Abstract
Advanced Practice with HIV population: Integrating Medication Therapy Management, Research, and Sociobehavioral Skills
Lillian Arce, Pharm D, RPh, CMTMP1, Georgina Silva-Suarez, PhD1, Silvia Rabionet, EdD2 and Carmen Zorrilla, MD3
(1)Nova Southeastern University, San Juan, PR, Puerto Rico, (2)Nova Southeastern University; University of Puerto Rico, Fort Lauderdale, FL, (3)University of Puerto Rico, Medical Sciences Campus, San Juan, PR
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Background: Pharmacists play a key role in the care of patients with HIV. Studies have demonstrated the benefits of incorporating a pharmacist in the multidisciplinary team that provide care to HIV patients. However, pharmacy students have limited opportunities to interact with HIV patients.
Methods: Advanced practice students at Nova Southeastern University, College of Pharmacy at the Puerto Rico Regional Campus selected a Medication Therapy Management (MTM) rotation in which they participated in an adherence research and perform a comprehensive interviews to HIV-patients. Students asked the patients about health perception, medication adherence, and risks of transmissions of HIV. They explored the patients' socio-demographics characteristics and sexual history. Patients brought their medications and students provided counseling following the tenants of MTM.
Students reflected on their experience by answering questions which explored their perception of HIV and the meaning they ascribed to this experience. They reflected on the skills acquired and on their willingness to continue doing HIV-research.
Results: Eight students completed the rotation. The majority agreed that having this opportunity increased their MTM skills. They reported that it helped them to develop interviewing and communication skills, and empathy towards a population in need. They realized the importance of the role of the pharmacist in caring for HIV-positive individuals. The majority of them further understood the rigors of research and stated that they are interested in participating in HIV-research in the future.
Conclusion: Initiatives like this complement students' academic experiences by providing the unique opportunity to get involved in research among vulnerable population.
Other professions or practice related to public health Social and behavioral sciences
Abstract
Advancing pharmacy student research roles in public health
Peter Hurd, Ph.D.1, Taehwan Park, Ph.D.2, Mara Hofherr1 and Julie Goldman, PharmD
(1)St. Louis College of Pharmacy, Saint Louis, MO, (2)St. Louis College of Pharmacy, St. Louis, MO
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
objectives. By comparing two different writing courses, we identified successful approaches to help pharmacy students complete public health research projects and present their findings at the college's student research symposium (SRS).
methods. A professional writing course was designed to help pharmacy students experience actually doing a public health research project. The class expectation included presenting the project findings at the college SRS. A writing intensive class in which students proposed a public health research project was used as a comparison. Between 2010 and 2015, 26 students enrolled in the doing-research class (DRC) and 65 enrolled in the proposal-development class (PDC).
results. In the DRC, 16/26 students presented a poster compared to 1/65 in the PDC. Successful methods included: faculty identification of interest areas and requiring research in those areas; an integrated class research topic (e.g., in pharmacoeconomics); independent study following the class; and the use of databases or web searches to test hypotheses. Unsuccessful approaches included allowing teams to select their own project, designing interventions without requiring implementation, and blending a didactic focus on public health topics with research methods. Lessons that were learned included: clear class expectations of presentation at the start of class, linking assignments (paper, poster, and oral presentation) to final grade, reminders of the presentation expectation during the semester, and faculty encouragement at the time of abstract submission.
conclusions. With a focused research project and proper faculty guidance, pharmacy students can create a presentable public health research project in one semester.
Biostatistics, economics Other professions or practice related to public health Public health or related education Public health or related research
Abstract
A Pharmacist-Led Multidisciplinary Care Model Providing Hepatitis C Treatment to Uninsured Patients: A Descriptive Analysis
Omar Sims, PhD1, Shaonin Ji, MD, PhD1 and Pam Melton, MSW2
(1)The University of Alabama at Birmingham, Birmingham, AL, (2)The University of Alabama, Tuscaloosa, AL
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Background: A majority of hepatitis C (HCV) patients will not receive treatment because many are uninsured and cannot afford treatment. Mercy Health Center, a small non-profit health agency, is unique in that it provides treatment at no cost to uninsured patients in its HCV clinic utilizing a pharmacist-led multidisciplinary model. The objectives of this study were to describe clinical characteristics of uninsured HCV patients served by the treatment team, report treatment completion and sustained virologic response (SVR) rates, and estimate the amount of HCV medications provided at no cost to uninsured patients.
Methods: A retrospective chart review was performed and identified 69 uninsured HCV patients who received medical care at Mercy Health Center between January 2008 and March 2015. Demographic, medical, psychiatric, substance use, HCV clinical characteristics, laboratory, and medication data were extracted.
