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1.  Establishing the Medication Safety Research Network of Indiana (Rx-SafeNet): Perspectives of Community Pharmacy Employees 
Innovations in pharmacy  2012;3(2):79.
The objective of this cross-sectional survey was to determine community pharmacy employee research project priorities and assess interest levels, barriers, and facilitators to joining a new community pharmacy practice-based research network (PBRN) and use this information in subsequent PBRN development. One hundred forty pharmacists and 40 support staff responded. The majority (72%) of respondents were somewhat interested or needed more information to determine their level of interest in joining a PBRN; 15% were very interested. While all research topics were regarded as important, dispensing errors were rated as the most important. Time constraints were considered the greatest barrier to participation. Greater knowledge of medication safety, enrichment of patient care, and improved patient and provider relationships were considered important reasons for joining a PBRN. Responses indicated favorable interest levels and project support from potential network members, though education and awareness campaigns are needed to enhance community pharmacy employee understanding of and involvement in research and PBRNs, specifically the Medication Safety Research Network of Indiana (Rx-SafeNet), a new network administered by the Purdue University College of Pharmacy. While the generalizability of survey results is limited, they were useful in determining policies and procedures of the new network. Surveying all employees involved in the future PBRN during the network development process is a unique approach to developing these types of networks in the U.S. Understanding support staff perspectives is important considering the critical role they play in project implementation and operations. Emerging PBRNs from any discipline may benefit from considering adding this step to their development.
PMCID: PMC4104412  PMID: 25057434
practice-based research networks; research; pharmacy practice; medication safety; community pharmacy
2.  Experience Developing a Community Pharmacy Practice-based Research Network 
Innovations in pharmacy  2012;3(2):Article 78.
In 2010, the Purdue University College of Pharmacy established the Medication Safety Research Network of Indiana (Rx-SafeNet), the first practice-based research network (PBRN) in Indiana comprised solely of community pharmacies. In the development of Rx-SafeNet and through our early project experiences, we identified several “lessons learned.” We share our story and what we learned in an effort to further advance the work of the greater PBRN community. We have formed the infrastructure for Rx-SafeNet, including an Executive Committee, Advisory Board, member pharmacies/site coordinators, and Project Review Team. To date, 22 community pharmacies have joined and we have recently completed data collection for the network's first project. Lessons learned during the development of Rx-SafeNet may benefit PBRNs nationally. Although community pharmacy PBRNs are not yet commonplace in the U.S., we believe their development and subsequent research efforts serve as an important avenue for investigating medication use issues.
PMCID: PMC4090306  PMID: 25018893
practice-based research networks; research; pharmacy practice; medication safety; community pharmacy
4.  Evaluating Pennsylvania Pharmacists’ Provision of Community-based Patient Care Services to Develop a Statewide Practice Network 
Innovations in pharmacy  2011;2(4):61-.
To identify and describe Pennsylvania pharmacists who currently provide or are interested in providing community-based patient care services and are interested in joining a statewide practice network.
Cross-sectional survey.
February to June 2009 in Pennsylvania.
1700 pharmacists.
Mailed and electronic survey.
Main outcome measures
Number and geographic location of pharmacists providing or interested in providing community-based patient care in Pennsylvania. Description of patient care documentation methods; physical space; services provided; perceived barriers to providing patient care; training needs; and interest in joining a statewide practice network.
The final analysis included data from 1700 pharmacists. Approximately one-third of pharmacists (n=554) were providing patient care services to community-based patients. Most were routinely documenting (67.5%) and many had a semi-private or private space to provide care. MTM and immunizations were the most common services provided. Respondents reported the most significant barrier to providing MTM, diabetes education, and smoking cessation education was time constraints, whereas training was a barrier for immunization provision. Most pharmacists were not being compensated for patient care services. Of the 869 pharmacists interested in joining a statewide network, those providing care were more interested in joining than those who were not (70.8% vs. 43.8%, p < 0.001). Conclusion: Pennsylvania pharmacists are interested in providing community-based patient care services and joining a statewide practice network focused on providing community-based patient care services. This research serves as a foundation for building a pharmacist practice network in Pennsylvania.
PMCID: PMC4232935  PMID: 25405069
Medication Therapy Management (MTM); network; statewide survey; cognitive services; pharmacy services
5.  Evaluation of Specialized Medication Packaging Combined With Medication Therapy Management 
Medical care  2012;50(6):485-493.
