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Annual Meeting Abstracts 2004 FEATURE E-mail: labauer@u.washington.edu Objective: Because phenytoin is a drug with a low hepatic extraction ratio, the unbound fraction of drug in the serum influences its pharmacokinetics and interpretation of serum concentrations. The objective of this study was to use NONMEM to determine the effects of the above characteristics on phenytoin pharmacokinetics. Methods: A total of 637 hospital inpatients taking phenytoin for seizures were studied; 57% of the patients took one or more of the other drugs, and 32% of the patients had abnormal albumin (1.5 mg/dL). Steadystate phenytoin total and unbound concentrations were measured using the TDx assay system (coefficient of variation 3.841, P 4 mg/day, valproic acid >750 mg/day, aspirin >1,300 mg/day. These patient covariates were statistically significant and decreased the maximum rate of metabolism (V max ) by more than 25%: albumin 3 mg/dL, valproic acid >500 mg/day. Conclusions: Unbound concentrations and unbound fractions of phenytoin should be measured in patients with characteristics that alter protein binding. When patients have more than two covariates present, the unbound fraction can be as high as 30% to 40%. Phenytoin doses should be reduced by 25% or more in patients with characteristics that decrease V max values. 46—USING THE OUTCOMES PHARMA- CEUTICAL HEALTH CARE CASE MANAGE- MENT SYSTEM AS A DATA COLLECTION TOOL FOR RESEARCH. Zillich A, Purdue University, Kumbera P, Outcomes Pharmaceutical Health Care, Carter B, University of Iowa. E-mail: azillich@purdue.edu Objective: To describe a system for collecting research-based data from community pharmacy programs. Methods: The Outcomes Case Management System (OCMS) is a Web-based patient care system. The system assists payers in implementing disease management programs while simultaneously offering pharmacists a method to bill for services provided. For pharmacists, patient-specific information can be captured, enabling pharmacists to maintain progress notes and document patient care services. OCMS identifies patients who qualify for services and reminds pharmacists about the types of assessments needed at each visit. A variety of reporting capabilities track clinical and service data for individual patients or groups. For payers, researchers and program managers, OCMS captures service data for quality assurance monitoring. Advanced administrative features of OCMS offer customized patient care protocols that detail patient visit frequency, types of services needed, and specific monitoring parameters (i.e., blood pressure, blood glucose, cholesterol). Pharmacist fees are calculated using a unit rate set by the payer for various services and clinical assessments. Fees can also be adjusted based upon percent or fixed dollar patient copayments. These data can be used for research purposes to evaluate pharmacy-based services. No additional data entry is required, and the system interfaces with a relational database. Data are captured via an encrypted and password-protected hyperlink. Recently, OCMS was tailored for use during a clinical research study conducted in 12 community pharmacies. The study evaluated a pharmacist-based home blood pressure monitoring program. The program consisted of four face-to-face visits with a trained pharmacist. In general, the visits lasted 15 to 60 minutes. Pharmacists were required to document all patient care activities and submit data via OCMS. As data were submitted, a claim was generated by the pharmacist to receive reimbursement for the service. Pharmacists were paid a set fee for each service visit. All claims data were instantly transferred to a relational database. The database was queried to provide researchers with the data collected in the pharmacies. Results: A total of 398 visit claims were submitted. Appropriate data, without specific patient identifiers, were transferred to researchers for analysis. Research personnel reported that the data were clean and easy to manage for analyses. Conclusions: OCMS can be used effectively for collection of research-based data. 47—VALUE OF SPECIALTY CERTIFICA- TION IN PHARMACY. Pradel F, Palumbo F, Flowers L, Mullins C, Haines S, Roffman D, University of Maryland at Baltimore. E-mail: fpradel@rx.umaryland.edu Objective: The purpose of this project was to develop a white paper addressing the value of Board of Pharmaceutical Specialties (BPS) certification. Our work primarily focused on the value of pharmacy specialty certification as perceived by different stakeholders (pharmacists, employers, government, and academia). We also examined specialization and certification in medicine to draw a parallel between the two disciplines. Methods: We searched electronic databases (Medline, International Pharmaceutical Abstracts, Sociological Abstracts), association/health care organization Web sites, and outside reports. Finally, clinical pharmacists involved in certification processes were consulted. Results: Board certification is perceived as valuable in a number of instances. Certified pharmacists report enhanced feelings of self-worth, improved competence, and greater marketability. Other values of certification include increased acceptance by health care professionals, salary increases, and job promotion. Employers acknowledge board-certified pharmacists through public recognition, increases in responsibility, and some type of monetary compensation. In a few governmental organizations, certified pharmacists receive salary raises and are granted prescribing authority. About one third of colleges of pharmacy in the United States also consider board certification as a criterion for promotion and tenure, and, to a lesser extent, for salary increases. In contrast, the overall value of specialty certification in pharmacy as perceived by the public or payers lags behind when compared with the status of specialty certification in medicine. Conclusions: The Board of Pharmaceutical Specialties needs to, in collaboration with pharmacists, further document and promote the value of certification to various stakeholders. 