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Annual Meeting Abstracts 2004 FEATURE colorectal cancer and its prevention will be increased with many patients receiving FOBT screening and education. Participants will establish appropriate screening habits, although continued education and reinforcement may be needed for enhancement of health attitudes and beliefs to occur. 164—PROVISION OF WEIGHT MANAGE- MENT SERVICES BY A PHARMACIST IN A GROCERY STORE COMMUNITY PHARMA- CY. Hussein S, Briggs A, Dominick’s Pharmacy/Midwestern University, Zgarrick D, Midwestern University. E-mail: shusse@midwestern.edu Objective: The primary objective of the weight management program is for patients to safely lose weight, maintain lower body weight, and reduce risk of obesity-related disorders. The secondary objective is to assess patients’ satisfaction with the program, pharmacist, and pharmacy; likelihood of returning for other clinical services and prescription needs; and income generated from the program. Methods: Inclusion criteria: Men and women between the ages of 18 and 64 with a body mass index (BMI) of 25 to 34.9 kg/m 2 . Exclusion criteria: Pregnancy, lactation, psychiatric illness, bulimia, anorexia nervosa, substance abuse, cancer, severe gastrointestinal disease, renal or hepatic dysfunction, and recent start of a thyroid hormone. A medical release form authorizing the start of the program and physical activity regimen will be obtained from the physician. The program will involve an initial, individualized consultation with counseling on a low calorie diet, physical activity, and behavior therapy and the development of a practical treatment plan for each patient. At follow-up group meetings, the treatment strategy will be evaluated and modified. NIH guidelines will be followed when considering and recommending pharmacotherapy. Outcome measures: Weight, BMI, waist circumference, blood pressure, fasting and/or 2- hour postprandial blood glucose, and lipid profile. In addition, patients will be surveyed concerning secondary objective variables 3 months from the commencement of the program. Results: Intention to treat analysis and paired t test will be used to compare baseline with last visit values and determine if a statistically significant improvement in outcome measures occurred. Descriptive analysis will be performed for the results of the satisfaction survey. Conclusions: NA. 165—REDUCING SENIORS’ DRUG EXPENDITURES THROUGH MEDICATION REGIMEN REVIEW AND REVISION IN A COMMUNITY PHARMACY. Owen J, Fry’s Pharmacy/University of Arizona, Herrier R, University of Arizona, Spencer J, Fry’s Pharmacy. E-mail: owen@pharmacy.arizona.edu Objective: To provide seniors with an economically viable alternative to purchasing medications outside the United States by reducing out-of-pocket expenditures through eliminating unnecessary drug therapy, switching to generic or the cheapest brand medications when possible, and using manufacturer and store discount plans. Methods: The medication regimen review will be piloted at a pharmacy located within an hour of the Mexican border. Patients will be targeted via instore and newspaper advertising. Additionally, patients who might benefit from this service will be identified using the pharmacy computer system. Targeted patients will include those who are paying cash for their prescriptions, members of Medicare HMOs, or using discount cards. The clinical recommendations to alter the therapeutic regimen will be based on published drug literature and the relative cost of alternative medications. The suggestions for change will be presented to the patient’s primary care doctor for approval and/or modification. Data will be collected and analyzed for loss in prescription sales revenue, changes in patient purchases in other parts of the store, changes in patient expenditures for medications including those medications obtained from outside the United States, physician acceptance rates, types of changes made, pharmacy expenses to perform the service, changes in disease control, and patient satisfaction. A fee schedule for services provided will be determined based on the evaluation of collected data. Results: The effectiveness of the medication regimen review will be assessed by evaluating profitability, patient health status, and patient satisfaction. Conclusions: It is expected that the medication review will maintain or improve disease control, reduce patient out-of-pocket expenses, and provide a viable alternative to purchasing medications outside the United States. 166—RETROSPECTIVE ASSESSMENT OF LONG-TERM OUTCOMES IN A COMMUNI- TY-BASED PHARMACEUTICAL CARE PRO- GRAM. Leighty J, Eckerd Corporation, Sullivan D, Ohio Northern University. E-mail: jrl5k@yahoo.com Objective: The role of a pharmacist is changing dramatically from dispenser of prescription drugs to a provider of patient care and medication management. Over the last few years, the value of pharmaceutical care has been evaluated in hospital, medical clinics, and community pharmacy settings. However, much of the research demonstrating the value of pharmaceutical care programs has been limited to short-term outcomes. One of the few projects that have evaluated long-term outcomes of pharmaceutical care was the Asheville Project. Unfortunately, there was a significant drop-out rate for its patients over the course of 3 years, which made the evaluation of long-term outcomes somewhat difficult. This leads us to the question of whether pharmaceutical care programs sustain positive patient outcomes over longer periods of time. The objective of this study is to assess the long-term outcomes of a community-based pharmaceutical care program for patients with diabetes, hypertension, and dyslipidemia. Methods: Patient charts will be randomly selected from all persons that have been enrolled in the Eckerd PatientCARE network for the last 3 years in