Impact of a statewide community pharmacy approach to opioid harm reduction.

BACKGROUND: The past several years have seen sharp increases in opioid overdose mortality. Harm reduction resources, such as nonprescription syringes and naloxone, are used to save lives. OBJECTIVES: To develop a statewide approach to increase the use of opioid harm reduction services through community pharmacies. PRACTICE DESCRIPTION: The North Carolina Association of Pharmacists was awarded a grant to address opioid mortality across the state, using community pharmacies to address opioid use disorder. PRACTICE INNOVATION: A statewide, standardized approach was implemented to increase knowledge and use of opioid harm reduction resources in the community pharmacy setting. EVALUATION METHODS: Pharmacies were offered training related to harm reduction. Participating pharmacies provided monthly updates related to staff training, syringe access status, naloxone kits distributed, and comments about how the training was changing their practice. At the project conclusion, pharmacies provided retrospective naloxone dispensing data along with naloxone dispensing during the intervention period. Pharmacies shared the greatest benefit of the program, a potential change to make implementation simpler, and the biggest change in the pharmacist(s) as a result of the project. Descriptive statistics were used to analyze data. RESULTS: A total of 58 pharmacies across 33 counties participated in the harm reduction project. Of the 100 North Carolina counties, 15 counties were identified as high-need, and 14 of the 15 high-need counties (93%) participated in this project. Of the 58 participating pharmacies, 40 pharmacies (69%) had or implemented a nondiscriminatory nonprescription syringe policy within their pharmacy. During the baseline period (January 1, 2018, to June 15, 2018), 177 prescriptions for naloxone were dispensed by participating pharmacies. During the intervention period (January 1, 2019, to June 15, 2019), 639 prescriptions for naloxone were dispensed, representing a 361% increase in naloxone dispensing. CONCLUSION: The successful implementation of a standardized, statewide approach increased access to harm reduction services.

Geriatric Polypharmacy: Pharmacist as Key Facilitator in Assessing for Falls Risk: 2019 Update.

This article highlights the significant health impact of falls among older adults. An emphasis is placed on the vital role of the pharmacist, regardless of practice setting, in assessing and reducing falls risk for this growing population. In addition, the importance of a stepwise comprehensive approach to falls assessment by pharmacists in collaboration with other clinicians is elucidated.

Impact of Students' Strengths, Critical Thinking Skills and Disposition on Academic Success in the First Year of a PharmD Program.

Objective. To determine the critical thinking skills, critical thinking disposition, and personal strengths that contribute to student success and excellence in the first year of a doctor of pharmacy (PharmD) program. Methods. Student pharmacists from three cohorts completed the Health Sciences Reasoning Test (HSRT) to assess their critical thinking skills, the California Critical Thinking Disposition Inventory (CCTDI) to assess their critical thinking disposition, and the StrengthsFinder 2.0 assessment to determine their top five Signature Themes. HSRT overall categories, CCTDI subcategories, and top five Signature Themes were analyzed to determine both independent predictors and a logistic regression model of success and excellence. Results. HSRT and the Signature Theme of Consistency were independently associated with both success and excellence. CCTDI Open-mindedness and the Signature Themes of Achiever and Learner were also independent predictors of excellence. Age and several Signature Themes were negative independent predictors of success. In a multiple logistic regression model, HSRT overall category and the absence of Signature Themes Command and Woo predicted success and HSRT overall category predicted excellence. Conclusion. This is the first model to determine performance in the first year of PharmD program using Signature Themes. Critical thinking skills, the critical thinking disposition of Open-mindedness and the Signature Themes of Achiever, Consistency, and Learner are associated with the highest student performance.

Geriatric Polypharmacy: Pharmacist as Key Facilitator in Assessing for Falls Risk.

This article highlights the significant health impact of falls among older adults. An emphasis is placed on the vital role of the pharmacist, regardless of practice setting, in assessing and reducing falls risk for this growing population. In addition, the importance of a stepwise comprehensive approach to falls assessment by pharmacists in collaboration with other clinicians is elucidated.

Documenting the use of calcium supplements with oral bisphosphonates.

