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Annual Meeting Abstracts 2004 FEATURE older than 40 years increased by 5% (P = .61). Conclusions: This community pharmacy-based breast cancer education program increased knowledge of and adherence to ACS guidelines, and may serve as a model for other programs. However, these improvements were not statistically significant, possibly because of a high baseline knowledge of and adherence to ACS guidelines, lack of control for outside factors influencing screening behavior, and the brief follow-up period. This project was supported by an APhA Foundation Incentive Grant for Practitioner Innovation in Pharmaceutical Care. 76—IMPLEMENTATION OF A LIPID MANAGEMENT PROGRAM IN A COMMU- NITY PHARMACY. Nesbitt K, Ferris State University/Pfizer/Meijer, Durst S, Ferris State University, Detloff R, Pfizer, Ruhlman B, Vanlente H, Meijer, Inc.. E-mail: nesbittk@meijer.com Objective: Approximately one in five Americans have one or more types of cardiovascular disease (CVD), including stroke, myocardial infarction (MI), angina pectoris, and congestive heart failure (CHF). Risk factors for CVD include: dyslipidemia, age, family history, cigarette smoking, hypertension, obesity, diabetes mellitus, and physical inactivity. High blood cholesterol is strongly related to the risk of CVD. The recommendations for screening for CVD include a fasting lipid profile consisting of high-density lipoprotein cholesterol (HDL- C), low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC), and triglycerides (TGs). Measuring blood pressure and fasting blood glucose levels is also important when screening for cardiovascular disease. This study investigates the impact of a community pharmacy-directed lipid management program (LMP) on the clinical outcomes associated with lipid management. The LMP will be offered each year in January and July over a 6- month timeframe. Monthly group sessions will be conducted that will provide the patient with intense education. Topics discussed will include risk factors for cardiovascular disease, diet, therapeutic lifestyle changes, and lipid-lowering drug therapy. Individual consultations will take place during refill visits to the pharmacy. The pharmacist will be notified when the patient picks up the refill and will keep track of when the refills are due. The patient will also be afforded the opportunity to call and schedule a visit with the pharmacist on an as-needed basis to allow the patient the opportunity to discuss issues with the pharmacist in private. Methods: Following approval by an investigational review board, the LMP will enroll patients by physician referral or patient interest. Recruitment will take place during monthly cholesterol screenings held at the Meijer Pharmacy. During these screenings risk assessment will be performed for every patient using coronary heart disease risk calculator software. Physicians in the area will be educated about the program for patient-referral purposes. Results: Data collection at baseline will include a patient self-knowledge survey of cholesterol and CVD, self-reported patient medication adherence survey, and full lipid profile to assess LDL-C goal attainment. These outcomes will be re-measured at the month 6 completion visit and compared with baseline to determine the effectiveness of the lipid management program. Conclusions: NA. 77—IMPLEMENTING MOTIVATIONAL STRATEGIES TO EMPOWER PATIENTS IN DIABETES MANAGEMENT. Heller K, Palm Beach Atlantic University, Greck B, Kerr Drug and Campbell University. E-mail: katherine_heller @pba.edu Objective: The best way to improve treatment adherence among patients with diabetes is unclear. This preliminary study investigated the development of a motivationally focused program empowering patients with diabetes who were previously uncontrolled to achieve therapeutic goal. Methods: Design: Qualitative, cross-sectional descriptive study. Setting: Asheville Project Diabetes Wellness Program in Asheville, N.C. Patients: The sample frame included all patients enrolled in the Diabetes Wellness Program who had not achieved two consecutive glycosylated hemoglobin values of 8.0% or lower. Data Collection: Patients were identified by retrospective chart review or by referral. After patient identification, the intervention pharmacist met with the provider pharmacist to review the following: (1) patient’s perspective regarding value of glycemic control, (2) provider pharmacist’s perception of patient’s self-efficacy and locus of control, (3) areas of need for referral, (4) patient’s short- and longterm health goals, (5) plan of action for achieving these goals, and (6) identify barriers to achieving glycemic goals. Analysis Plan: Qualitative and descriptive analysis of these reviews Results: Reviews of five patients were studied. External locus of control was identified in two of four patients. Pharmacist provider short- and long-term health goals were clearly outlined in three of four charts, with patient-identified goals outlined in all four charts from enrollment data but identified in recent visits in only 2 charts. A pharmacist provider plan of action was apparent in 4:4 cases while a patient plan of action was apparent in 2:4. Areas of need for referral were primarily psychological (n = 3) but also nutrition (n = 2) and fitness (n = 1). The predominant barrier identified was psychological (n = 3). Conclusions: For patients who have not achieved goal control of their diabetes, pharmacists will need to better assess and enhance their patients’ psychological readiness for change. Pharmacy training will need to include an individualized approach to using motivational strategies. 