Includes bibliographical references.

Development and Implementation of Interprofessional Relations Between a College of Pharmacy and Osteopathic Residency Programs in a Community Teaching Hospital -- Team Communication on Tasks Performed in Blood Pressure Clinics in Community Pharmacies -- Monitoring Commercial Ibuprofen Potency Changes Over 1 Year When Stored in a Household Setting -- Comparison of Interventions Made in an Ambulatory Pharmacist-Managed Refill Model to Usual Physician Care -- Opioid Prescribing in the Elderly: A Systematic Review.

[Article Title: Development and Implementation of Interprofessional Relations Between a College of Pharmacy and Osteopathic Residency Programs in a Community Teaching Hospital / Paul M. Boylan, Jordan Sedlacek, Melissa Santibañez, Andria F. Church, Nicole Lounsbury and Jacqueline Nguyen, p. 3-9]

Abstract:

Background: Team-based health care optimizes patient outcomes, and therefore, both interprofessional education (IPE) and interprofessional relations (IPR) are required in health professions education, postgraduate training, and real-world clinical practice. Existing literature describes progressive developments and assessments of IPE in colleges of pharmacy and medicine; however, there are fewer reports describing processes or projects that foster physician-pharmacist IPR in clinical practices without established interprofessional collaborations.

Objectives: The primary objective was to establish IPR between pharmacists and osteopathic residents in a community teaching hospital. The secondary objective was to innovate the delivery of pharmacotherapeutic content delivered to the residents during their didactic lecture series by providing active learning strategies.

Methods: This report describes a project wherein college of pharmacy faculty developed IPR with osteopathic residents in a community teaching hospital that previously did not have any established physician-pharmacist IPR. Osteopathic medical residents completed a post-implementation survey after they attended a 12-month series of didactic lectures that incorporated active learning delivered by pharmacist faculty.

Results: Sixty-six residents were eligible to complete the survey; 20 residents completed the survey. Eighteen residents believed that both physicians and pharmacists should be educated to establish IPR and that it should be included in professional, graduate, and continuing education settings for both professions. Sixteen residents believed that the active learning techniques employed by college of pharmacy faculty were useful for IPR.

Conclusions: Physician-pharmacist IPR may be achievable in settings where IPR was previously sparse. Shared interests, adherence, and innovations in IPR frameworks are essential for developing physician-pharmacist IPR.

https://doi.org/10.1177/8755122519865540

[Article Title: Team Communication on Tasks Performed in Blood Pressure Clinics in Community Pharmacies / Shih-Ying H. Hsu, Monica J. Hwang and Jeanine K. Mount, p. 10-15]

Abstract:

Background: To successfully deliver pharmacy services, pharmacists and technicians need to work as a team and have effective communication.

Objectives: To measure the amount of communication between community pharmacists and their technicians during monthly blood pressure (BP) clinics.

Methods: Cross-sectional survey method was used to assess the amount of communication pharmacists and technicians had on each task. Study participants were pharmacist-technician pairs (teams) from 10 intervention community pharmacies in the Team Education and Adherence Monitoring (TEAM) trial. Each team provided services designed to improve BP among hypertensive African American patients. Thirteen specific tasks were identified as essential in providing monthly BP clinics, and they were being performed by either the pharmacist or technician. At the end of the trial, each pharmacist and technician were asked to report his/her perception of discussion levels that occurred for each task. The level of team communication was summarized for each task (task-specific) and for each team (team-specific).

Results: For task-specific communication, 3 teams had communication regarding pharmacist tasks and 5 teams engaged in communication for technician tasks. More communication was reported for newly developed technician tasks in the BP clinic. For team-specific communication, 2 teams reported no communication on any task, and another 2 teams reported having communication on all the tasks. Overall, pharmacy teams showed different levels of communication in this study.

Conclusion: The amounts of communication between pharmacists and technicians were found to vary for different tasks and teams. This suggests that the nature of tasks and the unique dynamics existing in each pharmacy team could influence pharmacist-technician communication.

https://doi.org/10.1177/8755122519872697

[Article Title: Monitoring Commercial Ibuprofen Potency Changes Over 1 Year When Stored in a Household Setting / Timothy Archibald and Stacy Brown, p. 16-21]

Abstract:

Background: Most over-the-counter medications are labeled for storage in a dry, room temperature environment. Despite this, many households store medications in the bathroom, where temperature and humidity extremes may be experienced.

