Knowledge of folic acid and counseling practices among Ohio community pharmacists / Conocimiento sobre el ácido fólico y práctica de consejo entre los farmacéuticos comunitarios de Ohio

Objective: To determine knowledge of folic acid use for neural tube defect (NTD) prevention and counseling practices among community pharmacists registered in Ohio. Methods: A cross-sectional study was performed on a random sample (n=500) of community pharmacists registered with the Ohio Board of Pharmacy and practicing in Ohio. A survey previously used by researchers to assess folic acid knowledge and practices among samples of other healthcare provider groups in the United States was adapted with permission for this study. The final tool consisted of 28 questions evaluating the knowledge, counseling practices, and demographics of respondents. The cover letter did not reveal the emphasis on folic acid, and surveys were completed anonymously. The university institutional review board deemed the study exempt. Results: Of the 122 pharmacists who completed the survey, 116 (95.1%) knew that folic acid prevents some birth defects. Twenty-eight (22.9%) responded that they «always» or «usually» discuss multivitamins with women of childbearing potential, and 19 (15.6%) responded that they «always» or «usually» discuss folic acid supplements. Some gaps in knowledge specific to folic acid were revealed. While 63.1% of pharmacists selected the recommended dose of folic acid intake for most women of childbearing potential, 13.1% could identify the dose recommended for women who have had a previous NTD-affected pregnancy. Respondents identified continuing education programs, pharmacy journals/magazines, and the Internet as preferred avenues to obtain additional information about folic acid and NTD. Conclusion: This study represents the first systematic evaluation of folic acid knowledge and counseling practices among a sample of pharmacists in the United States. As highly accessible healthcare professionals, community pharmacists can fulfill a vital public health role by counseling women of childbearing potential about folic acid intake. Educational materials may be beneficial in augmenting knowledge of folic acid and facilitating patient education (AU)

Objetivo: Determinar el conocimiento del uso de ácido fólico para prevención de defectos del tubo neural (NTD) y las prácticas de consejo entre los farmacéuticos comunitarios registrados en Ohio. Métodos: Se realizó un estudio transversal en una muestra aleatoria (n=500) farmacéuticos comunitarios registrados en la Junta de Farmacia de Ohio y que ejercían en Ohio. Se adaptó para este estudio con permiso, una encuesta previamente utilizada por investigadores para evaluar el conocimiento y las prácticas con ácido fólico entre muestras de otros profesionales de la salud en los Estados Unidos. El instrumento final comprendía 28 preguntas que evaluaban el conocimiento, las prácticas de consejo, y la demografía de los respondientes. La carta de presentación no revelaba el énfasis en el ácido fólico y los cuestionarios fueron completados anónimamente. La comisión de investigación institucional consideró el estudio exento de requisitos. Resultados: De los 122 farmacéuticos que completaron el estudio, 116 (95,1%) sabía que el ácido fólico prevenía algunos defectos congénitos. 28 (22,9%) respondió que «siempre» o «normalmente» hablaba de los multivitamínicos con las mujeres con posibilidad de embarazo, y 19 (16,6%) respondió que «siempre» o «normalmente» hablaban de los suplementos de ácido fólico. Se revelaron algunas lagunas en conocimientos específicos sobre el ácido fólico. Mientras que el 63,1% de los farmacéuticos seleccionó la dosis recomendada para la ingesta de ácido fólico en una mujer con posibilidad de embarazo, el 13,1% pudo identificar la dosis recomendada para mujeres que habían tenido un embarazo previo afectado por NTD. Los respondientes identificaron los programas de formación continua, las revistas y periódicos farmacéuticos, e Internet como los medios preferidos para obtener información adicional sobre el ácido fólico y los NTD. Concusión: Este estudio representa la primera evaluación sistemática de los conocimientos y prácticas de consejo sobre ácido fólico en una muestra de farmacéuticos en los Estados Unidos. Como profesionales altamente accesibles, los farmacéuticos comunitarios pueden tener un papel vital en la salud pública aconsejando a las mujeres con posibilidades de embarazo sobre la ingesta de ácido fólico. Los materiales educativos pueden ser benéficos para aumentar el conocimiento del ácido fólico y facilitar la educación de los pacientes (AU)

