Efficacy of a Bariatric Surgery Clinic-Based Pharmacist.

PURPOSE: To evaluate the impact of a bariatric clinic-based pharmacist on inpatient length of stay, medication errors, and patient experience. MATERIALS AND METHODS: This was a retrospective cohort study comparing patients who received a pre-operative pharmacist consultation to historical cases without pre-operative pharmacist consultation prior to admission for bariatric surgery. A patient experience survey was administered post-operatively to the intervention group. The primary outcome was hospital length of stay (LOS). Secondary outcomes included corrected medication errors on reconciliation, pharmacist interventions, adverse drug event (ADE) prevention, and patient satisfaction. RESULTS: With 68 patients in the intervention group and 67 patients in the control group, the majority were female (76%) and received either laparoscopic Roux-en-Y gastric bypass (53%) or sleeve gastrectomy (47%). The median LOS in the intervention group was 55.5 h, which did not significantly differ from the median 57.9 h in the control group (p = 0.56). The clinic-based pharmacist made an average of 13 interventions per patient. Surveys were distributed to 73 patients with a 60% response rate. High overall satisfaction with the pre-operative pharmacist consultation was reported by 97% of patients. CONCLUSION: Although hospital LOS did not significantly differ between groups, pre-operative pharmacist consultation prevented potential ADEs, and provided strong patient satisfaction. Having pharmacists as part of a multidisciplinary approach to bariatric surgery patient care can prevent medication-related adverse events and improve patient satisfaction.

Identifying Perceived Barriers to Human Papillomavirus Vaccination as a Preventative Strategy for Cervical Cancer in Nigeria.

Background: Cervical cancer deaths are disproportionately higher in developing countries depicting one of the most profound health disparities existing today and is ranked as the second most frequent cancer among women in Nigeria. The Human Papillomavirus (HPV) vaccine as a primary prevention strategy is not widely used in Nigeria. This study investigated perceived barriers to HPV vaccination in a Nigerian community, targeting health workers' perceptions. Methods: This descriptive study captured responses from a cross-sectional, convenience sample of adult health workers within Anambra State, Nigeria. An anonymous 42-item survey with multiple validated scales was developed based on the Theory of Planned Behavior model and previous studies. The self-administered survey was distributed by research assistants at study sites within Anambra State which were identified through local constituents by the regional zones Adazi-Ani, Onitsha, and Awka. Data analyses were performed using Microsoft Excel for descriptive statistics and R software for the logistic regression, with a statistical significance level of 5%. Subgroup analysis was performed for the baseline knowledge questionnaire to determine if there were any differences in correct responses based on demographics such as: Institution type, profession, age, sex, religion and parental status. Results: Responses were collected from 137 Nigerian health workers; 44% nurses, 14% physicians, 6% pharmacists and 31% other health workers. The majority of respondents were female (69%), between 18 and 39 years of age (78%), from urban settings (82%), and identified as having Christian religious beliefs (97%). The most significant barriers identified were lack of awareness (39%), vaccine availability (39%), and cost (13%). When asked baseline knowledge questions regarding HPV, females were more likely to answer incorrectly as compared to males. Significant differences were found for statements: (1) HPV is sexually transmitted (p = 0.008) and (2) HPV is an infection that only affects women (p = 0.004). Conclusions: Perceived barriers to HPV vaccination identified by Nigerian health workers include lack of awareness, vaccine availability/accessibility, cost, and concerns about acceptability. Ongoing efforts to subsidize vaccine costs, campaigns to increase awareness of HPV vaccine, and interventions to improve attainability could advance administration rates in Nigeria, and ultimately improve death rates due to cervical cancer in this population.

Medicaid drug selection committees and inadequate management of conflicts of interest.

BACKGROUND: Drug selection decisions for state Medicaid reimbursement programs should be based on the best available evidence and free of conflicts of interest (COIs), but little is known about how the committees identify and manage COIs of the members. The objectives of this study were to (1) describe the content of Medicaid drug selection committees' COI policies for the US states and the District of Colombia, (2) categorize the policies by strength, and (3) identify characteristics of a strong policy. METHODS: For all states with Medicaid Preferred Drug Lists (47 states and the District of Columbia), we conducted a systematic search of official Medicaid websites and contacted Medicaid staff by e-mail and/or telephone to identify drug selection committee COI policies. We conducted a content analysis of the policies, extracting data on COI disclosure parameters, management strategies, and review processes using predefined categories modified through an iterative process. RESULTS: Policy documents were obtained for 27 of the programs (56%)-14 from websites and 13 by contacting Medicaid officials. We found high variability in COI policies, lack of public availability, and inconsistent enforcement and management of COI among states. The most common management strategy was disclosure of COI in 67% of policies (18 of 27), followed by self-recusal in 52% of policies (14 of 27). Only 15% of policies (4 of 27) ban certain relationships with industry. CONCLUSIONS: Current policies are not transparent and not standardized, and no state policy included all model components. Wide variations suggest that some policies may not adequately protect drug selection decisions against COI and industry influence. With expected growth of Medicaid due to health care reform, the selection of drugs for Medicaid patients should be protected from the influence of COI.