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Research Studies is a monthly compilation of research articles funded by AHRQ or authored by AHRQ researchers and recently published in journals or newsletters.
Results1 to 15 of 15 Research Studies Displayed
Ailabouni NJ, Marcum ZA, Schmader KE
Medication use quality and safety in older adults: 2018 update.
This study identified four key articles from 2018 that address medication use quality and safety for older adults. The first study highlighted a cluster-randomized trial that utilized a pharmacist-led education-based intervention delivered to both patients and doctors to deprescribe four types of inappropriate medications. The second study from the UK examined the association between anticholinergic exposure, overall and by medication class, and dementia risk in 40,770 older adults. The third study was a Swedish longitudinal cohort study examining the association between antihypertensive medications and incident dementia. The fourth and last study was a randomized, double-blind, placebo-controlled trial and examined the effect of daily low-dose aspirin for primary prevention of cardiac events and hemorrhage in 19,144 community-dwelling older adults.
Citation: Ailabouni NJ, Marcum ZA, Schmader KE . Medication use quality and safety in older adults: 2018 update. J Am Geriatr Soc 2019 Dec;67(12):2458-62. doi: 10.1111/jgs.16243..
Keywords: Elderly, Medication, Medication: Safety, Patient Safety, Quality of Care, Provider: Pharmacist, Provider
Adeoye-Olatunde OA, Curran GM, Jaynes HA
Preparing for the spread of patient-reported outcome (PRO) data collection from primary care to community pharmacy: a mixed-methods study.
This study’s aim was to prepare for implementation of PatientToc™, a patient-reported outcomes (PRO) data collection software that can be used to help facilitate resolution of non-adherence to medications. The study was a two-phase operation, but this report focuses on the phase of the evaluation which was conducted at primary care practices currently using PatientToc™ and community pharmacies in Indiana, Wisconsin, and Minnesota. One-day site visits were conducted along with observations, audio-recorded contextual inquires, semi-structured interviews with staff and patients, and post-visit site observation debriefs. Nine pharmacies, two primary care practices, and 89 individuals participated. Four major barriers, four major facilitators and 14 recommendations were identified. A stakeholder panel engaged in four Evidence-Based Quality Improvement (EBQI) implementation process sessions. The panel confirmed findings and designated high priority recommendations which included: explaining PatientToc™ and its benefits clearly and simply to patients, ensuring patients can complete questionnaires within 10 minutes, providing hands-on training/resources for pharmacy teams, and providing feedback on the adapted PatientToc™ application, and finalizing toolkit items for initial community pharmacy implementation.
Citation: Adeoye-Olatunde OA, Curran GM, Jaynes HA . Preparing for the spread of patient-reported outcome (PRO) data collection from primary care to community pharmacy: a mixed-methods study. Implement Sci Commun 2022 Mar 14;3(1):29. doi: 10.1186/s43058-022-00277-3..
Keywords: Provider: Pharmacist, Health Information Technology (HIT), Patient-Centered Outcomes Research
Reddy A, Lester CA, Stone JA
Applying participatory design to a pharmacy system intervention.
Researchers used participatory design (PD) to develop a patient-centered prototype for a community pharmacy. The stakeholders recruited for the intervention were pharmacy staff and older adult patients who received prescriptions at the pharmacy corporation involved in this study. The PD process is a series of six adaptive sessions: 1) problem identification, 2) solution generation, 3) convergence, 4) prototyping, 5) initial evaluation, and 6) formative evaluation. The sessions resulted in the development of a patient-centered community pharmacy prototype.
Citation: Reddy A, Lester CA, Stone JA . Applying participatory design to a pharmacy system intervention. Res Social Adm Pharm 2019 Nov;15(11):1358-67. doi: 10.1016/j.sapharm.2018.11.012..
Keywords: Provider: Pharmacist, Patient-Centered Healthcare, Medication, Patient Safety
Kurian S, Baloy B, Baird J
Attitudes and perceptions of naloxone dispensing among a sample of Massachusetts community pharmacy technicians.
Citation: Kurian S, Baloy B, Baird J . Attitudes and perceptions of naloxone dispensing among a sample of Massachusetts community pharmacy technicians. J Am Pharm Assoc 2019 Nov-Dec;59(6):824-31. doi: 10.1016/j.japh.2019.08.009..
Keywords: Medication, Medication: Safety, Opioids, Substance Abuse, Provider: Pharmacist, Provider, Patient Safety
Gilson AM, Stone JA, Reddy A
Exploring how pharmacists engage with patients about over-the-counter medications.
This study used an innovative information-gathering approach to provide insight into the nature and structure of pharmacy staff encounters with patients seeking over-the-counter (OTC) medications and revealed specific activities of pharmacy staff around these encounters. Through an 8-item OTC Encounter Form, results showed that pharmacists play a key role in ensuring that the benefits of OTC medications outweigh the risks, thereby providing an important resource for patient engagement about safe medication selection and use. Examining the features of OTC encounters creates an evidence base to promote best practices for OTC encounters, increasing pharmacists' ability to help people, especially older adults, navigate the intricacies of OTC medication use, without significantly increasing pharmacy staff workload.