Impact of a pharmacist-directed educational program on the long-term knowledge and use of folic acid among college women: a 12-month follow-up study / Impacto de un programa educativo dirigido por farmacéutico sobre el conocimiento a largo plazo y uso del ácido fólico entre universitarias: estudio de seguimiento de 12 meses

Few studies have examined the impact of educational interventions on participants’ long-term knowledge and use of folic acid for prevention of neural tube defects (NTD). Objective: The objective of this pilot study was to evaluate changes in knowledge and behaviors in a sample of college women one year after such a program. Methods: Female students of a residential college campus voluntarily attended the event, which was advertised to the campus community as a women’s health seminar. Participants completed a multiplechoice test assessing knowledge of folic acid and NTD and frequency of multivitamin use before and immediately after a 30-minute oral presentation. Following 3 reminder messages sent via email or mail, knowledge and multivitamin use were reassessed 1-month and 12-months post-intervention. Results: Thirty-two college women participated in the educational intervention; 27 (84%) completed the 12-month post-test. At 12 months, statistically significant increases in knowledge from baseline remained for questions pertaining to food high in folic acid (p=0.023); completion of spinal column (p=0.011); and 2 questions on NTD prevention (p=0.044). Increases in knowledge regarding recommended daily allowance of folic acid (p=0.817) and difficulty in receiving adequate folic acid from diet alone (p=0.617) were not statistically significant from baseline. Regular multivitamin use (≥4 times per week) was not statistically significantly increased from baseline (p=0.592). Conclusion: Although it was encouraging that the women retained much of the information learned during the program, it appears that the changes in multivitamin use seen at 1-month were not sustained at 12-months. Further study with larger groups of college women is recommended (AU)

Pocos estudios han examinado el impacto de las intervenciones educativas sobre el conocimiento a largo plazo de los participantes y el uso de acido fólico para prevenir los defectos del tubo neural (DTN). Objetivo: El objetivo de este estudio piloto fue evaluar los cambios en conocimientos y comportamiento en una muestra de universitarias un año después de tal programa. Métodos: Mujeres estudiantes de una residencia universitaria del campus atendieron voluntariamente al evento, que se promocionó en la comunidad universitaria como un seminario de salud de la mujer. Los participantes completaron un examen de preguntas de elección múltiple que evaluaba el conocimiento del ácido fólico y de los DTN y el uso de multivitamínicos antes e inmediatamente después de una presentación oral de 30 minutos. Después, se utilizaron 3 mensajes de recuerdo, enviados por email o correo, para reevaluar 1 mes y 12 meses post-intervención. Resultados: 32 universitarias participaron en la intervención educativa; 27 (84%) completaron el post-test de 12 meses. A los 12 meses, persisten aumentos significativos del conocimiento inicial para las preguntas relativas a los alimentos ricos en ácido fólico (p=,023), compleción de la columna vertebral (p=0,011); y las 2 preguntas sobre prevención de los DTN (p=0,044). Los aumentos en conocimiento relativos a la ingesta diaria recomendada de ácido fólico (p=0,817) y la dificultades en recibir la cantidad adecuada de ácido fólico solo en la dieta (p=0,617) no fueron estadísticamente significativas respecto al inicio. El uso de multivitamínicos ((≥4 veces a la semana) no se aumentó significativamente desde el inicio (p=0,592). Conclusión: Aunque es esperanzador que las mujeres retenían mucha de la información aprendida durante el programa, parece que los cambios en el uso de multivitamínicos que se veían tras 1 mes, no se mantuvieron a los 12 meses. Se recomiendan estudios con grupos mayores de universitarias (AU)

Employee attitudes toward participation in a work site-based health and wellness clinic.

