Class of 2012 Abstract / Specific Aims: Determine the incidence of scheduled co-administration times in handwritten (paper) and electronic prepared medication administration records of oral ciprofloxacin and oral moxifloxacin with interacting substances that can affect fluoroquinolone gastrointestinal absorption. Also, determine the incidence of actual co-administration of oral ciprofloxacin and moxifloxacin with interacting substances that can affect fluoroquinolone gastrointestinal absorption with electronic and handwritten prepared medication administration records. Methods: Retrospective data was obtained by a chart review of patients from an academic medical center for a one month period before (May 2010) and after (August 2010) implementation of an electronic prepared medical administration record system. The scheduled time and actual time given for all fluoroquinolone antibiotics, as well as all possible interacting substances, were recorded. Main Results: A total of 99 subjects were included in this study (36 paper and 63 electronic). There was no statistical difference (p=0.47) between the percentage of scheduling errors for the electronic prepared medication administration records, 25.3%, compared to the paper medication administration records, 22.1%. However, there was a decrease in the percentage of actual co-administrations of fluoroquinolones with interacting substances for the electronic prepared MARs compared to paper prepared medication administration records; 22.3% and 32.1% respectfully (p=0.03). Conclusions: After implementing electronic prepared medication administration records at an academic institution, co-administration errors went down even though the amount of scheduling errors did not decrease.

Class of 2014 Abstract / Specific Aims: To assess and compare prescribing error-identification rates by healthcare professionals Methods: Pharmacists and nurses from Northwest Medical Center were invited to participate in this study. Participants completed a questionnaire that consisted of 10 fictitious patient prescriptions. They were asked to evaluate the accuracy of the prescriptions and indicated the type of error found, if any. The number of correctly identified prescribing errors, correct types of errors, and error identification rates for each group were calculated. Rasch analysis was used to assess the validity and reliability of the questionnaire. Wilcoxon and Rasch-Welch t-test were used to assess the difference in prescribing error-identification rates. Main Results: Thirty-five out of 700 nurses and 6 out of 20 pharmacists completed the questionnaire (response rate 5% and 30% respectively). Pharmacists had significantly higher error-identification rates compared to nurses (p = 0.0001). Additionally, pharmacists were able to correctly identify the type of error in each prescription (p < 0.0001). Conclusion: Pharmacists were significantly able to correctly identify more prescribing errors and more types of prescribing errors in 10 fictitious prescriptions compared to nurses. Several assumptions and limitations were identified in this study, therefore future studies are warranted.

Class of 2014 Abstract / Specific Aims: To assess the impact of provider outreach for an MTM program by comparing two formats of recommendations: a general informational fax and a prescription template fax. Methods: This study was a retrospective analysis of pharmacist recommendations at an MTM center in 2012. Recommendations were made following either a comprehensive medication review with a patient or of available pharmacy claims. Interventions included in this analysis were those made to improve patient treatment through the use of medications consistent with national treatment guidelines (“guideline alerts”) or those made to reduce cost (“cost alerts”). A recommendation was a success if the change in medication therapy was noted in claims data within 120 days. The success rates between the two interventions were compared using Chi square. Main Results: The overall success rate was 20.9% (10,947/52,409). For guideline alerts, there was a significant difference in the acceptance of prescription faxes (13.1%) versus informational faxes (9.9%) (P <0.001). Prescription faxes recommending the addition of an ACE inhibitor for hypertension in diabetic patients was significantly higher compared to informational faxes in females over 60 years old (14.8% vs. 10.00%, P <0.001) and all males (13.2% vs. 9.9%, P <0.001). For cost alerts, there was a statistically significant difference in the acceptance of prescription faxes (49.7%) versus informational faxes (37.7%) (P <0.001). Conclusion: Prescription faxes produce higher rates of acceptance for guideline and cost recommendations. While both prescription and informational faxes could be used to further improve the communication between prescribers and pharmacists that provide MTM services, providers may prefer specific prescription faxes.

