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1.  Evaluation of a drug-drug interaction: fax alert intervention program 
Background
Clinicians often encounter information about drug-drug interactions (DDIs) during clinical practice. This information is found within product information (hardcopy and electronic) and various electronic systems. Prescribers may receive medication-related communications in practice that are distributed by facsimile (fax), mail, or telephone from pharmacies and pharmacy benefit managers (PBMs). The purpose of this study was to determine if near-real time fax alerts for potential drug-drug interactions (PDDIs) would influence prescribing.
Methods
A prospective study, in cooperation with a pharmacy benefit manager (PBM), was conducted targeting 18 clinically important PDDIs. Fax alerts included an individualized letter to the prescriber with a list of the interacting drugs, PDDI evidence summaries with citations, and recommended clinical management strategies. Among the 18 PDDIs, 13 PDDIs could be assessed for prescription therapy changes using pharmacy claims data. A prospective cohort design was used to evaluate changes in prescription dispensing 90-days following a PDDI fax alert.
Results
A total of 8,075 fax alerts were sent to prescribers and there were 4,712 alerts for the 13 PDDIs that could be assessed for change using pharmacy claims data. There were 2,019 patients (interventions) for which fax alerts were sent to their prescribers who were matched with a control group consisting of patients with the same PDDIs but for whom no fax alert was sent. Overall, this study found 154 (7.6%) of patients in the fax alert group compared to 132 (6.5%) in the control group had changes in therapy (p = 0.177).
Conclusions
This fax alert intervention program observed no statistically significant differences in prescribing with a fax alert compared to the control group. If PBMs chose to send individualized, evidence-based information to clinicians regarding drug-drug interactions, this study suggests it may not be an effective intervention to mitigate harm.
doi:10.1186/1472-6947-13-32
PMCID: PMC3598564  PMID: 23497373
Drug interactions; Drug safety; Physician; Prescriber; Fax
2.  A pre- post-evaluation of implementing an inpatient warfarin monitoring and education program 
Pharmacy Practice  2011;9(2):101-105.
Objective
The purpose of this study was to evaluate whether a new anticoagulation management program resulted in better monitoring of warfarin, increased warfarin patient education prior to discharge, and fewer bleeding complications associated with warfarin.
Methods
A retrospective chart review was conducted of patients who were inpatients and received warfarin from April 1, 2008 to July 31, 2008 (control group) and from April 1, 2009 to July 31, 2009 (after implementation of the new anticoagulation program). The frequency of warfarin-related laboratory orders that included international normalized ratios (INRs), complete blood counts (CBCs), and documented patient education by pharmacy, nursing, and dietary services were determined before and after program implementation. Also, data was collected to determine frequencies of bleeding complications associated with warfarin.
Results
There were 112 patients in the pre- and 115 patients in the post-program group. After implementation of the inpatient warfarin management program, obtaining baseline INRs increased from 74% to 90% (p=0.001). Orders for baseline CBCs increased from 85% to 94% (p=0.026). Obtaining CBCs every 3 days increased from 54% to 74%, (p<0.001). However, there was no significant change in orders for daily INRs (p=0.055). Education by nursing increased from 54% to 80%, (p<0.001), by pharmacy increased from 8% to 76%, (p<0.001), and by dietary increased from 11% to 79%, (p<0.001). Documentation by all three disciplines in each patient increased from 3.6% to 59%, (p<0.001). Significantly fewer patients received vitamin K and/ or fresh frozen plasma for supratherapeutic INRs with bleeding complications after the program was initiated compared to baseline (p=0.009).
Conclusions
The implementation of an inpatient warfarin management program led to better monitoring of patients receiving warfarin, and increased patient education. However, a larger and longer assessment is necessary to determine if these changes are maintained and how these changes affect long-term clinical outcomes.
PMCID: PMC3969833  PMID: 24688616
Warfarin; Inpatients; Pharmacy Service, Hospital; United States
3.  Evaluation of Curricula Content Based on Thai Pharmacy Competency Standards 
Objective
To evaluate the curricula content of Thai pharmacy schools based on the Thai pharmacy competency standards.
Methods
Course syllabi were collected from 11 pharmacy schools. A questionnaire was developed based on the Thai pharmacy competency standards. Course coordinators completed the questionnaire assessing the curricula content.
Results
The curricula for both the bachelor of science in pharmacy degree (BS Pharm) and doctor of pharmacy (PharmD) degree programs included the minimum content required by the 8 competency domains. The dominant content area in BS Pharm degree programs was product-oriented material. The content ratio of patient to product to social and administrative pharmacy in the BS Pharm degree programs was 2:3:1, respectively. However, the content ratio suggested by the Thai Pharmacy Council was 3:2:1, respectively. For the PharmD programs, the largest content area was patient-oriented material, which was in agreement with the framework suggested by the Thai Pharmacy Council.
Conclusions
The curricula of all Thai pharmacy schools met the competency standards; however, some patient-oriented material should be expanded and some product-oriented content deleted in order to meet the recommended content ratio.
PMCID: PMC2254234  PMID: 18322571
pharmacy education; curriculum; competency; evaluation; Thailand

Results 1-3 (3)