48—WOMEN’S USE OF INFORMATION SOURCES IN THE TREATMENT OF MENOPAUSE. Jackowski R, Kirking D, Huston S, University of Michigan. E-mail: jackowsk@umich.edu Objective: Recent studies regarding hormonereplacement therapy (HRT) have caused women to rethink decisions regarding its use. In light of the controversy surrounding HRT use, we sought to explore what sources women use for information regarding their decision to treat menopause. Thus, the objectives of this study were to (1) identify sources women use, ascertain their understanding of those sources, and assess how helpful sources were in influencing decisions to use HRT and (2) determine how these factors vary by patient characteristics, including HRT user status and presence of diabetes mellitus. Methods: A cross-sectional mail survey was used. Data were collected from women with and without diabetes mellitus aged 45 to 60 years who met specified inclusion criteria and were enrolled in a southeastern Michigan health-maintenance organization. Results: A total of 765 usable responses were obtained from 1,812 eligible, deliverable surveys (42.2%). The most frequent information source was physicians, followed by magazines/print publications, friends, and family, (80%, 57%, 48% and 43%, respectively). Pharmacists were used as an information source by 17% of respondents. The most trusted sources were physicians, pharmacists, and other health care professionals (82%, 59%, and 56%, respectively), with similar results for the most knowledgeable and helpful sources. Least trusted were print ads, television ads, television programs and the Internet (34%, 34%, 25%, and 13%, respectively). These sources were also most thought to be biased or to have a vested interest in promoting a particular view. Results show differences in trust among sources by various personal characteristics, including diabetes status. Three distinct groups were shown to be trusted differently by respondents: health providers, family and friends, and various media. 2004 Abstracts of Contributed Papers Vol. 44, No. 2 March/April 2004 www.japha.org Journal of the American Pharmacists Association 237 Downloaded From: http://japha.org/ on 01/25/2014
FEATURE Annual Meeting Abstracts 2004 Conclusions: Except for physicians, sources used most frequently by women were not always considered to be the best sources of information regarding treatment of menopause. 49—WORK AND COST ANALYSIS OF PHARMACEUTICAL CARE DELIVERED BY PHARMACISTS IN PRIMARY CARE CLIN- ICS. Helou L, Sorensen T, University of Minnesota. E-mail: helou002@umn.edu Objective: (1) Identify the amount of revenue generated by clinical pharmacists in primary care settings and compare this amount with the pharmacy personnel cost of service delivery and (2) model potential patient-care revenues using a resourcebased relative value scale (RBRVS) for reimbursement of pharmaceutical care. Methods: Clinical pharmacists practicing in four Minnesota primary care clinics will record workload and clinical data for patients evaluated during a 4- week period in October and November 2003. Billing in these clinics is accomplished via cash payment, “incident-to” billing, and/or institutional provider fees. Data collected will include but are not limited to: reason for pharmacist assessment, time committed to encounter, number of drugs and medical conditions reviewed during assessment, and number of drug therapy problems identified. Revenue collected, as cash or from third-party payers, from each encounter will be identified and compared with workload data. Workload and clinical data collected will be used to model projected revenues using a RBRVS for pharmaceutical care reimbursement that models the RBRVS applied to medical reimbursement for medical care. Results: Results of this project will allow determination of the cost–revenue differential for the delivery of pharmaceutical care in a primary care setting. Data collected will allow for a prospective modeling of the cost–revenue differential using a RBRVS for pharmaceutical care. Conclusions: The mechanism by which pharmacists will be reimbursed for pharmaceutical care, should these services be included in Medicare insurance plans, is unknown. Reimbursement may model the RBRVS of medical provider reimbursement. This project will allow prospective evaluation of one proposed RBRVS for pharmaceutical care. 50—EMERGENCY CONTRACEPTION PILLS—EDUCATING PHARMACISTS UTI- LIZING A CONTINUING EDUCATION PRO- GRAM. Morawiec K, Northeastern University, Dougherty T, Presbyterian Medical Center, Penn Family Care. E-mail: kmorawiec@hotmail.com Objective: To develop, conduct, and assess the effectiveness of an interactive, multidisciplinary continuing education (CE) program about emergency contraception pills (ECPs). Methods: A unique CE program about ECPs, practice guidelines and state/federal legislation was created for pharmacists practicing in Massachusetts. Pharmacists were invited to attend through pharmacy associations, E-mails, faxes, and site visits. A variety of learning methods were used: lecture, casebased discussions, and video-counseling sessions. Pamphlets in English and Spanish were developed and distributed to participants to facilitate patient counseling in their practice settings. The presenters panel consisted of a physician, faculty pharmacist, and assistant director for the Massachusetts Health Department