Evaluating patient-reported adherence and outcomes in specialty disease states: A dual-site initiative.

BACKGROUND: Patient-reported outcomes (PROs) are often used by clinicians to evaluate patient response to specialty medications used to treat multiple sclerosis (MS) and rheumatologic conditions. Identifying associations among PROs and patient characteristics could inform patient-centered treatment monitoring. OBJECTIVE: To examine the association among patient characteristics and PROs, including patient-reported adherence (defined as no missed doses), medication tolerance, patient perceived effectiveness, and health care resource utilization (HCRU; defined as emergency department visits or hospitalizations), for patients prescribed specialty medications in 2 health system specialty pharmacies. METHODS: A dual-center, retrospective review of monthly medication assessments completed by Vanderbilt Specialty Pharmacy and University of Illinois Hospital and Health Sciences System specialty pharmacy was conducted. Patients were included if they received at least 3 fills of a specialty medication from rheumatology or MS clinics from October 2019 to March 2022, excluding patients with more than a 30-day supply. Primary outcomes were the PROs of patient-reported adherence, medication tolerability, perceived effectiveness, and HCRU. For each of the 2 primary outcomes (adherence and tolerability), a mixed-effects logistic regression model was used to test for associations with age, sex, race, clinic, site, and the other PROs. RESULTS: A total of 61,926 assessments were completed from 3,677 patients (Site 1 = 3,346; 91.0% and Site 2 = 331; 9.0%). Patients were predominantly White (75.6%) and female (71.7%) with a median age of 50 years (IQR = 37-61). Assessments most frequently originated from rheumatology (76.0%). Nonadherence was reported 4.0% of the time, with the most common explanations being forgetfulness (33.1%) and medication being held because of a procedure or illness (29.5%). Most responses indicated perceived effectiveness as good/excellent (93.9%), with 98.5% of responses indicating no issues with tolerability. Patients who reported tolerability issues were 2.5 times more likely to report a missed dose (95% CI = 1.87-3.23, P < 0.001). An effectiveness rating of fair was associated with a 61% increase in the odds of a missed dose compared with a rating of good/excellent (95% CI = 1.33-1.94). CONCLUSIONS: Patients filling rheumatology or MS specialty medications within health system specialty pharmacies reported high rates of medication effectiveness and adherence and low rates of issues with tolerability and HCRU. Patients who report tolerability issues or lower perceived effectiveness may benefit from additional monitoring to prevent nonadherence.

Early skills laboratory warnings: Laboratory faculty perspectives on student barriers for progression to experiential education.

INTRODUCTION: This study characterized faculty perceptions of student barriers to achieving an Entrustable Professional Activities (EPA) level 2 or higher in the Patient Care Provider domain. METHODS: Pharmacy skills laboratory faculty participated in a nominal group technique (NGT) session. Participants reflected on two questions: "What behaviors would result in a student not achieving a rank of EPA readiness level 2 or higher?" and "What knowledge and skills would result in a student not achieving a rank of EPA readiness level 2 or higher?" Participants developed a ranked list using silent brainstorming, idea generation, clarification, and discussion. RESULTS: Two NGT sessions were conducted. Group 1 reported (lack of) professionalism, (inability to perform) physical skills, (lack of) critical thinking and interpreting data gathered during physical skills, and (inability to achieve) programmatic outcomes and mile makers exams as barriers. Group 2 ranked behaviors as lack of independence, not taking roles and responsibilities seriously, inability to follow instructions, lack of classroom engagement, and disorganized and unable to prioritize. Group 2 ranked knowledge and skills of significant errors when making medication recommendations, inability to identify accurate medication history, inability to perform tasks with time constraints, poor patient communication, and inability to identify resources. CONCLUSIONS: Pharmacy skills laboratory faculty can identify behaviors, knowledge, or skills that may prevent a student from achieving an EPA readiness level 2 or higher such as lack of professionalism and poor critical thinking skills and should be empowered to identify early warning signs for students' success and progression to experiential education.

Successful Development and Implementation of a Large Virtual Interprofessional Education Activity Applying the Social Determinants of Health.

