Development and assessment of an abbreviated medication regimen complexity index (the A-MRCI).

DISCLAIMER: In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE: Adaptation of the Medication Regimen Complexity Index (MRCI) for automation in an electronic medical record has the potential to improve medication optimization and patient outcomes. The purpose of this study was to develop and evaluate an abbreviated medication regimen complexity index (A-MRCI) and compare its associations with patient-level factors to those of the MRCI. METHODS: The MRCI was modified via several rounds of review with an expert panel of clinical pharmacists and outcomes researchers. Medication data from 138 electronic health records were abstracted to calculate MRCI and A-MRCI scores for dosage form, dosing frequency, and additional directions. Comparison between indices was performed using inferential statistics for a 1-month sample of patients admitted to a cardiology or advanced heart failure service in 2017. RESULTS: A-MRCI scores were higher than MRCI scores (mean difference of 3.97, P < 0.0005; 95% CI, 2.21-5.71). A significant association was observed between the A-MRCI score and both length of stay (P = 0.0005) and polypharmacy (P < 0.0005), whereas an association between MRCI score and the patient-level factors examined was not demonstrated. CONCLUSION: On average, A-MRCI scores were higher and more likely to be associated with several patient-level factors. Internal analyses show the potential for integration into an electronic health record for automation. However, further exploration of the A-MRCI in a larger external validation sample is warranted.

Utilization of a "Diversity Index" to Assess Racial Diversity of US School of Pharmacy Graduates.

OBJECTIVE: Diversity in the training environment for health professionals is associated with improved abilities for graduates to care for diverse populations. Thus, a goal for health professional training programs, including pharmacy schools, should be to pursue representation among graduates that mirrors that of their communities. METHODS: We evaluate racial and ethnic diversity among graduates of Doctor of Pharmacy (PharmD) programs across the United States (US) over time. Using a "Diversity Index", we quantify the relative racial and ethnic representation of each program's graduates compared with that of college-age graduates nationally and within the geographic region of the respective pharmacy school. RESULTS: Over the past decade, the number of US PharmD graduates increased by 24%. During this time, the number of Black and Hispanic PharmD graduates significantly increased. Still, representation of minoritized populations among graduates continues to be significantly lower compared with US benchmark populations. Only 16% of PharmD programs had a Diversity Index that matched or exceeded their benchmark comparator Black or Hispanic populations. CONCLUSION: These findings highlight the significant opportunity that exists to increase the diversity of graduates of US PharmD programs to better reflect the diversity of the US population.

Access to inclusive and culturally sensitive mental healthcare in Black, Indigenous, and People of Color pharmacy students and residents.

PURPOSE: Disparities in accessing culturally sensitive mental healthcare exist and may be exacerbated in pharmacy trainees. The purpose of this study was to identify barriers to culturally sensitive mental healthcare and how to improve access for racially and ethnically minoritized pharmacy students and residents. METHODS: This institutional review board-exempt study included in-person and virtual focus groups. Eligible participants were first-, second-, third-, and fourth-year doctor of pharmacy (PharmD) students and pharmacy residents completing a postgraduate year 1 or 2 program who identified as Black, Indigenous, and People of Color (BIPOC). Barriers to care, identity's influence on seeking care, and areas in which the training programs are doing well or areas for improvement were assessed. Responses were transcribed and analyzed using an open coding system by 2 reviewers, followed by discussion as a team to reach consensus. RESULTS: This study enrolled 8 first-year, 5 second-year, 7 third-year, and 2 fourth-year PharmD students and 4 residents (N = 26). Barriers to care included time, access to resources, and internal and external stigma. Identity barriers included cultural and family stigma and lack of representation in therapists with regard to race, ethnicity, and gender. Areas going well included supportive faculty and paid time off, while areas for improvement included wellness days, reduced workload, and increased diversity within the workforce. CONCLUSION: This study is the first to identify barriers to culturally sensitive mental healthcare in pharmacy trainees who identify as BIPOC while providing insight on how to increase culturally sensitive mental healthcare resources.

Reducing barriers to COVID-19 vaccine uptake through a culturally sensitive pharmacy-led patient medication education group in a behavioral health population.

