63 posts categorized "Mayes Connections"

10/30/2014

Chronic Medication Adherence: Diabetes

Diabetes is a chronic disease that affects millions of Americans. It is a group of metabolic disorder characterized by persistent hyperglycemia. Early diagnosis and proper treatment is important to reduce complications such as coronary artery disease, blindness, and loss of sensation. However, as stated by Dr. C. Everett Koop “Drugs don’t work in patients who don’t take them.”

Diabetes is one the leading causes of death. It is very important to eat a healthy diet especially with this disease. Patients who have diabetes should be encouraged to modify their diet to include more vegetables, whole grains, fruits, non-fat dairy products, beans, lean meats, poultry, and fish. A study done to see the correlation of self-monitoring of blood glucose to weight loss by doing a weight loss intervention showed increased self-monitoring of blood glucose and greater weight loss was achieved through better adherence to diet. The authors concluded self-monitoring of blood glucose leads to increased adherence to diet. Also, patients that were educated about the impact of diet on weight loss, showed increase adherence to diet and better glucose control.

A retrospective literature search was conducted by Cramer to assess the adherence to oral hypoglycemic agents and insulin products and its effect on glycemic control in diabetes patients. In this systematic analysis, she found that electronic monitoring was effective in identifying patients who were poorly adherent.   The study showed that electronic monitoring systems can be used to increase adherence by providing health care providers the information needed to identify patients than need interventions.

Pharmacists today use electronic monitoring through computerized programs that measure adherence rates such as refill rates. There are many ways pharmacists can intervene to increase adherence rates with chronic medications, such as oral hypoglycemic medications. Non-adherence can be detrimental to patients, so pharmacists can intervene by counseling newly diagnosed individuals of the benefits of taking their medication properly and the risks that may occur if medication is not taken. Also, pharmacists can review adherence rates with patients to identify reasons why patients may not be taking their medications. If patients cannot tolerate certain medications, or cannot follow directions appropriately, pharmacists can suggest other products.

The cost of not taking medications is high in patients with chronic medications, so it is important that pharmacists and patients work together to create a regimen that is most beneficial.

 

Urvi Patel, PharmD’16

10/15/2014

Community Pharmacy Medication Adherence

Medication adherence is a growing concern for health care providers. For this reason many community pharmacies are focusing on was to increase medication adherence rates. This can be done in various ways ranging in diverse settings.

            Medication therapy management (MTM) are services provided by pharmacists to increase therapeutic outcomes. There are approximately 1.5 billion preventable adverse effects that cause $177 billion in injury and death. A major target for MTM occurs in community pharmacies. The Pennsylvania Project studied 107 Rite Aid pharmacies that trained pharmacist to perform interventions including asking questions about medication adherence and 111 control pharmacies that did not perform these interventions.  The endpoints of this study showed an increase in medication adherence (PDC >80%) in the intervention group over the control group.  There was a significant increase in adherence of 3.1% for beta-blockers and 4.8% of for anti-diabetic drugs.

            Patient counseling is a great way for community pharmacists to change medication adherence rates. In an internal study, Walgreens Pharmacy is creating a way to identify patients that may need a little more help with medication adherence by examining  poor past medication adherence rates or new medications prescribed. In a study across 76 Walgreens, these interventions showed an increase in medication possession ratio.

            Chronic medications can be difficult to control of especially if a patient is taking multiple medications. An AHRQ tool used in community pharmacies called refill reminders, can help patients pick up their medications on time.  Using this script as part of an automated reminder system, can help prompt patients to refill their prescriptions or pick up their medication.

            While at work, I have come across these methods to increase medication adherence in the community setting. It is important as pharmacist to intervene early by educating and counseling the patient, so adherence rates start off high. These methods have proven extremely beneficial in my place of work. For example, automatic courtesy refills allow all patients on maintenance medications to be reminded to pick up their medication, so they do not miss doses. These are just some examples of methods being implemented in community pharmacies to help pharmacists identify these patients and improve medication adherence.

