Association Between Accreditation Era, North American Pharmacist Licensure Examination Testing Changes, and First-Time Pass Rates.

Objective. To estimate whether first-time pass rates on the North American Pharmacist Licensure Examination (NAPLEX) have been influenced by the number of pharmacy programs founded since 2000, the programs' accreditation era, and the changes to the blueprint as well as changes to the testing conditions and passing standards implemented by the National Association of Boards of Pharmacy (NABP) beginning in 2015.Methods. This was a retrospective, observational cohort study using publicly published data. The number of programs and pass rates were collected from 2008 to 2020. Programs reporting pass rates from 2016 to 2020 were eligible. Accreditation era was defined as programs accredited before or after 2000. Pass rates were categorized into NAPLEX tests administered before or after 2015. Statistical analyses were conducted for comparisons.Results. Pass rates were initially found to decline as the number of programs rose. First-time pass rates of programs accredited before 2000 were higher than pass rates of programs accredited after 2000 every year after 2011. Only 40% of the programs accredited after 2000 exceeded the national average between 2016-2020. Blueprint changes implemented in 2015 and the changes to testing conditions plus passing standards implemented in 2016 had a greater effect on pass rates than the number of programs or applicants.Conclusion. Programs accredited after 2000 generally had lower first-time NAPLEX pass rates. Even so, blueprint changes and changes to the testing conditions plus passing standards instituted by the NABP were more important predictors of the decline of first-time NAPLEX pass rates. Stakeholders should collaborate and embrace best practices for assessing practice-ready competency for licensure.

Awareness, perceptions, and attitudes toward community pharmacist clinical services: An analysis of data from 2004 and 2018.

OBJECTIVE: This study aimed to describe and compare the public's change in awareness and perceptions of, willingness to use, willingness to pay, and interest in insurance coverage for community pharmacist prescriptive authority services and point of care testing over a time span of 14 years. METHODS: This was a retrospective review of anonymous questionnaires administered by student pharmacists in 2004 and in 2018. Questionnaires were administered to individuals who presented to University of New Mexico College of Pharmacy sponsored health fair screenings and at various community pharmacies throughout the state of New Mexico (NM). RESULTS: In total, 545 (2004) and 659 (2017-2018) participants completed the questionnaire. Awareness of community pharmacist clinical services increased from 2004 to 2018. In 2018, awareness of newer prescriptive authority services provided by pharmacists in NM was low relative to the services assessed in previous years. Most respondents indicated a willingness to use and pay for pharmacist-provided clinical services and felt that pharmacists should receive compensation by their insurance for these services. Trust in pharmacist advice grew from 2004 to 2018. CONCLUSION: Overall rates of awareness of community pharmacist clinical services were low with the exception of immunizations; however, most participants indicated interest in and willingness to use these services. Most participants believed pharmacists should receive reimbursement from insurance companies for clinical services and were also willing to pay a copay or out-of-pocket cost for these services.

Curricular-driven screening for atrial fibrillation at community pharmacies.

BACKGROUND: Atrial fibrillation (AF) increases the risk of stroke. It can be asymptomatic and patients may be unaware they have AF. Therefore, there is a need to develop a sustainable community model to screen for unrecognized AF. OBJECTIVE: The objective is to assess a curriculum driven model developed by the University of New Mexico College of Pharmacy (UNM-CoP) to evaluate AF screening at 3 community pharmacy sites. METHODS: Screenings and education for AF were performed by fourth year pharmacy students during their advanced pharmacy practice experience (APPE) community rotation at pre-selected independent pharmacies. Patients were screened using the KardiaMobile device (AliveCor®, Mountain View, CA), an FDA-cleared device that interprets a medical-grade ECG in 30 seconds. All screening materials and devices were provided by UNM-CoP. Semi-structured interviews with each targeted pharmacy were conducted to assess the logistics, value, and sustainability of the program (N=5 pharmacists). RESULTS: AF assessment was performed over a 7-month period by 8 students at three pharmacies. Students screened a total of 63 patients (62% female, 56 ± 14 years of age) with 92% of the encounters taking less than 10 minutes to complete. Three patients (4.7%) were found to have possible AF. Positive scores were noted when assessing value to the pharmacy (8.8 ± 0.8, scale 1-10 with 10 being high value) and professionally (9.7 ± 0.6). DISCUSSION: Student-pharmacists provides a likely pathway for sustainability for this clinical initiative and provides for a novel and measurable APPE patient interaction. CONCLUSION: Curricular driven AF assessment in community pharmacies was shown to be a feasible model. Additional studies are needed to assess whether population-based real-time assessment and detection of AF can reduce the risk of stroke in previously undetected AF. If stroke reduction is realized, reimbursement for service is likely and can contribute to further sustainability.

