Thesis supervisor: Karen B. Farris. Includes bibliographic references (p. 224-237).

>Magister Scientiae - MSc / The pharmaceutical manufacturing sector operates within a highly regulated environment, with companies accountable to South African statutory bodies. The responsible pharmacist (RP) is responsible for their company’s adherence to the legislation requirements. Whilst the Pharmacy and the Medicines Acts outline the RP’s, there is no mandatory training requirement prior to registration as an RP, nor thereafter. This study investigated the role and competencies required of newly registered RPs in meeting their professional responsibilities in the pharmaceutical manufacturing sector. An online survey questionnaire elicited responses from RPs (n=102) about views and perceptions pertaining to their role and responsibilities. In addition, semi-structured interviews were conducted with statutory (n=3) and non-statutory representatives (n=5). Survey findings indicated that the majority (89,5%) of RPs felt competent and that they possessed the necessary skills and training. Almost two-thirds of respondents (63,2%) were experienced RPs who shared some reservations, that RPs may be excluded from far-reaching decisions with potential consequences for the company and patients. They added that RP performance monitoring was not regular, which may indicate that some companies view the RP as an appointment of convenience. The majority of respondents (89,5 %) were in favour of the development of training guidelines Findings from the semi-structured interviews indicated that RPs were not fully aware of their scope of duties and the implications thereof. The interviewees were also concerned that some companies, by not giving the RP role the level of importance and authority it required, were practicing tokenism. Further, that not all RPs had the necessary in-depth knowledge of the applicable laws, regulations, guidelines and codes. A competency framework for newly appointed RPs is needed to streamline their roles and responsibilities in the pharmaceutical manufacturing sector

Class of 2014 Abstract / Specific Aims: Tetanus, diphtheria, and pertussis are diseases, which are preventable through proper vaccination. In spite of the availability these vaccines, however, there has recently been a surge in the number of pertussis cases in the United States. The objective of this study is to determine provider adherence to tetanus, diphtheria and pertussis guidelines set forth by the Advisory Committee on Immunization Practices in a primary care setting before and after a clinical pharmacist intervention. Methods: A retrospective cohort of chart reviews was conducted between January 1 – September 30, 2013 to determine immunization adherence to tetanus, diphteria, and pertussis vaccination guidelines. A clinical pharmacist then preformed a series of cross-sectional chart reviews as an intervention. Following the intervention, a retrospective chart review was conducted to evaluate if Tdap vaccination rates improved between March 17-23, 2014. Main Results: Overall immunization rates greatly improved following the intervention (p<0.0001; x2=44.988). For non-pregnant adults between the ages of 19-64 the vaccination rate improved from 26% to 61.1% (p<0.0001; x2=47.07). A statistically significant improvement was not seen in the groups with patients 65 or older or pregnant women (p>0.05). Tdap vaccination status was appropriately evaluated and vaccinations given by primary doctors improved from 17.7% to 61.2% and those prescribed by nurse practitioners improved from 22.4% to 56.3%. Conclusion: Intervention by a Clinical Pharmacist helped improve overall provider adherence to the tetanus, diphteria, and pertussis vaccination guidelines.

Class of 2016 Abstract / Objectives: Specific Aim #1: Assess no difference in patient satisfaction. Our working hypothesis is that there is no difference in satisfaction with follow-up calls in women receiving HRT from pharmacists or pharmacy intern students at Reed’s Compounding Pharmacy. Specific Aim #2: Assess patient satisfaction with follow-up calls from pharmacy student interns. Our working hypothesis is that women receiving HRT are satisfied with follow-up calls for their therapy when it is conducted by pharmacy student interns, which enhances proper treatment guidance and adherence. Methods: This study will be a descriptive, direct comparison study that will use data obtained through an online questionnaire consisting of the following: four questions determining the patient’s demographics and eighteen questions on patient satisfaction with follow-up calls from Reed’s Compounding Pharmacy with pharmacy student interns. Results: Of the estimated 60 patients sample size, only 31 questionnaires were completed. The largest proportion of patients was between the ages of 51 and 60 (58%). The length of therapy in participating women varied quite significantly with one-fourth of patients on HRT for 4-5 years or more (26%). The patient satisfaction of follow-up calls conducted by pharmacy intern students survey results indicated, in general, that patients agreed that they were satisfied with the service that they were receiving from the pharmacy interns. There was no disagreement with the items, the intern provides education that will help me understand how to take my medications, being pleased that the intern is following-up, having input on hormone therapy, and with the items regarding intern professionalism and intern knowledge. The greatest disagreement was with three items asking about comfort talking with either a female or male intern, and the item about paying extra to ensure follow-up calls. Results from this study were compared with results from five questions adapted using a questionnaire from DiMaggio et al. Note that this study used 7 response fields: strongly disagreed, somewhat disagreed, disagreed, no opinion, agreed, somewhat agreed, strongly agreed. Data from DiMaggio et al used 5 response fields: strongly disagreed, disagreed, no opinion, agreed, strongly agreed. Responses were grouped by strongly disagreed, somewhat disagreed, disagreed, and no opinion in one and strongly agreed, somewhat agreed, and agreed in the second. The data from both studies were compared by considering proportion of patients who agreed at some level with each item. There was no statistical difference between the two groups (p > 0.08); both groups showed a high level of agreement on the five satisfaction items. Conclusions: The women receiving hormone replacement therapy in this study were satisfied with follow-up calls from pharmacy student interns at Reed’s Compounding Pharmacy. There is no difference in satisfaction with follow-up calls in women receiving HRT from pharmacists or pharmacy student interns. In addition to satisfaction, women are satisfied with follow-up calls for their therapy when it is conducted by pharmacy student interns, which enhances proper treatment guidance and adherence.

