Hypoglycemia: A closer look at a community pharmacist's impact in optimizing diabetes care.

BACKGROUND: Hypoglycemia is a complication of diabetes and can have considerable clinical impact on mortality, morbidity, and quality of life. Certain patient populations with diabetes are at an increased risk of experiencing hypoglycemia, posing as a safety concern and may have possible negative affect(s) on diabetes if not appropriately managed. With community pharmacies often being an accessible means of health care, there is potential for widespread diabetes education in this setting. OBJECTIVES: Assess impact of pharmacist-initiated education on proper recognition/management of hypoglycemia in patients with type 1 and 2 diabetes. Secondary objectives aim to optimize diabetes care: (1) assessment of patient need for a glucagon kit prescription, (2) evaluation of adherence to highly recommended vaccinations for individuals with diabetes and acceptance of pharmacist vaccination recommendations, and (3) assessment of patient satisfaction with the study intervention. SETTING AND PRACTICE DESCRIPTION: A community pharmacy in the Suffolk County of Massachusetts serving middle- to lower-class and medically underserved patients. Most of the population includes an elderly, Hispanic, and Asian demographic. EVALUATION: Outcomes evaluated through change in hypoglycemia questionnaire scores from preintervention to postintervention, the percentage of patients who received a prescription for glucagon kit post pharmacist intervention, the percentage of patients that received a vaccination because of pharmacist intervention, and Likert scale-based survey for the assessment of patient satisfaction. RESULTS: Participant knowledge of hypoglycemia awareness/treatment improved significantly post pharmacist intervention (P < 0.001). Average gain in questionnaire scores from pre-edcation to posteducation was 6.4 points (maximum score = 9, P < 0.001). Glucagon prescriptions were facilitated/dispensed for 28.5% of eligible participants. Fifty-eight vaccinations were recommended, and 25.8% were administered. Patients' overall satisfaction score averaged 4.7 out of a maximum of 5 (higher scores more favorable). CONCLUSION: An educational service in a community pharmacy setting can provide effective education to recognize signs, symptoms, and proper treatment of hypoglycemia in patients on diabetes therapy that carries a high risk.

Compatibility of Flavoring Agents in Compounding Extemporaneous Omeprazole Oral Liquid.

In a previous study, the results of which were provided in an article published in the International Journal of Pharmaceutical Compounding, it was determined that FLAVORx's Grape flavor in extemporaneously compounded omeprazole oral liquid was found suitable. A follow-up study was conducted in which the authors explored four additional flavors (Professional Compounding Centers of America's Cherry Concentrate and their Orange Concentrate, and FLAVORx's Bubble Gum flavor and their Watermelon flavor) to allow pharmacists and patients greater flexibility and options to flavor omeprazole oral liquid. Oral liquids were compounded using 20-mg omeprazole delayed-release capsules, 8.4% sodium bicarbonate, and each of four flavors to reach drug concentration at 2 mg/mL and flavor at 1.2% v/v (n=3). After the delayed-release pellets were disintegrated, the prescription bottles were stored in cold temperature overnight. For flavor alone in 8.4% sodium bicarbonate solution, samples were prepared the same as above except no omeprazole delayed-release capsules were added. High-performance liquid chromatographic assay was adopted from the United States Pharmacopeia's Omeprazole Monograph, but it is for the unflavored oral liquid. In order to ensure assay robustness, stability indication tests, 0.1 N HCl (acid), 0.1 N NaOH (base), 50°C (heat), and 3% hydrogen peroxide were also performed to the flavored omeprazole oral liquids, as well as to the individual flavor alone in sodium bicarbonate solution without omeprazole. Professional Compounding Centers of America's Cherry Concentrate, Orange Concentrate, and FLAVORx's Watermelon flavor showed no interference with the drug, and the assays were robust. However, FLAVORx's Bubble Gum flavor displayed five mini peaks at 280 nm with one embedded in omeprazole peak. The resolution of a Bubble Gum peak immediately next to an omeprazole peak computed by column kinetics was 0.91, while the separation factor was 1.15. A good separation is generally >1.5. This study examined only the Cherry Concentrate, Orange Concentrate, Bubble Gum flavor, and Watermelon flavor from the specified manufacturers. An insignificant interference was shown between FLAVORx's Bubble Gum flavor with omeprazole. The results are not intended to infer that all brands of the same flavor names would react the same way. Omeprazole and all four studied flavors should be protected from oxidation insult.