BACKGROUND: Hesitancy surrounding the coronavirus disease 2019 (COVID-19) vaccine is high in those with mental illnesses owing to intrapersonal barriers and barriers relating to social determinants of health. OBJECTIVES: This study describes the implementation of a pharmacy-driven, culturally sensitive education program focused on COVID-19 vaccine hesitancy. METHODS: This was an institutional review board-exempt, descriptive, quality improvement study held at a behavioral health facility. An education program dedicated to reduce COVID-19 vaccine hesitancy was developed. Each educator completed training on providing culturally sensitive care to behavioral health patients. Patients voluntarily attended pharmacist-led patient medication education groups (PMEGs) and were offered an anonymous survey. Participation was documented in the electronic health record (EHR). Vaccination status and perception of the education were collected through retrospective analysis of the EHR, survey results, and state COVID-19 vaccine registry. RESULTS: Twenty PMEGs were provided and reached 90 individuals, with 47% identifying as black, indigenous, or person of color. Sixty of 90 patients received at least 1 vaccine. For participants who were eligible for a second dose of a 2-dose series, 62% completed their second vaccination after PMEGs. Vaccination rates were highest in white participants (73.9%) followed by 64.7% of black participants, both higher than state specific rates. Participants self-reported an increase in their likelihood to become vaccinated after PMEG attendance on surveys and rated the quality of education as high. CONCLUSION: Patients who experience vaccine hesitancy had the opportunity to address their concerns on the COVID-19 vaccine. Overall, the program was well received and positively affected the patient's likelihood of obtaining and completing vaccination against COVID-19.

Impact of a resident-driven wellbeing committee on resident-perceived wellbeing, burnout, and resilience.

BACKGROUND: Limited data exists to guide strategies that reduce risks of burnout amongst pharmacy residents. OBJECTIVE: The primary objective of this analysis was to characterize wellbeing, burnout, and resiliency among pharmacy residents. The secondary objective was to assess the impact of a resident-run wellbeing committee on wellbeing, burnout, and resiliency. PRACTICE DESCRIPTION: In 2018, a wellbeing committee was developed at an academic medical center with the aim of promoting wellbeing and resilience amongst pharmacy residents. PRACTICE INNOVATION: The wellbeing committee functions through 3 workgroups focused on resources, engagement, and advocacy. Collectively, these workgroups aim to facilitate wellbeing discussions, plan mindfulness events, and advocate for policies to enhance the wellbeing of residents. EVALUATION METHODS: Pharmacy residents were invited to participate in an electronic survey aimed at characterizing resident wellbeing and assessing the impact of a resident-led wellbeing committee on wellbeing, burnout, and resiliency. The Resident & Fellow Wellbeing Index (RFWI) and Brief Resilience Scale (BRS) were utilized to assess burnout and resiliency, respectively. Continuous and categorical endpoints were assessed utilizing student t tests and chi-square tests, respectively. RESULTS: A total of 16 of 38 residents participated in this analysis. Scores for RFWI and BRS remained stable throughout the 16-week period. RFWI scores demonstrated that up to 50% of residents scored as "at risk" at any point during the study period, while over 80% of respondents maintained high levels of resilience. More than 50% of respondents reported a positive impact of the wellbeing committee on their wellbeing, burnout, and resilience. CONCLUSION: A resident-led wellbeing committee demonstrated favorable impact on wellbeing, burnout, and resilience for majority of pharmacy residents. While this data suggests that such a committee may serve to protect residents from the negative impacts of burnout, future studies are necessary to further elucidate strategies to promote resident wellbeing.

Healthcare Equity and Leadership: Implementation of Diversity, Equity, and Inclusion Training for Pharmacy Residents.