OBJECTIVE: Patients receiving an oral bisphosphonate for treatment of osteopenia or osteoporosis without adequate calcium intake are not optimally treated. Physicians prescribing bisphosphonates may not consistently document calcium supplementation recommendations. DESIGN: This is a retrospective chart review of osteoporotic or osteopenic outpatients with an active prescription for an oral bisphosphonate. This cross-sectional study was designed to determine the point prevalence of calcium supplementation recommendations by physicians. SETTING: Academic family medicine outpatient clinics. PATIENTS: Of the 1,229 patients with osteoporosis or osteopenia, 425 patients had an active prescription for an oral bisphosphonate and were included in the study. INTERVENTIONS: The active/inactive medication list and physician clinic notes in the electronic medical record were reviewed for documentation regarding calcium. MAIN OUTCOME MEASURES: The primary endpoint was the percentage of patients on bisphosphonates also receiving calcium. The secondary endpoint was the identification of demographic characteristics associated with lower use of calcium. RESULTS: The patient sample was 94% female, 69% white, with a mean body mass index of 27, and mean age of 72 years. Of the 425 patients, 387 (91.1%) were taking calcium or had a documented recommendation for calcium supplementation. Of the demographic characteristics evaluated, only age was statistically significantly different, with an average age of 76 years in the calcium group and 66 years of age in the noncalcium group. CONCLUSION: In this study, 91% of outpatients who were prescribed a bisphosphonate also were taking calcium or had it recommended to them. The only statistically significant difference between groups was greater age for those who received calcium.

Measuring adherence in a community-based elderly population.

OBJECTIVE: To examine the reliability and validity of the Medication Adherence Individual Review-Screening Tool (MedAdhIR-ST) for assessing medication adherence in a community-dwelling elderly population. DESIGN: A prospective, observational pilot study comparing the reliability and validity of the MedAdhIR-ST and the Medication Adherence Questionnaire (MAQ). SETTING: Independent senior-housing apartments and senior centers in Wake County, North Carolina. PARTICIPANTS: Eligible subjects included individuals 60 years of age or older who were living in the community and managing their own medication regimens. INTERVENTIONS: Each subject was asked to participate in two assessment visits, two weeks (+/- 3 days) apart, in which the questions of the MedAdhIR-ST and MAQ were administered. MAIN OUTCOME MEASURE: Medication adherence. RESULTS: Both tools showed moderate-to-high test/retest reliability in the study population (correlation coefficient of 0.632 for MAQ, and 0.699 for MedAdhIR-ST), and moderate internal consistency (Cronbach's a of 0.551 and 0.584, respectively). Moderate concordance in the ability to assess adherence was observed between MedAdhIR-ST and MAQ (positive correlation coefficient of 0.450). When compared with refill records, MedAdhIR-ST was slightly more sensitive (67% vs. 43%) and specific (60% vs. 50%) for detecting adherence and nonadherence, respectively, compared with MAQ. Exploratory factor analysis indicated that MedAdhIR-ST is multidimensional. CONCLUSION: MedAdhIR-ST appears to be a reliable and valid tool for screening nonadherence in a community-dwelling elderly population.

Medication errors and penalties in assisted living facilities.

OBJECTIVE: To determine the percentage of medication-related proposed penalties for licensed assisted living facilities in North Carolina. DESIGN: This retrospective, cross-sectional study examined all proposed penalties and related case-file narratives stemming from annual surveys of licensed assisted living facilities conducted by the state between July 2007 and December 2008. The percentage of medication-related deficiencies and proposed penalties were calculated. Associations between the medication-related proposed penalties and facility size, location, and penalty type were explored using chi-square tests. SETTING: Assisted living facilities in North Carolina. MAIN OUTCOME MEASURES: Percentage of medication- and non-medication-related penalties. RESULTS: A total of 1,256 licensed assisted living facilities (51% adult care homes, 59% metropolitan) were surveyed during the study period. There were 88 proposed penalties (51% medication-related) among 60 facilities. No association between medication-related proposed penalties and facility size or location was detected. However, an association (P = 0.002) was found between type of penalty (A or B) and whether the proposed penalty was medication- or non-medication-related (37.3% and 70.3% of Type A and B penalties, respectively, were medication related). Medications commonly cited were insulin, cardiovascular agents, supplements, anticonvulsants, and antipsychotics. Common categories of medication errors were drug not administered and wrong dose administered. CONCLUSIONS: Medication errors, regardless of facility size or location, were contributing factors in approximately one-half of violations sufficient enough to warrant a penalty proposal among the licensed assisted living facilities in North Carolina. These findings demonstrate a need for continued regulation and increased pharmacist involvement to improve medication safety.