will be provided every 30 minutes until anxiety and dyspnea intensity is decreased by at least 50%. Symptom relief will be evaluated using the Edmonton Symptom Assessment Scale. Patients will receive treatment for 14 days. The primary outcome will be the change in patients’ perception of their quality of life. This will be assessed using the Functional Assessment of Chronic Illness Therapy–Palliative Care scale, which patients will complete prior to initiation of therapy and after 7 and 14 days of treatment. An intentionto-treat analysis will be performed and Journal of the American Pharmacists Association Downloaded From: http://mustafa.japha.org/ on 06/09/2014 j apha.org the change in quality of life observed will be compared between groups using a multivariable logistic regression analysis to adjust for confounding variables. Results: Research in progress. Results are pending study completion. 322—EVALUATING HEALTH CARE PROFESSIONALS’ PERCEPTIONS REGARDING INADVERTENT DISPENSING OF DISCONTINUED MEDICATIONS. Fisher K, Djuric Kachlic M, Chan Marcelo J, University of Illinois at Chicago, E-mail: jchan16@uic. edu Objective: The primary objective of this study is to identify health care professionals’ perceptions of their responsibilities associated with dispensing of discontinued medications. Secondary objectives are to evaluate the misconceptions regarding use of electronic medical records and to assess the perception of health care professionals on patient awareness of discontinued medication. Methods: This is a prospective, survey-based study. The survey will assess participants’ perceptions, knowledge, and understanding of discontinuing medications and e-prescribing. Participants will include prescribers and pharmacists practicing within the health system. Potential study participants will be recruited through e-mail blasts sent to health care professionals on the health system’s listserves. The e-mail blast will include a link to the survey with a brief description of the study objectives. The survey engine, Qualtrics, will be utilized to collect responses. The survey will be piloted before initiation of e-mail recruitment. The survey will be sent to participants at the beginning of week 1 with a deadline of 8 weeks to respond. Weekly reminder e-mails will then be sent for the first month and biweekly for the second month. The survey will capture basic demographic information about each participant and responses will remain anonymous. Survey questions will be primarily formatted using a Likert scale. Data collection will be completed within 2 months from start date and data analysis will occur thereafter. The information obtained will be used to provide education to prescribers regarding discontinMA R /APR 2014 | 54:2 | JAPhA e193 APhA2014 ABSTRACTS ued medications and e-prescribing. Results: Research in progress. Data to be collected December through February. 323—EVALUATING THE IMPACT OF INTERDISCIPLINARY TEAMWORK ON MEDICATION SAFETY IN AN ETHIOPIAN EMERGENCY DEPARTMENT. Aboneh E, Chui M, University of Wisconsin–Madison School of Pharmacy, E-mail: aboneh@ wisc.edu Objective: The purpose of this study is to explore factors that impact medication safety resulting from deficiencies in interdisciplinary teamwork in a resource-limited emergency department (ED) in a developing country. Methods: A cross-sectional qualitative study design was employed at an academic ED in Ethiopia. Direct, nonparticipant observations and semi-structured interviews were conducted with 4 nurses, 2 pharmacists, and 2 physicians. Field notes and transcribed interviews were subjected to thematic analysis using the System Engineering Initiative for Patient Safety as a guiding framework. Results: Consistent with hazards identified in EDs in the United States, this study found poor interdisciplinary teamwork as a potential contributor to medication errors in the ED. Physicians, nurses, and pharmacists cited numerous work system contributors including organizational factors such as power gradients, lack of training, regular staffing turnover, and lack of clearly defined policies. The physical environment, in addition to being noisy, crowded, and cluttered, also was not designed to provide clues to the health care providers and facilitate coordinated care for acute needs of incoming patients. While the ED had access to technology such as electrocardiographs and portable ultrasound machines, these devices were old models and frequently not functional. Conclusion: Significant research has been conducted in EDs in the United States to identify and mitigate patient safety hazards, but interventions have been conducted in resource-intensive academic health centers with significant technology resources. The limited e194 JAPhA | 5 4:2 | M AR/AP R 2014 Downloaded From: http://mustafa.japha.org/ on 06/09/2014 resources and training available in EDs from developing countries means that the issue becomes even more important. In order to recommend and test redesign efforts aimed at reducing medication errors in low-resource EDs, it is important to understand this context for interventions to be successful. Specifically, because problems were identified with interdisciplinary teamwork, an area of focus for future research can be to determine how the ED pharmacist can better support the team to improve medication safety. 324—EVALUATION OF MEDICATION ERRORS VIA A RETURN-TOSTOCK AUDIT IN A COMMUNITY PHARMACY SETTING. Krinsky D, Elavsky M, Dahmen N, Northeast Ohio Medical University, E-mail: dkrinsky@ neomed.edu Objective: The objectives of this study are to: (1) assess the incidence of errors in prescriptions being returned to stock; (2) identify possible trends; and (3) determine potential action steps to correct these errors. Methods: The community pharmacy studied receives a daily printout listing prescriptions filled 10 days prior that had not been picked up by the patient. These prescriptions are credit returned, then returned to stock. Because these prescriptions have already been verified by a pharmacist and are ready to dispense, they are ideal for auditing for potential errors. Approximately once every 2 weeks ≥6 of these prescriptions are audited by second- or third-year student pharmacists who are on an introductory pharmacy practice experience rotation at this community pharmacy. The following elements are reviewed for accuracy and compared with the original prescription: patient name, drug name, dose, quantity, strength, dosage form, package size, directions, number of refills, prescriber, and bottle cap. Results: A total of 693 prescriptions were reviewed for possible errors from January 1, 2011 to October 1, 2013. Of these prescriptions, 570 were for an oral medication (82.3%), 73 were for a topical product (10.5%), and 50 were for an inhaled medication (7.2%). Twenty-six ja p h a .org errors were found for an error rate of 3.75%. The types of errors included: quantity (17), directions (4), and 1 each for physician name, number of refills, dosage form, missing Drug Enforcement Administration number on the original prescription, and safety cap. Conclusion: This audit has provided the pharmacy staff with valuable data to improve the dispensing processes and staff communication. These data are discussed at the quarterly Continuous Quality Improvement meetings and reemphasize to all staff (i.e., pharmacists, technicians, and student pharmacists) the importance of double checks and accuracy over speed. Data collection will continue on a regular basis and staff will continue to find ways to perform tasks more effectively and improve accuracy. 325—EVALUATION OF THE NUMBER AND TYPE OF POTENTIAL INTERACTIONS FOUND BETWEEN PRESCRIPTION AND OVER-THECOUNTER MEDICATIONS AT A COMMUNITY PHARMACY. Almada E, Fernandez C, Dorame M, Dominguez C, University of Arizona, E-mail: [email protected] Objective: The objective of this study is to explore the frequency and severity of potential over-the-counter (OTC) and prescription medication interactions among patients at a chain pharmacy location in Oro Valley, Arizona. Methods: A questionnaire was created listing 7 categories of the most common OTC medications and comorbidities among patients. Questionnaires (n = 1,200) were distributed in patient’s prescription bags from January 14 to March 29, 2013. Patients were notified about the project by pharmacy staff and asked to mark the OTC items they used, the comorbidities they have, and then return the questionnaire to the pharmacy. Upon return, a pharmacist used the compendium Clinical Pharmacology to review the questionnaire against the patient’s prescription profile to identify and classify the number, type, and severity of interactions found. Categories of severity were contraindicated, severe, moderate, major, and low. Once an interaction was found, patients were notified by phone Journal of the American Pharmacists Association APhA2014 ABSTRACTS call or counseled at the pick-up window. Chi-square with an alpha priori set at 0.05 was used to assess whether having ≥3 comorbidities increases the likelihood of an interaction. Results: A total of 67 questionnaires were returned to the pharmacy. Of the 67 questionnaires, 86 drug interactions were identified: 41 moderate, 7 major, 5 severe, 4 low, and 1 contraindicated. Pain medications accounted for a higher percentage of drug interactions compared with other categories (23.3%). While 46.3% of patients had ≥3 comorbidities, this relationship did not increase the probability that these patients would experience more drug interactions compared with those with either <3 or no morbidities (chi-square = 0.372, P = 0.542). Conclusion: Although the amount of interactions found was low, it would be beneficial for community pharmacies to have information about a patient’s OTC and herbal supplement use to help prevent major interactions that can affect drug therapy and a patient’s quality of life. 326—IDENTIFYING WHETHER A DISCUSSION IS NEEDED ON GENERIC-TO-GENERIC SWITCHING OF NARROW THERAPEUTIC INDEX DRUGS: A LITERATURE REVIEW. Nguyen Diep J, Shah M, Toscani M, Rutgers University, E-mail: jonathan. [email protected] Objective: An informal survey of the literature revealed that while the various controversies surrounding brand-to-generic switching (e.g., integrity of current bioequivalence criteria, clinical impact) are often discussed, it is difficult to find mention of the same controversies as they relate to generic-to-generic substitution for narrow therapeutic index (NTI) drugs. The purpose of this review is to assess the literature for commentary, guidance, surveys, or clinical trials related to generic-to-generic substitution of NTI drugs and the potential clinical, social, and economic impacts of making such a substitution. Current bioequivalence guidelines as they relate to this particular category of medications also will be reviewed and discussed. Methods: A list of NTI drug classes for which the literature search is to be conducted will be defined. The website of the Food and Drug Administration (FDA) will be consulted, along with other relevant FDA publications and guidances. English-language publications will be searched in Medline to retrieve references that relate to generic-to-generic substitution for this list of medication classes. Results: Research in progress. A list of NTI drug classes was defined to include the following: antiarrhythmic, antiepileptic, anticoagulant, hormone replacement, immunosuppressive, and oral contraceptive medications. The current accepted ranges for bioequivalence between brand and generic products are 80% to 125% for non-NTI medications and 95% to 105% for NTI medications. Two relevant publications have been identified thus far. The first of these, a survey, saw 88% of physicians concerned about breakthrough seizures with a formulation switch. The second publication saw a possible link between levothyroxine adverse event reporting and switching of the generic manufacturer of this drug. 327—IMPACT OF A COMMUNITY PHARMACIST TOOLKIT ON HIGHRISK MEDICATION USE IN THE ELDERLY. Pendley M, University of Kentucky, Nau D, Pharmacy Quality Alliance, Freeman P, University of Kentucky, Hanna C, American Pharmacy Services Corporation, Divine H, University of Kentucky, E-mail: [email protected] Objective: Specific quality measures on medication use have been developed by the Pharmacy Quality Alliance (PQA) and adopted by the Centers for Medicare and Medicaid Services (CMS) to rate Medicare Part D prescription drug plans, including a metric specific to reducing the use of high-risk medications (HRMs) in elderly adults. Community pharmacists are uniquely positioned to improve this quality measure through their regular communications with prescribers and patients. Providing targeted educational resources to assist the pharmacist with HRM-related interventions Journal of the American Pharmacists Association Downloaded From: http://mustafa.japha.org/ on 06/09/2014 j apha.org may impact pharmacy performance. The objectives of this study are to: (1) develop and evaluate the impact of an educational resource for pharmacists designed to reduce use of HRMs; and (2) evaluate the outcome of toolkit utilization on HRM usage and pharmacy performance on the HRM quality measure. Methods: Pharmacy shareholders of an independent pharmacy cooperative will be invited to participate. Pharmacists will receive a live education session about the PQA quality measures, HRMs, and potential alternatives to HRMs. Additionally, a toolkit will be provided with resources (e.g., template presentations, handouts, fax cover letters, brochures) to assist in presenting information to both prescribers and patients in their communities about HRMs and their alternatives. Pharmacists will implement resources over a 6-month period. A preand post-survey will be administered to collect basic demographic information, assess knowledge of HRMs and PQA quality measures, and confidence in addressing HRM usage with prescribers and patients. Additional questions to evaluate the usefulness of the toolkit will be included on the post-survey. Dispensing system records will be reviewed to compare HRMs dispensed at baseline and at the end of the 6-month intervention. Pharmacy performance scores at baseline and after 6 months on the PQA HRM-specific measure will be compared using the Electronic Quality Improvement Platform for Plans and Pharmacies (EQuIPP) platform. Results: Research in progress. 328—IMPACT OF NAUSEA AND VOMITING ON THE QUALITY OF LIFE OF ONCOLOGY PATIENTS. Souza C, Visacri M, Tuan B, Ferrari G, Lourenço A, Mazzola P, Lima C, Moriel P, Faculty of Medical Sciences, Unicamp, E-mail: [email protected] Objective: This study was designed to evaluate the impact of nausea and vomiting on the quality of life (QOL) of oncology patients. Methods: This was a quantitative, cross-sectional, descriptive study, in which patients receiving chemotherapy were asked about the occurrence of MA R /APR 2014 | 54:2 | JAPhA e195 APhA2014 ABSTRACTS nausea and vomiting at the moment of infusion and/or after a chemotherapy session, over the period of 1 year. The severity of effects was classified according to Common Toxicity Criteria (CTCAE v. 4.0; Grades 1–4) and by a visual analogue scale (VAS; range, 0–10). QOL was measured using a validated questionnaire (FACT-G, v. 4.0) with 4 fields: physical well-being, social/family, emotional, and functional, the first 3 with scores of 0–28 and the last with scores of 0–24. Statistical analysis of the data was performed using Spearman’s correlation (P<0.05). Results: Fifty patients were studied (58.2 ± 10.8 years of age, 54.0% men, and 72.0% with gastrointestinal cancer). Nausea was the most common adverse event (31; 62.0%), with grade 1 toxicity most prevalent (12; 24.0%). On VAS, nausea obtained an average of 4.4 (range, 2–9). Sixteen patients (32.0%) reported vomiting, mostly grade 1 (8; 16.0%), with a mean score on VAS of 5.9 (range, 4–9). The global QOL was given a score of 70.4 ± 6.4 (range, 54–88). Patients with cancer had reduced scores in the physical wellbeing (16.4 ± 4.2), social/family (20.3 ± 2.8), emotional (16.2 ± 3.2), and functional (17.5 ± 2.7) fields. Spearman’s test revealed a strong correlation between the instruments (degree of toxicity and VAS), showing that they had the same ability to evaluate the adverse effects of chemotherapy. Conclusion: There was no correlation between nausea and vomiting and QOL. Although there was a high prevalence of nausea and vomiting in chemotherapy, there were few severe symptoms, which may explain the lack of correlation with QOL. 329—THE INCIDENCE AND FINANCIAL IMPACT OF MEDICATIONS DISPENSED DESPITE ELECTRONIC MEDICAL RECORD DISCONTINUATION. Baranowski P, Peterson K, Dean Clinic–Janesville East, Statz-Paynter J, Dean Health System, Zorek J, University of Wisconsin–Madison, E-mail: [email protected] Objective: The primary aim of this study is to determine the incidence of medications dispensed to patients with- e196 JAPhA | 5 4:2 | M AR/AP R 2014 Downloaded From: http://mustafa.japha.org/ on 06/09/2014 in a health care network of affiliated primary care clinics and community pharmacies despite electronic medical record discontinuation by their health care providers. A secondary aim is to determine the financial impact resulting from this medication error. Methods: In this retrospective cohort study, the electronic medical and pharmacy records of patients who receive care from this health care network will be reviewed to identify the incidence of medications dispensed despite discontinuation (MDDD) by health care providers. Patients aged ≥18 years within the network who filled a prescription medication from June 2012 to August 2013 will be included in the study. A computer algorithm linked to the electronic medical and pharmacy records will identify all medications that were dispensed during this period and all medications that were electronically discontinued by a health care provider. These data points will be cross-referenced to identify MDDD and medications not dispensed following discontinuation (non-MDDD). Descriptive statistics will be used to characterize data and calculate the incidence of MDDD and non-MDDD. Chi-square tests will be used to compare the incidence of MDDD with non-MDDD. All MDDD will be categorized by pharmacological classification to identify problematic medication categories for future interventions. The wholesale acquisition cost will be applied to each MDDD to determine the financial impact of this medication error. Results: Research in progress. Conclusion: There are no mechanisms currently in place within this health care network to safeguard against MDDD. By determining the incidence of MDDD, identifying problematic medication categories, and calculating the financial impact of this medication error, this study has the potential to inspire and inform future interventions to reduce MDDD, improve medication safety, and positively impact patient care. 330—THE INFLUENCE OF COMMUNITY PHARMACISTS ON STAR RATINGS: AN ANALYSIS OF FACTORS AFFECTING PERFORMANCE ja p h a .org MEASURES. Culpepper B, University of North Carolina at Chapel Hill Eshelman School of Pharmacy, Michaels N, Petri D, Kerr Drug Inc., Ferreri S, Marciniak M, University of North Carolina at Chapel Hill Eshelman School of Pharmacy, E-mail: [email protected] Objective: As health care payment models evolve from fee-for-service to pay-for-performance, Medicare Part D plans are being graded and provided a star rating based on performance measures defined by the Pharmacy Quality Alliance (PQA). Plan reimbursement from the Centers for Medicare and Medicaid Services (CMS) is determined by the star rating. Pharmacists have an opportunity to affect performance measures such as medication adherence and appropriate treatment for chronic disease states. The purpose of this study is to identify factors that may impact achievement of performance measures and, therefore, star ratings. Methods: This retrospective study includes data obtained from Electronic Quality Improvement Platform for Plans and Pharmacies (EQuIPP), a PQA-developed platform that provides benchmarked performance data. The 4 performance measures included in this study are: proportion of days covered (PDC) for hypertension, diabetes, and cholesterol medications, and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker therapy in patients with diabetes. May 2013 data from 76 stores in a regional pharmacy chain will be extracted from EQuIPP. The stores will be ranked and given a star rating (from CMS) for each performance measure. A list of factors that may affect performance measure achievement has been developed by the investigators. These factors include: store setting, weekly prescription volume, number of interns employed, monthly hours of pharmacist overlap, years of pharmacist experience, pharmacist completion of a medication therapy management certificate training program, presence of residency-trained pharmacists, number of patients enrolled in a medication synchronization program, and percentage of comprehensive medication review claims. Data will be analyzed to determine which factors Journal of the American Pharmacists Association APhA2014 ABSTRACTS may have contributed to the store’s ranking for each performance measure. The probability of each store’s star rating as determined by CMS will be predicted for each variable separately using bivariate logistic regression and then include all variables simultaneously using multivariate logistic regression. Results: Research in progress. 