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The Role of Pharmacists in Clinical Sleep Apnea Services in Australian Pharmacies: A Public Health Opportunity?
Abstracts / Research in Social and Administrative Pharmacy 10 (2014) e1–e64 2011, namely Acinetobacter baumannii (A. baumannii), Escherichia coli (E. coli), Klebsiella pneumoniae (K. pneumoniae), Pseudomonas aeruginosa (P. aeruginosa), Staphylococcus aureus (S. aureus), Methicillin resistant S. aureus (MRSA) and Streptococcus pneumoniae (S. pneumoniae) were selected to demonstrate the application of the ATI. Two types of ATI were developed. The overall ATI (ATIall) includes all available antibiotic sensitivity data and indicates the chance of a successful antibiotic treatment, The modified ATI (ATIm) provides an early warning sign of developing antibiotic resistance by presenting the opportunity of a successful antibiotic treatment using only the first five antibiotic classes with the highest resistance rates. In order to identify problematic pathogens, we propose four categories of severity for the ATI: “safe” (O0.9687 chance of a successful treatment outcome), “warning” (0.92220.9687), “dangerous” (0.8319-0.9221) and “catastrophic” (!0.8319). Results: During the study period, an obvious problematic pathogen was A. baumannii. The A. baumannii ATIall dropped from ”safe” in 2003 (0.9463) to ”dangerous” in 2007 (0.8876). In addition, E. coli has shown early signs of becoming a problematic pathogen, with the E. coli ATIm in the “warning” category in 2003 (0.9632). Conclusion: The ATI is a novel index in antibiotic resistance monitoring that can simply and effectively identify problematic pathogens from existing antibiogram data. We hope that this may help promote effective communication among health care professionals to help manage the emergence and spread of antibiotic resistance. The impact of focused teaching sessions on New Zealand pharmacy students’ attitudes to people suffering from schizophrenia and other mental illnesses J.M. Tordoff, N.-A. Benner, L.D. Broomfield, L.J. Hamilton, Z.E. Jaques, J.M. Kerslake, C.A. Soeteman, J.L. Spittal, H.C. Wilson, P.S. Nishtala, School of Pharmacy, University of Otago, New Zealand Final-year undergraduate pharmacy students at the University of Otago, New Zealand receive teaching on mental illness during the central nervous system (CNS) module. This study was undertaken to determine the impact of this teaching on students’ attitudes towards people suffering from schizophrenia and other mental illnesses. Methods: Using previously-validated questions, two questionnaires were developed and administered to a cohort of final-year undergraduate pharmacy students. Questionnaire 1 sought responses on a Likert scale to seven questions on willingness to associate with a person previously hospitalised with schizophrenia (Social Distance (SD) scale); and to eight questions on common stereotypical beliefs. Questionnaire 2 comprised these questions plus two open questions about the teaching.
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Questionnaire 1 was administered prior to the CNS module, and questionnaire 2 after its completion. Participants’ responses were matched, and compared using the student’s t-test. Responses to open questions were examined for recurrent themes. Results: Eighty-six students completed both questionnaires. There was no significant difference in responses on the SD scale or on common stereotypical beliefs. Nevertheless, students appeared more willing to “share a flat with that person” (t¼2.12, p¼0.04) and “have that person as a baby sitter for a child” (t¼2.17, p¼0.03). Conversely, students more strongly agreed that people previously hospitalised with schizophrenia were “hard to talk to” (t¼3.15, p!0.001). Open questions found that the teaching sessions had a positive impact on students’ understanding of and attitudes towards people with mental illnesses, although some students wanted more education, or help with developing their communication skills. The session involving patients was greatly valued. Conclusion: Following focused teaching sessions, some positive changes but no significant overall change, was found in New Zealand pharmacy students’ understanding of and attitudes towards schizophrenia and other mental illnesses. Nevertheless, students may need more help in developing skills to communicate with people with mental illness. The Role of Pharmacists in Clinical Sleep Apnea Services in Australian Pharmacies: A Public Health Opportunity? C.A. Hanes1,2,5, K.K.H. Wong2,3,4,5, B. Saini1,2,5, 1 Faculty of Pharmacy, The University of Sydney, NSW, Australia, 2The NHMRC Center for Integrated Research and Understanding of Sleep (CIRUS), Glebe, NSW, Australia, 3Faculty of Medicine, The University of Sydney, NSW Australia, 4Royal Prince Alfred Hospital, Camperdown, NSW, Australia, 5Woolcock Institute of Medical Research, Glebe, NSW, Australia To provide an overview of the specialized role of pharmacy staff involved in sleep apnea-related services in Australian community pharmacies. Methods: Cross-sectional mail questionnaire. All pharmacies in Australia providing sleep apnea services at the time of recruitment were mailed the study questionnaire pack. Non-responders were contacted in 2 subsequent recruitment rounds. The questionnaire was developed by the researchers and designed to gather data on pharmacy demographics, clinical and structural elements of sleep apnea services offered, attitudes towards these services, and possible future directions. Results: A response rate of 55% (n¼110) was achieved. Clinical sleep apnea services offered by pharmacies included: obstructive sleep apnea screening, Continuous Positive Airway Pressure (CPAP) device trials, patient education and counseling, mask fitting, patient followup, adherence monitoring, and home diagnostic studies. Perceived benefits of providing a sleep apnea service