family planning program. Participants completed a voluntary pretest survey to assess knowledge, medical practices, attitudes, and patient encounters. A posttest survey was mailed 3 months later. A comparison of the pretests and posttests were used to assess the program’s effectiveness. Results: The program was attended by 21 pharmacists—12 community, 6 hospital, and 3 faculty pharmacists. Of 19 participants, 37% felt confident, 56% felt unconfident, and 5% felt very unconfident in the accuracy of ECP information they were providing. Of the 12 community pharmacists, 67% rarely or never discussed ECPs when counseling patients receiving prescription contraceptives. Among all participants, 81% knew ECPs were most effective when used within 72 hours after unprotected sex, and 43% did not know that progestin-only ECPs are more effective than combined ECPs. Results of the posttest survey will be presented and compared. Conclusions: The program may be an effective method of education as measured by the increased number of pharmacists counseling patients about ECPs and improved confidence in knowledge accuracy about ECPs. 51—PRESCRIPTION ASSISTANCE AND MEDICATION MANAGEMENT FOR SENIORS. Herndon A, School of Pharmacy, Roth M, University of North Carolina at Chapel Hill. E- mail: tig41ger@yahoo.com Objective: Senior Care, a prescription drug program for North Carolina seniors, covers 60% of the first $1,000/year for select prescription drugs. This includes medications used to treat cardiovascular disease, chronic obstructive pulmonary disorder (COPD), and diabetes. The program also funds 23 Medication Management Centers across the state to assist seniors in appropriate medication use. One of these centers, the University of North Carolina (UNC) School of Pharmacy, is responsible for providing medication assistance by telephone to seniors in 41 counties not covered by a local Medication Management Center. Methods: Senior Care eligibility requirements are age 65 years or older; annual income less than $17,720 (single individuals) and $23,880 (couples); medications used to treat cardiovascular disease, COPD, and diabetes; Medicaid ineligible; and no third-party prescription coverage. Interested individuals submit an application to Senior Care headquarters. Approved applications are mailed to the Medication Management Center in the senior’s respective county or to UNC. Upon receiving an application, UNC initiates patient contact. The senior is given an opportunity for a telephone interview to determine prescription assistance eligibility and learn more about his or her medications from a pharmacist. After completing the interview, a pharmacist documents the medication history in a letter to the patient. Additionally, a prescription assistance coordinator searches for prescription assistance programs for which the patient may qualify. The pharmacist’s letter along with applications for assistance programs are mailed to the patient. This concludes the patient encounter. Results: To date, 354 individuals have been contacted. Of these, 162 (46%) have been interviewed, and 98% of interviewed individuals received a pharmacist’s letter and applications. Some 2% were ineligible for prescription assistance, but received a pharmacist’s letter. The remaining 54% were unreachable or declined participation. Conclusions: Although 50% of Senior Care-eligible individuals are reached and the majority receive application packets, the program has limited ability to reach those in need and to detect meaningful outcomes because of lack of follow-up. APhA–APPM Community & Ambulatory Practice 52—ADHERENCE TO ANTIDEPRESSANT MEDICATIONS. Krueger M, Asher C, Mancuso L, U.S. Army Medical Department, Chou C, Pfizer, Inc. E-mail: mark.krueger@na.amedd.army.mil Objective: To assess medication adherence rates in an ambulatory setting. Methods: Design: A convenience sample of 98 patients completed a four-question validated survey (Adhere Rx). As a follow-on study, we conducted a retrospective analysis of antidepressant prescription data using the Standardized Therapy Adherence Research Tool (START). Participants: Military health care beneficiaries receiving new prescriptions during the pilot study and 5,830 patients receiving 16,800 prescriptions in the follow-on study. Analysis: After being stripped of patient identifiers, antidepressant (bupropion, citalopram, fluoxetine, mirtazapine, nefazodone, paroxetine, sertraline, trazodone, venlafaxine) prescription data from January 2002 through June 2003 were placed into a Microsoft Access 97 database. We employed a washout period to avoid bias and to be reasonably certain that all first instances of prescriptions included in the transformed database were new starts, leaving a population of 2,571 patients. Results: During the pilot study, the majority of respondents (84.7%) self-reported adherence scores in the medium or high categories. There was no correlation between medication adherence score and the number of medical conditions. There was, however, a correlation between medication adherence score and the type of medical condition, namely depression, anxiety, allergy, and asthma. Having a concern with antidepressants, we decided to examine general population results using START. The average length of therapy for SSRIs was 130.3 days, compared with 111.1 days for non-SSRIs. There was a higher median gap (44.8) for SSRIs versus non-SSRIs (30.7). Persistence on SSRI therapy at 3, 6, and 12 months was 74, 63, and 42 percent, respectively, while persistence on non-SSRI therapy at 3, 6, and 12 months 238 Journal of the American Pharmacists Association www.japha.org March/April 2004 Vol. 44, No. 2 Downloaded From: http://japha.org/ on 01/25/2014
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