331—INTRAVENOUS ACETAMINOPHEN USAGE IN PEDIATRIC PATIENTS. Samide J, Rumore M, Cohen Children’s Medical Center, E-mail: [email protected] Objective: This study aimed to delineate appropriate usage and improve safety of intravenous acetaminophen (IVAPAP) in pediatric patients at a metropolitan children’s hospital. Methods: This study was a retrospective medication use evaluation (MUE) of IVAPAP usage for July and August 2013. It restricted IVAPAP to 24 hours for febrile patients in whom oral/ rectal administration is not possible. IVAPAP is available in 1000 mg (100 mL) vials. The MUE was designed to examine compliance with this institution’s IVAPAP guideline and to assess feasibility of dispensing prefilled syringes. Results: IVAPAP was ordered 78 times for 52 patients. On average, patients received 13 mg/kg/dose and dosages were weight-based appropriate. The maximum daily dose of 2400 mg was exceeded in 1 patient. Despite the restriction, 55% (43/78) of orders were for pain. Seventy-seven percent (40/52) of patients receiving IVAPAP had documented NPO status and 42% of patients received other oral medications close to IVAPAP administration time. Approximately, 29% (23/52) of patients were on both intravenous and oral acetaminophen concurrently. Although the current policy states that order duration not exceed 24 hours, 15% were written for longer time periods. Analysis showed that almost all doses given at this institution require further drawing up on the floor. Further analysis showed that patients on average receive 1 dose, even when the order is written for multiple doses, complicating implementation of individual dose preparation. Conclusion: Iatrogenic 10-fold dosing errors have occurred in pediatric patients; the dose is calculated in mg but may be erroneously given in mL. This, as well as budgetary concerns, prompted restriction of IVAPAP to antipyretic use; conduct of an MUE to ensure its proper use; and conduct of staff education. Preliminary results of this ongoing study suggest that the policy is not being followed. In the future, there is planning to revise the policy, conduct additional education, and adopt the Institute for Safe Medication Practices recommendation for preparation of patient-specific doses in syringes. 332—LC-MS/MS METHOD DEVELOPMENT AND VALIDATION FOR THE SIMULTANEOUS QUANTITATION OF VENLAFAXINE AND ITS ACTIVE METABOLITE O-DESMETHYL VENLAFAXINE IN HUMAN K2-EDTA PLASMA. Dannana G, Andhra University College of Pharmaceutical Sciences, India, E-mail: [email protected] Objective: A highly sensitive, validated LC-MS/MS method with very short run time was developed for the simultaneous estimation of venlafaxine and its active metabolite O-desmethyl venlafaxine in human plasma by using clozapine as internal standard. Methods: The analytes and the internal standard were extracted from the human plasma by protein precipitation using methyl t-butyl ether. The analytes and the internal standard were separated by high-performance liquid chromatography on a BDS Hypersil C8 column (50 mm x 4.6 mm, 3 µm) using an isocratic mobile phase consisting of 5 mM ammonium acetate:acetonitrile:methanol in the ratio 10:20:70 v/v at a flow rate of 1.0 mL/min. The retention times were 0.86 min, 1.5 min, and 1.6 min, for clozapine, O-desmethyl venlafaxine, and venlafaxine respectively. The analytes were monitored by MS/MS in multiple reaction monitoring mode via positive electron spray ionization using the transitions m/z 278.20 precursor ion to the m/z 58.20 product ion for venlafaxine, m/z 264.20 precursor ion to the m/z 58.10 product ion for O-desmethyl venlafaxine Journal of the American Pharmacists Association Downloaded From: http://mustafa.japha.org/ on 06/09/2014 j apha.org and m/z 327.20 precursor ion to the m/z 270.10 product ion for clozapine. Results: The developed method was validated according to International Conference on Harmonisation guidelines. The assay exhibited linear dynamic range of 1.01–301.64 ng/mL for venlafaxine and 1.36–407.39 ng/mL for O-desmethyl venlafaxine. The average absolute recoveries of venlafaxine and O-desmethyl venlafaxine were >69.0% at all concentration levels with acceptable precision. Human plasma containing quality control samples were checked for freeze and thaw stability and they were found to be stable for 4 cycles. A run time of 2.5 min for each sample made it possible to analyze more than 300 human plasma samples per day. Conclusion: The validated method can be successfully used for pharmacokinetic, bioavailability, and bioequivalence studies to analyze venlafaxine and its major active metabolite O-desmethyl venlafaxine in human plasma samples. 333—A LONGITUDINAL ANALYSIS OF HIGH-RISK MEDICATION USE AMONG BENEFICIARIES IN TWO MEDICARE DRUG PLANS. Zhang Y, Doucette W, Brown G, Pendergast J, University of Iowa, Frank J, OutcomesMTM, E-mail: [email protected] Objective: The objective of this study is to assess factors associated with likelihood of filling high-risk medications (HRM) for beneficiaries from Medicare prescription drug plans (i.e., MAPD and PDP) over 3 years. Methods: Medicare Part D beneficiaries from the 2 drug plans were in 1 program regularly stimulating medication therapy management (MTM) service in a 6-month period. Four such periods occurring during 2010 to 2012 were identified as study periods. A cohort of Medicare Part D beneficiaries aged ≥65 years from either plan and had ≥1 prescription in any study period was included as study sample (n = 33,516). Their prescription claims (n = 115,206) generated throughout all study periods were extracted for analysis. The percent of beneficiaries using HRM was plotted for the 2 plans across the 4 study periods. Additionally, a generalized estimating MA R /APR 2014 | 54:2 | JAPhA e197 APhA2014 ABSTRACTS equation model was fitted to assess factors associated with likelihood of filling HRM among Medicare Part D beneficiaries who were potential MTM users. All statistical analyses were performed in SAS (version 9.3) and R (version 2.15). Results: The percent of beneficiaries using HRM declined over 4 study periods across both plans. The likelihood of filling HRM was significantly decreasing over time, controlling for other factors (P< 0.0001). Additionally, the association between likelihood of filling HRM and number of non–high-risk prescriptions (non-HRM), age, or sex significantly depended on prescription drug plan (P<0.0001). In either plan, female patients and younger elderly patients were found to have a higher likelihood of filling HRM compared with their counterparts. Conclusion: The use of HRM among beneficiaries in 2 Medicare drug plans decreased during 2010 to 2012. This trend might be explained by strategies implemented by the Centers for Medicare and Medicaid Services and the MTM program. Such strategies include having HRM use in drug plan quality (Star) ratings, MTM intervention targeted at HRMs, and efforts to increase comprehensive medication reviews. 334—MANAGEMENT AND STANDARDIZATION OF PEDIATRIC PRIMARY CARE CLINIC MEDICATION STOCK LISTS. Prusa C, Sebastian S, Nationwide Children’s Hospital, E-mail: sonya.sebastian@nationwidechildrens. org Objective: The objective of this project is to evaluate and standardize the medication stock lists for 9 pediatric primary care clinics (PCC) within a pediatric hospital network. It is important to stock medication in clinic to administer necessary therapy. Multiple barriers to safe medication use in PCCs exist, such as rotating staff, inconsistent stock lists, and unavailable technology. The current stock lists contain medications that are rarely used and have multiple strengths. In addition, PCCs are currently not equipped with barcode scanning or automated dispensing cabinets as a patient safety measure. Regardless of location, e198 JAPhA | 5 4:2 | M AR/AP R 2014 Downloaded From: http://mustafa.japha.org/ on 06/09/2014 safety will be enhanced by revising the stock lists and increasing the staff’s knowledge of available medication. Methods: A usage report of medication administered in clinics from December 2012 through September 2013 will be obtained from the hospital electronic medical records. Each medication on the stock list will be evaluated for appropriateness. Medications will be removed if usage does not warrant keeping the medication on the lists. Multiple dosage forms and strengths of medication will be consolidated to cover patients’ needs but minimize confusion. Revised lists will be proposed to the department chair and the head of nursing for approval. After approval, inventories will be updated to reflect the revisions. Results: Research in progress. 335—OREGON BOARD OF PHARMACY WORKPLACE SURVEY RESULTS. Zweber A, Oregon State University, E-mail: ann.zweber@oregonstate. edu Objective: The Oregon Board of Pharmacy conducted a survey of licensees to: (1) identify the scope of pharmacists’ concerns about work environment; (2) identify specific concerns about workplace conditions; (3) identify and quantify workplace setting and practices that impact patient safety; and (4) inform decisions and actions by the Oregon Board of Pharmacy. Methods: A 9-question electronic survey was sent to all Oregon licensed pharmacists with an e-mail address on file. The survey, conducted in July 2011, elicited perceptions of workplace factors affecting patient safety. Quantitative data from demographic and Likert scale questions, and qualitative responses from comments were analyzed using SPSS 19.0 and NVivo10. Results: A 29% response rate yielded 1,401 completed surveys. Over 40% of respondents disagreed or strongly disagreed with statements about adequate time for breaks, and lunches, and satisfaction with time to do their job. Over 30% disagreed or strongly disagreed with statements regarding adequate pharmacist and technician staffing. Further breakdown indicated significant ja p h a .org differences in work setting and pharmacist role. Over 500 respondents provided written comments, with the most frequent concerns being about staffing, breaks, and productivity metrics. Conclusion: The survey results highlighted workplace and patient safety issues for the Oregon Board of Pharmacy. Subsequently, the Board adopted rules to address work environment factors that may negatively affect patient safety. A follow-up survey was conducted 1 year after the rules went into effect. 336—PATIENT UNDERSTANDING AND PREFERENCES FOR COMMUNITY PHARMACY QUALITY MEASURES INFORMATION. Shiyanbola O, University of Wisconsin–Madison, Mort J, Harris T, Christensen A, South Dakota State University, E-mail: [email protected] Objective: The objectives of this study are to: (1) describe patient understanding of community pharmacy quality measures; and (2) describe patient preferences for community pharmacy quality information. Methods: Semi-structured focus groups combined with survey methodology were conducted in urban and rural areas of a Midwestern state. Patients who utilized community pharmacies and had a chronic illness discussed their understanding of Pharmacy Quality Alliance–approved quality measures. Questions examined preference of pharmacy quality information rating systems (e.g., stars versus percentages) and desired data display and formats. During the focus group discussions, participants completed a survey examining their understanding of each pharmacy quality measure. All discussions were audiorecorded and transcribed verbatim. Data were analyzed using thematic analysis and descriptive statistics. Results: Thirty-four patients participated (mean age = 62.85 years; standard deviation = 16.05). Patients were unfamiliar with quality measures information and their level of understanding differed for each quality measure. Survey results indicated most patients understood “drug-drug interactions” (94.1% of patients understood) and “helping pa- Journal of the American Pharmacists Association APhA2014 ABSTRACTS tients get needed medications” (94.1%) better than other measures (76.5% to 79.4%). Qualitative analysis indicated patients preferred an overall pharmacy rating displayed for quick access and use. However, patients wanted quality measures information displayed by health conditions. Patients disliked the “lower is better” format in comparing pharmacies and favored a comparison of their pharmacy to city data instead of state data. Patients had mixed feelings regarding the star rating system versus other methods of displaying data. In general, most patients liked star ratings better than percentages, grade letters, or numerical ratings. Patients understood the Medicare star rating better than a bar graph system, which they found confusing and difficult to comprehend. Conclusion: Specific quality measures were not understood by up to a quarter of patients. Patients had specific preferences for the display of pharmacy quality information, which will be helpful in the design of appropriate quality report systems. 337—PERCEIVED VALUE OF PHARMACY QUALITY MEASURES AMONG PATIENTS USING COMMUNITY PHARMACIES. Shiyanbola O, University of Wisconsin–Madison, Mort J, Harris T, Christensen A, South Dakota State University, E-mail: [email protected] Objective: This study examined patients’ use of quality measures in evaluating and choosing community pharmacies. Methods: Patients with a chronic illness, taking prescription medications and filling prescriptions in pharmacies participated in semi-structured focus groups that assessed the value of Pharmacy Quality Alliance–approved community pharmacy quality measures in evaluating and choosing a pharmacy. During the focus groups, participants completed questionnaires rating their perceived value of quality measures in evaluating a pharmacy (1 = low; 5 = high) or choosing a pharmacy (yes/no). Data were analyzed using thematic analysis and descriptive statistics. Results: Thirty-four adults par- ticipated. While comments indicated all measures were important, some measures were valued more highly than others (e.g., “helping patients get needed medication,” “use of high-risk medication in the elderly,” “drug-drug interactions”). The value of disease-specific measures related to diabetes, asthma, or hypertension treatment depended on whether the patient had the condition. Some patients questioned the pharmacist’s role in measures examining adherence. Rating of quality measure utility in evaluating a pharmacy ranged from 4.88 (“drug-drug interactions”) to 4.0 (“suboptimal treatment of hypertension in patients with diabetes” and “absence of controller therapy for persons with asthma”). Patients hesitated to use quality information to choose their pharmacy (depending on participant’s location) but may consider if moving to a new area. Use of select quality measures to choose a pharmacy ranged from 97.1% of participants using “drug-drug interactions” to 55.9% using “absence of controller therapy for persons with asthma.” Conclusion: Patients valued pharmacy quality measures in evaluating a community pharmacy with general safety measures valued highest. In addition, safety measures were more likely to be used to select pharmacies. Quality measures would not typically cause a switch in pharmacy but may influence selection on relocation. In addition, community pharmacy access in rural areas may limit the possibility of switching pharmacies. 338—PERCEPTIONS ON E-PRESCRIBING SAFETY AND QUALITY. Siracuse M, Galt K, Abbott A, Fuji K, Bramble J, Paschal K, Creighton University, E-mail: [email protected] Objective: The goal of this study was to determine differences between health care professionals (e.g., pharmacists, physicians, advanced practice registered nurses, physician assistants, registered and licensed practical nurses, medical assistants, therapists, technologists) and organizational personnel (e.g., receptionists, billing staff, medical records staff, schedulers, information technology support including management and clinical informatics, chief executive Journal of the American Pharmacists Association Downloaded From: http://mustafa.japha.org/ on 06/09/2014 j apha.org and chief financial officers, practice manager/administrator, business manager) regarding safety and quality of e-prescribing in rural ambulatory care practices and pharmacies. Methods: Health care professionals and organizational personnel at 5 rural ambulatory care practices in Nebraska and Iowa were surveyed. Each practice had an affiliation with the local critical access hospital. At each site, a clinic manager was identified as a facilitator for survey administration. After the total number of required surveys at each site was determined, paper copies of surveys were either hand delivered to the clinic or sent via overnight delivery. Clinic facilitators distributed a 90-item survey, of which 36 items were related to e-prescribing, and collected them 1 week later. All survey items had a binary response option. Results: Surveys were distributed to 164 individuals at 5 locations. A total of 141 surveys were completed for a response rate of 86.0%. Chi-square tests were run to determine differences in responses between health care professionals and organizational personnel. Statistically significant differences were shown in 12 of 36 survey items. Organizational personnel sometimes indicated e-prescribing as being safer compared with health care professionals. For example, 68% of health care professionals believed that e-prescriptions have been sent to the wrong pharmacy compared with 33% of organizational personnel (P< 0.001). Additionally, 64% of health care professionals believed e-prescriptions have been transmitted with incorrect information, compared with 27% of organizational personnel (P < 0.001). Conclusion: Perceptions about the safety of e-prescribing may differ between health care professionals providing direct patient care and others in the organization who have administrative oversight or provide other support. 