BackgroundPharmacy training programs infrequently include formal training in the areas of diversity, equity, and inclusion (DEI). Hence, the purpose of this report is to offer perspectives gained from the delivery of a DEI curriculum within a pharmacy residency program aimed at expanding experiential learning focused on DEI and health equity. Program Implementation: Pharmacy residents at an academic medical center were invited to participate in a longitudinal DEI/equity seminar series that was thoughtfully and strategically developed by a team of residents and program leadership based on a six-step process. Residents were offered 9 individual seminars covering 4 major focus areas to facilitate enhanced awareness, learning, and vulnerability. Participants were invited to provide evaluations of each seminar and the overall series. Program Assessment: A total of 41 residents (100%) participated in at least one of the 9 seminars that were offered and approximately 50% completed the post-series survey. Resident-perceived benefit of each individual session was consistently favorable. Additionally, greater than 70% of participants responded favorably when asked about the impact of each session on their awareness, resources provided, and ability to apply the learnings to their practice. Conclusion: Our inaugural experience with the integration of a DEI seminar series into a pharmacy residency program suggests that there is a clear benefit to including DEI/health equity into pharmacy residency training. This data may suggest that adoption of DEI-focused experiential training may increase cultural awareness and the availability of resources to better equip pharmacy residents in applying concepts of DEI into their practice.

Development and validation of a predictive model to predict and manage drug shortages.

PURPOSE: Pharmacy departments across the country are problem-solving the growing issue of drug shortages. We aim to change the drug shortage management strategy from a reactive process to a more proactive approach using predictive data analytics. By doing so, we can drive our decision-making to more efficiently manage drug shortages. METHODS: Internal purchasing, formulary, and drug shortage data were reviewed to identify drugs subject to a high shortage risk ("shortage drugs") or not subject to a high shortage risk ("nonshortage drugs"). Potential candidate predictors of drug shortage risk were collected from previous literature. The dataset was trained and tested using 2 methods, including k-fold cross-validation and a 70/30 partition into a training dataset and a testing dataset, respectively. RESULTS: A total of 1,517 shortage and nonshortage drugs were included. The following candidate predictors were used to build the dataset: dosage form, therapeutic class, controlled substance schedule (Schedule II or Schedules III-V), orphan drug status, generic versus branded status, and number of manufacturers. Predictors that positively predicted shortages included classification of drugs as intravenous-only, both oral and intravenous, antimicrobials, analgesics, electrolytes, anesthetics, and cardiovascular agents. Predictors that negatively predicted a shortage included classification as an oral-only agent, branded-only agent, antipsychotic, Schedule II agent, or orphan drug, as well as the total number of manufacturers. The calculated sensitivity was 0.71; the specificity, 0.93; the accuracy, 0.87; and the C statistic, 0.93. CONCLUSION: The study demonstrated the use of predictive analytics to create a drug shortage model using drug characteristics and manufacturing variables.

Medication-related characteristics of a high-utilizer psychiatric population.

OBJECTIVE: To identify medication-related and nonmedication-related characteristics and risk factors for readmission in a high-utilizer psychiatric population. METHODS: In this retrospective cohort study, patients were identified through the institution's electronic medical records as high utilizers if they had 5 or more psychiatric admissions or at least 1 30-day psychiatric readmission from July 2012 through March 2014. The primary outcome was to identify medication-related characteristics. Secondary outcomes were to identify if medication- and nonmedication-related factors were related to number of and time to readmissions. RESULTS: A total of 170 patients and 497 readmissions were included. Up to 89% of patients had 30-day readmissions, and 12% had 5 or more readmissions. A total of 52% of patients were discharged on 6 or more medications, with 54% discharged with at least 3 psychotropic medications. A total of 31% of patients had documented medication nonadherence, with adverse effects or cost reported as the most common reasons. Only 32% of patients filled a prescription at the hospital's outpatient pharmacy with 44% doing so within 7 days of discharge. Adherence and use of outpatient pharmacy were unrelated to the number of readmissions and time to readmission, but having a diagnosis of major depressive disorder was related to shorter time to readmission. CONCLUSIONS: Low outpatient pharmacy utilization, multiple psychotropic discharge medications, and unknown or documented nonadherence are common traits of this population. Future studies to determine what medication factors influence readmissions and whether targeting those specific medication-related factors would decrease the risk for readmission are needed.

Assessment of mental health needs and barriers to care in students enrolled in doctor of pharmacy and pharmaceutical sciences programs.

