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Class of 2012 Abstract / Specific Aims: The objective of this study is to first assess whether student pharmacist interns feel they can gauge patient health literacy levels with confidence, second to assess which methods are used most commonly in practice by student pharmacists to assess patient health literacy, and third to determine what techniques student pharmacist interns most often employ to communicate more effectively to patients with low health literacy. Methods: The questionnaire consisted of questions about demographics, and knowledge/experiential based questions. Key questions were: How well do you feel you are able to assess patient health literacy? How often do you use the following techniques to assess patient health literacy? (Observe contextual clues, Observe patient word pronunciation, Observe patient willingness to talk, Assess by demographics) When counseling low health literacy patients, how often do you use the following communication techniques? (Speak slowly, Give extra written material, Repeat information, Ask patient to repeat information, Ask if patient understands English, Avoid complicated medical terms). The answers to these questions are measured on a likert scale. Data from the questionnaire was analyzed using one sample t tests and paired t tests. Main Results: Regarding the first primary objective, on a scale of 1 to 5, with confidence measured 3 or greater and no confidence measured 2 or less, student intern pharmacists are statistically significantly confident in their ability to gauge patient health literacy (p< 0.001). There is no statistically significant difference in confidence in ability to gauge patient health literacy between males and females. The method student pharmacist interns used for assessing patient health literacy with the highest average use was observing patient willingness to talk (3.65 +/- 1.01) followed by observing patient word pronunciation (3.57 +/- 0.97), assessing patient demographics (race, age, ability to pay, culture, gender) (3.23 +/- 1.16) and observing contextual clues (patients identify pills by color, asks to be read to, etc) (3.04 +/- 1.04). There was no statistically significant difference between observing patient willingness to talk versus observing patient word pronunciation (p=0.55). There is a statistically significant difference between observing patient willingness to talk versus assessing patient demographics (p=0.011). The technique for improving communication with patients with low health literacy with the highest average use was avoiding complicated medical terms (3.97 +/- 0.95) followed by speaking slowly (3.91 +/- 0.89), repeating information (3.85 +/- 0.73), giving extra written material (3.02 +/- 1.36), asking patients if they understand English (2.85 +/- 1.21) and asking patients to repeat information. (2.39 +/- 1.02). There is a statistically significant difference between avoiding complicated medical terms and giving out extra written material (p<0.001) and speaking slowly and giving out extra written material (p<0.001). Conclusions: We conclude that students pharmacists working as interns are quite confident in their ability to assess patient health literacy, that observing patient willingness to talk is be the most commonly used method to assess patient health literacy, and that avoiding complicated medical terms is be the most commonly used technique student pharmacist interns use to communicate more effectively with patients who have low health literacy.

Class of 2012 Abstract / Specific Aims: To evaluate the effect on the incidence and nature of pharmacists’ drug utilization review (DUR) interventions of including patient diagnosis on electronic prescription (e-prescription) orders. Methods: This prospective pre-post evaluation was conducted in the outpatient pharmacy of a federally funded community health center over two consecutive four-week periods. During the pre-phase, a clinical pharmacist in the clinic’s onsite pharmacy prospectively reviewed the e- prescriptions received from the clinic’s primary care providers using a standard prospective DUR process and recorded all therapy-related interventions. In the post-phase, providers added a diagnosis on each e-prescription. Interventions were documented using a standard intervention form that has been used in previous research. Chi square and t-tests were used to assess the nominal and interval data, respectively (α=0.05). The Institutional Review Boards of the two collaborating universities approved the study. Main Results: Pharmacist intervention rates on problematic e-prescription orders significantly decreased (4% pre vs. 1% post, p<0.001). Drug-drug interactions (17.5% pre vs. 20% post) and missing information (15% pre vs. 20% post) were the most frequently cited problems that prompted the need for the pharmacist’s intervention. The medication classes most frequently involved in interventions were antibiotics (53% pre vs. 50% post) and central nervous system agents (17% pre vs. 10% post). After receiving clarification, the pharmacist most often dispensed the prescription (33.3% pre vs. 38.4% post) and educated the patient regarding their treatments (18.8% pre vs. 7.7% post). Conclusions: In this small pilot project, including the patient’s diagnosis on e-prescription orders significantly reduced the incidence of pharmacists’ DUR-related interventions. If duplicated in larger studies, our results suggest that providing pharmacists with additional targeted clinical information could reduce confusion and uncertainty thereby decreasing the number of unnecessary pharmacist contacts with prescribers and improving workflow and efficiency for both.