78—IMPROVING HEALTH AMONG RURAL MONTANANS: MOBILE PHARMA- CIST-CONDUCTED DISEASE SCREENING IN FRONTIER COMMUNITIES. Stratton T, University of Minnesota, Williams R, Meine K, University of Montana. E-mail: marimbafan@ yahoo.com Objective: To describe the provision of pharmacist-conducted disease screening services in remote frontier and rural Montana communities. Methods: A federal telehealth grant was awarded to this unique demonstration project, Improving Health Among Rural Montanans (IPHARM) in which a motor home was converted into a mobile office, and a recent doctor of pharmacy graduate was hired to use it in providing disease screening to residents of frontier and rural Montana counties. A satellite transmitting/receiving dish on the motor home provides wireless Internet access for researching drug information questions. The motor home also contains an ultrasound unit for testing heel bone density, a spirometer for testing lung function, and CLIA-waived devices to measure glycosylated hemoglobin and serum lipid levels. Pharmacist-conducted screening clinics are held in conjunction with county health departments, tribal health authorities, community pharmacies, county agricultural extension agents, community health centers, and migrant health centers. Employee wellness clinics are also conducted for public and private sector employers. Pharmacy students in advanced practice experiences assist with the screenings when the motor home is nearby. Descriptive statistics are generated for each clinic, and nonparametric statistical analyses are conducted for each screening test to compare results from rural and nonrural communities. Results: During the project’s first 6 months, the IPHARM pharmacist logged almost 6,000 miles, conducting 1,830 tests for 944 patients, 85% of whom live in rural communities. More than 34% of patients were referred to their primary-care providers for follow-up concerning out-of-normalrange test results. The age-corrected prevalence of low bone density was found to be statistically greater among rural residents tested than among nonrural residents tested. Some 40 pharmacy students, including more than one half of all students engaged in advanced practice experience rotations, participated in the clinics. In excess of $27,000 has been generated by the project in operating revenue and donations. Conclusions: Pharmacists and pharmacy students are capable of providing disease-screening services in remote frontier and rural communities. Obtaining sufficient payment for these services in rural communities to cover operational costs remains a challenge. 79—IMPROVING INDIGENT PATIENT MEDICATION ADHERENCE THROUGH PHARMACIST INTERVENTIONS USING MANUFACTURER PATIENT ASSISTANCE PROGRAMS. Hoyt C, Ohio State University. E- mail: hoyt.46@osu.edu Objective: Despite rising costs and complexity of medication regimens, pharmacists are the key professionals to improve access to medications. The primary goal of this project is to increase medication adherence by decreasing drug costs to low income patients through the use of pharmacist-managed manufacturer assistance programs (MAPs). 2004 Abstracts of Contributed Papers Vol. 44, No. 2 March/April 2004 www.japha.org Journal of the American Pharmacists Association 245 Downloaded From: http://japha.org/ on 01/25/2014
FEATURE Annual Meeting Abstracts 2004 Secondary goals are to encourage patients to proactively manage their medications by decreasing prescription drug coverage through continued MAP use and to decrease cost burden on the health center. Methods: Adult indigent patients on five or more medications will be recruited to the study from Columbus Neighborhood Health Center, Inc. (CNHC) through two methods, either patient selfreferrals or if patients are deemed unable to pay their copayments for medications by health centers or providers. These patients are “waived” copayments with CNHC paying the cost and will be asked to make a pharmacist appointment to assess their medications. Patients will complete a preintervention Morisky adherence survey. At the initial appointment, patient eligibility for MAPs will be determined and MAP education and paperwork provided. Patients will be responsible to complete forms and bring back for physician signatures. The pharmacist will also assess medication regimens for simplification, therapeutic substitution, and other potential interventions. Medication change recommendations will be left in the chart for provider approval if not available during the patient appointment. A follow-up chart review will be completed 3 months after the initial appointment to reassess whether the patient has refilled their next MAP order. At this time, a patient satisfaction questionnaire and post-Morisky adherence survey will be distributed to study participants. Results: Data analysis will include: before and after number of MAPs used, number of medications per patient, changes in adherence survey, and cost savings to the patient and CNHC per month. Pharmacist intervention acceptance rate, pharmacist time and salary versus cost to CNHC, and patient refills of next MAP orders will also be evaluated. Conclusions: By increasing MAP usage and decreasing patients cost burden, we anticipated that this program will improve medication adherence. Further research will need to be performed to assess long-term impact on savings to the health care system and medication adherence. 