Evaluation of Patient Adherence to Vaccine and Screening Recommendations during Community Pharmacist-led Medicare Annual Wellness Visits in a Family Medicine Clinic.

Background: The Centers for Medicare and Medicaid Services initiated annual wellness visits (AWV) to reduce healthcare costs and improve preventive healthcare for beneficiaries. Provider time constraints and varying preferences to perform AWVs have limited its clinical implementation in some areas, affording pharmacists an opportunity to expand their role. Objective: To evaluate patient adherence to pharmacist recommendations for vaccinations and preventive screenings in an annual wellness visit service at a family medicine clinic in northeast Mississippi. Methods: This study included patients receiving at least one vaccination or screening recommendation during an AWV. Investigators provided vaccination (influenza, pneumococcal and herpes zoster) and screening (mammograms, DEXA, and colorectal cancer) recommendations based on current guidelines. For services not provided in-clinic, investigators contacted outside facilities 45 days post-visit to confirm adherence to recommendations. Primary endpoints included the composite adherence rate of all recommendations and percentage of patients achieving the 60% goal composite adherence rate. Secondary endpoints included individual vaccination and screening adherence rates. Results: Investigators recommended 715 interventions to a total of 254 patients, of which 239 were completed within 45 days for a 33.4 percent composite adherence rate. 20.1 percent of all participants achieved the goal composite adherence rate (60%). Overall, participants were 30.5 and 41 percent adherent to all vaccinations and preventive screening recommendations, respectively. Conclusion: Pharmacists providing AWVs increased patient access to preventive health recommendations. Although, adherence to recommendations remains a challenge and warrants further study. The findings and limitations observed in this study have identified opportunities for future research to evaluate pharmacist-led AWV services.

Impact of Communication Method and Timeliness on Student and Faculty Perception of Professionalism and Value.

Objective. This study sought to evaluate the impact of faculty, preceptor, and student preferences for type of communication received and timeliness of communication on their perceptions of professionalism and personal value.Methods. An anonymous questionnaire was designed to assess pharmacy faculty, preceptor, and students' preferred method of communication, response time expectations, impact on their perception of the sender's professionalism, and personal perception of being valued. The questionnaire was sent to 924 faculty, preceptors, and students.Results. Of the 253 responses received, 27 (11%) were from full-time faculty, 94 (37%) from part-time faculty preceptors, and 132 (52%) from students. Overall, email was the preferred communication method for receiving information that was not time sensitive (98%), with a majority of faculty, preceptors, and students indicating that 48 hours was a reasonable response time. Most participants felt that less than 24 hours was a reasonable response time for texts or phone calls. Most students indicated that response time was somewhat or not impactful (58%) on their view of the faculty or preceptor's professionalism, while faculty and preceptors indicated that response time was neutral or somewhat impactful on their view of the student's professionalism (60%). Most students (77%) indicated that a faculty or preceptor's response time to their text or phone call impacted their perceptions of feeling valued and important.Conclusion. Communication preferences among faculty, preceptors, and students differ. Professionalism related to communication was important to all groups, and timeliness of communication between faculty, preceptors, and students impacted their perception of their value and self-worth.

Evaluation of a novel process for selecting advanced pharmacy practice experiences.

INTRODUCTION: Matching an increasing number of pharmacy students with a limited number of advanced pharmacy practice experience (APPE) sites has become challenging for pharmacy schools. Selective tiered optimization (STO), a process for matching students with competitive APPE electives, was implemented by The University of Mississippi School of Pharmacy (UMSOP) in 2015 to address these concerns. This pilot study sought to evaluate student and preceptor satisfaction with the process. METHODS: Electronic surveys were sent to students enrolled in APPEs and individuals who precepted APPE students at the UMSOP from 2016 to 2019. The surveys were designed to gauge satisfaction with STO's process, goals, utility, and fairness. RESULTS: There were 63 responses from 149 preceptors (42% response rate) and 70 respondents from 314 students (22% response rate). Overall, both students and preceptors expressed satisfaction and found value in participating in STO. Both groups indicated that the benefit they received from participating in STO outweighed the extra effort required. Preceptors indicated that students who participated in STO were of higher quality and more focused, hardworking, and interested than those who did not participate. CONCLUSIONS: Respondents were satisfied with the STO process and experience. The process was perceived by preceptors to be fair for all students and worthwhile for its participants. Our results also demonstrated that this process is effective for easing the competitive APPE selection process. Schools and colleges of pharmacy should consider utilizing this process to alleviate applicable challenges with APPE selection.

The Mississippi Delta Health Collaborative Medication Therapy Management Model: Public Health and Pharmacy Working Together to Improve Population Health in the Mississippi Delta.

INTRODUCTION: The Mississippi Delta has high rates of chronic disease and is known for its poor health outcomes and health disparities. The University of Mississippi School of Pharmacy (UMSOP) and the Mississippi State Department of Health partnered in 2009 through the Mississippi Delta Health Collaborative to reduce health disparities and improve clinical outcomes by expanding the UMSOP's evidence-based medication therapy management (MTM) initiative, focused in Mississippi's 18-county Delta region, to federally qualified health centers (FQHCs) in 4 of those counties. METHODS: Between January 2009 and August 2018, the MTM initiative targeted FQHC patients aged 18 years or older with a diagnosis of diabetes, hypertension, and/or dyslipidemia. Pharmacists initially met face-to-face with patients to review all medications, provide education about chronic diseases, identify and resolve drug therapy problems, and take appropriate actions to help improve the effectiveness of medication therapies. Clinical parameters evaluated were systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol, low-density lipoprotein (LDL) cholesterol, triglycerides, and hemoglobin A1c (HbA1c). RESULTS: The analysis included 335 patients with hypertension (n = 287), dyslipidemia (n = 131), and/or diabetes (n = 331). Significant mean reductions occurred in the following metrics: SBP (7.1 mm Hg), DBP (6.3 mm Hg), LDL cholesterol (24.9 mg/dL), triglycerides (45.5 mg/dL), total cholesterol (37.7 mg/dL), and HbA1c (1.6% [baseline ≥6%] and 1.9% [baseline ≥9%]). CONCLUSION: Despite the cultural and environmental disadvantages present in the Mississippi Delta, the integrated MTM treatment program demonstrated significant health improvements across 3 chronic diseases: hypertension, dyslipidemia, and diabetes. This model demonstrates that a partnership between public health and pharmacy is a successful and innovative approach to care.