PURPOSE: To conduct a needs assessment to determine employee attitudes and barriers toward participation in a multidisciplinary work site-based health and wellness clinic. METHODS: A 21-question survey was developed and sent electronically to all available (n = 874) employees of a self-insured employer. RESULTS: Of the 303 survey respondents (34.7% response rate), 67.3% (n = 204) individuals indicated a desire to meet with a pharmacist regarding medication information. Medication therapy management (MTM) services most often selected by survey respondents included basic education about each medication and its intended purpose (33%, n = 100); education on self-care (30%, n = 91); and information on generic or less expensive alternative medications and strategies for cost savings (25.1%, n = 76). Eighty-eight (29%) respondents indicated a desire for preventive care counseling to receive guidance on recommended disease screenings, immunizations, and other recommended services. Additional interest was observed in nutrition coaching (n = 131, 43.2%) and exercise programming (n = 272, 89.4%). CONCLUSIONS: The majority of respondents indicated a desire to participate in a work site-based health and wellness clinic, regardless of baseline health status or medication use. These data provide insight into the needs and preferences of participants in work site wellness programs and shows the value of a needs assessment.

The Assessment, Development, Assurance Pharmacist's Tool (ADAPT) for ensuring quality implementation of health promotion programs.

OBJECTIVE: To develop and validate the Assessment, Development, Assurance Pharmacist's Tool (ADAPT), an instrument for pharmacists and student pharmacists to use in developing and implementing health promotion programs. METHODS: The 36-item ADAPT instrument was developed using the framework of public health's 3 core functions (assessment, policy development, and assurance) and 10 essential services. The tool's content and usage was assessed and conducted through peer-review and initial validity testing processes. RESULTS: Over 20 faculty members, preceptors, and student pharmacists at 5 institutions involved in planning and implementing health promotion initiatives reviewed the instrument and conducted validity testing. The instrument took approximately 15 minutes to complete and the findings resulted in changes and improvements to elements of the programs evaluated. CONCLUSION: The ADAPT instrument fills a need to more effectively plan, develop, implement, and evaluate pharmacist-directed public health programs that are evidence-based, high-quality, and compliant with laws and regulations and facilitates documentation of pharmacists' contributions to public health.

Impact of a pharmacist-directed educational program on the long-term knowledge and use of folic acid among college women: a 12-month follow-up study.

UNLABELLED: Few studies have examined the impact of educational interventions on participants' long-term knowledge and use of folic acid for prevention of neural tube defects (NTD). OBJECTIVE: The objective of this pilot study was to evaluate changes in knowledge and behaviors in a sample of college women one year after such a program. METHODS: Female students of a residential college campus voluntarily attended the event, which was advertised to the campus community as a women's health seminar. Participants completed a multiple-choice test assessing knowledge of folic acid and NTD and frequency of multivitamin use before and immediately after a 30-minute oral presentation. Following 3 reminder messages sent via email or mail, knowledge and multivitamin use were re-assessed 1-month and 12-months post-intervention. RESULTS: Thirty-two college women participated in the educational intervention; 27 (84%) completed the 12-month post-test. At 12 months, statistically significant increases in knowledge from baseline remained for questions pertaining to food high in folic acid (p=0.023); completion of spinal column (p=0.011); and 2 questions on NTD prevention (p=0.044). Increases in knowledge regarding recommended daily allowance of folic acid (p=0.817) and difficulty in receiving adequate folic acid from diet alone (p=0.617) were not statistically significant from baseline. Regular multivitamin use (≥4 times per week) was not statistically significantly increased from baseline (p=0.592). CONCLUSIONS: Although it was encouraging that the women retained much of the information learned during the program, it appears that the changes in multivitamin use seen at 1-month were not sustained at 12-months. Further study with larger groups of college women is recommended.

Knowledge of folic acid and counseling practices among Ohio community pharmacists.