Citation: Gilson AM, Stone JA, Reddy A . Exploring how pharmacists engage with patients about over-the-counter medications. J Am Pharm Assoc 2019 Nov - Dec;59(6):852-56. doi: 10.1016/j.japh.2019.08.001..
Keywords: Medication, Provider: Pharmacist, Provider, Patient and Family Engagement
Bach P, Hartung D
Leveraging the role of community pharmacists in the prevention, surveillance, and treatment of opioid use disorders.
This narrative review explores the literature describing novel programs designed to capitalize on the role of the community pharmacist in helping to reduce opioid-related harms, as well as evaluations of existing practices already in place in the US and elsewhere around the world. Specific approaches examined include strategies to facilitate pharmacist monitoring for problematic opioid use, to increase pharmacy-based harm reduction efforts (including naloxone distribution and needle exchange programs), and to involve community pharmacists in the dispensation of opioid agonist therapy.
AHRQ-funded; HS024227; 2902015000091.
Citation: Bach P, Hartung D . Leveraging the role of community pharmacists in the prevention, surveillance, and treatment of opioid use disorders. Addict Sci Clin Pract 2019 Sep 2;14(1):30. doi: 10.1186/s13722-019-0158-0..
Keywords: Medication, Opioids, Provider, Provider: Pharmacist, Substance Abuse
McCarthy DM, Russell AM , Effler MR
Implementation fidelity of patient-centered prescription label to promote opioid safe use.
The authors assessed implementation of a patient-centered "PRN" (as needed) label entitled "Take-Wait-Stop" (TWS) with three deconstructed steps replacing traditional wording. They found that exact intervention adherence was not achieved in the majority of cases, limiting impact, but that community pharmacies were responsive to new instructions, with higher implementation reliability requiring additional supports.
Citation: McCarthy DM, Russell AM , Effler MR . Implementation fidelity of patient-centered prescription label to promote opioid safe use. Pharmacoepidemiol Drug Saf 2019 Sep;28(9):1251-57. doi: 10.1002/pds.4795..
Keywords: Opioids, Patient Safety, Health Literacy, Medication, Provider: Pharmacist, Provider
Nolan K, Zullo AR, Bosco E
Controlled substance diversion in health systems: a failure modes and effects analysis for prevention.
This study’s purpose was to demonstrate the utility of failure modes and effects analysis (FMEA) to identify potential sources of controlled substance diversion and developing solutions in an academic health system. A cross-functional team of 18 members was developed from the department of pharmacy. Scoring criteria was developed and ways were identified in which step of the medication supply there could be failure and result in diversion of controlled substances. Failure was indicated with a vulnerability score of 48 or 64. A total of 10 major steps and 30 substeps in the supply process was identified. From this 103 potential failure modes were identified, with 24 modes (23%) considered failing. Notable failure included controlled substance activity under temporary patients and discrepancy trends. Expanded use of cameras in high-risk areas and added verification checks were implemented after the analysis.
Citation: Nolan K, Zullo AR, Bosco E . Controlled substance diversion in health systems: a failure modes and effects analysis for prevention. Am J Health Syst Pharm 2019 Jul 18;76(15):1158-64. doi: 10.1093/ajhp/zxz116..
Keywords: Medication, Provider: Pharmacist, Hospitals, Quality Improvement, Quality of Care
Snyder ME, Jaynes H, Gernant SA
Alerts for community pharmacist-provided medication therapy management: recommendations from a heuristic evaluation.
This study evaluated the effectiveness of alerts for community pharmacist-provided medication therapy management (MTM). The alerts come in five categories: indication, effectiveness, safety, adherence, and cost-containment. The heuristic evaluation used the Instrument for Evaluating Human-Factors Principles in Medication-Related Decision Support Alerts (I-MeDeSA). Four analysts’ individual ratings were summed for each alert, and a mean score on the modified I-MeDeSA was computed. The analysts’ scores were similar. The scores indicated opportunities for improvement across all MTM alert categories including principles of alert prioritization; text-based information; alarm philosophy; and corrective actions.
Citation: Snyder ME, Jaynes H, Gernant SA . Alerts for community pharmacist-provided medication therapy management: recommendations from a heuristic evaluation. BMC Med Inform Decis Mak 2019 Jul 16;19(1):135. doi: 10.1186/s12911-019-0866-0..
Keywords: Decision Making, Health Information Technology (HIT), Medication, Provider, Provider: Pharmacist
Donovan E, Case P, Bratberg JP
Beliefs associated with pharmacy-based naloxone: a qualitative study of pharmacy-based naloxone purchasers and people at risk for opioid overdose.
The purpose of this study was to understand factors that impact the likelihood of obtaining pharmacy-based naloxone. Results showed that several themes emerged from the interview data: individual, interpersonal, pharmacy, community, and societal, suggesting that these factors can be used to inform interventions seeking to increase the provision of pharmacy-based naloxone.