Class of 2013 Abstract / Specific Aims: To assess the effect of a pharmacist-led education group on psychiatric patient-reported attitudes, knowledge, and confidence in self-managing medications. The reliability and validity of the questionnaire given to patients who attended a pharmacist-led medication education group was also evaluated. Methods: A retrospective pre-post questionnaire was distributed patients and collected variables collected including patient self-reported medication knowledge and attitudes, demographics, previous psychiatric hospitalizations, length of group attended, and outpatient pharmacist relationships. Knowledge and attitude items were measured on a 4-point Likert-type scale with response options ranging from “agree” to “disagree.” Rasch analysis was conducted to ensure all items measured the same construct and the probability of the person responding to an item was not dependent on other assessment items. Rasch measurement includes several diagnostic indices that allow item-specific and person-specific examinations of data reliability and measurement fit. In addition, the Rasch technique makes it possible to evaluate the contribution of each person’s measures on each item. A z-test was used to evaluate for instrument content gaps and a dependent t-test was performed to measure for statistical differences before and after the intervention. Main Results: Sixty patients responded to the Medication Attitude and Knowledge Questionnaire over a 16-week period. Gaps identified were not statistically significant (p=0.1064 and 0.5305) indicating that content validity is comprehensive. On a group level, no significant differences were identified in patient answers before and after the intervention (p=0.2162, p=0.8292). When each patient was analyzed separately, only one patient out of 60 showed a significant difference in answers after the intervention. Results also demonstrated that after attending a group, 100% of patients indicated they intended to adhere to their medication regimen post-discharge. Conclusion: This evaluation was unique because patient attitudes were explored before and after medication education group attendance. Medication Attitude and Knowledge items were valid and reliable.

Class of 2005 Abstract / Objectives: To assess whether the satisfaction of women with the pharmacist administered bio-identical hormone replacement therapy consultation service has improved since the implementation of a follow up call program at Reed’s Compounding Pharmacy. Methods: A questionnaire was mailed to 200 randomly selected women who had completed their HRT consultation and received all three follow-up calls provided by Reed’s Compounding Pharmacy within the time frame from July 22, 2003 to April 22, 2004. The returned surveys were then organized and analyzed using Microsoft Excel. Additionally, independent t-tests were used to compare data collected in 2001 vs. 2004 on relevant questionnaire items of interest. Main results: Of the 200 surveys sent out to patients, 125 replied (a response rate of 62.5%). Over 50% heard about it through referral from their provider, and almost 35.2% from a friend or a relative. Regarding the follow-up call service, 95.9% of the patients either agreed or strongly agreed that it was helpful; however, only 73.8% feel comfortable discussing their concerns with student interns, who are responsible for the follow-up calls. In the assessment of new health conditions developed after natural hormone therapy initiation, 94.3% of the respondents reported with no new health conditions. T-tests revealed an improvement in patient satisfaction items between 2001 and 2004 with p-values < 0.05. Principal Conclusions: The results of the study showed that there was an improvement in patient satisfaction with the consultation service since 2001, and most of the differences found were statistically significant. The survey result also showed that participants were happy about the follow-up calls, which in terms, perhaps contributed to the increase in satisfaction.

Class of 2005 Abstract / Objectives: The purpose of this retrospective investigation is to compare the quantity, importance, and associated cost implications of drug-related problems identified (and ultimately resolved) through order entry/verification versus other clinical activities of a decentralized critical care pharmacist. Methods: The data from this study was collected by one decentralized pharmacist assigned to a surgical intensive care unit. A standard form was used to document all interventions during the period of this observation. For the purposes of this retrospective evaluation the following data will be extracted from the existing database: amount of time spent performing various clinical activities, how drug-related problems were identified (e.g., order entry verification versus chart reviews), the time it took to identify and resolve drug-related problems, a general description of interventions, the importance of the intervention, and the estimated economic impact associated with interventions. Results: In only a 41⁄2 month period, 111 patients would have likely experienced an adverse drug event had the ICU pharmacist not intervened. This equals a cost avoidance to the institution of anywhere from $200,000 to $280,000 for as little on average of 15-30 minutes of the pharmacist time. Implications: As previous studies have shown, the presence of a pharmacist in an ICU is crucial to lowering the incidence of adverse drug events. Our results have proven the interventions pharmacist make during team rounding and chart review are not only cost effective, but substantially improve patient care.