Population screening for atrial fibrillation by student pharmacists at health fairs.

BACKGROUND: Individuals with unrecognized atrial fibrillation (AF) may be at an increased risk of stroke. There is a need to develop a sustainable and reproducible population-based screening model to identify unrecognized AF. OBJECTIVE: The objective of this study is to evaluate AF screening and education at student pharmacist-driven health fairs. METHODS: Screening for AF was performed by student members of the American Pharmacist Association Academy of Student Pharmacists with preceptor oversight. Participants were screened using the KardiaMobile device (AliveCor, Mountain View, CA), a Food and Drug Administration-cleared device that interprets a medical-grade electrocardiogram in 30 seconds. Student pharmacists also calculated a CHA2DS2-VASc score. Participant education was provided using an American Heart Association AF patient information sheet. Learning assessment was evaluated with 3 multiple choice questions. RESULTS: Students screened a total of 697 participants over a 6-month period at 13 health fairs. Overall, 71% of the participants were women aged 56 ± 15 years (mean ± SD). Sixteen of the participants (2.3%) who were screened received results indicating possible AF. None of the participants with a possible positive finding had symptoms suggestive of AF. Of these 16 participants, 11 (69%) had a CHA2DS2-VASc score greater than or equal to 2 (2.7 ± 0.7). Most participants answered each learning assessment question correctly. More than 95% of participants believed that screening for AF at health fairs was important or very important. CONCLUSION: Student pharmacist-driven health fairs were shown to be feasible models to screen for AF and were effective in providing AF education to the public. Student pharmacists also cultivated a clinical skill that is transferable to their future practice setting, including the community pharmacy setting. Additional studies are needed to assess whether population-based real-time assessment and detection of AF can reduce the risk of stroke in individuals with previously undetected AF.

Emerging evidence in NSAID pharmacology: important considerations for product selection.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used in the treatment of pain and inflammation. Emerging pharmacokinetic and pharmacodynamic evidence in NSAID pharmacology provides important criteria for selecting an appropriate NSAID. The inhibition of COX enzymes by NSAIDs affects physiologic functions in the gastrointestinal, cardiovascular, and renal systems. Of the 2 principal types of COX enzymes, COX-1 and COX- 2, the pain-relieving (anti-hyperalgesia) effects of NSAIDs are driven mainly by the inhibition of COX-2. Commonly, NSAIDs are categorized by in vitro selectivity (ie, the ratio of the NSAID concentrations required for inhibition of COX-1 and COX-2) as selective or nonselective. Theoretically, the concept of selectivity is convenient; however, the actual relative inhibition of COX-1 and COX-2 isoenzymes measured in vitro is dose-dependent. As a result, the predicted in vivo reduction of prostanoidinduced hyperalgesia and the expected adverse effects of an NSAID are dose dependent. Individual NSAIDs also differ on pharmacokinetic and pharmacodynamic parameters such as the absorption, time to availability of drug at the site of inflammation, and persistence at the site of inflammation. NSAIDs with longer half-life durations may offer longer durations of analgesia due to continued COX enzyme inhibition, but may provide less opportunity for recovery of COX activity between doses than NSAIDs with shorter half-lives. Understanding these pharmacokinetic and pharmacodynamic factors informs selection of an appropriate NSAID among this heterogeneous class of drugs.

Use of diabetes data management software reports by health care providers, patients with diabetes, and caregivers improves accuracy and efficiency of data analysis and interpretation compared with traditional logbook data: first results of the Accu-Chek Connect Reports Utility and Efficiency Study (ACCRUES).