the Tampa area. A total of 50 cases for each of the three disease states will be assessed for adherence to the nationally recognized clinical guidelines. Due to the overlap of some disease states within patients, the total number of patients evaluated will be between 80 and 120. For hypertension, the variables assessed will include the percentage of goal blood pressures, and proper choice of recommended medication. For diabetes, the variables assessed will include hemoglobin A1c, body mass index, and the ability to reach recommended goals. Preprandial and postprandial blood glucose values will also be included for those patients for whom the data is available. For dyslipidemia, the variables assessed will include triglycerides, total cholesterol, HDL, LDL, and the ability to reach recommended goals. Results: NA. Conclusions: NA. 167—RETROSPECTIVE COST–BENEFIT ANALYSIS OF A WELLNESS CENTER FROM AN INDEPENDENT COMMUNITY PHARMACY PERSPECTIVE. Kent K, McDonough R, Doucette W, University of Iowa, Ploehn L, Main at Locust Pharmacy Clinic. E-mail: kelly-bisgard@uiowa.edu Objective: Main at Locust Pharmacy Clinic developed and implemented a wellness center that provides health risk assessments and health screenings to interested patients. The purpose of the wellness center is to provide an advanced level of patient care as well as provide an additional revenue source for the practice. The objectives of this study are to (1) determine the revenues and costs associated with the delivery of the wellness center services, and (2) perform a cost–benefit analysis of the wellness center. Methods: Design: Retrospective review of the clinic’s wellness center records over a 2-year period. Setting: An independent community pharmacy wellness center. Data collection: Wellness center records for nine different services (blood pressure, blood glucose [BG], bone density, body fat, hemoglobin A1c, ALT, total cholesterol [TC]/HDL, TC/BG, full lipid panel) will be analyzed beginning October 1, 2001 thru September 30, 2003. Revenues will be determined by reviewing cash register receipts for that period. Direct and indirect costs associated with the delivery of the services will include the staff’s time involved with each service, equipment and supply costs, advertising, and the overhead costs associated with the practice. Data Analysis: Frequencies of each service will be tabulated. Revenues and costs will be determined for each service and discounted to October 2001 levels. A cost–benefit and sensitivity analysis will be performed. Sensitivity analyses will vary personnel costs and service volume. Results: Preliminary analysis of Main at Locust Pharmacy Clinic records demonstrates that more than 1,000 patient interactions have used the wellness center during the defined 2-year period. 2004 Abstracts of Contributed Papers Vol. 44, No. 2 March/April 2004 www.japha.org Journal of the American Pharmacists Association 267 Downloaded From: http://japha.org/ on 01/25/2014
FEATURE Annual Meeting Abstracts 2004 Conclusions: The wellness center has generated new revenue for the clinic. A cost–benefit analysis will determine the profitability and sustainability of the service. 168—SUCCESS RATE OF A PHARMA- CIST-MANAGED SMOKING CESSATION PROGRAM IN A COMMUNITY PHARMACY SETTING. Free H, Rodriguez De Bittner M, Layson-Wolf C, University of Maryland at Baltimore, Fairfax, CVS Pharmacy. E-mail: hfree@rx.umaryland.edu Objective: To assess the effectiveness of a pharmacist-managed smoking cessation program, in a community pharmacy setting, on patients’ ability to remain smoke free after quitting, and assess patients’ knowledge about the consequences of smoking and its treatment. Methods: The study design is a single-center, prospective, pilot study. Phase I involves training pharmacists to serve as the smoking cessation facilitators. The pharmacists will be trained using the American Lung Association, “Freedom from Smoking” program. Procedures will be developed that define the roles and responsibilities of the facilitators using the tobacco dependence guidelines. Phase II will involve the implementation of the smoking cessation program. The program will begin with three individualized (patient and pharmacist) appointments followed by three group sessions and a 3-month group follow-up. Throughout the program, patients will be educated on smoking consequences, how to incorporate behavior modifications, and how to prevent relapse. Pharmacotherapy may also be used. At every session, monitoring parameters will be assessed, including blood pressure, pulse, weight, adverse drug reactions, and carbon monoxide levels. Written education materials will be supplied at every session. Results: Analysis of the pre- and postknowledge tests will be conducted. Quality of life at baseline and completion of the program will be measured. A Kaplan Meier survival curve will be used comparing the percent abstinence and relapse at weeks 1, 4, and 12 and will be compared with other published studies. In addition, patient satisfaction surveys will be reported. Conclusions: It is anticipated that a pharmacistmanaged smoking cessation program in a community pharmacy setting will be successful in helping patients quit and maintaining smoking abstinence. 