Interprofessional education (IPE) activities provide students insight into healthcare teams, shared decision-making, and social determinants of health (SDOH). Virtual IPE activities with large student populations or across multicampus have not been evaluated. The study aimed to explore the interprofessional competency growth in students, across several disciplines, following participation in a large-scale, virtual IPE activity. Students from pharmacy, medicine, social work, and physician assistant programs across Tennessee participated in an IPE patient case and SDOH in fall 2020 and fall 2021. Pre- and postsurveys included Likert ranking of 16 statements based on the 2011 Interprofessional Education Collaborative (IPEC) framework. A total of 607 students completed surveys (overall response rate, 76%). Wilcoxon signed-rank tests were performed on the pre-/postsurvey data, in aggregate and by discipline. Significant increases in all IPEC competency statements were seen, both in aggregate (100% of statements with p < 0.001) and in pharmacy (100% of statements with p < 0.001) and medicine subgroups (94% of statements with p < 0.001). Implementing large virtual IPE activities involving a complex patient case and SDOH significantly increased student IPEC competency outcomes for participating students, whether in aggregate or on a discipline-specific basis.

Patients' use of smartphone apps for health record access in 2019: A cross-sectional study.

INTRODUCTION: The 21st Century Cures Act has expanded patients' access to portals through smartphone applications (apps). To date, the prevalence of patient portal smartphone apps use is unclear, especially on a national scale. METHODS: Using the 2019 Health Information National Trends Survey, we assessed factors associated with patient portal adopters accessing their records through a smartphone app. Multivariable logistic regression models were conducted and we reported results using predicted probability. RESULTS: Across a weighted sample of 75,324,288 respondents, 39 % reported using a smartphone app to access their health records. Adults with smartphone-only internet (40.0 %; 95 % CI: 35.4-33.3) were more likely to use a smartphone app compared to adults with home internet access (30.6 %; 95 % CI: 27.9-44.7). CONCLUSIONS: Optimizing the implementation and delivery of patient portal content via smartphone apps may improve their reach to patients.

Improving Pharmacy Students' Clinical Knowledge on Providing Care for Patients Belonging to the LGBTQ+ Community.

A 12-question survey instrument was developed, pilot-tested, and administered to 191 pharmacy students in their first professional year after engaging in a learning activity focusing on topics across five categories with clinical relevance to providing care to the LGBTQ+ community. A paired student t-test was performed on survey tool pre-test and post-test survey responses, with p < 0.05 considered significant. A total of 183 usable pre-test and post-test survey responses were received. Statistically significant differences between the pre-test and post-test correct responses were observed for scenarios involving proper pronoun use, hormone therapy (HT) counseling, immunization best practices, and communication hesitancy. The greatest knowledge change was reported in the categories of immunization best practices (48.9%), HT counseling (33.6%), and pronoun use (22.8%). Active learning assignments are effective teaching strategies to promote clinical knowledge in providing inclusive and culturally competent care to LGBTQ+ patients. Clinical topic areas including proper pronoun use, HT counseling, immunization best practices, privacy, risk awareness, and communication hesitancy are effective curricula additions for pharmacy colleges to advance inclusive curricula concerning providing care to the LGBTQ+ community.

The Lean Six Sigma Define, Measure, Analyze, Implement, Control (LSS DMAIC) Framework: An Innovative Strategy for Quality Improvement of Pharmacist Vaccine Recommendations in Community Pharmacy.

Community pharmacies represent a highly accessible and convenient setting for vaccination. However, setting-specific barriers exist which contribute to suboptimal vaccination rates, particularly for pneumococcal vaccinations. One proven quality improvement framework growing in use within healthcare settings is Lean Six Sigma (LSS). This paper describes the application of the LSS framework in select locations of a national pharmacy chain. The implementation of a training program for improved recommendation techniques to promote higher rates of pneumococcal vaccinations in high-risk adult populations is also addressed. A mixed-methods approach including pre/post quasi-experimental design and in-depth key informant interviews was used.

Comparison of student performance in therapeutics and communications courses to outcomes of objective structured clinical examinations: A retrospective analysis.