INTRODUCTION: The purpose of this study is to identify doctor of pharmacy and pharmaceutical sciences students' perceived barriers to mental health care and interest in mental health interventions and to assess student attitudes and perceptions of mental illness. METHODS: A mixed-methods survey was given to 706 students participating in a doctor of pharmacy and pharmaceutical sciences curricula to assess students' perceived barriers to care, interest in mental health resources and interventions within their curricula, attitudes towards seeking treatment, and perceived stigma. The last section included free text responses in which students expressed additional comments unacknowledged by previous sections. Quantitative data was analyzed using descriptive statistics, and free text responses were analyzed using thematic coding. RESULTS: From February to March 2018, 256 responses were received out of 706 students with a response rate of 36%. The most cited barriers to seeking mental health treatment were lack of time, lack of finances, and stigma-related concerns (25%, 13%, and 11%, respectively) with the most desired interventions being the implementation of an onsite counselor and wellness space. A majority of participants (88%) believe professional help for mental illness is effective; however, 63% cited they were negatively impacted by internal stigma. Common themes addressed in the free text responses reinforced these ideas and included additional responses regarding the impact of school culture. CONCLUSION: Students within a doctor of pharmacy and pharmaceutical sciences program experience non-stigma and stigma-related barriers to seeking mental health treatment.

Assessment of pharmacy-driven transitional interventions in hospitalized patients with psychiatric disorders.

OBJECTIVE: Pharmacy-driven transitions of care (TOC) services for psychiatric patient populations have not been systematically evaluated. The primary objective was to assess pharmacy TOC services for patients hospitalized for psychiatric care at an academic medical center. The secondary objectives were to evaluate the incidence of psychiatric-associated readmission, emergency department (ED) presentations, or both and outpatient clinic follow-up 30 days after discharge, in addition to characterizing the types and frequencies of psychotropic medications prescribed at discharge. DESIGN: Retrospective, double-cohort study. SETTING AND PARTICIPANTS: This study compares adult patients who received at least 1 pharmacy-driven TOC intervention before discharge from a psychiatric unit between June 1, 2017, and June 30, 2018, with a historical control group that was discharged between June 1, 2016, and May 31, 2017. Interventions included discharge education on selected high-risk medications, medication barriers assessment, TOC notes to outpatient providers, postdischarge telecommunication, and bedside medication delivery. OUTCOME MEASURES: The percentage of pharmacy TOC services provided for patients hospitalized for psychiatric care at an academic medical center and the incidence of psychiatric-associated readmission, ED presentations, or both and outpatient clinic follow-up 30 days after discharge. RESULTS: Fifty-three and 104 electronic health records were reviewed within the control and intervention groups, respectively. The most common interventions were discharge education (22.7%), bedside delivery of medications (22.7%), and medication barrier assessments (22.2%). Adherence (26.8%) and cost (19.5%) were the most common medication barriers. Thirty-day psychiatric-associated readmissions, ED presentations, or both occurred in 32.4% and 15.4% of patients in the control and intervention groups, respectively (P < 0.001). Of the patients, 15.1% and 20.1% presented for outpatient follow-up in the control and intervention groups, respectively (P < 0.001). Statistically, more patients in the control group were prescribed antidepressants at discharge (41.8% vs. 13.1%), whereas more patients in the intervention group were prescribed lithium (10.9% vs. 4.3%) and antipsychotics other than clozapine (40.0% vs. 25.9%). CONCLUSION: The findings show significant differences in clinical outcomes between patients receiving and not receiving pharmacy-driven transitional interventions. Future prospective studies are warranted to further elucidate these observations.

Secondary Binding Interactions in a Synthetic Receptor for Trimethyllysine.

We have systematically studied how secondary interactions with neighboring lysine (Lys) and arginine (Arg) residues influence the binding and selectivity of the synthetic receptor A2 N for trimethyllysine (Kme3 ). Multiple secondary binding sites on A2 N are formed by carboxylates rigidly positioned over aromatic rings, a motif that has been shown to stabilize salt bridges. We varied the spacing between KmeX (X=0, 3) and an ancillary Lys or Arg and measured binding by isothermal titration calorimetry (ITC). These studies revealed that both neighboring residues improve the binding of A2 N to KmeX by approximately 1 kcal mol(-1) , with little influence of the spacing. Nonetheless, the improvement in affinity caused by Arg is enthalpically driven, while for Lys it is entropically driven, suggesting different mechanisms by which the residues interact with the secondary binding site.