Results: Three-fourths of the patients were unemployment, a third had multiple HCV exposures, nearly half acquired HCV due to illicit drug use, and more than half had active psychiatric disorders. Of those who received HCV treatment, 84% completed 12-48 weeks of treatment and 85% achieved SVR. The agency facilitated and provided >$1.3 million of HCV antivirals at no cost to uninsured patients.
Discussion: Findings suggest a pharmacist-led multidisciplinary clinic can achieve HCV treatment completion and SVR rates comparable to traditional physician-led clinics, and successfully manage uninsured and underserved HCV patients—who are often regarded as “difficult-to-treat” patients. These findings underscore the critical role of pharmacists in disease management of HCV infection.
Chronic disease management and prevention Clinical medicine applied in public health Conduct evaluation related to programs, research, and other areas of practice Provision of health care to the public Public health or related research
Abstract
Assessing the impact of the California Patient Medication Safety Act on patient-centered drug labeling
Laurie Hedlund, MPPA1, Michael Wolf, PhD, MPH1 and Stacy Bailey, PhD, MPH2
(1)Northwestern University, Chicago, IL, (2)University of North Carolina, Chapel Hill, NC
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Background
In 2011, California was the first state to pass regulations supporting a standardized patient-centered label to address a known root cause of adverse drug events. Our team sought to determine the effect of the policy on actual pharmacy practice three years after its passage and uncover any barriers to implementation.
Methods
Mixed methods were used: 1) analysis of actual pharmacy labels obtained by the State Board of Pharmacy, and 2) key informant discussions. For the former, 110 labels were collected from 52 pharmacies state-wide. To determine compliance with the law, we examined font size, placement of content on the label, and whether a recommended standard for writing prescription instructions was followed (i.e. ‘morning' and ‘evening' vs. ‘twice daily'). Key informant discussions were held to review label analysis findings and to explore system-level barriers to label changes to identify potential solutions.
Results
Compliance with requirements related to layout of the label varied from moderate (dedicated space for critical information, 53%) to high (font size, 94%). There was low compliance with recommendations to use explicit time points in the instructions (37%) and no pharmacy used full “UMS” instructions. Barriers to implementation were categorized: low awareness, weak enforcement, pharmacist empowerment, workflow, software functionality, and bottle space.
Conclusions
Adoption of the patient-centered drug labeling policy was variable, and recommendations for improved medication instructions was non-existent. Practice challenges to implementation, questionable pharmacy acceptance, and lack of enforcement were all root causes that would need to be addressed to further advance such safety promotion efforts.
Implementation of health education strategies, interventions and programs Public health or related laws, regulations, standards, or guidelines
Abstract
An examination of over-the-counter medication use patterns in Medicare beneficiaries
Cynthia S. Valle-Oseguera, PharmD, APh, BCACP, BCGP1, Daryl Lorraine Marasigan1, Michael Xu, PharmD Candidate1, Elizabeth Qi1, Janet Yoon1 and Rajul Patel, PharmD, PhD2
(1)University of the Pacific Thomas J. Long School of Pharmacy and Health Sciences, Stockton, CA, (2)University of the Pacific Thomas J. Long School of Pharmacy, Stockton, CA
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
background: Over-the-counter (OTC) medication use is often difficult to quantify. Though Medicare beneficiaries have access to a prescription drug benefit (Part D), OTC medication coverage is unavailable for most. We sought to examine the extent to which beneficiaries self-medicate with OTC drugs, the types of products they take, and factors that explain differences in OTC use.
methods: Thirteen Mobile Health Clinics were held in fall 2015. Beneficiaries were offered multiple services including comprehensive medication evaluation and counseling. Health, drug, disease state, and sociodemographic data were recorded during each beneficiary intervention. The type/frequency of beneficiaries' OTC medications were evaluated. Differences in OTC use as a function of beneficiary characteristics were also examined.
results: A total of 866 beneficiaries were provided medication evaluation and counseling. The mean number of OTCs used was 3.30 (SD= 2.51). OTC use varied as a function of gender; females were significantly more likely to be taking vitamins or supplements, while males were more likely to be taking aspirin. OTC use also varied as a function of race; Asians were less likely to take allergy medications, but more likely to take natural health products. White/Caucasians were significantly more likely to take heartburn medications and pain relievers. OTC use patterns also varied as a function of marital status, education level, subsidy status, and certain chronic conditions.
conclusion: A better understanding of OTC medication use by Medicare beneficiaries, most of whom are seniors, can ensure that healthcare professionals are best prepared to provide individualized medication counseling and optimal patient-centered care.