Class of 2013 Abstract / Specific Aims: The objective of this study was to examine the availability of immunizations in community pharmacies and the out-of-pocket cost for those immunizations. Methods: Twelve community pharmacies in the Tucson area were examined and one pharmacist in each store was asked to complete a questionnaire. This questionnaire aimed to determine individual immunizations offered at each pharmacy and the out-of-pocket cost for those immunizations. Main Results: Differences in the availability and cost of immunizations were compiled for each category of community pharmacy. The categories included Supermarket/grocery store, chain, Mass merchant/big box, and independent pharmacy. Seven of the twelve (58%) pharmacies included in the analysis participated in pharmacist-based immunizations. Three out of the four (75%) supermarket based pharmacies, both chain pharmacies, and two of the four (50%) mass merchant pharmacies, provided immunizations. Neither of the independent pharmacies included in the analysis provided immunizations. The pharmacies that did not currently provide immunizations, none had plans in the future to provide immunizations. There were no other non-prescription immunizations provided at the pharmacies in the study. All seven pharmacies that provided immunization services stated they would accept insurance and only one of the chain pharmacies had a walk in clinic. Conclusion: Overall this study demonstrated that there are differences associated with cost and availability of immunization services offered between pharmacies. Further research is needed to determine what hinders community pharmacy from offering immunization services and how to develop a form of commonality between all immunizations offered.

Class of 2008 Abstract / Objectives: To describe a pharmacist-based treatment adherence program at an HIV ambulatory care clinic setting; to describe the patient population that the pharmacist provided services to from 2005 to 2007; and to describe the clinical outcomes of the program. Methods: A retrospective chart review of 381 patients enrolled in the pharmacist-based treatment adherence program from 2/01/05 to 03/01/2007. Inclusion criteria: HIV positive; greater than or equal to 18 years of age; a medical record; and enrollment in the treatment adherence program. The program provided support, education, and clinical management. Results: Patients were predominately male (86%), ages 45-64 (58%) or 25-44 (38%), identifying as Caucasian (57%) or Hispanic (31%), with psychiatric (50%) or substance abuse (39%) comorbidities (with 25% reporting both comorbidities). Baseline HIV viral loads were compared at four different follow-up periods: 90-180 days, 181-365 days, greater than 365 days, and the entire period of follow-up through the pharmacist-based HIV treatment adherence program. At baseline 34% of the patients had an undetectable HIV viral load (< copies/mL) and a mean CD4 count of 340. All follow-up periods reported significant improvements. At follow-up >365 days, 76% of the patients had undetectable virus (p<0.001) and a mean CD4 count of 442 (p<0.001). There were no significant results when viral load and mean CD4 counts were examined within the context of number of pharmacist visits and SA and/or psychiatric comorbidities. Conclusions: Patients in the pharmacist-based treatment adherence program showed significant improvements in CD4 count and percent of patients with undetectable virus from baseline to all follow-up periods. The magnitude of the improvement increased during each follow-up period suggesting an additive effect of continued enrollment in the program.

OBJECTIVE OF STUDY: The objective of the study was to examine the quality of interactions occurring between pharmacists and clients, the facilitators and barriers shaping the way pharmacists communicate with clients, and the use of client satisfaction ratings as an outcome measure for pharmacist-client communication. METHODS AND MEASURES: Verbal exchanges between consenting pharmacists (n=100) and clients (n=786) were audio-recorded during four-hour, on-site, observation periods. Clients rated their interaction with the pharmacist using an 11-item Client Satisfaction Rating instrument, while pharmacists completed a questionnaire examining the factors predisposing, enabling, and reinforcing their communication with clients. Subsequent to data collection, an expert panel listened to the audiotapes and rated the quality of the interactions using a 9-item Quality of Communication rating scale. FINDINGS: The mean overall expert rating for the pharmacist-client interactions was 4.0 (out of 7), and represented a "satisfactory" rating. Hierarchical multiple regression analysis revealed that the predisposing, enabling and reinforcing variables measured in the Pharmacists' Questionnaire accounted for 19% of the variance in pharmacists' technical quality scores. Client satisfaction ratings and expert ratings of communication quality were modestly correlated (r=0.14; p<0.001). CONCLUSIONS: While the 60% of consultations in this study met or exceeded the mandated communication requirements of pharmacy practice, pharmacists were uniformly weakest in their client assessment skills and in their discussions of medication precautions and non-pharmacologic approaches to symptom management. Most pharmacists in the study reported being highly predisposed to communicating with their clients, but many lacked the reinforcing factors, and to a lesser degree, enabling factors that are considered necessary to sustain quality communication in the workplace. Client satisfaction ratings were positively skewed with little variability, making it difficult to detect a relationship between the expert and client ratings. Reasons why the study was unable to capture more of the variance in its proposed relationships are provided, as well as areas for future research. KEY WORDS: pharmacist-client communication, client satisfaction, quality / Graduate and Postdoctoral Studies / Graduate