339 —PHAR M ACIST-INIT IAT ED PSYCHOTROPIC MEDICATION REVIEWS TO ASSURE OPTIMAL SAFETY MONITORING IN PATIENTS RECEIVING BEHAVIORAL HEALTH SERVICES IN A FEDERMA R /APR 2014 | 54:2 | JAPhA e199 APhA2014 ABSTRACTS ALLY QUALIFIED COMMUNITY HEALTH CENTER. Sokhal D, Gallimore C, University of Wisconsin, Schreiter E, Access Community Health Center, E-mail: [email protected] Objective: As a quality improvement (QI) project, pharmacists perform electronic health record (EHR) reviews of psychiatrically complex patients to provide recommendations regarding appropriate monitoring of psychotropic medications to primary care providers (PCP). The objectives of this project are to: (1) increase the percentage of patients up to date on recommended laboratory monitoring and Abnormal Involuntary Movement Scale (AIMS) assessment for psychotropic medications; and (2) minimize the percentage of patients at risk of clinically relevant drug interactions. Methods: Pharmacists quarterly receive a list of patients who had 1-time consultations with the clinic psychiatrist from the behavioral health team. Pharmacists review the EHR, and document and route recommendations to the PCP. Data for each patient will be recorded in a de-identified database that specifies whether laboratory monitoring and AIMS assessment were up to date and whether drug interactions were present at time of pharmacy review (pre-data set). A second retrospective EHR review will be performed 2 months following the initial pharmacy review for the same patients to evaluate the same parameters (post-data set). Data will be used to evaluate impact of the QI project by comparing percentage of patients up to date on laboratory monitoring and AIMS assessment, and at risk for drug interactions following pharmacists’ recommendations. McNemar test will be used to evaluate for statistically significant differences. Feedback will be collected from PCPs via survey to evaluate the utility of the QI project. Results: Research in progress. Reviews for 4 quarters are targeted for QI project; currently pre-data for first quarter (50 patients) and second quarter (18 patients) have been collected. Post-data collection for 3 quarters will be completed to report improvement in parameters being evaluated and results from statistical analysis using McNemar test. e200 JAPhA | 5 4:2 | M AR/AP R 2014 Downloaded From: http://mustafa.japha.org/ on 06/09/2014 340—SANITATION AWARENESS AMONG PHARMACY ASSOCIATES IN A COMMUNITY PHARMACY SETTING. Nguyen A, Lee K, Shell M, Chyan V, University of Arizona, E-mail: [email protected] Objective: This project aims to create awareness and increase frequency of sanitary practices in a community pharmacy to possibly prevent cross-contamination that may affect patient outcomes. Methods: Pharmacy technicians in a community pharmacy were observed by the authors. Each observer monitored up to 2 technicians at a time. Associates manually counted medications on a counting tray with a spatula. Cleaning by wiping the counting trays with paper towels and alcohol solution after use was observed. Pre-intervention data were collected for 1.5 months by observing how often trays were cleaned. Technicians were previously untrained in proper tray cleaning. Associates were given handouts explaining the importance of cleaning counting trays and verbally and visually educated on targeted medications: nonsteroidal anti-inflammatory drugs (NSAIDs), sulfa derivatives, warfarin, chemotherapy agents, antibiotics, and antivirals. Post-intervention data were collected for 1.5 months. The frequency of trays cleaned after use was recorded and analyzed using chi-square (alpha <0.05). This quality improvement project does not meet the federal definition of research and institutional review board approval was not required. Results: Six pharmacy associates were observed for 48 hours pre-intervention and 50 hours post-intervention. In pre-intervention, counting trays were cleaned 14% of the times they were used, which increased to 54% post-intervention (P<0.001). Cleaning practices increased post-intervention for all targeted medications: NSAIDs (75.9% cleaned), sulfa derivatives (83.0% cleaned), warfarin (96.0% cleaned), chemotherapy agents (58.3% cleaned), antibiotics (81.1% cleaned), and antivirals (66.7% cleaned), all showing P<0.001. Conclusion: Through this intervention, an increase of 40% was observed in tray cleaning from pre- to post-intervention. This may lead to a reduction ja p h a .org in cross-contamination of medications. Future research should focus on how sanitation practices improve the prevention of cross-contamination adverse reactions. 341—TIME REQUIREMENTS FOR CRITICAL-TO-QUALITY PHARMACIST INTERVENTIONS. Yee K, Bingaman M, Li P, Patel P, Yip S, University of Arizona College of Pharmacy, E-mail: [email protected] Objective: The objective was to measure the actual time community pharmacists needed to complete specific criticalto-quality tasks that were directed to patients and prescribers. The goal was to examine if time allocated by the company to perform these critical-to-quality functions was adequate. Methods: For this observational quality improvement (QI) project, student observers collected data at 3 different stores belonging to the same grocery store pharmacy chain in Tucson, Arizona, every Friday from 10:00 to 14:00 for 5 weeks. Observers used electronic timers to measure time spent completing critical-to-quality tasks by pharmacists as well as by student pharmacists. Observed times for each task were normalized and compared with pharmacy chain’s projected times using a 2-tailed independent Student t test. An alpha of 0.05 was selected a priori. This was a QI project therefore it did not meet the federal definition of research and institutional review board approval was not required per university guidance. Results: During the 5-week study, 60 hours of total data were collected. The observed proportion of time required for patient counseling was significantly greater than projected (mean observed = 0.099, standard deviation [SD] observed = 0.0187, mean projected = 0.066, SD projected = 0.00072, P = 0.041). At specific locations, the significant differences were identified between observed and projected times for patient counseling (P = 0.010) and customer phone calls (P = 0.001). Observed times for non-patient interaction tasks such as prescription verification, prescriber phone calls, and voicemail prescription retrieval were not significant (P>0.05). Journal of the American Pharmacists Association APhA2014 ABSTRACTS Conclusion: Overall, observed time for patient-interaction tasks such as counseling and customer phone calls at certain stores required more time than the company allotted for these tasks. This mismatch between allotted times for job-related functions and the actual time required to perform tasks may increase the risks for medication errors and job-related stress. 342—TRANSITIONS OF CARE IN HEART FAILURE PATIENTS: IDENTIFYING PATIENTS FOR INTERVENTION. Miles A, Gunning K, University of Utah Hospitals and Clinics, Stevens V, University of Utah, Jennings B, University of Utah Hospitals and Clinics, E-mail: [email protected] Objective: Studies recognize transitions of care as a significant cause of confusion, errors, and miscommunication with patients, families, and health care providers. The objective of this study is to define what drug-related problems occur during transitions of care at time of discharge from the hospital and at time of primary care physician follow-up. The study will categorize baseline characteristics of each patient to assess which patients are at higher risk of experiencing a drug-related problem. This process can be utilized to adapt practice models for pharmacists to identify patients for possible interventions. Methods: This descriptive study will identify patients with a heart failure admission to the hospital. A retrospective chart review will be performed on 100 patients. The charts will be reviewed in reverse chronological order based on date of admission. This study will assess each chart for drug-related problems at time of hospital discharge and time of primary care physician follow-up based on current evidence-based guidelines. The data collection process also will include collection of demographic data. This study will identify patients who the pharmacist should target for intervention. Results: Research in progress. Q 343—UTILIZATION OF A STANDARDIZED ASSESSMENT TOOL TO PROPEL PHARMACY PRACTICE IN A MILITARY TREATMENT FACILITY. Hellwig H, Gunter J, Fort Belvoir Community Hospital, E-mail: [email protected] Objective: The American Society of Health-System Pharmacists (ASHP) published a Pharmacy Practice Model Initiative (PPMI) to propel the practice of pharmacy. The objective of this presentation is to describe the utilization of a standardized assessment tool to measure progress and determine future plans for change to a pharmacy practice model. Methods: A team of pharmacists and pharmacy technicians representing all sections of the pharmacy was assembled to complete ASHP’s PPMI hospital assessment. Areas of weakness in the assessment were categorized by feasibility and importance to determine goals for implementation. After 1 year, the assessment was repeated to assess progress and determine goals for implementation. After 1 year, the assessment was repeated to assess progress and determine focus areas for the second year’s implementation. Teams were formed to address each focus area and develop performance improvement projects that targeted these areas. Results: The utilization of the hospital assessment tool identified baseline compliance with PPMI recommendations of 40% in Optimal Pharmacy Practice Model Characteristics Part I, 28% in Advancing the Use of Pharmacy Technicians, and 57% in Successful Implementation of New Pharmacy Practice Models. After 1 year, improvements of 33%, 14%, and 20%, respectively, were noted, demonstrating significant improvement in compliance with PPMI recommendations. These improvements were due to efforts to increase clinical responsibilities of inpatient staff pharmacists and increase responsibilities of pharmacy technicians. The repeat assessment was utilized to identify 5 areas for improvement that have been targeted for current performance improvement initiatives. Conclusion: The utilization of a standardized assessment tool at baseline and at set intervals assists in the documentation of progress resulting from change initiatives and is used to determine next steps for practice enhancements. This Journal of the American Pharmacists Association Downloaded From: http://mustafa.japha.org/ on 06/09/2014 j apha.org method of identifying weaknesses and making systemic improvements could be utilized throughout every area of pharmacy practice. Original Citation: Gunter A, Hellwig H, Maroyka E. Utilization of a standardized assessment tool to propel pharmacy practice in a military treatment facility. JAPhA. 2013; 53:e151-e170. Respiratory Care 344—ANALYSIS OF ASTHMA ACTION PLANS DEVELOPED AND MONITORED BY PHARMACISTS IN A COMMUNITY PHARMACY SETTING. Aguilar E, Pope N, Lawson K, Wilson J, The University of Texas at Austin, Bierle H, H-E-B Pharmacy, Montemayor D, H-E-B, E-mail: s0915a@heb. com Objective: The objective of this study is to evaluate the effectiveness of asthma action plans that are developed and monitored by community pharmacists in collaboration with health care providers. Methods: Participants will be selected using profiles from community pharmacy locations within the Austin, Texas, region. Ideal candidates will be individuals with asthma treated with multiple medications. Participants with no existing action plan will be provided an action plan along with a brief overview of the action plan and review of medications. The participant’s primary health care provider will be contacted and informed of the patient’s desire to create an asthma action plan. With collaborative efforts between the pharmacist and health care provider, a personalized action plan will be created. The medication history will be reviewed for 3 months prior to commencement of the action plan to establish the baseline frequency of medication fills. The participants will be monitored for 3 months following initial review of the asthma action plan. Effectiveness of the asthma action plan will be measured by completion of surveys at the beginning and conclusion of the study. Questions on the surveys will be designed to determine understanding and ease of use of the action plan in addition to disease state management related MA R /APR 2014 | 54:2 | JAPhA e201 APhA2014 ABSTRACTS items such as number of exacerbations per month. Self-reported medication adherence forms completed by the candidates will measure medication adherence. Results: Research in progress. assess group differences in demographic variables (IM versus FM patients). Chisquare tests will be used to evaluate differences in guideline implementation rates for IM versus FM patients. Results: Research in progress. 345—EVALUATION OF EVIDENCEBASED MANAGEMENT OF ADULT ASTHMA PATIENTS IN A PRIMARY CARE CLINIC. Wiechman B, University of Wisconsin–Madison, Schutten K, Statz-Paynter J, Dean Clinic, Zorek J, University of Wisconsin–Madison, Email: [email protected] Objective: The primary aim of this study is to determine the percentage of patients with asthma receiving evidencebased pharmaceutical care according to National Asthma Education and Prevention Program (NAEPP) guidelines in a primary care clinic consisting of internal medicine (IM) and family medicine (FM) departments. A secondary aim is to compare NAEPP guideline implementation rates for IM versus FM patients. Methods: In this retrospective cohort study, patient records from the IM, FM, and pharmacy departments of this primary care clinic will be reviewed and analyzed. At least 1 asthma-specific International Classification of Diseases–9th revision (ICD-9) diagnosis code will be required for inclusion. Exclusion criteria include ICD-9 codes specific to chronic obstructive pulmonary disease, cystic fibrosis, and emphysema or evidence of other lung-related comorbidities such as prescribed medications for these conditions. Demographic data and asthmarelated symptomatology (e.g., asthma exacerbations, frequency of nighttime symptoms, urgent care visits/hospitalizations) will be collected from medical records. Pharmacy records will be reviewed to document asthma-specific medication regimens and related information (e.g., dispensing data to evaluate adherence, use of oral steroids). Medication regimens will be compared with NAEPP guidelines to determine guideline implementation rates. Descriptive statistics will be used to characterize patients and calculate guideline implementation rates. Independent sample t tests and chi-square tests will be used to 346—KNOWLEDGE AND ATTITUDES ON LUNG HEALTH AMONG COLLEGE STUDENTS. Salgia A, Viscosi C, Janansky J, Lin Y, Mansukhani R, Rutgers, The State University of New Jersey, E-mail: [email protected] Objective: The purpose of this study is to evaluate the knowledge and attitudes of college students before and after attending a 1-hour educational program about lung health and how it impacts social behaviors. Methods: A 20-question pre- and post-survey will be provided to both pharmacy and nonpharmacy college students to assess baseline knowledge and attitudes about lung health. Two 1-hour educational sessions will be developed and implemented by student pharmacists. At the end of the session, a postsurvey will assess the knowledge gained from the program and how it affects future choices compared with current behaviors. The aim is to seek the differences initially within each group and to prove an education program will lead to similar behaviors. Results: Research in progress. The hypothesis is that the pharmacy students will have a higher overall point total for baseline knowledge compared with the nonpharmacy students. However, both groups are anticipated to have improvement in knowledge after the 1-hour session. It is expected that a higher education level on lung health will allow college students to make healthier choices. e202 JAPhA | 5 4:2 | M AR/AP R 2014 Downloaded From: http://mustafa.japha.org/ on 06/09/2014 Substance Abuse and Addictions 347—A CONSENSUS-BASED CLINICAL TOOL FOR EVALUATING CONTROLLED SUBSTANCE USE PRIOR TO DISPENSING AT COMMUNITY PHARMACIES WITHIN A HEALTH SYSTEM. Carbo A, Gehrke S, University of Wisconsin Hospital and Clinics, E-mail: [email protected] ja p h a .org Objective: The purpose of this study is to: (1) create and pilot a consensusbased clinical tool that standardizes the data-gathering and decision-making process for evaluating controlled substance use prior to dispensing at community pharmacies within a health system; (2) evaluate pharmacy staff competency and confidence with this clinical tool; (3) improve documentation of evaluations and subsequent pharmacist interventions. Methods: A modified Delphi consensus exercise will be used to create a clinical tool for pharmacy-initiated evaluations of controlled substance use. An initial list of draft statements, decision points, and recommended actions will be generated from a literature review of relevant strategies, including pharmacy utilization of state prescription drug monitoring programs. Following review by an advisory group composed of clinical pharmacists and pharmacy managers, items will be presented to an expert panel via a web-based questionnaire to approve and discuss inclusion in the clinical tool. The expert panel will include physicians, nurse practitioners, pharmacists, and other stakeholders. Recommendations receiving a high level of agreement from the workgroup will be incorporated into the final draft of the clinical tool to be endorsed by the advisory group. Educational programming will be developed to train pharmacy staff on the clinical tool, with corresponding pre- and post-training competency and confidence assessments. Subsequently, a 3-month pilot will be conducted at multiple community pharmacy sites within the health system. All controlled substance prescriptions and fills presenting at the pilot pharmacies will be eligible for evaluation via the clinical tool. Continuous feedback will be obtained from pilot participants via web-based questionnaires, with potential revisions reviewed by the advisory group. Evaluations and subsequent pharmacist interventions will be documented in the pharmacy dispensing software via a standardized process. Documentation rates and pharmacist interventions will be reported monthly during the pilot. Results: Research in progress. Journal of the American Pharmacists Association APhA2014 ABSTRACTS 348—DOCUMENTATION OF SMOKING STATUS: RESULTS FROM A RANDOMIZED TRIAL TO PROMOTE BRIEF SMOKING CESSATION INTERVENTIONS IN COMMUNITY PHARMACIES. Corelli R, Kroon L, University of California, San Francisco, Vatanka P, Safeway Incorporated, Rodondi K, University of California, San Francisco, Hille B, Safeway Incorporated, Hudmon K, Purdue University, E-mail: corellir@pharmacy. ucsf.edu Objective: The objectives of this study are to compare the effects of 2 training approaches on the extent to which pharmacy personnel (pharmacists and technicians) ask patients about tobacco use and document smoking status in community pharmacy dispensing systems. Methods: In a randomized trial to promote brief pharmacy-based smoking cessation interventions and referrals to a tobacco quitline, pharmacy personnel in 20 chain grocery store pharmacies received either (1) a written training program [W] or (2) a written + 4-hour live training program + active monitoring and coaching by pharmacy management [W+L]. Self-reported cessation interventions were assessed through surveys completed by pharmacy personnel (baseline, post-training, and 6- and 12-weeks post-training). The proportion of active patient profiles with documented smoking status was monitored prospectively through weekly store metrics reports, characterizing only profiles with dispensing activity during the study period. The study was approved by the Human Research Committee. Results: At baseline, most pharmacists (37 of 44; 84%) and technicians (53 of 55; 96%) indicated that they had asked zero patients about their smoking status in the past week. At the 12-week followup survey, the percentage of pharmacists asking zero patients had decreased to 14% and 15% in the W and W+L group, respectively, and among technicians to 25% and 9% in the W and W+L group, respectively. Similarly, documentation of smoking status in the pharmacy patient profiles at 6 and 12 weeks was 26% and 27% for the W group, respectively, and 35% and 45% for the W+L groups, respectively. A significant betweengroup difference was observed for the overall proportion of active profiles with documented smoking status at week 12 (P<0.05). Overall, pharmacy personnel reported high levels of perceived success in implementing brief smoking cessation interventions. Conclusion: Community pharmacy personnel are able to effectively and consistently integrate the identification and documentation of smoking status as a routine component of practice. 