Comparison of long-term knowledge retention in lecture-based versus flipped team-based learning course delivery.

OBJECTIVES: To determine whether team based learning (TBL) is superior to traditional lecture -based learning in confidence and knowledge retention one year later. DESIGN: A survey was administered 17 months after a completion of a required over-the-counter /self-care (OTC) course to two different cohorts of students. The survey assessed confidence and knowledge related to OTC topics. The lecture group had a traditional lecture based classroom experience; the intervention group experienced a TBL format throughout the entire course. ASSESSMENT: One hundred forty-seven students of 283 enrolled (51.9%) in the lecture group and 222 of 305 (72.8%) students in the TBL group participated in the knowledge assessment and survey. Demographic data including student grade point averages (GPA) and confidence were similar in both groups. Mean assessment scores (±SD) on OTC knowledge was significantly higher in the traditional lecture based group versus the TBL group; 62.9±19.3 vs. 54.9±15.7 (p=0.001). CONCLUSION: Although TBL is thought to improve student engagement and mastery of material, after an initial implementation of TBL, knowledge retention in the long term appears to be lower than lecture based learning.

The rise of biosimilars: How they got here and where they are going.

Biosimilars have become a subject of great interest in the past few years. The European Union and the United States are seeing an increasing number of biosimilar applications and approvals. The development of a biosimilar is significantly more complex and costly than a small molecule generic product. In the European Union, there has been a wider use of these medications compared to the United States. More biosimilars are gaining approval in the United States, and these products will likely alter the healthcare system in highly impactful ways. Understanding the regulatory process, the risks, and benefits will enable clinicians to be prepared and maximize the utility of these medications when they enter the market. This article introduces the concept of a biosimilar, discusses the regulatory process in the United States, and reviews the risks and benefits of these products.

Students' Attitudes, Academic Performance and Preferences for Content Delivery in a Very Large Self-Care Course Redesign.

Objective. To evaluate students' performance/attitudes toward a flipped team-based learning (TBL) format in a "very large" self-care course based on student content delivery preference. Design. Third-year students enrolled in the course were surveyed regarding elements of redesign and homework completion. Additionally, their performance and incoming grade point average were evaluated. Assessment. A survey was completed by 286 of 305 students. Nineteen percent of respondents preferred traditional content delivery, whereas 30% preferred flipped TBL, 48% preferred a mixed format, and 3% had no preference. The grades achieved in the course were: A (49%), B (48%), C (3%) and D (0%). The majority completed "all" or "most" of the homework, appreciated attributes of course redesign, felt home preparation and in-class activities engaged them, and reported improved communication/evaluation skills. Content delivery preference significantly affected attitudes. Conclusion. Students positively received a flipped team-based learning classroom format, especially those who preferred flipped TBL or mixed content delivery. A minority with preference for traditional teaching style did not enjoy the new format; however, their academic performance did not differ significantly from those who did.

Efficacy of an over-the-counter intervention follow-up program in community pharmacies.

OBJECTIVE: To evaluate whether patient adherence to appropriate self-care advice from a pharmacist or professional year 4 (PY4) advanced pharmacy practice experience (APPE) student provides satisfactory symptom relief. SETTING: Two community pharmacies in the same chain in Massachusetts from mid-December 2009 to June 2010. PRACTICE DESCRIPTION: Pharmacists and PY4 APPE students offered a follow-up phone call to patients who were seeking or had accepted the offer for self-care advice for themselves or others for whom they are primary caregivers. PRACTICE INNOVATION: Patients were provided detailed counseling documented on an over-the-counter (OTC) intervention document, administered a point-of-care survey, offered a follow-up phone call(s), and then administered a follow-up survey. MAIN OUTCOME MEASURES: Patient demographics, point-of-care survey assessing current use and perceived benefit from a pharmacist's consultation, intervention document assessing potential medication-related problems, and follow-up telephone survey assessing patient adherence to advice, symptom relief, and satisfaction with the service. RESULTS: Of the 207 patients offered a follow-up phone call, 83 accepted. Of these, 54 completed one call and 9 completed two calls. Of those who completed one phone call and claimed complete adherence to advice provided, 38 (82.6%) experienced great symptom relief. Three patients followed advice only partially and experienced the same level of improvement. More than 75% of patients classified the follow-up as "very helpful," felt that it led to greater symptom improvement, and would like to see this service offered all of the time. CONCLUSION: Pharmacist intervention in OTC therapy is widely accepted and can lead to improved patient outcomes.