This study evaluates the effect of a program combing specialized medication packaging and telephonic medication therapy management on medication adherence, health care utilization, and costs among Medicaid patients.
Research Design
A retrospective cohort design compared Medicaid participants who voluntarily enrolled in the program (n = 1007) compared with those who did not (n = 13,614). Main outcome measures were medication adherence at 12 months, hospital admissions and emergency department visits at 6 and 12 months, and total paid claim costs at 6 and 12 months. Multivariate regression models were used to adjust for the effect of age, sex, race, comorbidities, and 12-month preenrollment health care utilization.
Measures of medication adherence were significantly improved in the program cohort compared with the usual care cohort. At 6 months, adjusted all-cause hospitalization was marginally less in the program cohort compared with the usual care cohort [odds ratio = 0.73, 95% confidence interval (CI), 0.54–1.0, P = 0.05]. No statistically significant differences were observed between the 2 cohorts for any of the other adjusted utilization endpoints at 6 or 12 months. Adjusted total cost at 6 and 12 months were higher in the program cohort (6-month cost ratio = 1.76, 95% CI, 1.65–1.89; 12-month cost ratio = 1.84, 95% CI, 1.72–1.97), primarily because of an increase in prescription costs. Emergency department visits and hospitalization costs did not differ between groups.
The program improved measures of medication adherence, but the effect on health care utilization and nonpharmacy costs at 6 and 12 months was not different from the usual care group. Reasons for these findings may reflect differences in the delivery of the specialized packaging and the medication therapy management program, health care behaviors in this Medicaid cohort, unadjusted confounding, or time required for the benefit of the intervention to manifest.
PMCID: PMC4126258  PMID: 22498687
adherence; Medicaid; outcomes; pharmacy service
6.  Graduating Pharmacy Students’ Perspectives on E-Professionalism and Social Media 
Objective. To determine the use patterns of social media among graduating pharmacy students, characterize students’ views and opinions of professionalism on popular social media sites, and compare responses about social media behavior among students seeking different types of employment.
Methods. All graduating pharmacy students (n=516) at Purdue University, The University of Findlay, Butler University, and Midwestern University were invited to complete a survey instrument during the fall semester of 2011.
Results. Of 212 (41%) students who responded to the survey, 93% (194/209) had a social media profile. Seventy-four percent (120/162) of participants felt they should edit their social media profiles prior to applying for a job.
Conclusions. Many graduating pharmacy students use social media; however, there appears to be a growing awareness of the importance of presenting a more professional image online as they near graduation and begin seeking employment as pharmacists.
PMCID: PMC3776900  PMID: 24052649
social media; pharmacy students; e-professionalism; social networking
7.  Exploring successful community pharmacist-physician collaborative working relationships using mixed methods 
Collaborative working relationships (CWRs) between community pharmacists and physicians may foster the provision of medication therapy management services, disease state management, and other patient care activities; however, pharmacists have expressed difficulty in developing such relationships. Additional work is needed to understand the specific pharmacist-physician exchanges that effectively contribute to the development of CWR. Data from successful pairs of community pharmacists and physicians may provide further insights into these exchange variables and expand research on models of professional collaboration.
To describe the professional exchanges that occurred between community pharmacists and physicians engaged in successful CWRs, using a published conceptual model and tool for quantifying the extent of collaboration.
A national pool of experts in community pharmacy practice identified community pharmacists engaged in CWRs with physicians. Five pairs of community pharmacists and physician colleagues participated in individual semistructured interviews, and 4 of these pairs completed the Pharmacist-Physician Collaborative Index (PPCI). Main outcome measures include quantitative (ie, scores on the PPCI) and qualitative information about professional exchanges within 3 domains found previously to influence relationship development: relationship initiation, trustworthiness, and role specification.
On the PPCI, participants scored similarly on trustworthiness; however, physicians scored higher on relationship initiation and role specification. The qualitative interviews revealed that when initiating relationships, it was important for many pharmacists to establish open communication through face-to-face visits with physicians. Furthermore, physicians were able to recognize in these pharmacists a commitment for improved patient care. Trustworthiness was established by pharmacists making consistent contributions to care that improved patient outcomes over time. Open discussions regarding professional roles and an acknowledgment of professional norms (ie, physicians as decision makers) were essential.