349—NALOXONE-BASED HARM REDUCTION: IMPLEMENTATION IN THE STATE OF KENTUCKY. Riner E, Wermeling D, University of Kentucky College of Pharmacy, E-mail: dwermel@ uky.edu Objective: This document provides a how-to guide for implementing programs in Kentucky that prescribe naloxone for third-party administration with the goal of preventing opioid overdose deaths. Methods: Per Kentucky Revised Statute 217.186, effective June 24, 2013, health care providers acting in good faith can prescribe and dispense naloxone for administration by a third-party during an opioid overdose. Additionally, the third-party administering naloxone to whom it was prescribed shall not be subject to civil liability as long as he or she were acting in good faith and immediately called 911. These amendments to the Kentucky Food, Drug, and Cosmetic Act present a unique opportunity for pharmacists to create programs involving prescribing and dispensing naloxone to prevent opioid overdoses. Kentucky not only has the second-highest rate of accidental prescription painkiller overdose, but is also facing a growing heroin problem resulting from the 2012 House Bill 1, which limited access to prescription opioids. Kentucky has a need for harm reduction via naloxone to improve its citizens’ health and safety. Completing this project required research of existing naloxone programs’ practices and integrating information and guidelines from the Centers for Disease Control and Prevention, the Substance Abuse and Journal of the American Pharmacists Association Downloaded From: http://mustafa.japha.org/ on 06/09/2014 j apha.org Mental Health Services Administration, and the Office of National Drug Control. Results: Research in progress. This protocol contains guidance for pharmacists wishing to incorporate naloxone into their practices, including legal considerations, prescription templates, specific setting applications, billing, and working with prescribers to identify high-risk individuals and implement prescribing. An important aspect of this protocol is educating patients and their family and/ or friends about overdose prevention, recognition, and response. Implementing this protocol will include distribution via state pharmacy organizations, notifying practitioners through newsletters, and contacting pharmacists directly. By putting the information outlined by this protocol into practice, pharmacists will improve opioid-related patient safety and prevent opioid overdose deaths. Specialty Pharmacy 350—DEVELOPMENT AND ASSESSMENT OF A NEW PHARMACY SERVICE FOR PATIENTS WITH MULTIPLE SCLEROSIS. Luli A, Schiavo K, Zook T, NorthShore University HealthSystem, E-mail: aluli@northshore. org Objective: The aim of this study is to develop and assess a new pharmacy service for the procurement, dispensing, processing, and monitoring of specialty medications for patients with multiple sclerosis (MS) in an outpatient pharmacy. Methods: A need for a focused pharmacy service has been identified in MS patients within a health system in the northern Chicago suburbs. A voluntary survey of clinicians in the neurology department will be conducted to define the specific need that this service should fulfill. The survey will ask whether clinicians think pharmacy involvement will be beneficial for their practice, whether patients are currently being educated on medication-specific issues, and whether current practices for procuring, monitoring, and assessing adherence to specialty medications could be improved with pharmacist involvement. The survey will be distributed via e-mail to clinicians MA R /APR 2014 | 54:2 | JAPhA e203 APhA2014 ABSTRACTS including physicians, nurses, physician assistants, and medical assistants who care for patients with MS. The survey also will ask for an explanation of the responses provided. The service will then be implemented and tailored based on the survey responses. Following a 2-month implementation period, a postsurvey will be sent via e-mail to the same clinicians. This survey will ask whether the service was beneficial and whether obtaining, monitoring, and assessing adherence was improved with pharmacist involvement. Responses will be compared with the pre-implementation survey and will serve to identify weaknesses of the service and areas for improvement. Additionally, the results can help pharmacists in similar practice settings anticipate issues when developing a comparable service for any specialty medication. Ideal characteristics of the service will include: procurement; insurance adjudication; obtaining access and dispensing products in compliance with any and all regulatory mandates; and providing clinical services that will include patient counseling and therapeutic monitoring. Results: Research in progress. 351—IDENTIFYING FACTORS THAT INFLUENCE SELECTION OF PHARMACIES FOR SPECIALTY MEDICATIONS. Dyson A, Blom J, Walgreens Health-System Pharmacy, Kuehl P, University of Missouri–Kansas City, E-mail: [email protected] Objective: Individual patients cared for in this health system are being referred to multiple pharmacies. While this pharmacy fills prescriptions for these patients’ more traditional medications, prescriptions for their specialty medications are not received here. This research group believes it is best practice for patients to receive all of their medications from one pharmacy. Thus, the objective of this study is to identify factors affecting how ambulatory care providers in this health-system determine to which pharmacies they refer their patients for specialty and limited-distribution medications. Methods: Providers and staff from ambulatory care clinics located on the e204 JAPhA | 5 4:2 | M AR/AP R 2014 Downloaded From: http://mustafa.japha.org/ on 06/09/2014 premises of this health system will be surveyed using online survey software (Survey Monkey). The survey will be developed and piloted to ascertain, from the perspective of clinic personnel, those characteristics of a pharmacy they believe best meets the needs of their patients. Attributes regarding provider preferences and patient factors/barriers to obtaining medications will be collected, with emphasis on those services a pharmacy could provide to assist the clinic and patients with obtainment and adherence to specialty medications. For this study a specialty medication is a high-cost (e.g., >$500/month), selfadministered medication that may be limited to certain pharmacies that meet qualifications set by the manufacturer. Nominal data will be analyzed using descriptive statistics. Study participation will be voluntary and confidential. No financial incentives will be offered. This study will be submitted for approval by the Social and Behavioral Sciences institutional review board of this institution before initiation. Results: Research in progress. Based on the findings, educational and other promotional materials will be developed and presented to clinic personnel to address the concerns and barriers identified. Following this marketing intervention, we hope that patients will be able to fill all of their medications at a single pharmacy, allowing for a complete assessment of medication safety and adherence. 352—UTILIZATION OF AN ORAL CHEMOTHERAPY PRESCRIPTION QUEUE TO INCREASE ERROR RECOGNITION AND IMPROVE PHARMACEUTICAL CARE PROVIDED TO ONCOLOGY PATIENTS IN A HEALTH SYSTEM. Bhargava E, Nanavati P, Northshore University Health System, E-mail: pnanavati@northshore. org Objective: The purpose of this project is to validate the importance of an oral chemotherapy order verification system in the electronic medical record (EMR) for pharmacists. Methods: This project will be implemented in an outpatient oncology ja p h a .org specialty pharmacy. It will entail assessing the functionality of the current oral chemotherapy prescription queue and identifying oncology patients receiving oral chemotherapy medications from oncologists within the health system. To validate the need for an order verification system, pharmacists will screen for dosing errors and inconsistencies while documenting interventions. An oral chemotherapy order verification checklist will be developed to assist pharmacists in identifying these errors. Using this checklist, pharmacists will review all oral chemotherapy orders placed by oncologists within the health system. A documentation tool will be created to help quantify and categorize errors to determine the impact pharmacists had on patient outcomes. The data collected by the utilization of the oral chemotherapy prescription queue in combination with the documentation tool will help justify the need for an oral chemotherapy order verification system in the EMR. Results: Research in progress. Technology 353—APPLICATION OF THE SEIPS WORK SYSTEM MODEL TO EXPLORE BARRIERS AND FACILITATORS TO ADDRESSING PROBLEMATIC E-PRESCRIPTIONS IN COMMUNITY PHARMACIES. Odukoya O, University of Pittsburgh, Chui M, Stone J, University of Wisconsin–Madison, E-mail: [email protected] Objective: This study aims to explore barriers and facilitators to addressing problematic e-prescription errors in community pharmacies using the Systems Engineering Initiative for Patient Safety (SEIPS) work system and patient safety model. Methods: The study employed a cross-sectional qualitative design and was conducted at 5 community pharmacies in Wisconsin. Direct observations, interviews, and focus groups were conducted with 13 pharmacists and 14 technicians. Interviews and focus groups were audio-recorded. Recordings were transcribed and subjected to thematic analysis guided by the SEIPS model. Results: The SEIPS model was use- Journal of the American Pharmacists Association APhA2014 ABSTRACTS ful in capturing work system constraints related to people, use of e-prescribing technology, organizational policies, and the physical and external environments that affect resolution of e-prescription problems in community pharmacies. This study found that organizational factors such as communication, training, teamwork, and staffing levels play a significant role in addressing e-prescription problems. Other factors include: level of experience; knowledge of the pharmacy personnel; availability or usability of tools and technology; interruptions and time pressure when performing tasks; and noise in the pharmacy environment. Conclusion: Health care settings are complex, time-pressed environments where health care professionals interact with many patients taking multiple medications. Electronic prescribing is a health information technology that is being used in health care settings nationwide to ensure safe prescribing of medications to patients; however problematic e-prescriptions are encountered daily in community pharmacy settings. Numerous work system factors appear to be important in addressing problematic e-prescription in community pharmacies. For pharmacists to resolve e-prescriptions efficiently, pharmacies must provide the appropriate working conditions that support use of e-prescribing systems. Characteristics of the pharmacy organization such as staffing and training on skills related to communication and detecting e-prescription problems appear to be important. Further research is needed to quantify work system factors that may strengthen or weaken timely resolution of e-prescription problems to establish appropriate best practice safety guidelines. study are to: (1) assess patient satisfaction of a pharmacy counseling session on inhaler use with video augmentation; (2) determine the impact of these patient counseling sessions on patient confidence of inhaler use; and (3) determine utilization patterns of e-mailed counseling videos. Methods: This is a prospective, open-enrollment study that will be conducted in an independent community pharmacy setting over a 3-month period. For 3 months, participants who present to the pharmacy with a new prescription for an inhaler medication will be recruited for standard pharmacist-provided patient counseling with or without augmentation of video technology on a tablet computer (iPad). Patients will be asked to complete an anonymous, selfadministered questionnaire about their satisfaction and confidence of inhaler use following the counseling session. Results from patients whose counseling session was not augmented with video counseling will be compared with questionnaires from patients who were counseled with the use of video technology. Patients will have the option of receiving counseling videos through e-mail in addition to viewing them in the pharmacy. Questionnaires will be analyzed to determine utilization patterns of the e-mailed counseling videos. Patients <18 years of age will be excluded from the study. Data will be reported using descriptive statistics in aggregate fashion. Results will help to determine the impact of video technology on augmenting pharmacist-provided counseling on new prescriptions for inhalers in a community pharmacy setting and help to determine which patient populations are more likely to utilize counseling videos. Results: Research in progress. 354—WITHDRAWN. 355—EVALUATING THE USE OF VIDEO TECHNOLOGY TO AUGMENT INHALER COUNSELING STRATEGIES IN THE COMMUNITY PHARMACY SETTING. Barrickman A, Garofoli G, Elswick B, West Virginia University, E-mail: [email protected]. edu Objective: The objectives of this 356—IMPLEMENTING A TELEPHARMACIST SERVICE FOR BEHAVIORAL HEALTH PATIENTS WITHIN AN INTEGRATED CARE SYSTEM. Rinkus M, Gonyeau A, University of Pittsburgh School of Pharmacy, E-mail: [email protected] Objective: The objectives of this study are to: (1) evaluate how to best implement a pharmacist-provided patient Journal of the American Pharmacists Association Downloaded From: http://mustafa.japha.org/ on 06/09/2014 j apha.org care service remotely using interactive audio-video technology for behavioral health patients; and (2) subsequently determine the impact of the program on patient drug therapy problems and health care costs. Methods: This observational, prospective study is being conducted with a partnership between the school of pharmacy and Family Services of Western Pennsylvania. Case managers who routinely evaluate behavioral health patients in their homes will serve as the liaisons to connect these patients to a pharmacist via interactive audio-visual technology deployed using tablet computers. The pharmacist will conduct a comprehensive medication therapy review and electronically document the patient’s demographics, history, drug therapy problem assessment, and care plan. Student pharmacists will observe and document the interactions. Observational data will be collected using a structured tool and analyzed for consistent themes. Data on resolved therapy problems and potential cost-saving opportunities will be collected and reported using descriptive statistics. The study will be evaluated by the university’s institutional review board. Results: Research in progress. 357—MOBILE APPLICATION FEATURES DESIRED BY PATIENTS OF A GROCERY STORE CHAIN PHARMACY. McCartney E, Bacci J, University of Pittsburgh School of Pharmacy, DelPizzo D, DeJames J, Richardson R, Giant Eagle Pharmacy, McGivney M, University of Pittsburgh School of Pharmacy, E-mail: [email protected] Objective: This study aims to determine the features of a pharmacy mobile application that would be most valuable to patients of a regional grocery store chain pharmacy. Methods: With the expansion of both health care needs and technology services, electronic health (e-health) services have allowed patients to better connect and engage in their own health care needs. It has been shown that those patients who use pharmacy mobile applications spend more time at the pharmacy than those who do not use pharmacy mobile applications. This mixedMA R /APR 2014 | 54:2 | JAPhA e205 APhA2014 ABSTRACTS methods study will use focus groups to determine how patients already use mobile health-related applications, and what features they would like to see in a mobile application for the grocery store chain. Focus group audio recordings will be transcribed by a third party and analyzed using grounded theory to elicit themes. A survey will then be created based on the major themes from the focus groups. The survey will be administered by student pharmacists in multiple grocery store locations in the surrounding Pittsburgh area. Survey results will be analyzed with descriptive statistics to better describe patient interests. The study will be evaluated by the university’s institutional review board. Results: Research in progress. Focus group and subsequent survey results will provide guidance on the features to design and include in a pharmacy mobile application and which features to emphasize in the marketing of the application to patients. 358—NOVEL STRATEGY FOR BIOAVAILABILITY ENHANCEMENT OF POORLY SOLUBLE DRUGS EMBEDDED INTO ORAL POLYMER FILMS. Kalaria S, Ernest Mario School of Pharmacy, Rutgers University, Karry K, Rutgers University, Michniak-Kohn B, Ernest Mario School of Pharmacy, Rutgers University, E-mail: michniak@ biology.rutgers.edu Objective: The purpose of this study is to optimize the formulation of naproxen polymer films and characterize the final dosage form via nondestructive spectroscopic techniques with the aim of inhibiting drug recrystallization to improve its long-term stability. Polymeric film dosage forms offer advantages such as avoiding first-pass metabolism and enzymatic degradation by allowing the active pharmaceutical ingredient (API) to be dissolved and absorbed in the oral cavity. It is of importance to assure the long-term stability of these polymer films before delivering the medication to patients. Crystallinity variations in an API can affect its long-term stability, dissolution profile, and the expected therapeutic effects. Methods: Naproxen, a poorly solu- e206 JAPhA | 5 4:2 | M AR/AP R 2014 Downloaded From: http://mustafa.japha.org/ on 06/09/2014 ble compound, was embedded into the polymer films after solubilization with novel graft copolymers. Excipients were evaluated to optimize a formulation with limited recrystallization. Different grades and concentrations of polyvinyl caprolactam graft copolymers (solubilizer/recrystallization inhibitor), water-soluble plasticizers, surfactants, bioadhesives, and additives were assessed. Each polymer film solution was thoroughly mixed for ≥8 hours before being casted on a Teflon membrane and dried overnight in an oven at 40°C to 45°C. Post drying, the films were peeled off and characterized in terms of tensile strength, percent elongation, physicochemical interactions between the API and excipients via attenuated total reflectance Fourier transform–infrared (ATR FT-IR) spectroscopy, drug recrystallization, and dosage form stability. Drug recrystallization was evaluated using scanning electron microscopy and prediction of the final stability was performed with the aid of FT–near infrared and/or Terahertz spectroscopic techniques. Further testing was then completed after exposing the films to different temperatures and humidity levels in accelerated stability tests. Finally, biorelevancy comparisons were carried out by dissolution studies evaluating drug released over time from the films containing the solubilized API versus films with nanosized drug. Results: Data collection and analysis currently in progress. 