Diversity and culture Other professions or practice related to public health Planning of health education strategies, interventions, and programs Social and behavioral sciences
Abstract
Trends in utilization of original pill bottles vs. pillbox among diverse, low-income patients with chronic disease at a community health center in Massachusetts
Dina Gavrilyuk, BBA1, Sabina Dhakal, MPH1, Cristina Huebner Torres, MA, PhD1, Jeannie Lee, PharmD, BCPS, CGP2, Josephine Korchmaros, Ph.D.3, Molly Totman, MPH1, Susan Shaw, PhD3, Khanh D. Nguyen1 and Yoeli Pacheco4
(1)Caring Health Center, Springfield, MA, (2)University of Arizona College of Pharmacy, Tucson, AZ, (3)University of Arizona, Tucson, AZ, (4)Caring Health Center, Springfield
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Safe medication use is vital in chronic disease management. Pillboxes are often recommended to patients taking prescribed medications multiple times daily to avoid medication intake errors and to improve medication adherence. Our objective is to examine trends in patient utilization of original medication bottles vs. pillboxes among 5 ethnic groups.
Cross-sectional data was used to examine medication management and adherence among patients with chronic conditions taking at least one daily oral medication. In an interviewer-administered survey, participants were asked “How do you organize your medications at home?” Multiple-choice response options included “in original medication bottle/don't use anything” and “daily/weekly/monthly pillbox organizer”. Qualitative data was collected through in-depth interviews.
Out of 320 participants (mean age 57), 67.8% reported using original pill bottles, and 32.2% using a daily/weekly/monthly pillbox. Bottles vs. pillbox utilization varied by ethnic group, with greater pillbox usage among Vietnamese immigrant (37.4%) and African American (36.2%); followed by Russian-speaking immigrant (31.3%), Hispanic (30%), and White (15.6%) participants.
Qualitative data revealed interesting trends among those utilizing pillbox organizers. For instance, some participants used pillboxes as multi-compartment medication storage units or held all of day's medications in a single compartment rather than sorting according to daily regimen.
Preliminary analyses show pillbox usage to be significantly lower compared to original pill bottles. Qualitative findings indicate that some use pillbox organizers in unconventional ways, demonstrating the need for patient education on proper use. Further, assumptions cannot be made about how pillboxes are used or how usage impacts medication safety or adherence.
Assessment of individual and community needs for health education Chronic disease management and prevention Implementation of health education strategies, interventions and programs Other professions or practice related to public health Planning of health education strategies, interventions, and programs Public health or related research
Abstract
Using local legislative opportunities to eliminate the sales of tobacco in San Mateo County, California
Bob Gordon, MPH1, Gloria B. Soliz, MDiv, CTTS2, Shaunda Scruggs, MSHS3, Francesca Lomotan, MPH4, Montzerrat Garcia Bedolla5, Karen Licavoli, MPH6 and Chethana Manjunath7
(1)California LGBT Tobacco Education Partnership, San Francisco, CA, (2)PharmTeam, San Mateo County Tobacco Education Coalition, San Francisco, CA, (3)San Mateo County Health System, Belmont, CA, (4)San Mateo County Health, Belmont, CA, (5)Youth Leadership Institute, San Mateo, CA, (6)San Mateo County Tobacco Education Coalition, San Mateo, CA, (7)San Mateo County Health System, San Mateo, CA
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Background: The United States is virtually the only place in the world where pharmacies are in the business of selling tobacco. Pharmacists take an oath to improve the lives of their patients, yet a large number of pharmacists and drugstores find themselves working in retail environments that sell tobacco, alcohol and a wide variety of unhealthy foods. Methods: Volunteers interested in advocating for legislative tobacco control policies were recruited by the PharmTeam, a working group of the San Mateo Tobacco Education Coalition. Over a 2 year period, advocates conducted internal strategy sessions, surveyed community member attitudes, met with independent pharmacists, created tobacco-free pharmacy educational materials, made community presentations, met with elected officials, and spoke at City Council hearings. Results: Advocates were successful in passing a tobacco-free pharmacy policy in Daly City, California, the first such policy passed in San Mateo County California. Conclusion: It is imperative for advocates to emphasize that a pharmacy is a place of health. Research, media and community organizing principles all play a role in bringing about a change in what is sold in community drugstores. Policy-makers and the public are generally open to the passage of legislative tobacco-free pharmacy policies, yet it is important to study past successes as well as look at political and economic barriers to passing such policies.
