An evidence-based systematic review of chlorophyll by the Natural Standard Research Collaboration.

An evidence-based systematic review of chlorophyll by the Natural Standard Research Collaboration consolidates the safety and efficacy data available in the scientific literature using a validated, reproducible grading rationale. This article includes written and statistical analysis of clinical trials, plus a compilation of expert opinion, folkloric precedent, history, pharmacology, kinetics/dynamics, interactions, adverse effects, toxicology, and dosing.

Privacy in the pharmacy environment: analysis of observations from inside the pharmacy.

OBJECTIVE: To measure the extent to which pharmacist-patient conversations are private. DESIGN: Cross sectional. SETTING: New York State, April to June 2007. PARTICIPANTS: No individual participants were enrolled; the study consisted of observations of the pharmacy environment and pharmacy patient-staff interactions. INTERVENTION: Measurement of privacy-related distances in the pharmacy. MAIN OUTCOME MEASURES: Distance between patients at the pharmacy counter and staff behind the counter, distance between patient waiting area and pharmacy counter, and distance that a pharmacy counter conversation was audible. RESULTS: Observational data were recorded from 597 pharmacy staff-patient interactions in 282 pharmacies across New York State. Of the 597 interactions, 167 occurred while a second patient was within 6 ft. Of the 282 pharmacies, pharmacy staff-patient conversations were audible to observers more than 6 ft away in 229 pharmacies; 142 could be heard more than 15 ft away. CONCLUSION: Most staff-patient conversations in the pharmacy setting are not private and, as a result, have a high potential for incidental protected health information disclosures.

An evidence-based elective on dietary supplements.

OBJECTIVE: To implement and evaluate the effectiveness of a pharmacy elective on dietary supplements that emphasized evidence-based care. DESIGN: A 3-credit elective that employed both traditional lectures and a variety of active-learning exercises was implemented. The course introduction provided a background in dietary supplement use and evidence-based medicine principles before addressing dietary supplements by primary indication. ASSESSMENT: Student learning was assessed through quizzes, case assignments, discussion board participation, and completion of a longitudinal group project. Precourse and postcourse surveys were conducted to assess students' opinions, knowledge, and skills related to course objectives. CONCLUSION: The course was an effective way to increase students' knowledge of dietary supplements and skills and confidence in providing patient care in this area.

Alternative approaches to partner notification, diagnosis, and treatment: pharmacists' perspectives on proposed patient delivered partner therapy in New York State, 2007.

BACKGROUND: Supported by the American Medical Association, patient delivered partner therapy (PDPT) is becoming legal in many states. For some individuals exposed to sexually transmitted infections, the pharmacist may become the sole point of contact with the medical system. METHODS: To determine pharmacists' perceptions about PDPT, education on sexually transmitted infections, and potential barriers that need to be addressed in pharmacies for successful implementation of PDPT, we conducted a survey of pharmacists and observed privacy-related spaces in pharmacies. In 8 counties of the Capital Region, all community pharmacies were invited to participate. In 8 additional counties convenience sampling was utilized. The response proportion was 67.3% overall. RESULTS: Of the 193 pharmacists responding to the survey, 63% supported PDPT for Chlamydia and 78% do not want a behind-the-counter status for Chlamydia antibiotics. The majority (88%) of pharmacists want prescriptions marked as PDPT to alert them to counseling needs. About half the pharmacists reported they would automatically submit PDPT prescriptions to insurance company, a confidentiality issue. The barrier cited most often to patient counseling was time (49%). CONCLUSIONS: Pharmacists are open to considering PDPT as part of their professional functions. Although pharmacists need additional sexually transmitted infections education in general, capacity for this training can be developed. Confidentiality issues remain a priority issue to address to protect individuals treated through PDPT.

Use of and familiarity with dietary supplement information references by practicing pharmacists.

OBJECTIVE: To survey practicing pharmacists regarding their use of and familiarity with six dietary supplement information references. METHODS: Pharmacists attending a March 2005 continuing education program at the Albany College of Pharmacy on interactions between drugs and dietary supplements were surveyed about their use of and views on dietary supplement information references. Included in the survey were six references: Physicians Desk Reference (PDR) for Herbal Medicines; Facts and Comparisons: Review of Natural Products; German Commission E Monographs; Natural Medicines Comprehensive Database (online or textbook format); Micromedex: AltMedDex; and The Natural Therapeutics Pocket Guide. The survey was repeated by mail 1 year after the program. RESULTS: Of the 91 attendees at the program, 58 completed the survey, and 25 individuals returned the 1-year survey. Of those completing the surveys, 80% had more than 10 years in practice, 95% had bachelor's degrees, and most practiced in community or institutional pharmacies. At baseline, fewer than 40% had "heard of" four of the six references. Pharmacists were most familiar with PDR for Herbal Medicines and Facts and Comparisons: Review of Natural Products. Familiarity rates increased at 1 year for five of the six references, though, again, overall rates were low and differences from baseline were not statistically significant for any of the six references. Usage rates increased for two references (Facts and Comparisons: Review of Natural Products and Natural Medicines Comprehensive Database) at 1 year and declined for the remaining four. CONCLUSION: Experienced pharmacists in both community and institutional settings infrequently use and are unfamiliar with dietary supplement information references, including those found in studies to be of the highest quality. Education on the availability and features of these references could benefit pharmacists and potentially change usage patterns.