The findings support and extend the literature on pharmacist-physician CWRs by examining the exchange domains of relationship initiation, trustworthiness, and role specification qualitatively and quantitatively among pairs of practitioners. Relationships appeared to develop in a manner consistent with a published model for CWRs, including the pharmacist as relationship initiator, the importance of communication during early stages of the relationship, and an emphasis on high-quality pharmacist contributions.
PMCID: PMC3004536  PMID: 21111388
Pharmacists; Physicians; Collaborative working relationships; Pharmacist-physician collaborative index; Community
8.  Adherence: a review of education, research, practice, and policy in the United States 
Pharmacy Practice  2010;8(1):1-17.
To describe the education, research, practice, and policy related to pharmacist interventions to improve medication adherence in community settings in the United States.
Authors used MEDLINE and International Pharmaceutical Abstracts (since 1990) to identify community and ambulatory pharmacy intervention studies which aimed to improve medication adherence. The authors also searched the primary literature using Ovid to identify studies related to the pharmacy teaching of medication adherence. The bibliographies of relevant studies were reviewed in order to identify additional literature. We searched the tables of content of three US pharmacy education journals and reviewed the American Association of Colleges of Pharmacy website for materials on teaching adherence principles. Policies related to medication adherence were identified based on what was commonly known to the authors from professional experience, attendance at professional meetings, and pharmacy journals.
Research and Practice: 29 studies were identified: 18 randomized controlled trials; 3 prospective cohort studies; 2 retrospective cohort studies; 5 case-controlled studies; and one other study. There was considerable variability in types of interventions and use of adherence measures. Many of the interventions were completed by pharmacists with advanced clinical backgrounds and not typical of pharmacists in community settings. The positive intervention effects had either decreased or not been sustained after interventions were removed. Although not formally assessed, in general, the average community pharmacy did not routinely assess and/or intervene on medication adherence.
National pharmacy education groups support the need for pharmacists to learn and use adherence-related skills. Educational efforts involving adherence have focused on students’ awareness of adherence barriers and communication skills needed to engage patients in behavioral change.
Several changes in pharmacy practice and national legislation have provided pharmacists opportunities to intervene and monitor medication adherence. Some of these changes have involved the use of technologies and provision of specialized services to improve adherence.
Researchers and practitioners need to evaluate feasible and sustainable models for pharmacists in community settings to consistently and efficiently help patients better use their medications and improve their health outcomes.
PMCID: PMC4140572  PMID: 25152788
Medication Adherence; Pharmacists; Education; Pharmacy; United States
9.  Provision of clinical pharmacy services in two safety net provider settings 
Pharmacy Practice  2009;7(2):94-99.
The purpose of this report is to characterize the patient population served by the Grace Lamsam Pharmacy Program and to describe program outcomes.
A chart review was conducted for all patients (n=100) participating in the Grace Lamsam Pharmacy Program from January 1, 2007 to February 6, 2008. The primary outcome data collected were the medication related problems (unnecessary drug therapy, needs additional drug therapy, ineffective drug therapy, dosage too low, dosage too high, adverse drug reaction, noncompliance, and needs different drug product) identified by pharmacists, the number and type of pharmacist interventions made, estimated cost savings from perspective of the patient and clinical data (hemoglobin A1C, blood pressure measurements, and LDL-C) for patients with diabetes, hypertension, and hyperlipidemia, respectively. Basic demographic data was collected, including: patient gender, age, education level, race/ethnicity, marital status, and income. Patients’ smoking status, type and number of medical conditions, medications being used at baseline, and number of pharmacist visits per patient during the study review period were also recorded.
The majority of patients cared for were male, middle-aged, and African-American. The majority (90%) of patients had an income below 150% of the 2007 Federal poverty level. Patients were most commonly treated for diabetes, hypertension, and hyperlipidemia. During the period of review, 188 medication related problems were identified and documented with noncompliance being the most common medication related problem identified. Pharmacists completed 477 Pharmaceutical Manufacturer Assistance Program applications for 68 patients. These interventions represented a cost savings from the patients’ perspective of approximately 243 USD per month during the review period. Blood pressure, A1C, and LDL-C readings improved in patients enrolled in the clinical pharmacy program at the free clinic and the community health center.
A clinical pharmacy services model provides a role for the pharmacist in an interdisciplinary team (beyond the traditional dispensing role) to identify medication related problems in the drug therapy of patients who utilize safety-net provider health care services.
PMCID: PMC4139746  PMID: 25152784
Poverty; Homeless Persons; Medication Therapy Management; Pharmacists; United States

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