359—PREVALENCE OF POTENTIALLY INAPPROPRIATE MEDICATION ORDERING FOR DRUGS WITH SEDATIVE EFFECTS IN ACUTE GERIATRIC INPATIENT CARE USING ELECTRONIC HEALTH RECORDS. Yu C, University of California at San Francisco, Newman C, Brisbane L, Zak M, Saubermann L, University of Rochester Medical Center, E-mail: [email protected] Objective: The purpose of this study is to determine the baseline prevalence and variables influencing potentially inappropriate medication (PIM) ordering by utilizing pharmacoinformatics for data mining and implementation of subsequent clinical advisory interventions ja p h a .org to improve patient outcome. Methods: Preventable adverse drug events (ADE) of bone fractures from falls, delirium, and gastrointestinal complications, caused by sedative PIMs with anticholinergic properties or in the benzodiazepine class, in elderly patients, ≥65 years of age, can be reduced through adherence to the Beers criteria, which specifies high-risk medications for seniors. System analytics and structured queries of electronic medical records (EMR), from January 1, 2013 to June 30, 2013 retrieved criteria PIMs information from the medical center formulary and medication orders in acute inpatient care. Frequency analysis assessed PIM ordering rates. Further evaluations by clinicians excluded PIMs that were therapeutic to specific indications, isolated PIMs that were consistently ordered over safer alternatives, and characterized the major factors that contributed to ordering PIMs. Results: Retrospective inspection of EMRs found 7,237 sedative PIM orders for the identified 9 high-risk anticholinergic or benzodiazepine PIMs. Diphenhydramine had 2,361 orders (32.6% of PIM orders), of which 46.0% were administered. The mean age was 73.6 years. The mean therapy duration was 3.5 days, and the mean hospital stay was 17.2 days. Seventy-two percent of the orders were entry orders, and 26.4% came from order sets of which 14.6% were admission order sets. Some reasons that led to PIM ordering are outdated practices and lack of knowledge about the impact of PIMs. Computerized clinical decision support can ameliorate PIM prescribing behavior. Conclusion: PIMs increase ADE risks and hospitalizations for elderly patients. Using pharmacy informatics, baseline PIM prevalence was reported. Implications of these findings are the development of evidence-based targeted alerts and meaningful restrictions of medications to provide relevant clinical guidance and education in changing prescriber behavior and improving patient outcome. 360—QUANTITATIVE ANALYSIS OF MEDICATION UTILIZATION Journal of the American Pharmacists Association APhA2014 ABSTRACTS RATES FOR IMPLEMENTATION OF AN OUTPATIENT PHARMACY AUTOMATED MEDICATION STORAGE CAROUSEL. Walsh A, University of Arizona, Edwards B, Leon S, Southern Arizona Veteran’s Affairs Healthcare System, E-mail: [email protected] Objective: The primary goal was to determine the top 100 medications with highest turnover and assign them to specific carousel locations; the secondary goal was to educate pharmacists of the new technology. Because of space constraints, there was a need to implement an automated medication storage/ shelving carousel system to increase efficiency and maximize available floor plan. Medication carousels are commonly utilized in inpatient pharmacies, therefore the installation of this automation in an outpatient pharmacy setting was unique. Methods: Medication reorder point (par) levels and fill frequencies from 2012 determined highest and lowest turnover medications using Microsoft Excel. Accuracy of par levels was assessed; when dosage form, container type, and corresponding units of medication were inappropriate, par levels were recalculated to reflect current procurement trends. The top 100 medications with the highest turnover (fast movers) were assigned to bins based on medication container size, par levels, and estimated physical space requirements of maximum (max) levels. Many medications were assigned fractions of bins. Fast movers were grouped on lowest-numbered rows to reduce carousel spin time. Heavy items were split among rows to distribute weight and reduce mechanical stress. Medical supplies, refrigerated medications, controlled substances, and heavy/bulky items were not assigned a bin, but were assigned barcodes and inventoried. Results: The top 100 fast movers were determined and assigned locations in the medication carousel, which filled approximately the first 8 rows. A presentation was delivered to interested pharmacy staff, who verbally expressed increased confidence and familiarity with the technology. Conclusion: The primary goal was met, which was successful assignment of the top 100 fast movers to carousel locations. The secondary goal was met, indicating that a summary presentation increased familiarity and successfully educated pharmacists about the timeline, specifications, and calculations involved with setup of a medication carousel in an innovative practice setting. 361—UNDERSTANDING THE USABILITY OF PHARMACY DISPENSING COMPUTER SYSTEMS TO PREPARE AND DOCUMENT COMPREHENSIVE MEDICATION REVIEWS. Scarpace K, Chui M, Kieser M, University of Wisconsin–Madison School of Pharmacy, E-mail: [email protected] Objective: The objectives of this study are to: (1) identify the usability of pharmacy dispensing computer systems in the preparation and documentation of comprehensive medication reviews; and (2) describe how pharmacists overcome the limitations of pharmacy dispensing computer systems in preparing and documenting comprehensive medication reviews. Methods: Pharmacists employed at pharmacies that conduct ≥1 comprehensive medication reviews per month will be recruited for this study through e-mail. One pharmacist from each recruited pharmacy will complete a survey and observation conducted by the principal investigator. The survey assesses various components within the pharmacy dispensing computer system and their usability. During the observation, the pharmacist will use the think-aloud technique to walk the observer through the typical workflow of preparation and documentation of comprehensive medication reviews. Results: Research in progress. Results from 5 to 8 pharmacy sites will be presented. Workforce and Manpower 362—DIFFERENCES IN CAREER PATHS AND ATTRIBUTES OF PHARMACISTS COMPLETING A COMMUNITY PHARMACY RESIDENCY PROGRAM. Ulbrich T, Northeast Ohio Medical University, Adams Journal of the American Pharmacists Association Downloaded From: http://mustafa.japha.org/ on 06/09/2014 j apha.org A, National Association of Chain Drug Stores, Bright D, Sullivan D, Ohio Northern University, Schnur E, Walmart Stores Inc., Bess D, University of Tennessee College of Pharmacy, Owen J, American Pharmacists Association, Bradley-Baker L, American Association of Colleges of Pharmacy, E-mail: tulbrich@neomed. edu Objective: The study objective was to determine any differences in career paths and career attributes of pharmacists who have completed a postgraduate year 1 (PGY1) community pharmacy residency program (CPRP) compared with those who have not completed a PGY1 CPRP. Methods: A web-based survey evaluating various aspects of community pharmacists’ careers was distributed to 274 CPRP graduates in addition to a random sample of 7,376 community pharmacists. The survey contained 31 questions evaluating various career attributes. Questions that assessed level of agreement were on a 6-point Likert-type scale (1 = strongly disagree; 6 = strongly agree). Results: A total of 353 participants completed the survey, with 224 indicating that they had not completed a CPRP. No significant differences were observed between CPRP and non-CPRP graduates as it relates to employment status (employed full time vs. part time or unemployed), length of employment with the primary employer, perceived workload, number of job offers received following graduation (from school or from a CPRP), or age. Pharmacists who completed a CPRP are more likely to spend significantly more time on patient care services, teaching, and research, and spend less time dispensing medications. CPRP graduates were less likely to agree that current level of workload negatively impacts job performance, motivation to work, job satisfaction, mental/emotional health, and physical health. Conclusion: Pharmacists completing a CPRP noted significant differences in their current employment and job responsibilities. Additional expansion and education regarding the importance of CPRPs should be considered. MA R /APR 2014 | 54:2 | JAPhA e207 APhA2014 ABSTRACTS 363—EVALUATING CURRENT COMMUNITY PHARMACY TECHNICIAN TRAINING PRACTICES FOR NEW EMPLOYEES. Robertson K, University of Kentucky College of Pharmacy/Kroger Pharmacy, Roberts P, Kroger Pharmacy, Divine H, University of Kentucky College of Pharmacy, E-mail: [email protected]. com Objective: Pharmacy technician training for new employees in the community pharmacy varies greatly among pharmacies in the United States. These training procedures range from on-thejob training to structured orientation programs, including preparatory courses for pharmacy technician certification. In 1 division of a chain community pharmacy, a newly employed pharmacy technician receives training that includes a series of computer-based modules and a defined number of hours of on-the-job training in the pharmacy. An assessment of the training components has not been performed to determine areas for quality improvement. The objectives of the study are to: (1) evaluate current pharmacy technician training practices offered in the chain pharmacy division; and (2) identify the need for additional technician training components to further assist pharmacists with professional patient care responsibilities. Methods: Approximately 139 pharmacists and 139 pharmacy technicians in 1 division of a chain community pharmacy will be invited to participate in a group-specific survey. The survey will assess the group’s (i.e., pharmacist or technician) perspective of the current training. The survey will be distributed by e-mail and fax with options to anonymously complete either a web-based or paper copy. The survey will be designed to collect basic demographic information, assess current training practices for pharmacy technicians, and explore pharmacy technician training needs for expanded clinical roles. Survey reminders will be e-mailed and faxed to the pharmacies at weeks 3, 5, and 6. The study will conclude at 6 weeks. Results will be analyzed using descriptive statistics. Results: Research in progress. e208 JAPhA | 5 4:2 | M AR/AP R 2014 Downloaded From: http://mustafa.japha.org/ on 06/09/2014 364—IMPACT OF A PHARMACY TECHNICIAN ON COST OF PROVIDING IN-HOME MEDICATION THERAPY MANAGEMENT SERVICES. O’Connor S, University of Washington, Akers J, Kelley-Ross and Associates, E-mail: soconnor21@yahoo. com Objective: The objective of this study was to determine the financial impact of incorporating a pharmacy technician into an in-home medication therapy management (MTM) service. Methods: Kelley-Ross (KR) Pharmacies is an independent 4-store pharmacy that is contracted with a state agency to provide in-home MTM for patients with complicated medication regimens. Approximately 20 hours per week of a pharmacy technician’s time is used to cover administrative tasks related to the MTM service, including scheduling, billing, assimilating documents, and running reports. The technician was included in workflow to decrease pharmacist time spent on non-clinical tasks. Both pharmacist and technician time are tracked as part of the requirement for the MTM service. This study retrospectively examined the time used for patient care from August 1 to September 30, 2013 using a pharmacist and technician. This time was compared with the amount that would have been needed to accomplish the same tasks if completed solely by a pharmacist, which excluded activities that would not be done if a technician were not involved. Time measurements were converted to cost to the pharmacy based on pharmacy’s approximated cost (salary plus benefits) of a pharmacist ($90/hour) and technician ($40/hour). Results: Time was reported for 21 patients during the 2-month review period: 1,111 minutes of pharmacy technician and 2,227 minutes of pharmacist time were used, which equates to $4,081.17. In a pharmacist-only scenario, the time used is estimated at 3,119.2, which equates to $4,678.80. Use of a pharmacy technician uses 218.8 more minutes but costs $597.63 less to care for the same patient load. Conclusion: It is less expensive to have a pharmacist technician involved in an MTM service, even if more time ja p h a .org overall is used. This information is relevant for negotiating contract rates, as an increased margin can be achieved by utilizing a technician for appropriate tasks. 365—LEVEL OF DEMAND FOR PHARMACISTS IN COMMUNITY PHARMACIES IN WISCONSIN. Arora P, Mott D, University of Wisconsin–Madison, E-mail: [email protected] Objective: The goal of this study is to obtain statewide estimates of the level of demand for pharmacists and pharmacy characteristics for community pharmacies in Wisconsin and make comparisons by rurality. Methods: A descriptive, cross-sectional survey design was used. Surveys were mailed to key informants (i.e., pharmacy managers/owners) for community pharmacies (N = 1,064) located in rural and urban areas of Wisconsin in July–August 2011 and March–April 2012, respectively. A 1-page cover letter and 3-page survey instrument were used. Responses to the survey form were submitted via fax. Nonresponders received a second mailing 3 weeks after the first mailing. The survey instrument contained questions about the pharmacy setting, workload, staffing characteristics, total and vacant number of budgeted full-time equivalent (FTE) pharmacist positions, and additional number of unbudgeted FTE pharmacist positions needed to attain adequate staff size. Results: A total of 522 pharmacies responded for a response rate of 49.8%. A weighted total of 25.65 vacant budgeted FTE positions (represented by 1% of the respondent pharmacies) were reported. The proportion of community pharmacies with a vacant position was significantly higher in rural areas than in urban areas. The prescription volume per day in the community pharmacies did not differ significantly by rurality. Twenty-seven percent of key informants reported the need for additional number of unbudgeted FTE pharmacist positions. A weighted total of 316.37 additional unbudgeted FTE pharmacist positions were reported as needed in community pharmacies in Wisconsin. Conclusion: Results suggest that the unmet demand for budgeted phar- Journal of the American Pharmacists Association APhA2014 ABSTRACTS macist positions is close to being met in community pharmacies in Wisconsin. It is important to systematically assess the level of demand for pharmacists to understand the impact of the growing supply of pharmacists and the economy on the level of pharmacist demand and to help pharmacy schools determine the need for pharmacists in their states and the United States. 366—A PROFILE OF PHARMACISTS OF RETIREMENT AGE IN ILLINOIS. Brown A, Quinones-Boex A, Mata D, Midwestern University, E-mail: aquino@ midwestern.edu Objective: The objective of this study was to identify the set of characteristics that best describe pharmacists of retirement age (>65 years) in Illinois. The 2009 National Pharmacist Workforce Survey reported an increased proportion of pharmacists actively practicing during 2004 through 2009, especially for pharmacists aged ≥60 years. Methods: A 4-page questionnaire was mailed in early January 2013 to 500 pharmacists licensed and residing in Illinois, randomly selected from a list purchased from the Illinois Department of Financial and Professional Regulation. One follow-up postcard reminder was sent to the whole sample 2 weeks from the original mailing. Data collection ended 3 months after the original mailing date. The data were analyzed using IBM SPSS. An alpha level of 0.05 was employed to determine statistical significance. Results: The response rate was 44.4% (n = 222). Most respondents reported being retired but still working part-time (41.8%) or being retired and not practicing pharmacy (39.5%). Twelve percent reported practicing full-time as pharmacists. Pharmacists of retirement age who reported practicing pharmacy (full-time or part-time) were white (99.2%) and male (87.4%). Their average age was 74.7 years old. Statistically significant results showed that these pharmacists wish to spend more time providing patient care and engaging in other activities (e.g., teaching, precepting, research) and less time dispensing. Pharmacists working full-time have worked significantly longer with their current employer and were more likely to hold managerial-type of positions. They also were younger than their part-time counterparts. Conclusion: An understanding of practicing pharmacists of retirement age has implications for employers since growing market saturation has been partially attributed to a reluctance of older pharmacists to retire due to the recent recession. Results of this study suggest that pharmacists of retirement age practicing in Illinois transition from full-time practice to part-time practice between the ages of 75 and 80 years. Emerging Topics 367—EVALUATING THE IMPACT OF A PEDIATRIC WEIGHT-BASED DOSING PROCEDURE IN OUTPATIENT PHARMACY. Grant J, Johns Hopkins Home Care Group, E-mail: [email protected] Objective: The primary objective of this project is to describe the percentages of outpatient pediatric prescriptions with initial inappropriate prescribing identified by a pharmacist that resulted in a dosage change among both pediatric prescriptions that required prescriber contact for prescription clarification and total number of pediatric prescriptions dispensed. Secondary objectives include describing categories of initial inappropriate prescribing errors, Institute for Safe Medication Practices (ISMP) highalert medications, patient demographics, prescriber office location, and prescription origin. Methods: This retrospective outpatient prescription record review will be performed at an outpatient pharmacy located in an academic teaching hospital. The study will review pediatric prescriptions from a 6-month time period. Data will be collected through the use of the outpatient pharmacy’s database. Two reports will be generated; one will quantify all pediatric prescriptions during the 6-month time period and another will describe pediatric prescriptions that required pharmacist intervention and prescriber contact. The prescriptions that required pharmacist intervention will be Journal of the American Pharmacists Association Downloaded From: http://mustafa.japha.org/ on 06/09/2014 j apha.org further analyzed to address the secondary objectives. To determine percentages for the primary objective, 2 calculations will be performed. The first calculation will include the total number of prescriptions that required intervention and resulted in a dosage change divided by the total number of pediatric prescriptions filled at the pharmacy. The second calculation will consist of the total number of prescriptions that required intervention and resulted in a change in dosage divided by the total number of prescriptions that required pharmacist intervention. A Kruskal-Wallis 1-way ANOVA will be used to compare the intervention type with the different age groups, weights, and sex and to compare the intervention type with the different ISMP high-alert medication categories. A chi-square test will be used in comparing the rates of prescribing errors from house staff versus non–house staff and hand-written versus computer-generated prescriptions. Results: Research in progress. Q 368—APIXABAN IS EFFICACIOUS AND SAFE IN PATIENTS WITH