Class of 2017 Abstract / Objectives: To assess the perceived confidence level of community pharmacists in utilizing weight-based dosing, dispensing prescriptions, counseling, and recommending over-the-counter medications for the pediatric population in rural and non-rural settings. Methods: A 33-item questionnaire generated through REDCap was distributed to 11,280 pharmacists registered with the Arizona State Board of Pharmacy via email from March 14 to April 4 of 2017. The survey collected information on the participants’ experiences in managing pediatric prescriptions and demographics. Results: Of the 11,280 surveys distributed, a total of 857 responses were submitted by the end of the survey period (7.6%) and 482 responses were included in the analysis; 49 (10.2%) were practicing in rural areas and 433 (89.8%) were practicing in non-rural areas (including urban and suburban) in Arizona. There was no significant difference in the rural group compared to the non-rural group regarding experiences with dispensing pediatric medications. In regards to the confidence level, there was a significant difference between the two groups in calculating and recommending weight-based dosing for prescription and OTC pediatric medications (p = 0.022 and 0.031, respectively) and identifying a dosing error in pediatric prescriptions (p = 0.016). Conclusions: Community pharmacists practicing in rural and non-rural settings in Arizona had similar experiences with dispensing pediatric medications and confidence levels in managing medications for pediatric patients.

Class of 2009 / OBJECTIVES: To compare the attitudes of community pharmacy managers who did and did not contract with Mirixa to provide Medicare Part D medication therapy management (MTM) services in 2006. METHODS: Design: Cross-sectional descriptive study. Setting: United States in 2006. Participants: 100 pharmacy managers contracted to provide MTM services in 2006 and 100 pharmacy managers not contracted to provide MTM services in 2006. Intervention: Telephone-administered survey of independent community pharmacy managers. Main outcome measures: Pharmacist knowledge of and attitudes toward Medicare Part D MTM services. RESULTS: 200 pharmacy managers completed the study (n = 100 for each group). Pharmacists who contracted with Mirixa to provide MTM services in 2006 were more familiar with Medicare Part D MTM (80% vs. 59%, P = 0.001). Significantly more pharmacists contracted with Mirixa to provide MTM services agreed that they were qualified to provide MTM services (96% vs. 88%, P = 0.01) and strongly agreed that an annual personal medication review would benefit patient outcomes (59% vs. 45%, P = 0.04). No significant difference was found between groups with regard to other variables addressed in the survey. CONCLUSIONS: Results of this study suggest that familiarity with Medicare Part D MTM services was a key factor in whether pharmacists chose to contract to provide MTM in 2006. Additionally, significantly more pharmacists who contracted felt strongly that personal medication reviews would improve patient outcomes.

Class of 2009 Abstract / OBJECTIVES: The purpose of this study is to describe clinical pharmacist services in a nurse practitioner (NP) run clinic and how clinical pharmacists might influence prescribing. METHODS: The description of the clinical pharmacist services is based on a 12-week experience of a clinical pharmacist and senior student pharmacist working with the nurse practitioner and nurse practitioner students. A questionaire was developed and consisted of items relating to the nurse practitioners ability to identify possible interactions of OTC medications, herbals and prescription medications. In addition, the questionnare assessed the comfort level of NP’s taking a prescription medication history, checking a patient’s prescription formulary, and selecting appropriate medication therapies. The questionaire uses a retrospective pretest format and was tested as a method of collecting data on how a pharmacist influenced NP prescribing. The site selected for this study was the Arizona State University Center for Healthcare Innovation (ASU Center) located in the heart of Downtown Phoenix (3rd Ave and Van Buren). RESULTS: Only one nurse practitioner worked at the ASU Center. The facility is new to the neighborhood and does not see many patients. The nurse practitioner partner in this project responded that working with a clinical pharmacist on a regular basis, with more patients would definitely help her hone skills necessary to identify interactions and prescribe according to a patients formulary. CONCLUSIONS: Pharmacists provide value-added services in an ambulatory care clinic run by nurse practitioners and provide valuable education and consultation on drug interactions. Pharmacist influence can be measured successfully to using a questionnaire in a retrospective pretest-posttest study design.