e56
Abstracts / Research in Social and Administrative Pharmacy 10 (2014) e1–e64
included meeting patient and community needs, improved professional image of the pharmacy, and professional satisfaction. Perceived barriers included cost of equipment to patients, online competitors, and lack of time. Inter-professional relationships were listed as both a benefit of and a barrier to providing the service. A majority of respondents (89%) indicated there was room for improvement in some aspect of their service. Key areas for improvement identified from analysis of open-ended responses (n¼96) were: 1) Staff training and knowledge 2) Promotion of the service and increasing public awareness 3) Infrastructure and expansion 4) Inter-professional collaboration and communication 5) Patient follow-up. Conclusions: Given the public health burden of obstructive sleep apnea (OSA) and the need to improve patient access to sleep services, pharmacies may be poised to contribute to the multidisciplinary management of OSA. The Australian experience suggests pharmacists can play a role in the primary care sleep health team and pharmacy-based CPAP services may serve community needs well.
The use of cardiovascular medications in patients with coronary artery disease before and after percutaneous coronary intervention P. Tangsucharit, T. Samkaew, C. Laowachirasuwan, S. Jantaruechai, Pharmaceutical department, Queen Sirikit Heart Center of the Northeast, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand 40002 To evaluated the use of cardiovascular medications in patients with coronary artery disease (CAD) before and after PCI. Method: Guideline-based recommendations that the use of cardiovascular medications have been proven to gain benefits in patients with unstable angina (UA)/non ST elevation myocardial infarction (NSTEMI) or ST elevation myocardial infarction (STEMI) and post percutaneous coronary intervention (PCI). This study evaluated the use of cardiovascular medications of 163 patients who underwent PCI for CAD at a Northeast Heart Center, Thailand, between October 2008 to September 2009. Results: CAD patients were male (64.4%) and had average age 6611.26 years. They had single vessel disease, double vessel disease and triple vessel disease 38.1, 42.3, and 19.6%, respectively. Aspirin and Clopidogrel were used 96.3% and 69.8% in patients before PCI and 100% after PCI. Statins were used 84.0% in patients before PCI and 97.5% after PCI. b-blockers (BBs) were used 43.8% in patients before PCI and 84% after PCI. Angiotensin converting enzyme inhibitors (ACEIs) were used 34% in patients before PCI and 64.4% after PCI. Angiotensin receptor blockers (ARBs) were used 4.3% in patients before PCI and 31.3% after PCI. At 1-year after PCI, Aspirin were used 98.2% in patients and 1.8% were discontinued in patients who
had adverse drug reactions. Clopidogrel were used 60.7% in patients and 38.7% were discontinued in patients who had stable symptoms and low CAD risk. Statins, BBs, ACEIs and ARBs were used 71.1, 57.1, 23.9 and 26.4% in patients. Conclusion: Antiplatelet agents were used appropriately in CAD patients before and after PCI. Statins, BBs, and ACEIs were used appropriately in CAD patients after PCI but were underused for CAD patients who underwent PCI in the past 1 year. There are opportunities to optimize medical therapy in patients who had PCI more than 1 year. The way forward: Towards a model of state health policy development to facilitate the interprofessional practice of pharmacists B.Y. Urick, J.M. Urmie The objective of this study is to develop a model to explain state level variation in health policies that facilitate the interprofessional practice of pharmacy. Examples include policies facilitating collaborative drug therapy management and recognizing pharmacists as health care providers. Methods: This study will use the Integrated Theory of State Policy (ITSP) as a structural framework to create a model of state policy change specific to the advancement of pharmacy practice. The ITSP consists of four domains that describe influences on the state policy development: contextual effects, political systems, extrinsic demands, and institutions. Semi-structured interviews will be used and participants will include employees and associates of state and national professional pharmacy organizations, members of boards of pharmacy, and state