We assessed users' proficiency and efficiency in identifying and interpreting self-monitored blood glucose (SMBG), insulin, and carbohydrate intake data using data management software reports compared with standard logbooks. This prospective, self-controlled, randomized study enrolled insulin-treated patients with diabetes (PWDs) (continuous subcutaneous insulin infusion [CSII] and multiple daily insulin injection [MDI] therapy), patient caregivers [CGVs]) and health care providers (HCPs) who were naïve to diabetes data management computer software. Six paired clinical cases (3 CSII, 3 MDI) and associated multiple-choice questions/answers were reviewed by diabetes specialists and presented to participants via a web portal in both software report (SR) and traditional logbook (TL) formats. Participant response time and accuracy were documented and assessed. Participants completed a preference questionnaire at study completion. All participants (54 PWDs, 24 CGVs, 33 HCPs) completed the cases. Participants achieved greater accuracy (assessed by percentage of accurate answers) using the SR versus TL formats: PWDs, 80.3 (13.2)% versus 63.7 (15.0)%, P < .0001; CGVs, 84.6 (8.9)% versus 63.6 (14.4)%, P < .0001; HCPs, 89.5 (8.0)% versus 66.4 (12.3)%, P < .0001. Participants spent less time (minutes) with each case using the SR versus TL formats: PWDs, 8.6 (4.3) versus 19.9 (12.2), P < .0001; CGVs, 7.0 (3.5) versus 15.5 (11.8), P = .0005; HCPs, 6.7 (2.9) versus 16.0 (12.0), P < .0001. The majority of participants preferred using the software reports versus logbook data. Use of the Accu-Chek Connect Online software reports enabled PWDs, CGVs, and HCPs, naïve to diabetes data management software, to identify and utilize key diabetes information with significantly greater accuracy and efficiency compared with traditional logbook information. Use of SRs was preferred over logbooks.

The effect of hormonal oral contraception on acquisition of peak bone mineral density of adolescents and young women.

Maximizing bone mass in youth is touted as the best strategy to offset the natural losses of aging and the menopausal transition. Not achieving maximum peak bone mineral density (BMD) is an independent risk factor for osteoporosis and thus a public health concern. Adolescence is a critical time of bone mineralization mediated by endogenous estradiol. Research has shown that the highest velocity of bone mass accrual occurs 1 year before menarche and after the first 3 years. Low-peak attainment of BMD in young women is associated with contributing factors such as diets low in calcium, eating disorders, lack of exercise, smoking, and low estrogen states. Oral contraceptives (OCs) suppress endogenous estradiol production by suppressing the hypothalamic-pituitary-ovarian axis. Thus, OCs, by replacing endogenous estradiol with ethinyl estradiol (EE), establish and maintain new hormone levels. The early initiation and the use of very low dose of EE raises the possibility that bone mass accrual at a critical time of bone mineralization in young women or adolescents may be jeopardized. This review examines the studies of BMD in adolescents and young women that use combination hormonal contraception. Some studies had inherent limitations, such as small trial, poor control of confounders, failure to exclude women with prior use of hormonal contraceptives, or prior pregnancy from control groups. The vast majority of reviewed studies showed OCs containing 20 to 30 µg of EE interfere with acquisition of peak BMD. Limited numbers of studies examine the effects of OCs containing 35 µg on adolescents and young adults. Additionally, studies are needed evaluating the progestin component of OCs as their differing androgenic properties may affect bone mineralization as well.

Knowledge, attitudes and practices of pharmacists concerning prescription drug abuse.

This study assessed the knowledge, attitudes, and professional practices of pharmacists regarding addiction and patient use of controlled medications. This research project explored the relationship between pharmacy education, perceived and actual knowledge, and professional interactions as it pertains to problems surrounding dependency and addiction. A questionnaire of 25 items was administered at three separate continuing education programs in Florida in 2005. A total of 484 surveys were completed. Pharmacists (67.5%) reported participating in two hours or less of addiction/substance abuse education in pharmacy school. Of particular concern was that 29.2% reported having received no addiction education. Pharmacists who had greater amounts of addiction-specific education had a higher likelihood of correctly answering questions relating to the science of addiction and substance abuse counseling. In addition, pharmacists who reported more education counseled patients more frequently and felt more confident about counseling. A majority of respondents (53.7%) reported that they had never referred a patient to drug treatment in their career. These findings suggest that the neurobiological basis for addictive diseases, standards of care, and pain management guidelines were not widely understood by the sample. More research should be undertaken to determine the educational needs of practicing pharmacists to enable them to assume a leadership role in detecting, preventing, and treating prescription drug abuse.