Objective: In this project, we sought to investigate the effect that long-term storage in a household bathroom had on potency of over-the-counter ibuprofen (IBU) products as well as on the emergence of a known toxic degradation product, 4-isobutylacetophenone (4-IBP).

Methods: A liquid chromatography-tandem mass spectrometry method was developed for the quantitative determination of IBU and 4-IBP in aqueous samples. Three brands each of IBU tablets (200 mg) and suspensions (100 mg/5 mL) were assayed for IBU concentration at the initiation of the study and once monthly thereafter. The samples were stored in a household bathroom, with continuous temperature and humidity monitoring. Each sample was assayed in triplicate and percent recovery was calculated against freshly prepared standards of IBU using bulk powder.

Results: Tablets maintained >90% average strength through 3 months, with statistically significant deviation from initial concentration (2-way analysis of variance, P = .05) detected after 6 to 7 months. Suspensions maintained >90% average strength through 5 months, with statistically significant changes from initial concentration emerging after 7 months. After 12 months, the average strength was 73% and 83% for tablets and suspensions, respectively. 4-IBP was not detected in any of the samples during the duration of the study.

Conclusions: These data indicate that, while 4-IBP was not detected following 12-month bathroom storage of commercial IBU products, significant changes in potency should negatively affect efficacy.

https://doi.org/10.1177/8755122519877808

[Article Title: Comparison of Interventions Made in an Ambulatory Pharmacist-Managed Refill Model to Usual Physician Care / Stephanie Okraszewski, Rebecca Sattler-Leja, Monika Brodman, David Goll and Simon W. Lam, p. 22-27]

Abstract:

Background: With the current practice model, there is less time for physicians to address refill authorization requests (RARs) while performing consistent quality care, which creates an opportunity for pharmacists to assist in refills. Currently, inadequate evidence is available to support this intervention.

Objective: To compare the rate of medication management interventions (MMIs - drug therapy changes, laboratory monitoring ordered, or office visit scheduled) initiated by the pharmacist-managed authorization center (PMAC) to usual care.

Methods: A retrospective, noninferiority study looked at 4000 RARs from 6 primary care centers from January 2016 through March 2017. The primary endpoint compared the rate of MMIs between PMAC and usual care. Noninferiority was concluded if the upper limit of the 95% CI of the difference in interventions was <2%. Secondary endpoints included total, type, and acceptance rate of PMAC recommendations.

Results: A total of 3830 patients were included, with 4732 medications requested (2183 reviewed by PMAC and 2549 by usual care). MMIs occurred in 153 medications within PMAC (7.0%) versus 90 for usual care (3.5%). The difference in total MMIs between PMAC and usual care was −3.5% (95% confidence interval = −4.8% to −2.2%). Medications reviewed by PMAC had significantly higher number of laboratory monitoring (P = .036) and scheduled appointments (P < .001). There were 294 PMAC recommendations (13.5%) with a 52.0% acceptance rate.

Conclusion and Relevance: This study showed that PMAC was superior to usual care for reviewing RARs. There was a statistically significant improvement in medication monitoring and patient follow-up, supporting the idea of including a pharmacist in the decision making.

https://doi.org/10.1177/8755122519874686

[Article Title: Opioid Prescribing in the Elderly: A Systematic Review / Melissa Jassal, Greg Egan and Karen Dahri, p. 28-40]

Abstract:

Objective: To characterize the literature describing the therapeutic use of opioids in the elderly.

Data Sources: Two electronic databases, EMBASE and MEDLINE, were searched from years 1990 to September 5, 2018. Relevant reference lists were reviewed. Searches were restricted to English language.

Study Selection and Data Extraction: Two reviewers independently screened 827 citations to identify observational studies, population-based cohort studies, retrospective analyses, and control trials looking at the management of persistent pain in patients aged ≥65 years and/or frail patients.

Data Synthesis: Thirty-nine articles were included in the systematic review. More specifically, 17 observational studies, 7 population-based cohort studies, 10 retrospective analyses, and 4 controlled trials. The most common etiology of persistent pain was musculoskeletal (50%), and the most often adverse effects reported were central nervous system related (41%) and falls/fractures (39%).

Relevance to Patient Care and Clinical Practice: As there is a lack of strong evidence-based recommendations for opioid use in the elderly, this review aims to evaluate opioid use in the elderly and compare their efficacy and safety among this population.

Conclusions: Overall, central nervous system adverse effects were most commonly seen in the elderly. However, higher quality evidence is required to further appreciate the dose-related effects on efficacy and safety of opioids in the elderly.

https://doi.org/10.1177/8755122519867975