legislators. Participants will be drawn from a variety of states and organizations in order to maximize the sample variation. Thematic analysis will be used to inductively determine themes which will be deductively categorized into the four ITSP domains. Participants will be gathered through a snowball sampling technique and interviews will be conducted in the late spring and early summer of 2014. Data will be assessed iteratively and collection will cease once saturation of policy themes has been achieved across the types of participants surveyed. Ethical approval for this study will be sought from the institutional review board at the University of Iowa. Results: This study will result in a model of pharmacy practice policy advancement that can be used to suggest ways in which pharmacy change makers can more effectively promote policies that facilitate pharmacists practicing interprofessionally. Therapeutics and Prescribing Interprofessional Education (IPE). Medical and Pharmacy Students Working and Learning Together S.A. Coulman1, D.N. John1, A. Jenkins1, S.J. Wilkins1,2,3, H. Sweetland1, J. Hayes2,3, J.M. Coulson1, J.P.
e55
Questionnaire 1 was administered prior to the CNS module, and questionnaire 2 after its completion. Participants’ responses were matched, and compared using the student’s t-test. Responses to open questions were examined for recurrent themes. Results: Eighty-six students completed both questionnaires. There was no significant difference in responses on the SD scale or on common stereotypical beliefs. Nevertheless, students appeared more willing to “share a flat with that person” (t¼2.12, p¼0.04) and “have that person as a baby sitter for a child” (t¼2.17, p¼0.03). Conversely, students more strongly agreed that people previously hospitalised with schizophrenia were “hard to talk to” (t¼3.15, p!0.001). Open questions found that the teaching sessions had a positive impact on students’ understanding of and attitudes towards people with mental illnesses, although some students wanted more education, or help with developing their communication skills. The session involving patients was greatly valued. Conclusion: Following focused teaching sessions, some positive changes but no significant overall change, was found in New Zealand pharmacy students’ understanding of and attitudes towards schizophrenia and other mental illnesses. Nevertheless, students may need more help in developing skills to communicate with people with mental illness. The Role of Pharmacists in Clinical Sleep Apnea Services in Australian Pharmacies: A Public Health Opportunity? C.A. Hanes1,2,5, K.K.H. Wong2,3,4,5, B. Saini1,2,5, 1 Faculty of Pharmacy, The University of Sydney, NSW, Australia, 2The NHMRC Center for Integrated Research and Understanding of Sleep (CIRUS), Glebe, NSW, Australia, 3Faculty of Medicine, The University of Sydney, NSW Australia, 4Royal Prince Alfred Hospital, Camperdown, NSW, Australia, 5Woolcock Institute of Medical Research, Glebe, NSW, Australia To provide an overview of the specialized role of pharmacy staff involved in sleep apnea-related services in Australian community pharmacies. Methods: Cross-sectional mail questionnaire. All pharmacies in Australia providing sleep apnea services at the time of recruitment were mailed the study questionnaire pack. Non-responders were contacted in 2 subsequent recruitment rounds. The questionnaire was developed by the researchers and designed to gather data on pharmacy demographics, clinical and structural elements of sleep apnea services offered, attitudes towards these services, and possible future directions. Results: A response rate of 55% (n¼110) was achieved. Clinical sleep apnea services offered by pharmacies included: obstructive sleep apnea screening, Continuous Positive Airway Pressure (CPAP) device trials, patient education and counseling, mask fitting, patient followup, adherence monitoring, and home diagnostic studies. Perceived benefits of providing a sleep apnea service
e56
Abstracts / Research in Social and Administrative Pharmacy 10 (2014) e1–e64
included meeting patient and community needs, improved professional image of the pharmacy, and professional satisfaction. Perceived barriers included cost of equipment to patients, online competitors, and lack of time. Inter-professional relationships were listed as both a benefit of and a barrier to providing the service. A majority of respondents (89%) indicated there was room for improvement in some aspect of their service. Key areas for improvement identified from analysis of open-ended responses (n¼96) were: 1) Staff training and knowledge 2) Promotion of the service and increasing public awareness 3) Infrastructure and expansion 4) Inter-professional collaboration and communication 5) Patient follow-up. Conclusions: Given the public health burden of obstructive sleep apnea (OSA) and the need to improve patient access to sleep services, pharmacies may be poised to contribute to the multidisciplinary management of OSA. The Australian experience suggests pharmacists can play a role in the primary care sleep health team and pharmacy-based CPAP services may serve community needs well.