Obtaining and providing health information in the community pharmacy setting.

Community pharmacists are a valuable information resource for patients and other healthcare providers. The advent of new information technology, most notably the Internet, coupled with the rapid availability of new healthcare information, has fueled this demand. Pharmacy students must receive training that enables them to meet this need. Community advanced pharmacy practice experiences (APPEs) provide an excellent opportunity for students to develop and master drug information skills in a real-world setting. Preceptors must ensure that students are familiar with drug information resources and can efficiently identify the most useful resource for a given topic. Students must also be trained to assess the quality of resources and use this information to effectively respond to drug or health information inquiries. This article will discuss key aspects of providing drug information in the community pharmacy setting and can serve as a guide and resource for APPE preceptors.

Development and validation of an instrument to determine patient knowledge: the oral anticoagulation knowledge test.

BACKGROUND: Studies examining the relationship between patient knowledge regarding warfarin therapy and its safe and effective use are limited by the lack of validated knowledge assessment tools. OBJECTIVE: To develop and validate an instrument to assess patient knowledge regarding oral anticoagulation therapy. METHODS: Four nationally recognized anticoagulation experts participated in the instrument development process to ensure content validity. The Oral Anticoagulation Knowledge (OAK) test was administered to subjects on warfarin and a group of age-matched subjects not on warfarin to assess construct validity. A subgroup of warfarin subjects were retested approximately 2-3 months after initial testing to assess test-retest reliability. Internal consistency reliability was assessed by calculating a Kuder-Richardson 20 value. Item analysis was used to assess performance of individual questions. RESULTS: An initial 23 item instrument was pilot tested for readability and comprehension. The OAK test was administered to 74 subjects taking warfarin and 27 age-matched subjects not on warfarin. Thirty-two subjects on warfarin repeated the OAK test an average of 75 days following initial administration. Subjects taking warfarin scored significantly higher than those not on warfarin (72% vs 52%, respectively; p < 0.001), supporting the construct validity of the instrument. Test-retest reliability was acceptable, with a Pearson's correlation coefficient of 0.81. Internal consistency reliability was confirmed by a calculated Kuder-Richardson 20 value of 0.76. CONCLUSIONS: The OAK test is a brief, valid, and reliable knowledge assessment instrument that may be a useful tool for research and clinical practice to augment patient education programs.

Community pharmacy Target Intervention Program to improve aspirin use in persons with diabetes.

OBJECTIVE: To identify the rate of aspirin or antiplatelet/anticoagulant use in persons with diabetes presenting to community pharmacies and determine whether a student pharmacist-driven Target Intervention Program (TIP) could increase the number of eligible persons with diabetes receiving aspirin therapy in accordance with American Diabetes Association (ADA) recommendations. DESIGN: Unblinded, single intervention. SETTING: Eight Community Pharmacy Advanced Practice Experience (CPAPE) sites in New York State. PARTICIPANTS: Persons having prescriptions filled for diabetes medications or supplies who were not receiving antiplatelet/anticoagulant medications. INTERVENTIONS: Assessment sheets were completed by student pharmacists for eligible patients to determine appropriateness for aspirin therapy. Recommendations for aspirin therapy were faxed to physicians when indicated, and physicians responded via fax for aspirin therapy implementation. The student pharmacists contacted patients, informed patients of physician decisions, and provided appropriate counseling. MAIN OUTCOME MEASURES: Number of persons with diabetes currently receiving aspirin or antiplatelet/anticoagulant medications and the number initiated on aspirin as a result of the TIP. RESULTS: A total of 436 persons with diabetes were identified. Of those contacted, 322 agreed to participate and 31 declined; 228 were taking aspirin or other antiplatelet/anticoagulant agents at baseline. Students completed assessment sheets, which were forwarded to physicians, for 79 subjects potentially eligible to receive aspirin therapy; 65 physician responses were received (82% response rate). Aspirin therapy was initiated in 53 patients (67%). CONCLUSION: The TIP enabled CPAPE students to increase aspirin use among eligible persons with diabetes in accordance with ADA guidelines.

Assessment of the effects of a community pharmacy women's health education program on management of menopause survey scores.