OBJECTIVE: To determine knowledge of folic acid use for neural tube defect (NTD) prevention and counseling practices among community pharmacists registered in Ohio. METHODS: A cross-sectional study was performed on a random sample (n=500) of community pharmacists registered with the Ohio Board of Pharmacy and practicing in Ohio. A survey previously used by researchers to assess folic acid knowledge and practices among samples of other healthcare provider groups in the United States was adapted with permission for this study. The final tool consisted of 28 questions evaluating the knowledge, counseling practices, and demographics of respondents. The cover letter did not reveal the emphasis on folic acid, and surveys were completed anonymously. The university institutional review board deemed the study exempt. RESULTS: Of the 122 pharmacists who completed the survey, 116 (95.1%) knew that folic acid prevents some birth defects. Twenty-eight (22.9%) responded that they "always" or "usually" discuss multivitamins with women of childbearing potential, and 19 (15.6%) responded that they "always" or "usually" discuss folic acid supplements. Some gaps in knowledge specific to folic acid were revealed. While 63.1% of pharmacists selected the recommended dose of folic acid intake for most women of childbearing potential, 13.1% could identify the dose recommended for women who have had a previous NTD-affected pregnancy. Respondents identified continuing education programs, pharmacy journals/magazines, and the Internet as preferred avenues to obtain additional information about folic acid and NTD. CONCLUSIONS: This study represents the first systematic evaluation of folic acid knowledge and counseling practices among a sample of pharmacists in the United States. As highly accessible healthcare professionals, community pharmacists can fulfill a vital public health role by counseling women of childbearing potential about folic acid intake. Educational materials may be beneficial in augmenting knowledge of folic acid and facilitating patient education.

Preliminary results from a multidisciplinary university-based disease state management program focused on hypertension, hyperlipidemia, and diabetes.

OBJECTIVE: To describe the implementation and evaluation of a pilot multidisciplinary disease state management (DSM) program for diabetes, hypertension, and hyperlipidemia at a private, self-insured university (over 900 covered lives). METHODS: Enrollees met with a pharmacist, nurse, exercise physiologist, and students in these disciplines to improve clinical outcomes and fitness parameters. Clinical values, quality of life, patient knowledge of disease states, and patient satisfaction were assessed. RESULTS: Of the 20 patients in the pilot program, 17 completed 1 nursing and 2 pharmacist visits; 8 completed exercise physiology visits. At baseline, elevated blood pressure readings were observed in 64.7% (11 of 17) of patients, 20% of those with diabetes (1 of 5) had an elevated hemoglobin A1c value (HbA1c), and 82.4% (14 of 17) had a cholesterol value that was not at goal. At least 1 medication-related problem was observed in 16 patients (94.1%). At 3 months, all patients with diabetes achieved HbA1c levels at or below 7%, 4 patients attained blood pressure control, and 1 achieved normal cholesterol readings. Patients characterized participation in the program as valuable and convenient. CONCLUSIONS: Patients involved in the multidisciplinary DSM showed improved clinical outcomes after 3 months. Ongoing analysis of patient outcomes will determine the long-term effectiveness of the DSM.

Principles of drug literature evaluation for observational study designs.

Clinical pharmacists must often interpret and use data derived from observational studies when making clinical decisions and recommendations, answering drug information questions, and educating patients about drug therapy. This is the third article in a three-part series intended to enhance clinical pharmacists' understanding of methods frequently used in such research and their application to patient care. Principles for critical evaluation of published observational studies are presented. Issues of bias and confounding that must be taken into account when assessing the data derived from observational studies are explained. Finally, examples of applications in pharmacy practice are presented.

Knowledge and use of folic acid among college women: a pilot health promotion program led by pharmacy students and faculty / Conocimiento y uso de ácido fólico entre estudiantes universitarias: un programa piloto de promoción de la salud conducido por estudiantes de farmacia