Class of 2011 Abstract / OBJECTIVES: To assess the attitudes of future health professionals towards taking medication. METHODS: A beliefs about medications questionnaire (BMQ) was passed out to pre-pharmacy students at a pre- pharmacy club meeting on April 4, 2011. The questionnaire utilized a five-point Likert scale with 1 being strongly disagree and 5 strongly agree. The collected data was used to compare with the BMQ scores from the general public available in the Horne et.al. study. RESULTS: Pre-pharmacy students had significantly less agreement with negative statements (mean and SD, 2.43 ± 0.65) than the lay public (mean and SD, 3.75 ± 0.29) (p = 0.029). CONCLUSION: We found that pre-pharmacy students tended to view medication use more positively than the general public. However, more surveys were needed in order to confirm these results. Overall we found a significant difference between attitudes held by pre-pharmacy students towards medication use and attitudes held by the lay public.

Class of 2011 Abstract / OBJECTIVES: To determine the perceptions of a Vietnamese population provided medication counseling in Vietnamese and their understanding of the directions, the indication, side effects, and importance of adherence to their medications. They also rated the helpfulness of the counseling. METHODS: Vietnamese speaking pharmacists performed medication reviews with Vietnamese adults who self-identified their level of English proficiency. Participants rated the helpfulness of the reviews on understanding medication directions, indication, side effects, and importance of adherence. Demographic data also was collected. The questionnaires were administered after each “brown bag” session. RESULTS: Twenty-nine Vietnamese patients received counseling; all completed the questionnaire (no English proficiency = 8; some = 11; full proficiency = 10). Average number of years residence in the United States was 17.4 (SD = 9.6 years, range from 2 months to 35 years). Approximately half of the patients (44.8%) found having pharmacists who spoke Vietnamese to be the most helpful; 48.2% answered “both” language fluency and shared culture were most helpful. The service was rated “somewhat to very helpful” in understanding medication directions (93%), indication (86%), side effects (79%), and the importance of adherence (79%). CONCLUSION: Overall, subjects found medication review services helpful when provided in their native language, indicating the need for language-directed services to help non-English speaking patients understand their medications.

ST-segment elevation myocardial infarction (STEMI) is a common presentation of acute myocardial infarction, constituting approximately 30% of all cases. Based on the highest level of evidence for improvement in both morbidity and mortality in these patients, clinical guidelines from around the world support the prolonged use of secondary preventative medications (e.g., acetylsalicylic acid, second antiplatelet [clopidogrel, prasugrel, and ticagrelor], statin, beta-blocker, and angiotensin blocker). While in-hospital and discharge prescription rates for these essential life-saving medications is excellent, adherence is known to decline within weeks of hospital discharge. This decline in evidence-based medication use was confirmed in a population of patients with coronary artery disease in Ontario (Chapter 3). Furthermore, it was demonstrated that this decline was consistent across all medication classes and subgroups of patients. We developed a protocol (Chapter 4) for a cluster-randomized controlled trial evaluating the impact of repeated reminders sent by mail to the family physician and the patient, starting one month after the STEMI. The fifth chapter highlights the results of the cluster-randomized controlled trial, which demonstrates suboptimal persistence to all 4 of 4 cardiac medication classes at 12-months. There was no significant difference compared to usual care in the use of guideline-recommended medications post-STEMI when participants (and their family physicians) receive repeated postal reminders.

Pliarmacobezoars, bezoars comprised of medications, are unusual entities. Medications reported to cause bezoars include aluminum hydroxide gel, enteric-coated aspirin, sucralfate, guar gum, cholestyramine, enteral feeding formulas, psyllium preparations, nifedipine XL, and meprobamate. They most often occur, as do bezoars of any type, in a background of altered motility or anatomy of the gastrointestinal tract. Bowel hypoactivity, dehydration, and concomitant use of anticholinergics and narcotis appear to contribute to the propensity for bezoar formation by aluminum hydroxide gel and Isocal. The hygroscopic properties of psyllium and guar gum appear to contribute to their propensity to form bezoars. Insolubility of the carrying vehicle of enteric-coated aspirin and nifedipine is the setting in which these medications form bezoars. In contrast to nonmedication bezoars, pliarmacobezoars may produce additional symptoms, those related to the release of their active ingredients. In patients with suspected gastrointestinal tract emptying problems, whether esophageal, gastric, small bowel, or colonic, the astute clinician should consider pharmacobezoar in the differential diagnosis.