Class of 2009 Abstract / OBJECTIVES: To evaluate Club Medbox, a pharmacist-run intervention in which a pharmacist addresses barriers to treatment that arise in patients with HIV via a weekly educational group session. METHODS: A retrospective chart review and patient interview were utilized to evaluate Club Medbox member characteristics and changes in clinical HIV markers over the course of membership; and survey instruments were used to assess patient-perceived impacts of Club Medbox on overcoming barriers to antiretroviral therapy adherence, general health, social support, and disease- state comprehension. RESULTS: A total of 28 patients met inclusion criteria and were included in this study. HIV-ASES scores were significantly increased (p <0.001). SF-12 scores showed significant improvement for the physical health domain (p <0.001) with minimal changes to the mental health domain (p=0.949). CD 4 counts, CD 4%, and undetectable viral load values were all observed with an upward trend from baseline until after intervention with Club Medbox. Social and educational participant influence were shown to improve based on interview responses (p <0.001). CONCLUSIONS: This investigation showed significant improvement in the confidence of participants to adhere to treatment plans when barriers are present, self-perceived physical health, disease state management, patient-perception of feelings of social support, and patient-understanding of HIV as a disease state from baseline until after Club Medbox affiliation. This study did not show an influence of Club Medbox participation on self-perceived mental health. Club Medbox should be considered an effective intervention in the improvement of medication therapy adherence and disease state management in HIV positive patients.

Class of 2008 Abstract / Objectives: To determine whether community, institutional, or specialty pharmacists have greater job satisfaction and what factors were most positively associated with job satisfaction. Methods: A prospective study was performed by distributing a 47-item online questionnaire to a listserv of 6,700 pharmacists’ email addresses. Respondents completed the questionnaire by following the instructions provided in an invitation email. Results: Questionnaires were completed by 273 participants (mean age [SD] = 42.85 [11.90]). Ninety- seven (35.5%) participants classified themselves as community pharmacists, 90 (33.0%) classified themselves as institutional pharmacists, and 86 (31.5%) classified themselves as specialty pharmacists. All pharmacists reported mean satisfaction scores above 2.5, indicating they were satisfied in their jobs. However, specialty pharmacists were more optimistic than community pharmacists about the prospect of remaining in their current practice setting for the rest of their working lives (p < .05). Perceived utilization of skills was the factor most associated with job satisfaction (p < .001). Conclusions: Job satisfaction was directly related to pharmacists’ perceived utilization of skills. Community, institutional, and specialty pharmacists had comparable job satisfaction, with specialty pharmacists having a higher level of agreement that they would enjoy spending the rest of their careers in their current job compared to those in community practice.

Class of 2007 Abstract / Objectives: To evaluate the impact of decentralized clinical staff pharmacists (CSPs) on nursing staff in a university- affiliated teaching hospital. Areas of interest include perceived quality of patient care, job satisfaction and nursing job retention. Methods: CSP impact was evaluated using a print-based survey utilizing outcomes items and a four-point Likert-type scale with response options ranging from “Agree” to “Disagree.” Nurses also answered demographic questions about experience, time at the institution, education leve and frequency of interaction with a CSP. Analysis of the data included use of descriptive statistics as well as use of Kendall’s tau-b to evaluate differences between groups based frequency of CSP interaction. Results: Respondents included 122 nurses at University Medical Center (UMC) in Tucson, Arizona in positions supported by a CSP during the summer of 2006. Nurses overwhelmingly selected “Agree” or “Somewhat Agree” for all 12 statements about the CSPs indicating that they found their interaction with CSPs valuable. Nurses who interacted more frequently with CSPs were more likely to “Agree” or “Somewhat agree that CSPs were valuable members of the hospital (p=.049), one reason they remained at UMC (p=.007), helpful with medication questions (p=.008) and improved job satisfaction (p=.013), made their job easier (p=<.001) as well as more enjoyable (p=.027)

Class of 2007 Abstract / Objectives: To conduct a survey instrument on a pharmacists’ knowledge of and attitudes toward dispensing narcotic medications for the management of chronic pain. Methods: A focus group of 39 pharmacy managers for a local chain drug store reviewed 6 knowledge questions and 10 attitude statements for content validity, clarity and readability. The results of their responses to the survey and other comments were tabulated and analyzed. Results: The focus group sample was small and results were not statistically significant. Pharmacists were highly confident about their training, yet most did not score well on the test, especially those questions designed to distinguish between addiction, pseudo-addiction and tolerance. This limited knowledge may have been related to age since many of the wrong answers selected were based on older definitions. Several questions and statements were identified as ambiguous, plus having unclear directions or incorrect information. Focus group discussions confirmed the limited knowledge found in the survey and clarified pharmacist's responses to the attitude statements. Conclusions: What is clear from the literature and our study is that pharmacists' knowledge about chronic pain and the uses of opioids strongly influences their attitdues. Therefore, the survey questions and statements need to be reworded and restructured to specifically evaluate the relationship between pharmacists' knowledge and their attitudes.