ATRIAL FIBRILLATION USING CONCOMITANT AMIODARONE: AN ANALYSIS FROM THE ARISTOTLE TRIAL. Flaker G, University of Missouri Health System, Wojdyla D, Duke Clinical Research Institute, Hohnloser S, Johann Wolfgang Goethe University, Sullivan R, University of Missouri Health System, Hylek E, Boston University School of Medicine, Garcia D, University of Washington, Lopes R, Granger C, Duke University Medical Center, Al-Khatib S, [email protected]. edu, Medicine, Cardiology and Internal Medicine , E-mail: [email protected] Objective: The purpose of this study is to evaluate interactions between apixaban and amiodarone on clinical outcomes in the ARISTOTLE (Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation) trial. Compared with warfarin, apixaban has been shown to reduce stroke, systemic embolism, mortality, and major bleeding. When used with warfarin, amiodarone may lead to poor control of MA R /APR 2014 | 54:2 | JAPhA e209 APhA2014 ABSTRACTS international normalized ratio (INR) and excess embolic and bleeding events. Methods: ARISTOTLE included 18,201 patients randomized to apixaban 5 mg twice daily or warfarin (target INR, 2–3). Endpoints, including stroke/ systemic embolism (SSE), major bleeding, and intracranial hemorrhage (ICH), were summarized using rates/100 patient-years of follow-up. The Cox regression model was used to derive hazard ratios (HRs) comparing apixaban versus warfarin and test the interaction between randomized treatment and amiodarone. Results: From the overall population, 2,051 patients (11%) received amiodarone at randomization, including 1,009 patients assigned to apixaban and 1,042 assigned to warfarin. Patients on amiodarone were younger (median 68 years vs. 70 years) and had a lower mean CHADS2 (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, prior stroke or transient ischemic attack) score (2.0 vs. 2.1). Patients assigned to warfarin and receiving amiodarone had a lower mean time in therapeutic range (TTR) than those not receiving amiodarone (56.5% vs. 63%, P<0.0001). Among patients on amiodarone, the yearly rate of SSE was 1.24% for apixaban-treated patients and 1.85% for warfarin-treated patients (HR 0.68, 95% confidence interval [CI] 0.40–1.15); respective HRs (95% CIs) for major bleeding and ICH were 0.61 (0.39–0.96) and 0.46 (0.28–0.66). The yearly rate of SSE among patients not taking amiodarone was 1.29% and 1.57% for apixaban- and warfarin-treated patients, respectively (HR 0.82, 95% CI 0.68–0.99); respective HRs (95% CIs) for major bleeding and ICH were 0.72 (0.62–0.78) and 0.25 (0.09– 0.67). Conclusion: Despite a lower TTR with warfarin and amiodarone, the efficacy and safety of apixaban versus warfarin is consistent in patients with or without concomitant amiodarone therapy. Original Citation: Flaker G, Wojdyla D, Hohnloser S, Sullivan R, Hylek E, Garcia D, Lopes RD, Granger CB. Apixaban is efficacious and safe in patients with atrial fibrillation using concomitant amiodarone: an analysis from the AR- e210 JAPhA | 5 4:2 | M AR/AP R 2014 Downloaded From: http://mustafa.japha.org/ on 06/09/2014 ISTOTLE trial. Presented at: American College of Cardiology ACC.13 and i2 Summit; March 9-11, 2013; San Francisco, CA. 369—ASSESSING FIREFIGHTERS’ AND FIRST RESPONDERS’ KNOWLEDGE AND PERCEPTIONS OF THE VIAL OF LIFE PROGRAM: DO THEY THINK PHARMACISTS CAN HELP THIS PROGRAM SUCCEED?. Passafiume S, Brody Jr. P, University at Buffalo, E-mail: pmbrody@ buffalo.edu Objective: The objectives of this study are to: (1) reveal the knowledge and perceptions of firefighters and first responders of the Vial of LIFE program; and (2) determine whether these primary users believe that pharmacists may successfully promote the Vial of LIFE. Methods: The Vial of LIFE is a medical information program in which LIFE stands for “lifesaving information for emergencies.” The intent is for patients to have their medical information in 1 place if they suffer a medical emergency in their home. Minimal data exist regarding utilization of the program. The study cohort was drawn from local firefighters and first responders in western New York. Participants were asked to complete a non-validated 15-question survey that included a combination of yes/no, fill-in-the-blank, rank order, and Likert scale questions. The purpose was to uncover participants’ base knowledge of the program, assess participants’ opinions of the program, and reveal perceptions regarding the potential for pharmacist involvement. Results: Response rate was not recorded. Sixty-nine participants completed the survey. Five participants (7.2%) correctly defined the acronym (LIFE) and 25 participants (36%) had heard of the Vial of LIFE program previously. Fifty-two participants (75%) agreed that the Vial of LIFE program could help firefighters and first responders save lives during emergencies. Moreover, 58 participants (84%) indicated that pharmacists could successfully promote the Vial of LIFE program, with 23 (33%) citing that pharmacists are accessible health care providers and 22 (32%) citing that ja p h a .org pharmacists understand the importance of having medical information in 1 place. Conclusion: Firefighters and first responders have limited knowledge of the Vial of LIFE program, but perceive the program as valuable. These primary users identify a potential role for the pharmacist in promoting the Vial of LIFE. 370—CHARACTERISTICS AND DETERMINANTS OF BUYING MEDICINES AND VITAMINS ONLINE. Desai K, Chewning B, Mott D, University of Wisconsin–Madison, E-mail: [email protected] Objective: With increased use of the Internet, more people buy medications and health supplements online. A key question is what opportunities providers get and their impact. This study aims to test the following: (1) the association between online buying and use of health services; (2) the association between buying online and discussion of Internet information with providers; (3) the association of discussion of Internet information with providers and perceived quality of communication with provider. Methods: The National Cancer Institute’s 2007 Health Information National Trends Survey was analyzed to study online medication buying among Internet users (n = 5,074). Multivariate logistic regression analysis identified factors associated with online buying. Results: In 2007, 17% (n = 872) of Internet users bought a medication or vitamin online. Approximately 77% of online buyers had a regular provider, but only 37.1% talked to the provider about online information even though most visited the provider ≥1 times per year (93.7%). Multivariate analyses found Internet health product consumers were more likely to: (1) have insurance; (2) be aged >50 years; (3) have an income >$50,000; (4) visit providers ≥1 times during the last year; (5) use complementary medicines; and (6) talk to their doctors about Internet information. Additionally, individuals reporting being in poor health, who were college graduates, with a regular provider and perceived the quality of communication with provider to be fair or good, were more likely to talk about online information. Journal of the American Pharmacists Association APhA2014 ABSTRACTS Conclusion: The association of online buying with frequency of visits and discussing online information, which in turn was associated with perceived quality of communication, reinforces the importance of patient-provider relationships. This also suggests that health care providers (e.g., physicians, pharmacists) have a potential role in educating consumers about evaluating online pharmacies, products, and information. However, both groups would need to be prepared to fulfill this role well and have strong communication skills as perceived by patients. Q 371—THE COMMUNITY PHARMACIST’S ROLE IN TRANSITIONS OF CARE: A QUALITATIVE THEMATIC ANALYSIS. Long B, The Ohio State University, Kuhn C, The Kroger Co., Hilligoss B, The Ohio State University, Broedel-Zaugg K, Marshall University, Bennett M, The Ohio State University, E-mail: [email protected] Objective: The purpose of this study is to identify the perceptions of the community pharmacist’s role in a patient’s transition of care (TOC) as perceived by health-system and community pharmacists. Methods: This qualitative study was done with 25 community and health-system pharmacist participants from the greater Columbus, Ohio, area. Three separate focus groups consisting of exclusively community pharmacists, exclusively health-system pharmacists, and a combined group were conducted. Focus groups were audio-recorded and transcribed, and then participant statements were thematically analyzed. Results: Community and healthsystem pharmacists perceived that the community pharmacist’s primary role in a patient’s TOC is to provide patient education, which includes resolution and explanation of drug-related problems (DRPs). An identified opportunity for collaboration between community and health-system pharmacists was medication reconciliation. However, an identified barrier to this collaboration is lack of a well-established hand-off mechanism between settings. Both health-system and community pharmacists also re- ported that community pharmacists are easily accessible and community pharmacists stated the desire to participate in these services. Time and workload were identified as the most common barrier for community pharmacist inclusion in TOC services. Conclusion: Community and health-system pharmacists perceive that community pharmacists do have a role with patient education and DRP resolution, specifically in regard to a patient’s TOC. Pharmacists describe that community pharmacists are accessible and truly desire to participate in TOC services to ensure seamless patient care. Community pharmacists can assist in a patient’s TOC by collaborating with health-system pharmacists through medication reconciliation and establishing hand-off mechanisms through discharge instruction receipt. As time and workload are barriers, community pharmacy practice models should evolve to allow and encourage participation in TOC services. Original Citation: Long B, Kuhn C, Hilligoss B, Broedel-Zaugg K, Bennett M. The community pharmacist’s role in transitions of care: a qualitative thematic analysis. J Am Pharm Assoc. 2013;53(2):e8-e117. 372—A COMPARISON OF THE EFFECT OF SHORT INTERMITTENT AND PROLONGED INTERMITTENT INFUSION OF MEROPENEM ON THE PREVALENCE OF NAUSEA IN PEDIATRIC PATIENTS WITH CYSTIC FIBROSIS. Draime J, Nicholls J, Sibbitt B, Gryka R, Simpson D, Cedarville University, E-mail: [email protected] Objective: The objectives of this study are to: (1) assess nausea of pediatric patients with cystic fibrosis (CF) following prolonged and short intermittent administration of meropenem by comparing episodes of emesis, doses of anti-nausea medication, and patientreported nausea to each of the following: type of administration, peak serum levels, and area under concentration time curves; and (2) assess the difference between measured serum meropenem levels from peripheral blood samples and percutaneously inserted central venous Journal of the American Pharmacists Association Downloaded From: http://mustafa.japha.org/ on 06/09/2014 j apha.org catheters. Methods: In CF, patients experience frequent lung infections along with nausea, loss of appetite, and poor absorption of nutrients. Current treatment for these infections involves antibiotic therapy, including continuous or intermittent intravenous (IV) infused beta-lactam antibiotics, resulting in additional nausea and gastrointestinal side effects. A crossover design will be used for this pilot study to establish clinical protocols for meropenem administration in pediatric, hospitalized CF patients in order to reduce the incidence of nausea. Patients (N = 10) will be randomly assigned to 1 of 2 treatment groups. One group will receive 4 days of a 120 mg/kg/day continuous IV dose of meropenem followed by an intermittent 40 mg/kg/dose infused over 30 minutes every 8 hours for another 4 days. The other group will receive the intermittent dose followed by the continuous infusion. Serum concentrations will be quantified utilizing a high-performance liquid chromatography instrument, and incidence of nausea will be measured through the average doses of granisetron (Kytril), ordered for each patient in addition to the number of episodes of emesis. Results: Institutional review board approval has been obtained, and training of hospital staff to prepare for data collection is currently underway. This study may provide information on the type of infusion (prolonged or short intermittent) that reduces the side effects of nausea and result in the creation of established clinical protocols for meropenem administration in pediatric patients with CF admitted to the hospital, thereby improving patient quality of life and care. 373—ENGAGEMENT OF COMMUNITY PHARMACISTS’ IN TRANSITIONS OF CARE SERVICES. Eubank D, Layson-Wolf C, Congdon H, Hose B, Fulton D, University of Maryland School of Pharmacy, E-mail: [email protected] Objective: Community pharmacists have been an underutilized segment of the health care system by hospitals nationwide as they continue to search for ways to reduce readmission rates. Medication reconciliation is used as a MA R /APR 2014 | 54:2 | JAPhA e211 APhA2014 ABSTRACTS way to identify possible errors in patient medication regimens during transitions of care. The primary objectives of this study are to: (1) determine the extent to which community pharmacists currently engage in transitions of care practices, including medication reconciliation activities; (2) identify barriers in the provision of these services; and (3) evaluate the utility of a common framework to optimize transitions of care. Methods: The study population for this survey will include community pharmacists in Maryland. A survey will be distributed by e-mail to community pharmacists with a link to an online survey. The survey will be available for 6 weeks with reminder e-mails sent at 2 weeks, 4 weeks, and 4 days prior to end date to improve survey response rate. The survey consists of questions that will gather the following information: practice demographics, exposure to medication reconciliation, level of involvement in medication reconciliation, barriers to performing medication reconciliation, findings from medication reconciliations identified, and general perceptions about medication reconciliation. Based on responses, the online survey will utilize skip logic to represent only applicable questions. The responses to the survey will be anonymous. Survey responses will be entered into an Excel database for analysis. Results: Research in progress. Survey will be sent and data collection will begin after institutional review board approval. It is anticipated that the information obtained will be used to characterize current practices and help develop a best practices program that meets the needs of Maryland hospitals as well as streamlining the process to increase participation by community pharmacists. 374—ESTABLISHING COMMUNITY PHARMACY RESIDENCY AT AN INDEPENDENT PHARMACY: TIME ALLOCATION AND RETURN ON INVESTMENT. Shugart K, Ziegler B, South Carolina College of Pharmacy, Kress D, University of South Carolina, Connelly L, Medicine Mart Pharmacy of West Columbia, Brittain K, South Carolina College of Pharmacy, E-mail: brit- e212 JAPhA | 5 4:2 | M AR/AP R 2014 Downloaded From: http://mustafa.japha.org/ on 06/09/2014 [email protected] Objective: This study will assess time allocation and return on investment (ROI) for a community pharmacy residency at an independent pharmacy. The time allocation for predefined categories was measured for a community pharmacy resident, and the ROI for the first year of community pharmacy residency at an independent pharmacy was estimated. Methods: Dispensing, clinical revenue generating, clinical incidental nonrevenue generating, site training, marketing, site precepting, research, public health, didactic teaching, professional meetings, residency meetings, resident education, and miscellaneous were the predefined time allocation categories the pharmacy resident used to consistently classify time completing residency activities. To determine ROI, the costs of establishing and maintaining the resident office and site preceptor (owner) time were included. The costs of the residentinitiated programs were established and compared with the revenue generated from each of these programs (immunization service, medication administration service). To establish cost savings achieved by a pharmacy resident when completing prescription dispensing requirements, a pharmacist average hourly wage was compared with the resident hourly wage for the time allocated to dispensing. To establish additional revenue and benefit generated by the resident, including programs that were not directly revenue generating, a retrospective-prospective comparison of overall change in revenue, prescription volume, and financial benchmarks were assessed. Results: Research in progress. 375—EVALUATION OF THE USE OF DAPTOMYCIN AND LINEZOLID AT A LARGE UNIVERSITY HOSPITAL. Ojong M, Philadelphia College of Osteopathic Medicine School of Pharmacy, Prue M, George Washington University Hospital, E-mail: mebangaoj@ pcom.edu Objective: The objective of this study is to analyze the use of daptomycin and linezolid at a large university hospital. Methods: A drug inquiry report ja p h a .org was utilized to identify inpatients who received daptomycin, linezolid, and vancomycin from January 1, 2013 to July 31, 2013. A total of 150 charts of patients (50 patients each who were treated with vancomycin, daptomycin, and linezolid) admitted for skin and soft tissue infections, bacteremia, pneumonia, osteomyelitis, kidney infection, or urinary tract infection were evaluated for inclusion in the study. Patients’ profiles were then accessed and the following data were collected: demographics (age, sex), cost of drug, site of infection, whether vancomycin was first utilized in patient, and drug allergy to vancomycin. Chi-square and analysis of variance (ANOVA) were utilized for statistical analysis. The primary endpoint was to evaluate use of daptomycin and linezolid at this hospital. The secondary endpoint was to evaluate the cost of therapy associated with the use of daptomycin and linezolid. Results: The average duration of therapy for the vancomycin control group hospital stay was 4.16 days, and 4.06 days and 6.56 days for linezolid and daptomycin, respectively. An ANOVA analysis found that the duration of therapy among the 3 drug treatments were equal (P = 0.11). For patients on linezolid, a chi-square test found that use of linezolid prior to vancomycin was independent of the site of the infection (P = 0.155329). For daptomycin-treated patients, a chi-square test also found that use of daptomycin prior to vancomycin was independent of the site of infection (P = 0.403389). Conclusion: Overall, vancomycin was not utilized as mainstay therapy, as recommended by the Infectious Diseases Society of America guidelines. The use of daptomycin or linezolid, as firstline agent, did not decrease duration of therapy. The clinical significance of these effects must be determined in a larger sample size, long-term evaluation. 