Medication complexity and nonadherence are significant risk factors for avoidable hospitalizations and health care spending for older adults in the United States. However, limited empirical research has investigated pharmacist-run telephonic medication management programs as a potential solution to the problem of reducing medication complexity while improving medication adherence. This quantitative study employed the behavioral change model to analyze archival data from a sample of 1,148 participants, examining the relationship of a pharmacist-run telephonic consulting program on medication adherence and medication complexity for one pharmacy benefit management firm's Medicare Part D recipients. The primary research questions investigated the relationship of medication therapy management programs to medication adherence and complexity. Data were assessed using correlation and regression analysis to determine the association between receiving pharmacist counseling, medication adherence, and medication complexity, and to assess the strength of any relationships identified. No linear relationship was found between pharmacists' counseling, medication complexity, and medication adherence. However, the study found a weak correlation between medication complexity and comorbidities, and between medication complexity and medication adherence. This study promotes positive social change by identifying information that can be used to reduce pharmaceutical industry liability by improving proper management of medications, by reducing the burden of comorbidities related to poor management of chronic disease, and streamlining health services and improving their outcom

Research relating to illicit use of prescription stimulants (IUPS) has, for the most part, focused on describing behaviors of IUPS. However, there have been few attempts to measure IUPS in a consistent manner or determine how to best predict IUPS in an effective and concise manner. Data from Mississippi State University undergraduates (N = 703) were analyzed to create two shortorm measures to predict lifetime IUPS. The data-driven shortorm consisted of 15 items and 5 factors, and accurately classified 74.8% of participants as users versus non-users. The hand-picked shortorm consisted of 8 items and 5 factors, and accurately classified 84.6% of participants as users versus non-users. Results of this study can begin to provide information and possible tactics for briefly and quickly measuring risk for IUPS, particularly in applied settings, like university health centers or academic admissions. Future directions for research include testing these created shortorm measures with longitudinal data collection, validating the measures on different populations, and determining if these measures can accurately predict specific behaviors related to IUPS (e.g., diversion, IUPS within certain time frames).

Children with oppositional defiant disorder (ODD) and a concurrent Axis I diagnosis are often prescribed drug therapy for attention deficit hyperactivity disorder (ADHD) to manage disruptive behavior. However, ODD symptoms tend to be poorly controlled, raising questions about the effectiveness of drug therapy in children with the condition. Safety and long term consequences of pharmacological agents for ODD are important factors clinicians must consider before initiating treatment. The purpose of this literature review is to examine the pharmacodynamics and efficacy of drug therapy used for ODD in school-age children and adolescents. Additionally, awareness of poor behavior patterns and recognition of symptoms associated with ODD in children among health care providers was explored. A literature review exploring ODD and drug therapy for ODD and related behavioral disorders was conducted from various online databases. Results from 15 reviewed studies suggest that pharmacologic therapy is typically prescribed for ODD symptoms when a comorbid condition such as ADHD, a mood disorder, or an anxiety disorder is present. Drug therapy for ADHD has demonstrated effective behavioral outcomes in reducing ODD symptom severity in children and tolerable side effects when used for short-term therapy. Studies have demonstrated success and better control of ODD symptoms with a focused drug therapy regimen. Overall, the benefits of drug therapy can potentially outweigh the risks of adverse effects, and improve the quality of life in children with ODD. In conclusion, uncovering the reasons for poorly controlled ODD in children can be of clinical significance to health care providers and can support decision making when considering drug therapy for children with this condition.