Urvi Patel, PharmD ‘16

10/05/2014

Measurement of Medication Adherence

            Medication adherence is a growing concern for health care professionals today. For this reason, there are various ways to measure medication adherence. This can be done by pharmacists, physicians, or patients themselves.

            Pharmacists can measure medication adherence through many ways. A cheap and easy way to see if a patient is adherent is to look at the refill rates. These medication adherence rates can be calculated by the medication possession ratio (MPR) or proportion of days covered (PDC). MPR, as stated by Dr. Nau, is the days’ supplied over a time interval. The PDC is the number of days covered by prescription fills divided by the number of days between first fill and the end of the measurement time period. Pharmacist can also measure adherence rates through talking to the patient and asking various questions. The Morisky Medication Adherence Scale provides questions to measure medication-taking behavior such as “Do you sometimes forget to take your high blood pressure pills?” or “how many times this past week have you skipped your medication?”

            Physicians can also measure medication adherence. Poulos and her colleagues made a compilation of direct and indirect approaches to measuring medication adherence.  For example, the physician can obtain lab values for plasma drug concentration, use biological markers, or directly observe the therapy to see if there are sign and symptom improvement. These direct methods of measurement would be useful in finding that the medications have been taken, but it’s use is limited because it is hard for patients to come in for appointments in the outpatient setting, and there are kinetic variations for individual patients. Indirect methods of measuring medication adherence include pill counts, or electronic monitors that show how many times a bottle were opened. These methods are easy to use, however, they cannot show if the medication regimen has actually been followed.

            Patients can measure medication adherence themselves. This can be done through self-reports by the patient, which is the easiest way to get feedback on the medication adherence. Also, patients can keep personal diaries or fill out surveys. These methods are easy to use and inexpensive. However, they may have varying accuracy, lost/not recorded data, and bias. Patients may provide information that can lead to misinterpretation, or patients can present data that overestimates the medication adherence.

            Ways of measuring medication adherence rates can vary from healthcare providers to patients. There is no one-way of measuring medication adherence, however; multiple ways could be implemented to help guide health care practitioners to see how beneficial therapy is and make adjustments to medications. When pharmacists cannot implement certain measures, clinical outcomes should be evaluated to see if the medication is making an impact. After talking to the patient, the pharmacist and patient can find ways to improve medication adherence, so they can achieve appropriate clinical outcomes.

Urvi Patel, PharmD ‘16

05/12/2014

Student Pharmacists Can Help Improve Medication Adherence

All pharmacy personals can take initiative in improving patient’s adherence. Pharmacists and pharmacy students have very unique skills that will help patients better understand their medications and use it appropriately. Student pharmacists can develop skills such as patient communication, disease management and gather resources which will all help patients with adherence to medications.

Barriers and Solutions: Student pharmacists were surveyed to determine some of the barriers to pharmacy involvement in patient’s adherence. Through the survey, student pharmacists said that they felt that pharmacists didn’t have enough time to counsel patients, or conduct follow-up phone calls. Another issue that student pharmacists noticed was that there was no supplementary assistance for both patients and students to improve adherence. Students also claimed that they were not sufficiently trained to manage adherence issues while they were in pharmacy school.

These are some of the issues that student pharmacists can try to resolve while on experiential practice rotations. To address the time factor, it is important to understand the complexity of a pharmacy work flow during a regular day. There might not be enough systems, funding and support in place to allow pharmacists to step out and counsel a patient for 5-10 minutes. However, student pharmacists or interns may have the opportunity to take the initiative and help patients with medications.  Although students are not actively taught the importance of medication adherence, they have the basic knowledge regarding the importance of pharmacy practice. Through their pharmacy school they can practice different techniques of counseling, and under the supervision of their pharmacist can counsel a patient at their local community pharmacy.