INTRODUCTION: The objective was to examine the association between course grades and objective structured clinical examination (OSCE) performances in a pharmacy student cohort. METHODS: A retrospective analysis of demographics, final grades in the Therapeutics I through IV and Communications courses, and multiple OSCE scores (therapeutic knowledge and general communication skills [GCS]) was performed for two cohorts. RESULTS: Female students scored higher than male students on the warfarin OSCE therapeutic knowledge (P = .008) and GCS scores (P = .02). Age was inversely correlated with warfarin OSCE therapeutic knowledge score (P = .001). The warfarin OSCE therapeutic knowledge score was positively related to Therapeutics II final grades (P < .001). The Communications course final grade was positively correlated to the warfarin OSCE faculty-rated GCS score (P = .005). Therapeutics final grades were not significantly related to station scores of a multi-station OSCE (P > .05). The final regression model included gender and Therapeutics II final grade and explained 6% of the variance in warfarin OSCE therapeutic knowledge scores. CONCLUSIONS: A number of significant associations were found between demographics, final course grades, and specific OSCE scores. A regression model was significant, but only explained a low percentage of the warfarin OSCE therapeutic knowledge score variance, suggesting other factors not evaluated had a greater effect on scores. This research suggests that OSCEs play an important role in demonstrating student competency in educational domains other than knowledge and brings forth new data suggesting that age and/or gender may influence OSCE performance.

Use of value stream mapping to improve the medication synchronization process.

BACKGROUND: Lean methodology, specifically value stream mapping, can be used to identify and reduce inefficiencies in the medication synchronization process. OBJECTIVES: The objectives of this study were to (1) evaluate potential medication synchronization process improvements to reduce nonvalue-added actions, (2) assess fidelity to the medication synchronization core components, and (3) identify the best process for medication synchronization for an independent community pharmacy with multiple locations. METHODS: This study used an observational, cross-sectional design. A value stream map was created to provide a detailed illustration of each step in the medication synchronization process. Time for each step of the medication synchronization process was observed on site on different days and times as well as the time required to process, package, and verify prescription medications. These steps were conducted before interventions were made to the process and after to compare the difference. The organizational readiness for change tool was administered to employees of the independent pharmacy before interventions to determine their perspective of the medication synchronization process and assess their readiness for change. RESULTS: Owing to various interventions made to the medication synchronization process, 2 steps in the process were eliminated. This resulted in a decrease in adherence packaging time workflow by 69.4%. Staff (n = 9) rated the medication synchronization process on 4 components: acceptability of the current process (13.8 ± 3.6), intervention appropriateness (13.7 ± 3.7), feasibility of a new medication synchronization process (17.1 ± 2.3), and organizational level of support (21.8 ± 4.1). CONCLUSION: Value stream mapping proved to be a valuable tool in identifying inefficiencies in the medication synchronization process and reducing nonvalue-added waste. The result was a decrease in time required for adherence packaging workflow and a more standardized medication synchronization process across multiple independent pharmacy locations. This more standardized process can play a key role in improving the continuity of patient care, increasing medication adherence, and in turn decreasing the number of hospital admissions.

Use of Rapid Assessment Procedures when analyzing qualitative data in pharmacy research.

Qualitative research analytics and methodology are a useful part of many research projects. However, qualitative data analysis may be time intensive causing delays in results. This is especially problematic in time-sensitive projects where there an urgent need for results and a rapidly evolving situation being studied, such as during health crisis or early stages of project implementation. An emerging body of literature around the use of Rapid Assessment Procedures (RAP) suggests that this method of qualitative assessment provides more efficient coding and categorizing of data without comprising rigor. The objectives of this manuscript are to: 1) describe how RAP can be used in pragmatic healthcare research studies and 2) provide an example of when RAP was applied to a qualitative research study in the healthcare setting. RAP includes 5 core features: 1) use in combination with quantitative outcomes or process data (mixed methods approach), 2) quick timeline from start to finish (weeks to months), 3) population of interest participation in planning and implementing the research, 4) team approach to research process, and 5) iterative cycle of data collection and analysis. Use of RAP provides key stakeholders and decision makers the ability to generate solutions to problems faster than ever before without compromising rigor, a method needed now more than ever. The progression of healthcare and clinical management is moving at an unprecedented rate, and RAP allows researchers to stay ahead by providing quicker results for better outcomes.

A social media microinfluencer intervention to reduce coronavirus disease 2019 vaccine hesitancy in underserved Tennessee communities: A protocol paper.