As pharmacists and pharmacy students are increasingly called upon to assume roles in public health activities, it is important to recognize unique opportunities to educate community members on health, wellness, and disease prevention. Objective: To evaluate the impact of a pilot health promotion program on college women's knowledge regarding folic acid and prevention of neural tube defects (NTD) and frequency of multivitamin use. Methods: A health promotion program was developed by a pharmacy student and two pharmacy faculty members that included an oral presentation and reminder messages. A multiple-choice test assessing knowledge of folic acid and NTD and frequency of multivitamin use was given to participants before and immediately after the presentation. Participants then received a reminder message regarding folic acid once a week for three weeks. Knowledge and multivitamin use were re-assessed four weeks post-intervention. Results: Thirty-two college women voluntarily attended the oral presentation. Twenty-five women (78.2%) completed the four-week post-test. Compared to the pre-test, there were statistically significant increases in average test score (p<0.0001) and correct responses to questions regarding folic acid and NTD (p<0.05 for each question). Participants reported a statistically significant increase in regular (> 4 times/week) multivitamin use (p=0.023). Conclusion: Participants in the pilot health promotion program demonstrated a statistically significant increase in knowledge about folic acid and frequency of multivitamin use. A similarly-modeled health promotion program may be an effective way of increasing folic acid and NTD knowledge and changing behaviors of multivitamin use in college women (AU)

Como los farmacéuticos y estudiantes de farmacia están llamados cada día más a asumir papeles en actividades de salud pública, es importante reconocer las oportunidades para educar a los miembros de la comunidad en salud, bienestar y prevención de la enfermedad. Objetivo: Evaluar el impacto de un programa piloto de promoción de la salud en el conocimiento de las universitarias sobre ácido fólico y prevención de defectos del tubo neural (DTN) y la frecuencia del uso de multivitamínicos. Métodos: Se desarrolló un programa de promoción de la salud por un estudiante de farmacia y dos profesores de la facultad que incluía una presentación oral y mensajes recordatorios. Se dio a las participantes antes e inmediatamente después de la presentación un test de respuesta múltiple que evaluaba el conocimiento sobre ácido fólico y DTN y la frecuencia de uso de multivitamínicos. Las participantes recibieron después un mensaje recordatorio sobre el ácido fólico una vez a la semana durante tres semanas. Los conocimientos y el uso de multivitaminicos fueron re-evaluados cuatro semanas después de la intervención. Resultados: 32 universitarias asistieron voluntariamente a la presentación oral. 25 mujeres (78,2%) completaron las cuatro semanas post-intervención. Comparado con el pre-test, hubo incrementos estadísticamente significativos en la puntuación media del test (p<0,0001) y en las respuestas correctas a preguntas sobre ácido fólico y DTN (p<0,05 para cada pregunta). Las participantes comunicaron un aumento estadísticamente significativo en el uso regular (> 4 veces/semana) de multivitamínicos (p=0,023). Conclusión: Las participantes en el programa piloto de promoción de la salud demostraron un aumento estadísticamente significativo en conocimientos sobre el ácido fólico y la frecuencia de uso de multivitamínicos. Programas diseñados de modo similar podrían ser efectivos para aumentar el conocimiento sobre ácido fólico y DTN y cambiar las actitudes sobre el uso de complejos vitamínicos entre universitarias (AU)

Preventing unintended pregnancy: pharmacists' roles in practice and policy via partnerships.

OBJECTIVES: To review the literature regarding pharmacists' roles in preventing unintended pregnancy, review the relevant laws and policies in the United States to describe pharmacists' and/or pharmacy's role in policy development related to unintended pregnancy, and identify partners who pharmacists can work with in this public health area. DATA SOURCES: A systematic review was conducted focusing on the role of pharmacists in unintended pregnancy. For practice, articles were identified in Medline through July 1, 2009, using MeSH and keywords. For policy, two authors examined the current status of access issues related to over-the-counter (OTC) status and collaborative practice agreements. Partners were identified in the reviews and authors' experiences. DATA EXTRACTION: English-language, U.S.-based articles that contained either qualitative or quantitative data or were review articles addressing pharmacist interventions, pharmacists' knowledge and attitudes regarding contraception, and pharmacists' comfort and ability to counsel on preventing unintended pregnancy were included. DATA SYNTHESIS: Some improvements to emergency contraception (EC) access in pharmacies have occurred during the previous decade. Studies focused on counseling, pharmacist provision of depot reinjection, and pharmacist initiation of oral contraceptives were positive. No studies linked increased contraceptive access in pharmacies to lower pregnancy rates. In terms of policy, the literature described three access-related areas, including (1) EC and conscience clauses, (2) collaborative practice agreements, and (3) changes in prescription to OTC status. Pharmacists' partnerships may include physicians/clinicians, local health departments, family-planning organizations, nongovernmental organizations, and colleges of pharmacy. CONCLUSION: Currently, pharmacists may increase access to contraceptives primarily via EC and use of collaborative practice agreements to initiate and/or continue hormonal contraceptives. New practice models should be implemented in community or clinic practices as allowed by collaborative practice regulations in each state. We encourage researchers and practitioners to consider a community approach in their endeavors by working with numerous types of primary care providers and organizations to explore ways to increase contraceptive access.