169—TARGET INTERVENTION PRO- GRAM TO PROMOTE CALCIUM SUPPLE- MENT USE IN COMMUNITY PHARMACY. Cinelli E, Cerulli J, Albany College of Pharmacy. E- mail: cinellie@acp.edu Objective: To determine if a Target Intervention Program (TIP) developed for community pharmacy can increase appropriate calcium supplement intake in patients receiving prescription osteoporosis therapy. A secondary objective is to determine baseline calcium supplement use in this population. Methods: Eligible patients will be identified by pharmacists and/or PharmD candidates based on a prescription (new or refill) for a medication to treat and/or prevent osteoporosis at six Community Pharmacy Advanced Practice Experience sites that include chain and independent settings. All eligible patients identified will be documented on an enrollment log. An assessment tool will be used by the students to determine baseline supplement use either in person or via telephone. Students will determine if patients presently on a calcium supplement are receiving the appropriate dose and/or are using the correct administration technique and will intervene as needed. A recommendation for an appropriate calcium supplement will be made to the patient and their physician if patients are not currently receiving a calcium supplement. Two months following any intervention, students will perform a follow-up phone call to patients to determine if the recommendations were accepted. Results: The percent of patients taking a calcium supplement with their prescription at baseline will be reported. The impact of the intervention will be determined by the number of recommendations made to add calcium supplementation or improve administration/dose. The number of patients who purchased a calcium supplement following the intervention and the number of patients reporting use on follow-up will be documented. Conclusions: Assuming baseline calcium supplementation is low, a recommendation by a pharmacist or pharmacy student is anticipated to increase calcium supplement intake in patients receiving osteoporosis medications. 170—THE EVALUATION OF JNC VII ADHERENCE IN AN INTERDISCIPLINARY OUTPATIENT SETTING. Wylie K, Green C, Medow M, Ohio State University. E-mail: wylie.19@osu.edu Objective: (1) Evaluate percentage of patients at target blood pressure according to the seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VII) guidelines, (2) determine areas in need of intervention, and (3) develop a patient assessment form to address deficits. Methods: Research will be conducted retrospectively at an interdisciplinary primary care clinic. Patients will be identified via ICD-9 codes signifying a hypertension diagnosis (401.X). Exclusion criteria include pregnancy, less than 18 years of age, and/or primarily managed by nephrologists. The primary end point is the percentage of patients achieving their blood pressure goal according to JNC VII guidelines. Secondary end points include assessment of drug selection, risk factors, comorbidities, and interventions. Individual charts will be pulled onsite and reviewed since the initiation of JNC VII (on May 14, 2003) using a self-created data collection sheet. The data collected will identify the patient’s goal, if the patient has met his/her goal, risk factors for major cardiovascular disease, relevant family history, comorbidities, and receipt of appropriate follow-up, laboratory tests, medications, and interventions. Upon completion of each chart review, a patient assessment sheet will be added to each chart as a reminder to health care providers of monitoring parameters. Results: Once data collection is complete, the percentage of clinically diagnosed hypertensive patients at goal and not at goal will be documented and reported. For those not at goal, the following will be taken into consideration and reported: treatment, follow-up, interventions, assessment of risk factors, and comorbidities. Conclusions: We anticipate that these results will accurately identify the percentage of patients at their target blood pressure and identify areas in need of intervention. The results will provide feedback to team members to determine whether we need to reengineer workflow to optimize hypertension management. 171—THE EVALUATION OF PHARMA- CISTS’ ATTITUDES TOWARDS PROVIDING SMOKING CESSATION COUNSELING IN A CHAIN PHARMACY SETTING. Hendrickson J, Jackson T, University of Illinois at Chicago. E-mail: jaimeh@uic.edu Objective: The U.S. Public Health Service has published guidelines for treating tobacco use. A goal of these guidelines is to change practice patterns of health care professionals in identifying and offering treatment to tobacco users. While numerous smoking cessation programs exist, barriers prevent pharmacists from implementing them. The primary objective of this study is to objectively evaluate pharmacists’ knowledge and attitudes regarding smoking cessation counseling. Additionally, the frequency of identifications and interventions made will be evaluated. Methods: Pharmacists in the Chicago metropolitan area will be invited to attend a smoking cessation training program. The program will be developed using medical literature and U.S. Public Health Service guidelines. Pharmacists will be trained to identify smokers visiting the pharmacy and to apply the transtheoretical model to individually tailor counseling based upon information about a patient’s smoking behavior. Pharmacists will provide brief counseling on health consequences of smoking, behavioral strategies in quitting, and the use of nicotine replacement therapy. Investigators will assess pharmacists’ perceived knowledge and attitudes regarding the provision of smoking cessation counseling using an 11-item retrospective pretest/posttest administered 12 weeks after the training program. Additionally, program effectiveness and the number of smoking cessation interventions by pharmacists will be evaluated. Results: Responses to the assessment instrument will measure pharmacists’ knowledge and attitudes towards providing smoking cessation counseling. These data will be analyzed using the Rasch rating scale model. Conclusions: It is expected that pharmacists participating in this program will gain skills and confidence in counseling patients on smoking cessation. It is predicted that attitudes toward providing smoking cessation interventions will improve, and the frequency of the interventions will increase accordingly. 268 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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