BACKGROUND: Central to effective public health policy and practice is the trust between the population served and the governmental body leading health efforts, but that trust has eroded in the years preceding the pandemic. Vaccine hesitancy among adults is also a growing concern across the United States. Recent data suggest that the trustworthiness of information about the coronavirus 2019 (COVID-19) vaccine was a larger concern than the vaccine's adverse effects or risks. OBJECTIVE: This study aims to describe the methods used to create a public health microinfluencer social media vaccine confidence campaign for the COVID-19 vaccine in underserved Tennessee communities. A secondary objective is to describe how the Social-Ecological Model (SEM) and Social Cognitive Theory may address vaccine hesitancy using community pharmacies. METHODS: In late 2020, 50 independent community pharmacies in underserved communities across Tennessee were involved in a public health project with the State of Tennessee Department of Health and the University of Tennessee Health Science Center College of Pharmacy. The project involved a 3-pronged, pharmacy-based COVID-19 vaccination outreach project, including (1) social media messaging (i.e., microinfluencer approach), (2) community partner collaboration, and (3) in-pharmacy promotion. Quantitative and qualitative data will assess the quality and effectiveness of the program. Social media outcomes will also be assessed to measure the impact of the microinfluencer social media training. RESULTS: Project implementation is planned for 6 months (January 2021 to June 2021) after an initial month of planning by the research team (December 2020) and preceding several months of assessment (July 2021 and beyond). CONCLUSIONS: Novel, theory-based approaches will be necessary to improve vaccine confidence. One approach to promoting public health, derived from the SEM, may be to use trusted microinfluencers on social media platforms, such as local community pharmacists and community leaders.

The catalyst for change in teaching and assessing virtual laboratory skills.

INTRODUCTION: Historically, pharmacy skills laboratory courses have primarily been delivered utilizing in-person instruction; however, changes in methods of healthcare delivery serve as a catalyst to consider best practices for virtual learning in the skills laboratory setting. PERSPECTIVE: Shifting to a virtual delivery method is valuable for future curriculum and course development. Three specific delivery methods including flipped classroom, virtual formative simulations, and telehealth objective structured clinical examinations, provide examples of the opportunities and challenges instructors may encounter when shifting delivery methods. Furthermore, the examples illuminate the need to deliberately incorporate virtual technology into pharmacy skills laboratory courses to ensure students are practice-ready for the changing methods of delivery in the healthcare environment. IMPLICATIONS: Skills laboratory instructors and students must reimagine how patient care skills can be taught and assessed. It is imperative to reassess priorities and adapt skills-based courses to incorporate the virtual learning environment to prepare student pharmacists for future practice.

The Tennessee Medicaid medication therapy management program: early stage contextual factors and implementation outcomes.

BACKGROUND: First investigated in the 1990s, medication therapy management (MTM) is an evidence-based practice offered by pharmacists to ensure a patient's medication regimen is individualized to include the safest and most effective medications. MTM has been shown to a) improve quality of patient care, b) reduces health care costs, and c) lead to fewer medication-related adverse effects. However, there has been limited testing of evidence-based, a-priori implementation strategies that support MTM implementation on a large scale. METHODS: The study has two objectives assessed at the organizational and individual level: 1) to determine the adoption, feasibility, acceptability and appropriateness of a multi-faceted implementation strategy to support the MTM pilot program in Tennessee; and 2) to report on the contextual factors associated with program implementation based on the Consolidated Framework for Implementation Research (CFIR). The overall design of the study was a hybrid type 2 effectiveness-implementation study reporting outcomes of Tennessee state Medicaid's (TennCare) MTM Pilot program. This paper presents early stage implementation outcomes (e.g., adoption, feasibility, acceptability, appropriateness) and explores implementation barriers and facilitators using the CFIR. The study was assessed at the (a) organizational and (b) individual level. A mixed-methods approach was used including surveys, claims data, and semi-structured interviews. Interview data underwent initial, rapid qualitative analysis to provide real time feedback to TennCare leadership on project barriers and facilitators. RESULTS: The total reach of the program from July 2018 through June 2020 was 2033 MTM sessions provided by 17 Medicaid credentialed pharmacists. Preliminary findings suggest participants agreed that MTM was acceptable (µ = 16.22, SD = 0.28), appropriate (µ = 15.33, SD = 0.03), and feasible (µ = 14.72, SD = 0.46). Each of the scales had an excellent level of internal (> 0.70) consistency (feasibility, α = 0.91; acceptability, α = 0.96; appropriateness, α = 0.98;). Eight program participants were interviewed and were mapped to the following CFIR constructs: Process, Characteristics of Individuals, Intervention Characteristics, and Inner Setting. Rapid data analysis of the contextual inquiry allowed TennCare to alter initial implementation strategies during project rollout. CONCLUSION: The early stage implementation of a multi-faceted implementation strategy to support delivery of Tennessee Medicaid's MTM program was found to be well accepted and appropriate across multiple stakeholders including providers, administrators, and pharmacists. However, as the early stage of implementation progressed, barriers related to relative priority, characteristics of the intervention (e.g., complexity), and workflow impeded adoption. Programmatic changes to the MTM Pilot based on early stage contextual analysis and implementation outcomes had a positive impact on adoption.