Methods in epidemiology: observational study designs.

This article is the first of a three-part series intended to enhance clinical pharmacists' understanding of methods frequently used in epidemiologic research and their applications. The basic tenets of epidemiology and uses for data derived from epidemiologic studies are given, along with a high-level overview of the differences between experimental and observational study designs. The defining characteristics of each of the observational study designs (case report or case series, ecologic, cross-sectional, cohort, case-control, nested case-control, and case-cohort) and the resultant strengths and limitations of the study designs are presented. Applications for observational studies in pharmacoepidemiology (including the case-crossover and case-time-control study designs) are discussed. Finally, points to consider when evaluating data from observational studies are addressed.

Knowledge and use of folic acid among college women: a pilot health promotion program led by pharmacy students and faculty.

UNLABELLED: As pharmacists and pharmacy students are increasingly called upon to assume roles in public health activities, it is important to recognize unique opportunities to educate community members on health, wellness, and disease prevention. OBJECTIVE: To evaluate the impact of a pilot health promotion program on college women's knowledge regarding folic acid and prevention of neural tube defects (NTD) and frequency of multivitamin use. METHODS: A health promotion program was developed by a pharmacy student and two pharmacy faculty members that included an oral presentation and reminder messages. A multiple-choice test assessing knowledge of folic acid and NTD and frequency of multivitamin use was given to participants before and immediately after the presentation. Participants then received a reminder message regarding folic acid once a week for three weeks. Knowledge and multivitamin use were reassessed four weeks post-intervention. RESULTS: Thirty-two college women voluntarily attended the oral presentation. Twenty-five women (78.2%) completed the four-week post-test. Compared to the pre-test, there were statistically significant increases in average test score (p<0.0001) and correct responses to questions regarding folic acid and NTD (p<0.05 for each question). Participants reported a statistically significant increase in regular (≥4 times/week) multivitamin use (p=0.023). CONCLUSION: Participants in the pilot health promotion program demonstrated a statistically significant increase in knowledge about folic acid and frequency of multivitamin use. A similarly-modeled health promotion program may be an effective way of increasing folic acid and NTD knowledge and changing behaviors of multivitamin use in college women.

Hepatic effects of duloxetine-II: spontaneous reports and epidemiology of hepatic events.

OBJECTIVE: Review spontaneous reports and epidemiology of hepatic events associated with duloxetine. METHODS: Spontaneous reports of adverse events potentially associated with hepatic injury were identified. Classification schemes were Clinical Significance and Etiologic Category relative to likelihood of being related to duloxetine. RESULTS: Duloxetine has been taken by an estimated 5,083,000 patients, representing approximately 1,551,000 person-years (PY) of worldwide exposure. In the Etiologic categorization of the 406 cases containing event terms potentially related to the liver that have been reported to the manufacturer, 26 were deemed Probable and 127 Possible. Because of scantly-reported information, 182 cases were considered Indeterminate. For Severe Hepatic Injury, the observed spontaneous reporting rate was 0.7/100,000 persons exposed. Of the 406 cases, 225 experienced enzyme elevations to values <500 U/L, most with concentrations well below this level. The calculated cumulative spontaneous reporting rate of all duloxetine hepatic-related events combined was 0.00799%, in the context of other drug-induced hepatic injury rates reported in the literature of 0.7 to 40.6 per 100,000 PY of observation. CONCLUSIONS: There were few cases of true hepatic injury possibly or probably related to duloxetine. The calculated cumulative reporting rate is consistent with very rarely reported per the Council for International Organizations of Medical Sciences.