OBJECTIVE: This study examined the effect of a community pharmacy-based menopause education program on scores of the Management of Menopause (MoM) survey. The MoM survey is a tool administered to managed care organization members by the National Committee for Quality Assurance to determine the level of menopause-related education offered by their health care providers. The primary outcome was comparison of the median MoM survey scores of participants at baseline, 3 months, and 1 year posteducation. METHODS: Women aged 47 to 55 years who were able to provide informed consent were enrolled. Subjects completed a baseline MoM survey. Trained pharmacists working in 7 pharmacies conducted one-on-one education sessions regarding the consequences of menopause, treatment options, and the known risks and benefits of each option. Follow-up MoM surveys were administered by mail at 3 months and 1 year posteducation. The survey is scored on a 100-point scale for an overall composite score and includes 3 subsections: exposure, breadth, and personalization of counseling. RESULTS: A total of 31 subjects were enrolled, with 24 and 16 completing both baseline and 3-month or 1-year MoM follow-up surveys, respectively. Median 3-month composite MoM survey scores (86.1; 95% CI, 61.1-93.1) were significantly improved from baseline (54.2; 95% CI, 36.1-62.5; P<0.001). Scores on each subsection of the MoM survey also improved at 3 months, and median 1-year composite scores were significantly improved from baseline. (54.2 to 89, P = 0.001). Patient satisfaction with the education session was high, with a median satisfaction rating of 5 (a range of 4 to 5) on a 5-point satisfaction rating scale. CONCLUSION: A community pharmacy-based menopause education program significantly increased scores on the MoM survey, and subjects were satisfied with this program.

Impact and feasibility of a community pharmacy bone mineral density screening and education program.

OBJECTIVE: To assess the impact of a community pharmacy-based bone mineral density (BMD) screening and education program and determine the feasibility of providing such a service in community pharmacies. DESIGN: Uncontrolled study using convenience sample combined with economic feasibility analysis. SETTING: Two independent and four chain community pharmacies. PARTICIPANTS: Women age 18 years and older. INTERVENTION: Pharmacy patrons were invited to a free BMD screening. Demographic information was collected, and patients were screened using an ultrasound BMD analyzer. BMD results were reviewed with the participant during an education session and forwarded to primary care providers. Questionnaires were completed at baseline and after 3 months. MAIN OUTCOME MEASURES: Time spent with each participant, project costs, and willingness to pay for screenings were used to estimate feasibility; questionnaire responses assessed impact of the intervention on participants' health care decisions, lifestyle modifications, and communications with their prescribers about osteoporosis. RESULTS: Of the 140 women screened at baseline, 82% indicated the screening was "very useful" for making health care decisions, and 91% believed it encouraged them to talk with their physicians about osteoporosis. At 3 months, 11% of patients reported having improved exercise habits, and 30% had increased their calcium and vitamin D intake. A total of 41% of respondents indicated a willingness to pay dollar 20 or more for the BMD screening service. The average screening time was 23 minutes. Based on fixed costs of the screening device and materials and variable costs associated with personnel time, a community pharmacy could generate a positive net income with a BMD screening program. Cost of the BMD analyzer could be recovered through revenue generated in 24-35 screening days, depending on the fees charged. CONCLUSION: A community pharmacy osteoporosis program had a positive impact on patient health care by influencing lifestyle modifications, increasing use of medications, and encouraging participants to discuss osteoporosis with their physician. Patients are willing to pay for this service; feasibility varies depending on available resources and patient population served.

Training experiences of current and former community pharmacy residents, 1986-2000.

OBJECTIVE: To identify why current and former community pharmacy residents chose a community pharmacy residency program (CPRP), what factors in the program were emphasized and not emphasized, what opportunities were available to them postresidency, and, for former residents, what skills learned during their residency have been most useful in their careers to date. DESIGN: Mail survey. PARTICIPANTS: 1999-2000 residents and former residents dating back to 1986. MAIN OUTCOME MEASURES: Reasons residents chose a CPRP over other residency or employment opportunities and respondents' ratings of the emphasis placed on a variety of skills and activities in their training programs. RESULTS: A total of 44 surveys were included in the final analysis, 18 (41%) of which were completed by 1999-2000 CPRP residents performing their residency at the time of the survey. The most common reasons for choosing a CPRP over other types of programs were opportunities for developing innovative services and direct patient interaction. Communication skills, clinical skills, and level of patient interaction were reported as being most highly emphasized. Management of the distribution system was most frequently cited as having "low" or "no" emphasis in their residency. Respondents listed marketing skills as the most common area requiring improvement or additional focus in their residency. Former residents cited leadership skills and the development of patient care services as the factors in their residency having the greatest impact on their careers to date. Postresidency opportunities most frequently sought included faculty, staff pharmacist, and clinical pharmacist positions. CONCLUSION: Candidates are drawn to CPRPs because of the opportunities such residencies offer to develop innovative services and provide direct patient care. Residents feel that many programs fail to provide adequate training in the areas of marketing services and obtaining reimbursement. Residency program directors should consider these findings when evaluating and marketing their programs.