Screening for social determinants of health in community pharmacy: Identifying best practices, barriers, and strategies for success.

The social determinants of health (SDOH) play a key role in patients' access to health care and medications. There exists an area of opportunity to leverage community pharmacists to make a large impact in identifying and incorporating an understanding of a patient's SDOH into their treatment plan. Community pharmacies are accessible and trusted avenues for health care interventions. With the advancement of appointment-based models as well as the increased training of support personnel, community pharmacies may be well suited for this public health task. However, there are major challenges such as paradigm shifts in workflow, reimbursement, and training that must be addressed to make this endeavor successful. This commentary explores the sparse literature related to community pharmacists conducting screening for social risk factors to identify best practices and barriers to implementation and outlines how screening for social needs aligns with the Pharmacists' Patient Care Process.

Facilitating pneumococcal vaccination among high-risk adults: Impact of an assertive communication training program for community pharmacists.

BACKGROUND: Community pharmacies are vital access points to provide a range of vaccines to adults, including pneumococcal vaccines; however, despite a growth in the number of vaccines given at these sites, the most recent rates of adults being immunized against pneumococcal disease remain below the goals set by Health People 2020. Low patient awareness is a leading reason for suboptimal vaccination rates, suggesting that a need exists to improve provider communication in recommending pneumococcal vaccination in high-risk adults. OBJECTIVES: To evaluate the impact of a communication training program to improve pharmacist promotion of the pneumococcal vaccine among high-risk adults in Tennessee. METHODS: A multiphase training program was initiated in partnership with 2 regions of a nationwide community pharmacy chain (n = 100) focusing on improving evidence-based, presumptive recommendations related to pneumococcal vaccination. All locations were randomized to one of 3 arms on the basis of training intensity: (1) no training; (2) online training only; and (3) online and in-person simulation training. The program focused on improving evidence-based, pharmacist vaccine recommendations using health behavior theories, sales techniques, and improvisation provided through online and in-person simulation training. Changes in vaccinations (compared with the same 6-month period in the previous year) and provider self-efficacy were evaluated by Mann-Whitney U tests, chi-square tests, and general linear models. RESULTS: Completing the full training program led to nominal changes in pharmacist self-efficacy across the 6 items measured (P > 0.05). Overall counts of all pneumococcal vaccines were lower (-11.3%) across all stores in the period after training; however, a small increase (2.1%) was observed in the stores that underwent the full training, versus changes of -22.0% (P = 0.084) and -9.4% (P = 0.199) in control and online-only training comparisons, respectively. CONCLUSIONS: Pharmacists' vaccine-related self-efficacy may be improved through an evidence-based communication training program, but a more holistic focus on all recommended adult vaccines may be necessary to realize meaningful improvements.

Extent of and Reasons for Vaccine Hesitancy in Adults at High-Risk for Pneumococcal Disease.