Advocacy for health and health education Public health or related public policy
Abstract
Naloxone Sales without a Prescription in a Community Pharmacy: First 30 Days, 2016
Catherine Felberbaum, Pharm. D. Candidate 2017
St. John Fisher College, Rochester, NY
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Purpose: To improve community health outcomes, a national chain pharmacy became the first in the country to implement naloxone sales without a prescription starting January 15, 2016. Our purpose is to describe the first 30 days of experience with the new policy at an urban national chain pharmacy store in the Northeast staffed by pharmacists 24-hours per day, 7 days per week. Background: Opioid abuse and overdose deaths have reached epidemic proportions in the US. Naloxone is an opioid antagonist which blocks opioids such as oxycodone or heroin from binding to receptors, restoring breathing and consciousness. Methods: Sales data were captured in a database designed specifically to track naloxone sales. Sale dates included in this study are January 15 to February 14, 2016. Total volume of naloxone sales was determined by the database summary property “drug usage report”. The US Census American Factfinder by zip code showed that the typical store neighborhood resident is a 50 year-old Caucasian female. Results: Within the first 30 days of the new national policy to distribute naloxone without a prescription, no sales were recorded at this urban, pharmacy staffed by pharmacists 24-hours per day. Conclusions: The new national chain pharmacy policy of selling naloxone without a prescription may reduce overdose mortality and morbidity only if it results in the distribution of this life saving medication. This new policy may need to be accompanied by the development of precision public health strategies to reach the right population with the right intervention at the right time.
Administer health education strategies, interventions and programs
Abstract
What's pharmacy got to do with it? Getting health education to national audiences through independent pharmacists: A CDC and Good Neighbor Pharmacy case study
April Onufrak
AmerisourceBergen, Conshohocken, PA
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Background: Good Neighbor Pharmacy, a collaborative network of almost 3,000 independently owned and operated pharmacies, has partnered with the Centers for Disease Control (CDC) on a tobacco education campaign. Good Neighbor Pharmacy locations serve as local healthcare destinations in their communities, providing critical access to quality care for almost 12 million patients annually. The role Good Neighbor Pharmacy members play in healthcare makes the brand a perfect model to communicate public health initiatives and in this specific case, directly work with patients to help make quitting a reality.
Methods: It's proven that the CDC's tobacco education campaign encourages smokers to think about quitting. Using open-access content, Good Neighbor Pharmacy generated a smoking cessation mini-site. The mini-site features a quit guide, health news, support advice and recommended products. In addition to the mini-site, Good Neighbor Pharmacy provided pharmacists with collateral to promote smoking cessation to patients: Posters, counter cards, bag stuffers, social media graphics and CDC branded notepads. An 8 week social media campaign accompanied these efforts.
Results: Measurements of success for this partnership include Good Neighbor Pharmacy mini-site web traffic, social media engagement and the increased usage of the CDC 1-800-QUIT hotline.
Conclusions: Pharmacists are no longer just administrating prescriptions. Pharmacists have the ability to reach the public and communicate educational solutions to a number of public health problems. The role of a pharmacist has grown to provide diabetes support and testing, Medicare insurance advice, immunization evaluations, free colorectal screening kits and as seen in this example, smoking cessation support.
Administer health education strategies, interventions and programs Other professions or practice related to public health
Abstract
Describing and assessing attitudes of pharmacy students in a Public Health interprofessional course
Evangelina Berrios-Colon, PharmD, MPH, BCPS, Batoul Senhaji-Tomza, PharmD, MPH, Charnicia Huggins, PharmD, MS and Feng-Hua Loh, BPharm, PhD, MBA
Touro College of Pharmacy, New York, NY
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Background
Pharmacists are integral players in public health, providing disaster preparedness services, health promotion, immunizations and developing health policy. The Institute of Medicine and the American Public Health Association promote teamwork throughout professional disciplines. The tenets of interprofessional education (IPE) are best instilled prior to starting experiential training. Pharmacy students who experience IPE demonstrate improved relations as healthcare providers. However, the scope of published research evaluating students' attitudes prior to taking IPE courses is limited.
Methods
Second-year pharmacy students enrolled in an elective Public Health IPE course were administered a 29-question survey including three sections: demographics, general knowledge, attitudes (via Likert scale). The primary objectives were to describe perceptions of pharmacy students on IPE and to assess beliefs regarding the value of teamwork in the context of a public health course. Descriptive statistics were used.
Results
100% (n=27) of surveys were completed. Most students were female (78%), aged 25-29 (62%) and self-identified as White (41%). Although nearly half (48%) were unfamiliar/vaguely familiar with IPE, 89% strongly agreed/agreed that learning with another discipline would enhance their education. Also,89% strongly agreed/agreed that IPE would be more beneficial in improving teamwork skills than learning in traditional settings. Further, 93% strongly agreed/agreed that IPE would improve relationships after licensure.
Conclusions
Nearly half of pharmacy students were unfamiliar with IPE but were open to learning with other disciplines. Increased opportunities to interact and learn with other disciplines would raise awareness of the benefits
Public health or related education