Comparing the T scores from bone sonometer measurements in Hispanic and non-Hispanic white women

Ethnicity is an important risk factor for the development of osteoporosis. Non-Hispanic white or Asian women are commonly considered at higher risk than other ethnicities. Hispanics in the U.S. are of Mexican, Caribbean, Central American, or South American descent. Conclusive data on the relative risk of osteoporosis in Hispanic women based upon heritage within the Hispanic population are not available. Objective: To investigate whether Hispanic white women are at a significantly lower risk than non-Hispanic whites for the development of osteoporosis. Methods: Cross-sectional study. Setting: Community health screenings. Participants: Hispanic and non-Hispanic white women. Intervention: Bone density measurements of the non-dominant heel. Descriptive statistics and inferential statistics including regression analyses were performed using SPSS 14.0. Main Outcomes Measure: T scores. Results: Overall, measurements were obtained from 352 women (209 Hispanic & 143 non-Hispanic white) ranging in age from 55-97 years old. The mean T score obtained for Hispanic women was -1.194 and -1.280 for non-Hispanic white women. The correlation between the obtained T score and age was negative (r = -0.36, p<0.01), reflecting bone loss with increasing age. Regression analysis using age and ethnicity showed that ethnicity was a non-significant contributor to the best-fit regression line (t=0.60, p=0.55). Conclusion: This study indicates that Hispanic white women may be at comparable risk of developing osteoporosis as non-Hispanic white women (AU)

La etnia es un importante factor de riesgo para el desarrollo de la osteoporosis. Las mujeres blancas o asiáticas están consideradas como de mayor riesgo que otras etnias. Los hispanos en los Estados Unidos son descendientes de mejicanos, caribeños, centro o sudamericanos. No están disponibles datos concluyentes del riesgo relativo de osteoporosis en mujeres hispanas en base a la herencia en la población hispana. Objetivo: Investigar si las mujeres hispanas blancas tienen significativamente menor riesgo de desarrollar osteoporosis que las blancas no hispanas. Métodos: Estudio transversal. Ámbito: cribado de salud comunitaria. Participantes: Mujeres blancas hispanas y no hispanas. Intervención: medidas de densidad ósea en el talón no dominante. Se realizó estadística descriptiva e inferencial, incluyendo un análisis de regresión, utilizando SPSS 14.0. Variables de resultados principales: T score. Resultados: Se obtuvieron medidas de 352 mujeres blancas (209 hispanas y 143 no hispanas) que oscilaban entre 55-97 años. La media de T score obtenido de las mujeres blancas hispanas fue de -1,194 y el de las no hispanas de -1,280. La correlación entre el T score obtenido y la edad fue negativa (r= -0,36, p<0,01), reflejando que la perdida de peso aumenta con la edad. El análisis de regresión usando edad y etnia mostró que la etnia no era un contribuidor significativo para un mejor ajuste de la línea de regresión (t=0,60, p=0,55). Conclusión: Este indica que las mujeres blancas hispanas tienen un riesgo comparable de desarrollar osteoporosis que las mujeres blancas no hispanas (AU)

Comparing the T scores from bone sonometer measurements in Hispanic and non-Hispanic white women.

UNLABELLED: Ethnicity is an important risk factor for the development of osteoporosis. Non-Hispanic white or Asian women are commonly considered at higher risk than other ethnicities. Hispanics in the U.S. are of Mexican, Caribbean, Central American, or South American descent. Conclusive data on the relative risk of osteoporosis in Hispanic women based upon heritage within the Hispanic population are not available. OBJECTIVE: To investigate whether Hispanic white women are at a significantly lower risk than non- Hispanic whites for the development of osteoporosis. METHODS: Cross-sectional study. SETTING: Community health screenings. PARTICIPANTS: Hispanic and non-Hispanic white women. INTERVENTION: Bone density measurements of the non-dominant heel. Descriptive statistics and inferential statistics including regression analyses were performed using SPSS 14.0. MAIN OUTCOMES MEASURE: T scores. RESULTS: Overall, measurements were obtained from 352 women (209 Hispanic & 143 non-Hispanic white) ranging in age from 55-97 years old. The mean T score obtained for Hispanic women was - 1.194 and -1.280 for non-Hispanic white women. The correlation between the obtained T score and age was negative (r = -0.36, p<0.01), reflecting bone loss with increasing age. Regression analysis using age and ethnicity showed that ethnicity was a non-significant contributor to the best-fit regression line (t=0.60, p=0.55). CONCLUSION: This study indicates that Hispanic white women may be at comparable risk of developing osteoporosis as non-Hispanic white women.