PURPOSE: To determine the extent of and reasons for hesitancy toward vaccination among adults at high-risk for pneumococcal disease. DESIGN: Cross-sectional. SETTING: Online survey in March-April 2019 via QuestionPro. SUBJECTS: Tennessee adults (18-64 years) at high-risk of pneumococcal disease (n = 1,002). MEASURES: Modified version of the validated Vaccine Hesitancy Scale assessed vaccine-related beliefs, reasons for hesitancy, external influences on vaccination, and prior vaccination. ANALYSIS: Descriptive and inferential statistics provided an overview of the responses and comparisons among subgroups. Logistic regression determined the odds of being hesitant using the listed beliefs and influencers as predictors. Thematic analysis was performed on the qualitative data gathered from free response questions throughout the survey. RESULTS: Analysis included 1,002 complete responses (12% response rate [total viewed = 8,331]) with 34.3% indicating hesitancy toward one or more recommended vaccinations, with 53% of which indicating hesitancy to the pneumococcal vaccine despite it being recommended by the Advisory Committee on Immunization Practices (ACIP) for all respondents. The odds of vaccine hesitancy or resistance were higher in minorities (OR: 1.6; 95% CI: 1.19-2.11), those not believing others like them get vaccinated (OR: 1.82; 95% CI: 1.262-2.613), and respondents recalling negative media about vaccines (OR: 2.56; 95% CI: 1.797-3.643). CONCLUSIONS: Patients at high-risk of pneumococcal disease lack awareness of the need for the recommended vaccine, and provider education may need improving to increase vaccination in this population.

Stages of Change: Moving Community Pharmacies From a Drug Dispensing to Population Health Management Model.

Given their clinical training and accessibility, community pharmacists are well positioned to support primary care, especially in providing medication management services. There is limited evidence, however, on implementation of community pharmacist-led services in coordination with other health care providers. The aim of this study was to examine the implementation process of community pharmacies in North Carolina participating in a Medicaid population health management intervention. We conducted semistructured interviews with 40 representatives from high- and low-performing community pharmacies from June to August 2017. We analyzed for themes organized around Rogers's Stages in the Innovation Process in Organizations. Community pharmacies employed numerous implementation strategies such as developing relationships with providers and redefining job responsibilities to ensure pharmacists and pharmacy technicians are working at the top of their license. Findings also revealed differences in the implementation process among high- and low-performing pharmacies. Continued research is needed to determine which implementation strategies improve program performance.

Medication synchronization adoption and pharmacy performance.

BACKGROUND: While medication synchronization programs are becoming a staple in community pharmacies, a standard process needs to be identified to provide consistent positive outcomes. Many studies demonstrate how medication synchronization affects individual level patients but have not examined how medication synchronization affects the pharmacy's performance. Because community pharmacies are calibrated based on performance to adherence measures for all patients, it is important to understand whether resource-intensive interventions, such as medication synchronization, lead to improved performance. OBJECTIVES: The aims of this study were to 1) examine pharmacy characteristics associated with medication synchronization adoption and 2) examine whether medication synchronization is associated with pharmacy-level performance on select medication adherence and utilization measures. METHODS: This study used a cross-sectional design. Community pharmacies participating in the North Carolina Community Pharmacy Enhanced Services Network (NC CPESN℠) program were included in this study. Pharmacy performance was measured as summary score of pharmacy's performance on seven risk-adjusted measures which were used to measure pharmacy's performance in the program. Adoption of medication synchronization was measured as a binary variable capturing whether the pharmacy offered med sync at the time the survey was administered. RESULTS: Surveys were received from 160 out of 268 participating pharmacies (59.7% response rate) with a total of 155 pharmacies being included in the analytic sample. Pharmacies that adopted medication synchronization were more likely to have a clinical pharmacist on staff (c = 5.4, p = 0.019). Holding all else constant, medication synchronization adoption was not significantly associated with total medication adherence performance (p = 0.371). CONCLUSION: Medication synchronization has proven successful in improving individual patient level adherence but may not change a pharmacy's overall performance in adherence for all patients. Further research is needed to examine how effective implementation might contribute to whether a medication synchronization program leads to meaningful gains in adherence for all patients.

Longitudinal examination of perceived stress and academic performance of first-year student pharmacists.