376—EXPOSURES TO PHARMACEUTICAL DUST IN PHARMACIES USING AUTOMATIC DISPENSING MACHINES. Fent K, Tapp L, CDC/ NIOSH/USPHS, E-mail: [email protected] Objective: The main objective of this study was to characterize employees’ Journal of the American Pharmacists Association APhA2014 ABSTRACTS exposures and health effects from pharmaceutical dust at 3 pharmacies using automatic dispensing machines (ADMs). Methods: Real-time particle monitoring was used to identify tasks that generated pharmaceutical dust; 72 inhalable dust air samples were collected in or near the employees’ breathing zones and 57 air samples were selected for analysis of lactose, a common excipient in tablets. The real-time particle monitoring results, observations, and information from employees on the dustiness of pharmaceuticals were used to select 28 air samples for analysis of specific active pharmaceutical ingredients (APIs). Medical interviews were conducted with 116 employees at 2 pharmacies. Results: Pharmaceutical dust was generated during tasks such as emptying and refilling ADM canisters. Cleaning canisters and manual count machines using compressed air produced the highest peak number concentrations of particles. Employees refilling, cleaning, or repairing ADM canisters, or hand-filling prescriptions were exposed to higher median air concentrations of lactose (5.0– 12 µg/m3) than employees doing other job tasks (0.04–1.3 µg/m3). Ten APIs were detected in air, including lisinopril, levothyroxine, and methotrexate. Three air concentrations of lisinopril (1.8–2.7 µg/m3) exceeded the lower bound of the manufacturer’s hazard control band (1–10 µg/m3). All other API air concentrations were below applicable occupational exposure limits. More than 35% of the interviewed employees reported mucous membrane irritation, which could be caused by occupational factors such as pharmaceutical dust exposure as well as non-occupational factors. Conclusion: These findings indicate that pharmacy employees could be exposed to multiple APIs. Potential health effects from the exposures are not well understood but could include mucous membrane irritation. Measures are needed to control these exposures and thereby minimize the potential for adverse health effects. 377—IDENTIFYING PERFORMANCE BEHAVIORS AND EXPECTATIONS OF PRACTICE-BASED RESEARCH NETWORK CLINICIAN MEMBERS. Patterson B, Stoner S, University of Iowa, Doucette W, University of Iowa College of Pharmacy, Levy B, Carter B, Urmie J, Schroeder M, University of Iowa, E-mail: brandon-patterson@ uiowa.edu Objective: Practice-based research networks (PBRNs) are opportunities for health care professionals, including pharmacists, to participate in knowledge creation focused on improving health care delivery and outcomes for realworld patients. PBRNs are diverse and complex organizations dependent upon committed and productive clinician members participating in all research stages, from conceptualization to dissemination. Currently, no tools exist that can help PBRN directors evaluate the performance of their members, which is critical for developing productive practice-based research partners. The objective of this study was to identify expected and experienced PBRN clinician member performance behaviors. Methods: As part of a larger study on leadership and performance in PBRNs, 32 semi-structured interviews were conducted with 16 PBRN directors and 16 non-director participants (e.g., clinician members) selected using a maximum variation strategy. Interview questions addressed performance expectations as well as positive and negative critical incidents experienced with clinician members while completing PBRN projects. Interview questions were piloted with experienced PBRN directors and participants from 2 PBRNs. After transcription, interview data were randomized. Two researchers used a systematic behavioral item coding process that evaluated both content validity and reliability of their analysis. Disagreements were resolved and performance domains were identified through a consensus-forming process involving both researchers. Results: PBRN clinician member performance was discussed in 30 of 32 interviews, which averaged 26 minutes. Twenty-two behavioral item codes were generated. Content validity and reliability of item generation were statistically demonstrated. A consensus process was used to identify 4 performance domains: Journal of the American Pharmacists Association Downloaded From: http://mustafa.japha.org/ on 06/09/2014 j apha.org commitment, leadership, awareness, and communication, within the data that were face validated by 2 experienced PBRN directors. Conclusion: Evaluation of clinician member performance within a PBRN should focus on commitment, leadership, awareness, and communication. Future research should evaluate factors contributing to increased performance, which would be valuable to PBRN directors interested in developing clinician practice research partners. 378—IMPACT OF A TRANSITIONS OF CARE TRAINING MODULE ON COMMUNITY PHARMACISTS’ KNOWLEDGE AND ATTITUDES. Powers M, Azzi A, Lengel A, Mangan M, University of Toledo, E-mail: andrew. [email protected] Objective: The objectives of this study are to: (1) develop a transitions of care training module for community pharmacists; and (2) assess the training impact of the training module on pharmacists’ transition of care knowledge and their attitude toward actively participating in the transition of care for their patients. Methods: The Affordable Care Act mandated in the 2013 fiscal year that up to 1% of Medicare payments may be withheld due to excessive 30-day hospital readmission rates for 3 conditions. In fiscal years 2014 and 2015, Medicare payments may be withheld increasingly, with 4 more conditions being monitored in 2015. Nationally, two-thirds of all eligible hospitals were penalized in 2013 based on excessive 30-day readmission rates for a total of $280 million. The ease of patient access and medication history situates community pharmacists to have a significant impact in the transitional care of patients. The purpose of this study is to prepare community pharmacists to provide transitional care for their patients post discharge. The study sample will be composed of pharmacists employed by a supermarket pharmacy chain. Volunteer participating pharmacists will attend an approximately 2-hour transition of care educational session. Participants will complete a pre- and post-survey immediately prior to and MA R /APR 2014 | 54:2 | JAPhA e213 APhA2014 ABSTRACTS following the educational session, in addition to a course evaluation. The survey will be used to assess the impact of the educational session on pharmacists’ ability to participate in a transition of care program. The attitude assessment will consist of a 5-point Likert scale format with the knowledge-based assessment composed of true/false and multiplechoice questions. SPSS version 21.0 will be used to generate descriptive and nonparametric statistical analyses. This study has been submitted for approval by the university’s institutional review board. Results: Research in progress. 379—A MULTIDISCIPLINARY INTERVENTION FOR REDUCING READMISSIONS AMONG OLDER ADULTS IN A PATIENT-CENTERED MEDICAL HOME. Remington T, University of Michigan Health System and College of Pharmacy, Stranges P, St. Louis College of Pharmacy, Marshall V, Walker P, University of Michigan, Hall K, Griffith D, University of Michigan Health System, Guhad A, University of Michigan, E-mail: [email protected] Objective: The objective of this study was to assess the impact of a multidisciplinary transitions of care (TOC) intervention on rehospitalization rates among older adults. Methods: This was a case-controlled, retrospective cohort study of a TOC intervention based in a patient-centered medical home providing primary care to geriatrics patients. Patients ≥60 years of age who were discharged from a large academic hospital and received care in the health system’s outpatient clinics were included; 197 patients who received the TOC intervention were compared with 985 matched controls who received “usual care” in other clinics. The primary outcome was all-cause 30-day rehospitalization rates. Logistic regression was used to test the effect of covariates on the study outcome and adjusted for possible confounders in matched subjects. Results: Rehospitalization rate was lower among patients receiving TOC intervention compared with matched controls (11.7% vs. 21.9%, P = 0.01). Further e214 JAPhA | 5 4:2 | M AR/AP R 2014 Downloaded From: http://mustafa.japha.org/ on 06/09/2014 analysis demonstrated lower rehospitalization rate among patients who had a pharmacist included in the TOC interdisciplinary team, compared with those who did not have a pharmacist included (11.7% vs. 21.3%, P = 0.006). Conclusion: A clinic-based TOC intervention targeting older adults can substantially reduce rehospitalizations, with attendant costs and morbidity. Pharmacists can contribute through care management, medication reconciliation, and comprehensive medication reviews. 380—N-ACETYL CYSTEINE BLUNTS IMPACT OF PROTEASOME INHIBITION IN A GLUTATHIONEINDEPENDENT MANNER. Jiang E, Duquesne University, Rumble J, Penn State University, Unnithan A, Pulugulla S, Choi H, Posimo J, Titler A, Leak R, Duquesne University, E-mail: asu3201@ live.com Objective: N-acetyl cysteine (NAC) has been shown to improve cognition in patients with Alzheimer’s disease and to prevent the neurological symptoms of blast injury in soldiers during combat. NAC is also used in some psychiatric conditions. Most studies assume that NAC works by raising the antioxidant glutathione. However, NAC was observed to raise heat shock protein 70 (Hsp70) levels in neuronal cells treated with the proteasome inhibitor MG132. MG132 prevents the proteasomal degradation of misfolded proteins that are tagged with a ubiquitin tail and is frequently used in cellular models of neurodegeneration. Hsp70 helps refold misfolded proteins and guides ubiquitinated proteins to the proteasome for clearance. The present study therefore tests the hypothesis NAC protects neuronal cells by facilitating the Hsp70 response to stress. Methods: Neuroblastoma N2a cells were treated with NAC and the peptide aldehyde MG132, a reversible inhibitor of proteasomal degradation of misfolded proteins. Hsp70 ATPase activity was inhibited with the compound VER155008. Viability was assessed by 3 independent and unbiased assays: (1) an ATP assay (Cell Titer Glo) and (2) by staining for the cytoskeletal protein alpha-tubulin or (3) for the nucleus and cytoplasm with inja p h a .org frared DRAQ5 + Sapphire. Results: NAC shifted the MG132 dose-response curves to the right in all 3 assays, confirming that NAC protected N2a cells against MG132 toxicity. NAC increased Hsp70 levels in MG132-treated cells and attenuated MG132-induced increases in misfolded, ubiquitinated proteins. No parallel change was elicited in heat shock cognate 70 (Hsc70), a closely related member of the heat shock protein family. Inhibition of Hsp70 activity with VER155008 attenuated the protection afforded by NAC in a dose-responsive manner. VER155008 also prevented the reduction in ubiquitinated proteins by NAC. These data reveal that NAC can no longer reduce levels of misfolded proteins or protect N2a cells from MG132 toxicity when Hsp70 activity is inhibited. Conclusion: NAC protects neuronal N2a cells from proteasome inhibition by raising the Hsp70 chaperone protein. Proteasome inhibition is relevant to neurodegenerative disorders because protein-misfolding stress is a central feature of these conditions. If findings of this study can be generalized to the human brain, they may explain why NAC was effective in multiple double-blind, placebo-controlled clinical trials. These findings therefore broaden the potential mechanisms of action of this dietary supplement. 381—NANOTECHNOLOGY FOR TOXICOLOGY: PRELIMINARY RESULTS OF IN VITRO ADSORPTION STUDIES COMPARING HALLOYSITE NANOTUBES TO ACTIVATED CHARCOAL. Israel M, University of Louisiana Monroe, Weisman J, Louisiana Tech University, Khaled K, Louisiana State University, Mills D, Louisiana Tech University, E-mail: [email protected] Objective: Overdose of toxic compounds can be treated with activated charcoal or chelating agents. Activated charcoal does not adsorb heavy metals well or certain charged molecules. Currently, there are few studies looking at using nanotechnology for toxicology. Halloysite clay nanotubes are biocompatible aluminum silicate tubes that average a 15 nanometer diameter and Journal of the American Pharmacists Association APhA2014 ABSTRACTS large lumen surface area. Halloysite nanotubes are naturally occurring clay deposits that are affordably mined. The purpose of this study is to determine whether nanotechnology such as halloysite nanotubes could adsorb substances comparably to activated charcoal. Methods: A 1 mg/mL solution of boric acid was created to act as a solution of interest. Boric acid was chosen as a substrate for preliminary studies due to size, previous spectrophotometry work, and cost. Then 1 mL of this boric acid solution was placed into 2 sets of 5 test tubes. Each set of test tubes had a 1 mL solution of boric acid per tube then 5 mg, 10 mg, 25 mg, 50 mg, or 100 mg of either halloysite nanotubes or activated charcoal were added. The test tubes were vortexed then placed on a shaker. After 1 hour, a sample was drawn from each tube to determine the level of boric acid remaining in the supernatant via spectrophotometry. A NanoDrop spectrophotometer was used at the 260 nm wavelength of light. The resulting absorbance of light and concentrations of the remaining substrate was recorded and charted for comparison. Results: Research in progress. Halloysite adsorbed solution depending upon halloysite concentration. Activated charcoal samples were able to adsorb, although not as well as activated charcoal normally adsorbs. A gram of halloysite has a surface area in excess of 69 square meters and activated charcoal has in excess of 500 square meters. The completed data set will compare these compounds. 382 — PH A R M AC IST-PROV IDED MEDICATION MANAGEMENT SERVICES IN TRANSFORMATIONAL PRIMARY CARE PRACTICES. Smith M, University of Connecticut School of Pharmacy, E-mail: marie. [email protected] Objective: The objectives of this study are to: (1) describe the type and extent of pharmacist-provided medication management services (MMS) in the Center for Medicare and Medicaid Innovation Comprehensive Primary Care (CPC) program; (2) compare the pharmacist and physician leader responses about CPC MMS to identify any percep- tion “gaps”; and (3) identify policy implications for scalable and sustainable primary care MMS. Methods: A 20-question survey instrument was developed based on a comprehensive literature review and the author’s research with medical homes and community-based health care teams. Online surveys will be sent in October 2013 to a pharmacist and clinical leader (usually a physician) at each of the 29 CPC practices that included pharmacists on their CPC team. Reminder notices will be sent to all nonrespondents at 1 and 2 weeks after fielding the survey. The survey will collect pharmacist demographics, type and extent of pharmacist-provided MMS, workflow integration of MMS into primary care practices, and value of pharmacist-provided MMS. The online survey software (Qualtrics) will be used to compile the results. The study will provide descriptive data for the pharmacist demographics, and will identify any perception gaps between pharmacists and clinician leaders on the provision, clinical impact, and value of pharmacist-provided MMS. Results: Research in progress. Survey will be fielded in October 2013 with final results compiled in November 2013. The implications are: (1) better description of pharmacist-provided MMS in innovative, national health care transformation programs; (2) Centers for Medicare and Medicaid–supported program with high national visibility can scale pharmacist-provided MMS; (3) multiple payers (Medicare, Medicaid, and several commercial plans) involved in the CPC program can be informed about the value of pharmacist-provided MMS for payment policy changes. 383—PHARMACISTS MAKE HOUSE CALLS? A DESCRIPTION OF AN INNOVATIVE COMMUNITY PHARMACY PRACTICE MODEL. Passafiume S, Brody Jr. P, University at Buffalo, Comerford Jr. P, Trzewieczynski D, Andrus Jr. K, Mobile Pharmacy Solutions, Monte S, University at Buffalo, Email: [email protected] Objective: This project aims to describe innovative services provided by community pharmacists, with an em- Journal of the American Pharmacists Association Downloaded From: http://mustafa.japha.org/ on 06/09/2014 j apha.org phasis on the home visit component of a unique practice model. Methods: Ten innovative services have been implemented by pharmacists at a community pharmacy in Buffalo, New York. The services are as follows: inbound phone call triage to a clinical pharmacist–managed hub; outbound adherence phone calls linked to home delivery scheduling; medication refill synchronization and customized adherence packaging; extemporaneous compounding; certified public accountant– managed patient accounts receivable; free home delivery with an option for mailing or personal courier; pharmacist home visit; community pharmacist liaison; utilization of an electronic medical records interface; and a 24/7 on-call pharmacist. The study cohort will be drawn from a population of patients who received home visit services during the study period of August 2012 through August 2013. The following information will be collected for each patient: age, sex, insurance type, referral source, zip code, chronic medications, and chronic disease states. Data on travel time and pharmacist preparation time also will be collected. This study will describe the types of patients visited, the types of referrals, as well as the time and financial expense associated with sending pharmacists to the patient’s home. Evidence that home visits are adaptable into a community pharmacy practice model is critical for expanding the role of the pharmacist in evolving health care paradigms and moving toward sustainment of new payment sources for community pharmacy. Results: Research in progress. 