Health literacy is still a major barrier in preventing patients from taking their medications on a regular basis. It may cause the patient to question the purpose, adverse effect and effectiveness of the medication if they do not know all the details. As per the interventions of 3rd year pharmacy students conducting visits to multiple independent-living apartments and educating the elderly using multiple techniques there was a lot of benefits. Some of the benefits included patients being satisfied with the program, increased assurance when asking a question to their pharmacist, and more appreciation for the importance of adherence.

Interventions such as student pharmacist education programs and personal visits really allow patients to gain a better understanding of a pharmacist’s role. It will allow them to reach out to their pharmacists more often and take into consideration the value of correctly managing their disease state with medications. Therefore, student pharmacists should be able to step out of their comfort zone and assist pharmacists in reaching out to more patients. Student pharmacists have many skills that they can offer to the community and really emphasize the importance of adherence. 

Sheenu Joseph, PharmD '15

04/29/2014

'Business As Usual' for USciences' Pharmaceutical & Healthcare Biz Program

The spring semester was business as usual for University of the Sciences' Pharmaceutical and Healthcare Business Program, as recent events included a highly successful ‘Entrepreneurial Forum’ featuring three industry executives, as well as new inductions to its honor society, Sigma Beta Delta.

The 2014 Entrepreneurial Forum included panelist presentations, followed by a robust group conversation. Panelists were Kristin Ball Motley PharmD, CGP, president of Health Care Solutions of Delaware Valley, LLC; Len Rosenberg, PhD, RPh, president and COO of ePharmaSolutions; and Marcus Wilson PharmD, president of HealthCore.

Each speaker shared compelling and motivating stories to engage an audience of more than 50 students and faculty, including University president Helen Giles-Gee, PhD.

On the academic side, USciences’ chapter of the international business honor society extended new membership to nine students and faculty members. Established in 2011, the University's chapter of Sigma Beta Delta recognizes academic achievement of pharmaceutical and healthcare business students. Members must achieve a GPA of 3.0 or higher, be in the top 20 percent of the class, and have completed at least half of their PHB program.

The following individuals were recently inducted into Sigma Beta Delta:

Undergraduate students:

  • Ingrid Beaver-Kepner PhB’14
  • Andrew Lyle PhB’15
  • Gino Randazzo PhB’14
  • Alice Woo PhB’15

MBA students:

  • Andrew Armitage
  • Ashley Johnson
  • Phuong Tran
  • Yelena Yankovskaya

Faculty:

  • Brian Colfer, assistant professor of pharmaceutical and healthcare business

Chapter Officers:
Richard Minoff, president
Robert Mueller, vice president
Alice Levy, secretary
Cassandra Henderson, managing officer


Submitted by Christine Luczka, intern in the Department of Marketing and Communications

04/17/2014

Role of a Pharmacist in Medication Adherence - Across the Ages

Pharmacists are healthcare professionals known for their medication expertise to provide the best care for their patients. Using very unique skills such as medication knowledge, disease management, and patient education, pharmacists can improve patients’ medication adherence. Patients have the opportunity to contact their local pharmacist through multiple ways to develop a connection with their pharmacist and receive the best treatment. Focusing on pharmacists’ relationships with patients of various age groups can help determine ways to improve overall medication adherence.

Pediatrics:  Pharmacists play an important role in the well-being of pediatrics. Factors contributing to non-adherence may include minimal parental support, improper timing of dosage, and even inaccurate dosing. A study shows that the intervention of pharmacists counseling patients and families in regarding to medication regimen improves health outcomes for pediatrics. Accurate dosing and timing of doses also play an important role in treating children. Therefore, pharmacist’s role in electronic scripts allows for safe pediatric prescribing, when prescriptions include child’s age, weight, and proper directions to minimize miscommunication. Pharmacists can continue to be involved in a patient’s care, as the child becomes a young adult.

Young Adults:  When people aged 16 to 24 are diagnosed with a disease, it can be extremely difficult for individuals to understand their condition, medication purpose and still be adherent to therapy. Pharmacists can play an active role in managing these barriers of limited disease knowledge, minimal support from family and friends, and fear of adverse reactions. For example, pharmacists are in a key position to communicate with young adults diagnosed with HIV about the  the importance of 100% medication adherence, missed dose scenarios, and management of adverse effects.  Pharmacist can even provide details of the disease state and how the patient  can contact a local support group.