INTRODUCTION: First-year pharmacy students (P1s) may experience a number of stressors that may affect academic performance due to the transition into a professional program. Study objectives were to evaluate student demographic and pre-pharmacy factors associated with perceived stress among P1s, analyze relative change in perceived stress over the P1 year, and assess associations between perceived stress and academic performance. METHODS: The Perceived Stress Scale (PSS-10) was administered three times to P1s: during orientation, midpoint of fall semester, and midpoint of spring semester. Data were also collected using school records, including demographics, P1 fall grade point average (GPA), P1 spring GPA, and P1 year GPA. Paired-sample t-tests, independent samples t-tests, Analysis of Variance, correlational analysis, and multiple linear regression were conducted. RESULTS: Of 202 P1s, 201 (99.5%) completed the orientation survey administration and 110 (54.5%) completed all three administrations. PSS-10 score significantly increased across survey administrations. Differences in PSS-10 scores at orientation were noted based on gender and race/ethnicity (P < .05), with female and minority students experiencing greater levels of stress. PSS-10 score (spring administration) was significantly, inversely correlated to P1 fall GPA, spring GPA, and year GPA (P < .05). Undergraduate science GPA, PSS-10 score (orientation administration), and age were included in the final version of the regression model as significant predictors of P1 year GPA. CONCLUSIONS: Perceived stress increased over the P1 year, and higher perceived stress was associated with lower P1 academic performance. Future studies should examine strategies to assist P1s in managing stress.

Using the Drug Burden Index to identify older adults at highest risk for medication-related falls.

BACKGROUND: The Drug Burden Index (DBI) was developed to assess patient exposure to medications associated with an increased risk of falling. The objective of this study was to examine the association between the DBI and medication-related fall risk. METHODS: The study used a retrospective cohort design, with a 1-year observation period. Participants (n = 1562) were identified from 31 community pharmacies. We examined the association between DBI scores and four outcomes. Our primary outcome, which was limited to participants who received a medication review, indexed whether the review resulted in at least one medication-related recommendation (e.g., discontinue medication) being communicated to the participant's health care provider. Secondary outcomes indexed whether participants in the full sample: (1) screened positive for fall risk, (2) reported 1+ falls in the past year, and (3) reported 1+ injurious falls in the past year. All outcome variables were dichotomous (yes/no). RESULTS: Among those who received a medication review (n = 387), the percentage of patients receiving at least one medication-related recommendation ranged from 10.2% among those with DBI scores of 0 compared to 60.2% among those with DBI scores ≥1.0 (Chi-square (4)=42.4, p < 0.0001). Among those screened for fall risk (n = 1058), DBI scores were higher among those who screened positive compared to those who did not (Means = 0.98 (SD = 1.00) versus 0.59 (SD = 0.74), respectively, p < 0.0001). CONCLUSION: Our findings suggest that the DBI is a useful tool that could be used to improve future research and practice by focusing limited resources on those individuals at greatest risk of medication-related falls.

Impact of STEADI-Rx: A Community Pharmacy-Based Fall Prevention Intervention.

OBJECTIVES: To evaluate the effects of a community pharmacy-based fall prevention intervention (STEADI-Rx) on the risk of falling and use of medications associated with an increased risk of falling. DESIGN: Randomized controlled trial. SETTING: A total of 65 community pharmacies in North Carolina (NC). PARTICIPANTS: Adults (age ≥65 years) using either four or more chronic medications or one or more medications associated with an increased risk of falling (n = 10,565). INTERVENTION: Pharmacy staff screened patients for fall risk using questions from the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) algorithm. Patients who screened positive were eligible to receive a pharmacist-conducted medication review, with recommendations sent to patients' healthcare providers following the review. MEASUREMENTS: At intervention pharmacies, pharmacy staff used standardized forms to record participant responses to screening questions and information concerning the medication reviews. For participants with continuous Medicare Part D/NC Medicaid coverage (n = 3,212), the Drug Burden Index (DBI) was used to assess exposure to high-risk medications, and insurance claims records for emergency department visits and hospitalizations were used to assess falls. RESULTS: Among intervention group participants (n = 4,719), 73% (n = 3,437) were screened for fall risk. Among those who screened positive (n = 1,901), 72% (n = 1,373) received a medication review; and 27% (n = 521) had at least one medication-related recommendation communicated to their healthcare provider(s) following the review. A total of 716 specific medication recommendations were made. DBI scores decreased from the pre- to postintervention period in both the control and the intervention group. However, the amount of change over time did not differ between these two groups (P = .66). Risk of falling did not change between the pre- to postintervention period or differ between groups (P = .58). CONCLUSION: We successfully implemented STEADI-Rx in the community pharmacy setting. However, we found no differences in fall risk or the use of medications associated with increased risk of falling between the intervention and control groups. J Am Geriatr Soc 68:1778-1786, 2020.