384—PHARMACISTS’ AWARENESS AND SELF-EFFICACY OF RESOURCES AVAILABLE FOR SPANISH-SPEAKING PATIENTS. Devraj R, Marchello A, Southern Illinois University–Edwardsville, Pearson, Jr. M, Walgreens, E-mail: [email protected] Objective: Hispanics, the largest minority group in the United States, face challenges communicating with pharmacists, negatively impacting their medication use and outcomes. Evidence is lacking regarding pharmacists’ MA R /APR 2014 | 54:2 | JAPhA e215 APhA2014 ABSTRACTS knowledge about available resources to communicate with Spanish-speaking patients. The study objectives were to: (1) determine Illinois pharmacists’ knowledge about types of Spanish-speaking resources (SSR); (2) determine frequency, accessibility, and usefulness of available SSR; and (3) determine pharmacists’ selfefficacy in handling Spanish-speaking patients. Methods: A survey addressing the study objectives was designed and pilottested with 10 community pharmacists. The final survey, currently administered over the phone, consists of items addressing: (a) types of available SSR, including how often, easy, and helpful they were; (b) pharmacists’ self-efficacy in handling Spanish-speaking patients, determined using a previously validated 9-item instrument; and (c) demographics. Items enquiring about how often, easy, and helpful the resources were belonged to a 5-point scale (1 = never; 5 = always). Using 3 sources (i.e., Superpages.com, Zipcodes.com, and Quickfacts.census.gov) a random sample of 10% of pharmacies from counties with low concentrations of Spanish-speaking patients and 20% of pharmacies with high concentrations of Spanish-speaking patients were identified to form the study sample. Data collection is ongoing with more than 80% (n = 200) of the data collected to date from the 231 pharmacies that are part of the study. This study was approved by the university’s institutional review board committee. Data will be analyzed using frequencies, t tests, and chi-squares. Results: Research in progress. The top 3 types of resources available to pharmacists were computer-based resources (91.5%), patients’ family members (81.4%), and phone help lines (77.4%). Among the computer-based resources, computer-generated prescription labels (mean = 1.94 + 1.50), and leaflets (mean = 1.89 + 1.42) were used most often, were easy to use (labels mean = 3.43 + 1.76; leaflets mean = 3.43 + 1.72), and helpful (mean = 3.49 + 1.82; mean = 3.34 + 1.85). Self-efficacy item means ranged from 2.74 + 1.36 to 3.87 + 1.29 based on a 5-point scale (1 = not at all confident; 5 = extremely confident). e216 JAPhA | 5 4:2 | M AR/AP R 2014 Downloaded From: http://mustafa.japha.org/ on 06/09/2014 385—PHARMACY PRACTICE MODEL TO ADVANCE THE HEALTH AND WELL-BEING OF PATIENTS. Thompson B, Hennepin County Medical Center, E-mail: bruce.thompson@ hcmed.org Objective: The primary objectives are to improve the health of patients by decreasing the 30-day readmission rate, reducing preventable adverse events, and reducing the cost of care. This is accomplished by maximizing the use of pharmacists during the transitions of care. Methods: Initial work with a pharmacist-driven discharge medication reconciliation model for patients transferred to skilled nursing facilities (SNF) was followed up with a total care model in a controlled patient population with capitated payments much like an accountable care organization (ACO) model. Pharmacy worked with the hospital and clinics to further enhance the medical home model to focus on patient health. Pharmacists provide discharge medication reconciliation and patient follow-up within 3 to 5 days post-discharge with medication therapy management (MTM) visits. Patients in the population who were high risk for hospitalizations were identified and MTM visits were arranged, which proved valuable in reducing total health care expenses. Pharmacy worked on patients’ behalf to provide medications when financial barriers exist. Results: The SNF patient 30-day readmission rate decreased by more than 40% when pharmacists provided discharge medication reconciliation from the hospital while essentially eliminating preventable adverse medication events. The reductions in readmissions have been sustained for the past 4 years. The ACO model reduced emergency department visits by 37% and hospitalizations by 42% thus saving approximately $2,500 per patient annually in this 8,000-patient cohort. Conclusion: Pharmacy has improved and expanded services to benefit the medical center’s patients, improve safety, and improve quality in this health system. The use of pharmacy personnel has been maximized to allow pharmacists additional time to provide patient ja p h a .org care. This transition of care model has shown to provide value to patients, be financially viable, sustainable for the past 4 years, and transferable to other health systems. 386—PHARMACY STUDENTS HELP LAUNCH THE CONNECTICUT HEALTH INSURANCE MARKETPLACE. Kirchhoff K, Wang J, Sounthonevat C, Smith M, Tyczkowski P, University of Connecticut School of Pharmacy, E-mail: marie.smith@uconn. edu Objective: This project aimed to: (1) create summer internships for doctor of pharmacy (PharmD) students with the Connecticut Health Insurance Marketplace (CTIM); (2) assist the CTIM with statewide implementation of a health care marketplace as part of the Affordable Care Act (ACA); and (3) train PharmD students to provide in-person assistance to help people choose the best individual or family health care plan. Methods: Pharmacy faculty met with CTIM leaders to create a paid summer internship program for PharmD students. Interns launched the outreach and enrollment campaign for the CTIM. Students developed field-testing scripts for outreach workers and in-person assistors (navigators), collected data on uninsured populations to determine high-density regions of Connecticut, and created a visual image of the state’s uninsured population. Interns also organized outreach activities throughout the state including festivals, concerts, and storefronts to advocate and educate consumers about ACA and CTIM. Student pharmacist organizations were contacted to participate in the CTIM grant program to train in-person assistors to help Connecticut residents enroll in a health care plan. Results: During summer 2013, 3 PharmD students worked full-time for 10 weeks on multiple outreach activities. They talked to 5,480 individuals and collected lead generation information for 400 individuals. Consumer interest and lead generation was higher when opening questions to engage consumers about ACA or CTIM were as follows: “Have you heard of the tax penalties in 2014 if you do not have health insurance?” Journal of the American Pharmacists Association APhA2014 ABSTRACTS and “Did you know you might save on health insurance with just 2 minutes of your time?” The CTIM in-person assistor training program was completed by 9 PharmD students, resulting in $18,000 for student pharmacist organizations. Conclusion: Pharmacy school faculty and students can be active participants in health care advocacy and reform. As accessible health care professionals, pharmacists should anticipate patient questions about ACA as well as the state and federal insurance marketplace. Pharmacists and PharmD students can be trained as in-person assistors to facilitate the consumer enrollment into health care plans. 387—PHYSICIANS’ VIEWS OF COMMUNITY PHARMACY EMERGENCY SUPPLY/REFILL DISPENSING PRACTICES. Noureldin M, Purdue University, DeJager M, Target, Myers J, Plake K, Purdue University, E-mail: [email protected] Objective: The aim of this study is to explore physicians’ views of community pharmacy prescription medication lending practices (also known as emergency supply/refill dispensing). Methods: Five hundred physicians were randomly selected from the Indiana Medical Licensing Board database and sent a 25-item mail survey. Data were collected from October to December 2012. The survey explored physicians’ views of pharmacists’ lending of 10 different prescription medications to patients on Monday and Saturday evenings as well as physicians’ views toward medication lending based on patients’ duration of therapy (<1 month, 1–3 months, >3 months, >6 months). A 5-point Likert scale (1 = strongly disagree; 5 = strongly agree) was used to assess level of agreement with each statement. A demographic section included sex, age, race/ethnicity, specialty practice, and physicians’ previous awareness of medication lending. Descriptive statistics and nonparametric tests were performed. Results: A total 114 physicians completed the survey (response rate 22.8%); 68% of respondents were male, 75.9% were white, and 22.1% identified family medicine as their specialty. Fifty-eight percent of respondents were previously unaware of lending practices. Physicians agreed (>70% strongly agreed or agreed) with pharmacists’ emergency lending of phenytoin, albuterol, and clopidogrel; disagreed (>70% strongly disagreed or disagreed) with lending of hydrocodone/acetaminophen, zolpidem, or sildenafil; and respondents were split (40%–60% agreement) on lending rosuvastatin, sumatriptan, escitalopram, and ethinyl estradiol/drospirenone. For 9 out of 10 medications, physicians’ agreement with lending increased for Saturday compared with Monday evening (P<0.05). There also was a trend of increased agreement toward lending medications with increased duration of therapy. Conclusion: The majority of physicians were unaware of prescription medication lending in community pharmacies and had mixed opinions regarding this practice. Medication lending/emergency refill dispensing is an accepted but unexplored practice in community pharmacies. Additional studies may shed light on its prevalence, attitudes toward medication lending, and its impact on patient care. Q 388—REDUCING THE RISK OF INADEQUATE SEDATION DURING RAPID SEQUENCE INTUBATION IN THE EMERGENCY DEPARTMENT SETTING. Nengchu P, Tripler Army Medical Center, E-mail: [email protected] Objective: The objective of this study is to reduce the risk of inadequate sedation during rapid sequence intubation in the emergency department (ED). Methods: The emergency department (ED) clinical pharmacist identified variation in drug selection and timing during rapid sequence intubation (RSI). A retrospective chart review showed that post-intubation sedation was sometimes omitted or delayed. Factors such as drug selection, sequence timing, and post-intubation sedation issues were recorded for each encounter. A 1-year pharmacy education initiative focused on nursing and provider staff. A mandatory lecture available by compact disc Journal of the American Pharmacists Association Downloaded From: http://mustafa.japha.org/ on 06/09/2014 j apha.org and an RSI quiz was administered to all nursing staff. Educational lectures about the RSI drug selection and timing issues identified at the medical center were given to both nursing and provider staff. After the education initiative was complete, 100% of patients who underwent RSI were identified and included in a 3-month post-education initiative chart review. Results: The pre-initiative chart review revealed that 18% of patients did not receive any sedatives post-intubation and 15% of patients possibly had paralysis without sedation based on the timing of drug administration. After the education initiative by the ED pharmacist, variability in drug selection decreased. Only 1 patient did not receive a sedative post-intubation due to immediate transfer of care and no patients possibly had paralysis without sedation based on the timing of drug administration. Conclusion: Education initiatives by the ED pharmacist can improve the timing and selection of drugs utilized in RSI to improve patient safety and comfort in the ED. [The views expressed in this publication/presentation are those of the author(s) and do not reflect the official policy or position of the Department of the Army, Department of Defense, or the U.S. Government.] Original Citation: Reducing the risk of inadequate sedation during rapid sequence intubation in the emergency department setting. 389—REVIEW OF HEADACHE AND MIGRAINE-RELATED APPLICATIONS AVAILABLE FOR SMARTPHONES. Murray K, O’Neal K, Lamb M, Carter S, University of Oklahoma College of Pharmacy, E-mail: [email protected] Objective: Evidence suggests that educational tools may be beneficial to migraineurs to manage their condition and help to ameliorate the severity of their disease. This study aims to: (1) identify migraine-related applications available for smartphones; and (2) categorize the content of these applications according to the following criteria: background information, consumer ratings, technical capability, and patient-focused criteria MA R /APR 2014 | 54:2 | JAPhA e217 APhA2014 ABSTRACTS based on the available description of the application from the seller. Methods: This study utilizes content analysis in a cross-sectional design to systematically categorize product descriptions of migraine-related applications advertised in the iTunes application “store” using the search terms migraine and headache. Two clinical pharmacists will search for applications during a specified time window and enter content in the data abstraction form, following their training by the project investigator on operational definitions, coding, and other information on content analysis procedures. Open-ended data will be coded and viewed by an additional rater for agreement on coding categories. Coding will be based on majority rule. kappa statistics will be used to discern inter-rater reliability. Descriptive statistics will be used to address the study objectives. Applications deemed unrelated to migraines by reviewer consensus will be excluded from analysis. Results: Research in progress. The piloting of this study is complete and the data abstraction tool has been finalized. A full review of available migraine-related applications for smartphones using these search terms identified 227 applications, including those that appeared in both search term results. Final data procurement and data analysis of abstracted variables will occur until January 2014. The evidence from this study is intended to help describe the type of applications available for use by patients with migraines and headaches and provide clinicians with more information about which applications offer certain specific and relevant features. 390—STUDENT PHARMACISTS’ INVOLVEMENT IN LEADERSHIP ROLES. Lloyd A, Elmore L, Samford University, E-mail: [email protected] Objective: Student leadership within pharmacy school is highly encouraged, and it may aid students in differentiating themselves from their classmates. Volunteerism also may enhance effective communication, peer collaboration, and strategic planning. The purpose of this cross-sectional study was to: (1) quantify students serving in leadership positions; e218 JAPhA | 5 4:2 | M AR/AP R 2014 Downloaded From: http://mustafa.japha.org/ on 06/09/2014 (2) determine how satisfied students are with their pharmacy education; and (3) determine whether they desire additional leadership opportunities. Methods: Following institutional review board approval, an adapted version of a previously validated, 24-question survey with quantitative and qualitative questions was distributed to first-, second-, and third-year pharmacy students before class by the student researcher. Students were informed that this survey was anonymous and participation was voluntary. Survey items assessed student involvement, grade point average (GPA), and desired level of involvement. Results: The survey was completed by 209 students: 65 students (56.5%) from the first-year class, 66 students (52.8%) from the second-year class, and 78 students (65.3%) from the third-year class. Qualitative analysis revealed that 48% of students held at least 1 leadership role within the school; 32% of those students held 2 leadership positions; 15% held 3 positions; and 0.2% held 5 positions. Fifty-four percent of students were satisfied with their GPA (self-reported), and 72% of respondents were satisfied with their overall experience in pharmacy school. Sixty-eight percent of students said they would be more involved within extracurricular activities given an ideal situation (enough time, money, etc.). Conclusion: Data show that half of the students have some leadership position. This may reveal a need for education early in the curriculum that will aid students in selecting the most appropriate leadership opportunities. Given that students desire to hold additional leadership opportunities, the number of leadership opportunities within the school may be expanded. Q 391—USE OF APIXABAN AND WARFARIN IN PATIENTS UNDERGOING INVASIVE PROCEDURES: INSIGHTS FROM ARISTOTLE. Lopes R, Duke University Medical Center, Garcia D, University of Washington, Wojdyla D, Duke Clinical Research Institute, Dorian P, St. Michael’s Hospital, The University of Toronto, Alexander J, Duke University Medical Center, Wallentin L, Uppsala University, Lanas F, ja p h a .org Universidad de La Frontera, Hanna M, Bristol-Myers Squibb, Held C, claes. [email protected], Department of Medical Sciences, Cardiology and Clinical Research Center Granger, Co-Author, Duke University Medical Center Cardiac Care Unit, Department of Cardiology, Email: [email protected] Objective: The purpose of this study is to investigate rates of invasive procedures among patients in the ARISTOTLE (Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation) trial as well as the risk of stroke and major bleeding following invasive procedures. The risk of stroke or systemic embolism (SSE) associated with stopping warfarin for invasive procedures is thought to be low. Little is known about apixaban use in patients undergoing invasive procedures. Methods: Using data from 18,201 patients in ARISTOTLE (median followup 1.8 years), this study described the most common invasive procedures, use of bridging therapy, and risk of stroke and major bleeding during the 30 days following these procedures. Procedures were classified as major if they required general anesthesia or were considered to pose a significant postoperative bleeding risk. Investigators classified procedures as emergent or nonemergent. Results: There were 11,417 invasive procedures performed in 6,162 patients: 477 (4.2%) were major and 10,940 (95.8%) nonmajor; 322 (2.8%) were emergent and 11,095 (97.2%) nonemergent. The most common procedures were dental extraction/oral surgery, colonoscopy, upper endoscopy, and ophthalmic surgery. In 4,082 procedures (35.8%), study drug was not stopped. Median time of study drug stop was 4 days before the procedure for both apixaban- and warfarin-treated patients. A second bridging anticoagulant, most commonly lowmolecular-weight heparin, was used in 1,335 procedures (11.7%). Of 5,660 events in the apixaban group, 0.43% were associated with SSE and 1.55% with major bleeding. Of 5,757 events in the warfarin group, 0.56% were associated with SSE and 1.80% with major bleeding. Conclusion: Invasive procedures are common in patients with atrial fibril- Journal of the American Pharmacists Association APhA2014 ABSTRACTS lation. Most procedures are nonmajor and nonemergent, and anticoagulation therapy is likely to be stopped periprocedure. Overall and among emergent procedures, rates of clinical events in the first 30 days post-procedure were low and comparable between patients receiving warfarin and apixaban. Original Citation: Lopes RD, Garcia DA, Wojdyla D, Dorian P, Alexander JH, Wallentin L, Lanas F, Hanna M, Held C, Granger CB. Use of apixaban and warfarin in patients undergoing invasive procedures: insights from ARISTOTLE. Presented at: Annual congress of the European Society of Cardiology; August 31-September 4, 2013; Amsterdam, Netherlands. Eur Heart J. 2013;34(suppl):98-99. 392—VALIDITY OF CARDIOVASCULAR RISK PREDICTION MODELS IN KIDNEY TRANSPLANT RECIPIENTS: A SYSTEMATIC REVIEW. Mansell H, Stewart S, Shoker A, University of Saskatchewan, E-mail: [email protected] Objective: The objective of this systematic review was to assess the validity of cardiovascular risk prediction models in kidney transplant recipients. Pharmacists can play a role in cardiovascular risk assessment within the community or as part of the transplant team. Cardiovascular disease is the leading cause of mortality in kidney transplant recipients and although evidence is lacking, risk-scoring methods used in the general public are often applied to this population. Methods: The protocol was registered in Prospero, an international database of prospectively registered systematic reviews in health and social care. Five databases (MEDLINE, EMBASE, SCOPUS, CINAHL, and Web of Science) were searched and 2 investigators independently reviewed the abstracts. Cohort studies involving the ability of a risk scoring system to identify cardiovascular events in renal transplant recipients, with at least 1 year of follow-up were included. Data extraction included variables that described population characteristics, study design, and prognostic performance. Risk of bias was evaluated using the QUIPS tool. Results: Seven studies met criteria for inclusion: 5 investigated the Fram- Journal of the American Pharmacists Association Downloaded From: http://mustafa.japha.org/ on 06/09/2014 j apha.org ingham risk score; 3 used a transplantspecific model; and 2 utilized a 7-year risk major adverse events calculator. Sample sizes ranged from 344 to 23,575, and 3 studies lacked sufficient event rates to confidently reach conclusion. Potential for bias was present in all the papers, though only 1 manuscript had significant bias. Four studies reported discrimination (as measured by c statistic), which ranged from 0.701 to 0.75, and only 1 risk model was both internally and externally validated in kidney transplant recipients. Conclusion: While the Framingham has underestimated cardiovascular events in renal transplant recipients, these studies have not been robust. Recently, a transplant-specific risk prediction model has been externally validated. Comprehensive validation in multiple cohorts and impact analysis is recommended, however, before widespread clinical application is advocated by pharmacists and other health professionals. MA R /APR 2014 | 54:2 | JAPhA e219
© Copyright 2024 Paperzz