80—INCORPORATION OF ANIMAL THERAPY INTO THE PHARMACY SCHOOL CURRICULUM: ANIMAL THERAPY AS AN ADJUNCT TO PHARMACOTHERAPY IN CLINICAL PHARMACY PRACTICE. Coffman R, Allison W, Nevada College of Pharmacy. E-mail: rcoffman@nvcp.edu Objective: To expose pharmacy students to adjunctive therapies, and raise pharmacy students’ awareness of the importance of treating not only the disease, but the psychological and emotional manifestations of disease through an elective course that combines animal-assisted therapy with the tenets of the pharmaceutical care model (PCM). Methods: Students who sign up for the elective follow trained therapy dogs providing adjunctive therapy to patients in hospitals and hospices. Students are assessed on their ability to articulate tenets of the pharmaceutical care model and their knowledge of the use of animal-assisted therapy in various diseases. Students make a formal presentation on their observations of the impact on animalassisted therapy in patients followed during the 4- week elective. Results: Students taking the elective demonstrated a more complete understanding of the pharmaceutical care model as well as the positive impact that animal-assisted therapy can have on therapeutic outcomes for patients. Conclusions: Bringing together the pharmaceutical care model and animal-assisted therapy as a component of pharmacy education is logical and can be of great benefit to the practicing clinical pharmacist as well as their patients. By incorporating this novel and innovative elective into the Nevada College of Pharmacy curriculum, the college raises student awareness of adjunctive therapies and can serve as a resource for the increasing number of undergraduate and graduate students who are interested in both research and applied clinical aspects of the field of animal-assisted therapy and clinical pharmacy practice. 81—MORBIDITY AND MEDICATION PREFERENCES OF HEADACHE PATIENTS IN A COMMUNITY PHARMACY. Wenzel R, Diamond Headache Clinic Inpatient Unit, Schommer J, University of Minnesota, Marks T, Martin Avenue Pharmacy. E-mail: rwenz@ hotmail.com Objective: A complaint of headache has always been among the foremost reasons people have sought the help of a pharmacist. In 2000 and 2001 the number 1 over-the-counter (OTC) product recommendation pharmacists performed was for a “headache product,” more than 53,000 times daily. This project quantified the degree of morbidity (via Migraine Disability Assessment, or MIDAS, a validated disability assessment tool) and the treatment views of headache patients presenting to a community pharmacy. Methods: Pilot project of 22 self-administered surveys of individuals presenting to a community pharmacy with a complaint of headache and seeking a pharmacist’s recommendation Results: A total of 13 patients had MIDAS scores of Grade III or Grade IV (highest levels). Of the sample population, a substantial minority (41%) did not believe their headaches can be effectively managed with OTC medications, 72% did not feel OTC agents are safer than prescription products, 96% did not indicate that OTC drugs are more effective than prescription items, and 50% disagreed that a physician’s evaluation was not necessary. Only one half of the population was satisfied with their current therapy, and patients overwhelmingly (91%) wished they could prevent their headaches. Conclusions: The majority of headache patients presenting to a community pharmacy had high levels of morbidity and are in need of education regarding the proper role of OTC products, the advantages of prescription agents, and the benefits of a physician’s referral. These preliminary results indicate that community pharmacies are potentially important locations of headache patient identification, education, and referral. 82—PATIENT AND PHYSICIAN RESPONSE TO BONE MINERAL DENSITY MEASUREMENT IN COMMUNITY PHAR- MACY. Mcfee J, University of Illinois at Chicago. E-mail: jennifer.mcfee@walgreens.com Objective: Osteoporosis contributes to more than 1.3 million fractures in the United States each year. Early detection of low bone mineral density (BMD) is the best fracture risk predictor. In recent years, the early detection of low BMD has become more accessible through use of portable units. Few studies have focused on low BMD detection in community pharmacies using portable ultrasound technology. Also, little tracking of the impact of pharmacist intervention on outcomes has been completed. The purpose of this study is to identify and enroll women at risk for osteoporosis in a pharmacist-managed intervention that aims to improve awareness and patient health in these subjects. Methods: Women will be recruited through marketing strategies available at approximately 20 chain pharmacies in the Chicagoland area. Subjects will complete a questionnaire, and their BMD will be assessed by quantitative ultrasound of the calcaneus. Pharmacist recommendations will be made regarding calcium intake, weight-bearing exercise, fall prevention, and further follow up with diagnostic technology. BMD results and pharmacist recommendations will be mailed to each subject’s physician. Physicians will be asked to complete a survey instrument that asks them to evaluate and assess the services provided by the osteoporosis monitoring program. Study subjects will be contacted by telephone 6 months after the intervention and asked questions from a survey designed to evaluate patient adherence with pharmacist recommendations and follow-through with their physicians. Results: Responses to the two instruments will be analyzed using the Rasch rating scale model. Conclusions: Increased patient and physician awareness and positive attitudes about the community pharmacists’ role in osteoporosis management are anticipated. 83—PHARMACEUTICAL CARE EVALU- ATION OF NON-ENGLISH SPEAKING PATIENTS. Westberg S, Sorensen T, University of Minnesota. E-mail: biebi001@d.umn.edu Objective: (1) Identify and publicize foreign language services available at pharmacies near a medical clinic serving a large immigrant population; and (2) determine whether the type of drug therapy problems experienced differ between English and non-English speaking patients. Methods: Language services were identified by contacting pharmacies in the neighborhood served by the clinic via telephone survey. A pharmacist provided pharmaceutical care to clinic patients, working with interpreters when necessary. Patientspecific data and the results of the pharmacist’s assessment were recorded in a patient management database. Results: Of the six primary languages spoken by clinic patients, written or verbal information was available for five languages in one or more area 246 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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