Adults:  As patients grow older, issues such as medication expenses, comorbidities and health literacy may contribute to improper management of therapy. Many adults are also taking multiple medications to manage disease states such as asthma, diabetes and hypertension. A study conducted in Spain shows that community pharmacist intervention significantly improved asthma control. Pharmacist interventions included explaining inhaler techniques, distinguishing between acute verses chronic asthma management, increasing pharmacy visits and stressing the importance of adherence. Thus pharmacist contribution greatly assists adult patients with adherence issues.

Elderly: Additional barriers develop as patients continue to age, such as polypharmacy, medication perception, and even growing disabilities. Pharmacists can play a significant role in patients’ adherence levels as seen by the study results, conducted in patients >65 years old, at Walter Reed Army Medical Center. There was a significant reduction in systolic blood pressure and an increase in adherence for those patients in pharmacy care compared to usual care. Interventions used in the study such as individualized medication education, blister packs, and regular follow up visits can be adapted into all pharmacy practice settings. The elderly population needs constant assistance and it is a great place for pharmacists to intervene by small modifications such as providing large font labeling, easy open caps, timely refills and patient education.

As patients of all ages get sick, they go to their doctor, receive a prescription, fill the prescription at a local pharmacy, take medication home and then return to the pharmacy for refills. This timeline of events repeats every time someone is sick. Therefore, pharmacists play an integral role in  patients’ medication therapy management and can help improve adherence. Focusing on different age group barriers and finding solutions, can contribute to the development of a relationship between the patient and the pharmacist, to receive and provide the best care.

Sheenu Joseph, PharmD ‘15

04/11/2014

VIDEO: 6abc Highlights Students, Faculty at USciences Research Day

 
 
6abc showcased the diversity and growth of research pursuits at University of the Sciences during its 12th Annual Research Day and 27th Annual John C. Krantz, Jr., Distinguished Lecture on Thursday, April 10. Research Day recognizes and highlights the research efforts of faculty, as well as undergraduate and graduate students, to encourage and promote communication and collaboration among researchers.
 
USciences distinguishes itself by offering undergraduate students the opportunity to conduct research early in their academic careers. The diverse research activity that was on display spanned several aspects of the University’s scholarly pursuits, including:
  • Determining occupational therapists’ role in working with pediatric cancer patients
  • Discovering the personality traits that cause adolescents to kill
  • Using yoga to improve quality of life for patients with anorexia nervosa
  • Identifying predictors of successful post-secondary transitions for autistic students

04/02/2014

Medication Adherence in the Elderly Population

Which population do you see most at your local pharmacy? It is the elderly population (ages >65), that are usually at the pharmacy trying to fill multiple prescriptions. There are many areas that the elderly population needs assistance with, in order to achieve optimal medication therapy and prolong life. Barriers such as polypharmacy, comorbidities, and growing disabilities can be analyzed to provide better treatment outcomes.

Barriers: The elderly population struggles with an increasing number of medications or polypharmacy as they age. Italian researchers concluded that number of drugs prescribed at hospital discharge and minimal comprehension about the purpose of each medication contributed to overall non-adherence. The average patient in the study had a total of 9 drugs to take on a regular basis. It is this pill burden that the elderly population needs help managing. Because of multiple medications, patients may feel overwhelmed and even stop taking their medication accurately according to schedule. Patients are taking multiple medications for hypertension, diabetes, cholesterol and other comorbidities.

Comorbidities, if not managed properly can lead to future complications and decrease patients’ life expectancy. Schuz and colleagues concluded that if older people with multiple illnesses are convinced that their medication serves their specific needs, the more likely they will stay adherent. Elderly patients may not see a purpose in taking so many medications and may even consider one disease state more important the other. Thus, it is important to explain the use of each medication in treating a specific illness.