Ultra-long-acting insulins: A review of efficacy, safety, and implications for practice.

BACKGROUND AND PURPOSE: In the past decade, there has been much advancement in oral antidiabetic agents, but few changes in insulin therapy. With the addition of the ultra-long-acting insulins, insulin glargine U300 (IGlar 300) and insulin degludec (IDeg 100 and IDeg 200), it is important to understand key aspects in the agents' clinical properties, efficacy, safety, dosing, packaging, and place in therapy. METHODS: A literature review was conducted using PubMed database and was limited to English, full-text articles published from January 2000 to January 2018. The following search terms were used: insulin glargine 300, insulin degludec, Toujeo, Tresiba, and ultra-long-acting insulin. CONCLUSIONS: These agents are longer acting with sustained insulin coverage as compared with other basal insulins while having a low potential for hypoglycemia. Efficacy and safety profiles are quite good, and potential for weight gain was similar to IGlar 100. IMPLICATIONS FOR PRACTICE: Depending on the patient's needs, these newer agents may offer some advantages. Insulin glargine U300 and IDeg 200 are concentrated, allowing for administration of large doses by less volume, thereby theoretically improving absorption. For patients needing flexible dosing, IDeg may be beneficial. The ultra-long-acting agents may also be useful if it is suspected that the basal insulin is not lasting the entire day.

The impact of participation in a Research/Writing Group on scholarly pursuits by non-tenure track clinical faculty.

BACKGROUND AND PURPOSE: The purpose of this study was to evaluate the success of a faculty Research/Writing Group (RWG) by quantifying the amount of scholarly productivity from participants in the group compared with that of a matched cohort. EDUCATIONAL ACTIVITY AND SETTING: The RWG meets monthly to discuss current projects, providing an assessment of their scholarly activity. Participants offer ideas on improvement, resources and possible platforms for presentations and/or publications. FINDINGS: To evaluate the success of this model, scholarly production from the participants in the RWG was compared to a matched group of clinical non-tenure track faculty not participating in the group over a three year period. Faculty perception of RWG participation was evaluated by data collected through a survey using Qualtrics. SUMMARY: Participation in the RWG provided these junior faculty the support system to feel confident in their pursuit of scholarly activities; and therefore, they outpaced their counterparts in dissemination of their research.

The role of Toujeo®, insulin glargine U-300, in the treatment of diabetes mellitus.

PURPOSE: The purpose of this article is to educate nurse practitioners about the role of Toujeo®, insulin glargine U-300 (Gla-300), which is a new option for the treatment of diabetes mellitus. DATA SOURCES: A comprehensive literature search was conducted using MEDLINE with the key terms: insulin glargine 300, Toujeo, Gla-300, and EDITION for clinical trial data. Other resources included package inserts, drug information websites, and the World Health Organization (WHO). CONCLUSIONS: Gla-300 appears to be a safe and effective option for basal insulin therapy. In clinical trials, it was shown to be equally efficacious as Gla-100 with fewer episodes of hypoglycemia and slightly less weight gain, and subjects receiving Gla-300 required approximately 10 units more basal insulin to obtain the same hemoglobin A1c (HbA1c) as subjects receiving Gla-100. IMPLICATIONS FOR PRACTICE: This new basal therapy option represents a potential advantage for patients who require higher doses of insulin because of the higher concentration of Gla-300. The lower incidence of hypoglycemia and more predictable pharmacokinetics could offer a significant therapeutic benefit in difficult-to-control patients with diabetes mellitus. The biggest disadvantage of this product is the slightly higher insulin dosage that is required to improve and/or maintain patients' HbA1c.

A multipreceptor approach to ambulatory care topic discussions.

OBJECTIVE: To assess the impact of a multipreceptor approach to facilitating topic discussions on students' knowledge and confidence in clinical decision-making during an ambulatory care advanced pharmacy practice experiences (APPEs). DESIGN: Faculty members with relevant expertise and experience facilitated discussions with fourth-year doctor of pharmacy (PharmD) students regarding 7 ambulatory care topics. A student self-assessment survey and knowledge-assessment instrument was administered before and after discussions. ASSESSMENT: Students' examination scores increased significantly from 59.1% ± 13.9% at baseline to 76.5% ± 12.6% at the end of the 5-week experience (p<0.001). The majority of participants were comfortable making therapeutic decisions regarding medication use as it related to all discussion topics except heart failure. CONCLUSIONS: Participation in topic discussions led by faculty members with expertise and experience for each ambulatory care topic was associated with a significant improvement in knowledge-assessment scores.

Health information technology use in a rural clinic: the pharmacist's perspective.

Poor communication of medical information during care transitions can lead to medication errors, adverse drug events, and increased health care costs. The crucial pharmacist's role sometimes requires efforts to improve documentation. Here, we describe our experience integrating a pharmacist into a medical team at a federally qualified health center.