The use of cardiovascular medications in patients with coronary artery disease before and after percutaneous coronary intervention P. Tangsucharit, T. Samkaew, C. Laowachirasuwan, S. Jantaruechai, Pharmaceutical department, Queen Sirikit Heart Center of the Northeast, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand 40002 To evaluated the use of cardiovascular medications in patients with coronary artery disease (CAD) before and after PCI. Method: Guideline-based recommendations that the use of cardiovascular medications have been proven to gain benefits in patients with unstable angina (UA)/non ST elevation myocardial infarction (NSTEMI) or ST elevation myocardial infarction (STEMI) and post percutaneous coronary intervention (PCI). This study evaluated the use of cardiovascular medications of 163 patients who underwent PCI for CAD at a Northeast Heart Center, Thailand, between October 2008 to September 2009. Results: CAD patients were male (64.4%) and had average age 6611.26 years. They had single vessel disease, double vessel disease and triple vessel disease 38.1, 42.3, and 19.6%, respectively. Aspirin and Clopidogrel were used 96.3% and 69.8% in patients before PCI and 100% after PCI. Statins were used 84.0% in patients before PCI and 97.5% after PCI. b-blockers (BBs) were used 43.8% in patients before PCI and 84% after PCI. Angiotensin converting enzyme inhibitors (ACEIs) were used 34% in patients before PCI and 64.4% after PCI. Angiotensin receptor blockers (ARBs) were used 4.3% in patients before PCI and 31.3% after PCI. At 1-year after PCI, Aspirin were used 98.2% in patients and 1.8% were discontinued in patients who
had adverse drug reactions. Clopidogrel were used 60.7% in patients and 38.7% were discontinued in patients who had stable symptoms and low CAD risk. Statins, BBs, ACEIs and ARBs were used 71.1, 57.1, 23.9 and 26.4% in patients. Conclusion: Antiplatelet agents were used appropriately in CAD patients before and after PCI. Statins, BBs, and ACEIs were used appropriately in CAD patients after PCI but were underused for CAD patients who underwent PCI in the past 1 year. There are opportunities to optimize medical therapy in patients who had PCI more than 1 year. The way forward: Towards a model of state health policy development to facilitate the interprofessional practice of pharmacists B.Y. Urick, J.M. Urmie The objective of this study is to develop a model to explain state level variation in health policies that facilitate the interprofessional practice of pharmacy. Examples include policies facilitating collaborative drug therapy management and recognizing pharmacists as health care providers. Methods: This study will use the Integrated Theory of State Policy (ITSP) as a structural framework to create a model of state policy change specific to the advancement of pharmacy practice. The ITSP consists of four domains that describe influences on the state policy development: contextual effects, political systems, extrinsic demands, and institutions. Semi-structured interviews will be used and participants will include employees and associates of state and national professional pharmacy organizations, members of boards of pharmacy, and state legislators. Participants will be drawn from a variety of states and organizations in order to maximize the sample variation. Thematic analysis will be used to inductively determine themes which will be deductively categorized into the four ITSP domains. Participants will be gathered through a snowball sampling technique and interviews will be conducted in the late spring and early summer of 2014. Data will be assessed iteratively and collection will cease once saturation of policy themes has been achieved across the types of participants surveyed. Ethical approval for this study will be sought from the institutional review board at the University of Iowa. Results: This study will result in a model of pharmacy practice policy advancement that can be used to suggest ways in which pharmacy change makers can more effectively promote policies that facilitate pharmacists practicing interprofessionally. Therapeutics and Prescribing Interprofessional Education (IPE). Medical and Pharmacy Students Working and Learning Together S.A. Coulman1, D.N. John1, A. Jenkins1, S.J. Wilkins1,2,3, H. Sweetland1, J. Hayes2,3, J.M. Coulson1, J.P.