Citation: Donovan E, Case P, Bratberg JP . Beliefs associated with pharmacy-based naloxone: a qualitative study of pharmacy-based naloxone purchasers and people at risk for opioid overdose. J Urban Health 2019 Jun;96(3):367-78. doi: 10.1007/s11524-019-00349-1..
Keywords: Medication, Provider, Provider: Pharmacist, Opioids, Risk, Substance Abuse
Schiff GD, Klinger E, Salazar A
Screening for adverse drug events: a randomized trial of automated calls coupled with phone-based pharmacist counseling.
In this study, the investigators evaluated an automated telephone surveillance system coupled with transfer to a live pharmacist- to screen potentially drug-related symptoms after newly starting medications for four common primary care conditions: hypertension, diabetes, depression, and insomnia. Systematic automated telephone outreach monitoring coupled with real-time phone referral to a pharmacist identified a substantial number of previously unidentified potentially drug-related symptoms, many of which were validated as probably or possibly related to the drug by the pharmacist or their physicians.
Citation: Schiff GD, Klinger E, Salazar A . Screening for adverse drug events: a randomized trial of automated calls coupled with phone-based pharmacist counseling. J Gen Intern Med 2019 Feb;34(2):285-92. doi: 10.1007/s11606-018-4672-7..
Keywords: Adverse Drug Events (ADE), Adverse Events, Medication, Medication: Safety, Health Information Technology (HIT), Provider: Pharmacist, Provider, Patient Safety
Qato DM, Daviglus ML, Wilder J
'Pharmacy deserts' are prevalent in Chicago's predominantly minority communities, raising medication access concerns.
The authors examined whether trends in the availability of pharmacies varied across communities in Chicago with different racial or ethnic compositions and whether "pharmacy deserts," or low-access neighborhoods, were more common in segregated black and Hispanic communities than elsewhere. They found that in 2012 there were disproportionately more pharmacy deserts in segregated black communities, as well as in low-income communities and federally designated Medically Underserved Areas. These findings suggest that public policies aimed at improving access to prescription medications may need to address factors beyond insurance coverage and medication affordability.
Citation: Qato DM, Daviglus ML, Wilder J . 'Pharmacy deserts' are prevalent in Chicago's predominantly minority communities, raising medication access concerns. Health Aff 2014 Nov;33(11):1958-65. doi: 10.1377/hlthaff.2013.1397.
Keywords: Access to Care, Medication, Provider: Pharmacist, Racial / Ethnic Minorities, Urban Health
Werth SR, Sachdeva N, Roberts AW
North Carolina Medicaid recipient management lock-in program: the pharmacist's perspective.
The objectives of this study were (a) evaluate pharmacists’ perceptions of the implementation of the North Carolina (NC) recipient management lock-in program (MLIP) and (b) determine how the beliefs and attitudes of pharmacists could promote or inhibit its success. It concluded that, although possible improvements were identified, the NC MLIP has strong potential for success as it utilizes pharmacists’ medication gate-keeping role, while minimizing the effort required for successful implementation.
Citation: Werth SR, Sachdeva N, Roberts AW . North Carolina Medicaid recipient management lock-in program: the pharmacist's perspective. J Manag Care Spec Pharm 2014 Nov;20(11):1122-9..
Keywords: Medicaid, Medication, Opioids, Provider: Pharmacist, Substance Abuse
Snyder ME, Frail CK, Jaynes H
Predictors of medication-related problems among Medicaid patients participating in a pharmacist-provided telephonic medication therapy management program.
The objective of this study was to identify predictors of medication-related problems (MRPs) among Medicaid patients participating in a telephonic medication therapy management (MTM) program. The analysis of study results supports the relative importance of number of medications as a predictor of MRPs in the Medicaid population and identifies other predictors.
Citation: Snyder ME, Frail CK, Jaynes H . Predictors of medication-related problems among Medicaid patients participating in a pharmacist-provided telephonic medication therapy management program. Pharmacotherapy 2014 Oct;34(10):1022-32. doi: 10.1002/phar.1462..
Keywords: Adverse Drug Events (ADE), Care Management, Community-Based Practice, Medicaid, Medication, Provider: Pharmacist
Ness GL, Sheehan AH, Snyder ME
Graduating student pharmacists' perspectives on e-professionalism and social media: qualitative findings.
The researchers conducted a cross-sectional survey of 212 graduating student pharmacists to characterize their views of professionalism on popular social media sites. The themes identified in the analysis were separation of personal and professional lives, how accountability for actions should vary by severity, and the extent of representation of the students’ character on social media.
Citation: Ness GL, Sheehan AH, Snyder ME . Graduating student pharmacists' perspectives on e-professionalism and social media: qualitative findings. J Am Pharm Assoc 2014 Mar-Apr;54(2):138-43. doi: 10.1331/JAPhA.2014.13188..
Keywords: Education: Academic, Education: Continuing Medical Education, Provider: Pharmacist, Social Media