Additionally, growing disabilities such as vision loss can contribute to a patient’s overall adherence. It is common for elderly patients to lose their eye sight as they age and therefore contribute to unwanted difficulties. Patients will have trouble reading medicine labels or treatment directions. With this inconvenience, patients may even ignore the direction on the prescription bottle and start taking the medication on their own terms. It is these arising issues with age that may result in poor adherence and unsuccessful disease management.

Hypertension: Most elderly patients are on antihypertensive agents to prevent future cardiac issues. Although patients may not see physical changes, it is important for them to be adherent for long term results. Multiple questionnaires showed that illness perception and beliefs about antihypertensive medications played a role in patients’ adherence. It was more likely that patients followed a drug regimen if they knew that the long-term health consequences of cardiac complications, stroke, and mortality can be decreased. Elderly patients tend to take antihypertensive medication if they know that it is purposeful and efficacious for their health.

Barriers such polypharmacy, comorbidities and other disabilities should be resolved so that the elderly can better manage their health. Pharmacists can work one-on-one with these patients so that they can provide better resources for these patients. Resources such as pill kits, large font instructions or even a counseling session can go a long way in assisting elderly patients. The pharmacy has a lot of valuable information that patients can use in order to improve their overall medication adherence.

Sheenu Joseph, PharmD '15

03/20/2014

All Grown Up - Medication Adherence in Adults

As individuals grow older, the more likely they are to depend on medications to manage a disease state or to even extend their life. Therefore, in order for a medication regimen to be successful in treating a patient, it is important to stress the value of medication adherence. The adult population (ages 19-64) takes many medications on a regular basis, either for acute or chronic diseases. To improve adherence in adults, barriers such as cost, health literacy, and pill burden should be addressed.

Barriers: Prescription medication can be very expensive and therefore may play a role in adult patients’ adherence levels, even if they are not in good health. Cost influence on the patient can be verified by questions such as whether patients got their prescriptions filled, used herbal medications rather than prescription medications, or even stretched out the time till next refill. During a study, it was seen that when there is a cost barrier to medication adherence, adults tend to have a low income status, no drug coverage, or have multiple disease states. Therefore, different programs can be used to assist patients in decreasing medication expenses and thus improve adherence.

Besides cost, health literacy is also a barrier that prevents adults from reaching optimal medication adherence. Most adults will have to manage certain illnesses for the rest of their lives and thus it is important for them to have the necessary disease knowledge. Presentation about the medication include the purpose, mechanism of action, and other drug benefits which may lead patients to have increased medication adherence because they are expecting better health outcomes.

Additionally, many adults have multiple diseases to manage, which results in difficulty to many medications rather than just one. It is during this age that adults are newly diagnosed with chronic diseases such as diabetes, asthma, and hypertension. Therefore issues such as pill burden can be problematic when there are comorbidities involved. Patients may feel overwhelmed if they have to take multiple medications for diabetes, then asthma and also manage another serious condition of HIV. Options of combination medication therapy should be considered to decrease pill burden.

Asthma: The disease of asthma requires abundant counseling in order for patients to receive optimal therapy and avoid complications. With many inhaler options for both rescue and maintenance therapy in avoiding asthma exacerbations, it can become real confusing for patients to manage. When asthma is not appropriately managed it can lead to increased hospital visits and unwanted health expenses. Recent studies have concluded that patients with increased knowledge, attitude and self-efficacy in managing asthma can improve adherence. This is a disease state that, if patients understand signs and symptoms of asthma and use personal skills in managing the complications, it will result in a better quality of life. It is important to review both disease state and therapy schedule with adult patients every time they receive an inhaler, so patients can be in charge of their own health.

Pharmacists are constantly dispensing medications to adults and thus they have the perfect opportunity to help adults overcome barriers such as cost, health literacy and pill burden. Adulthood is a time in life where patients have to take care of their own health, income, and knowledge. Although adults are independent, pharmacists can step in to provide cost effective solutions and information about managing chronic illnesses such as inhaler techniques for managing asthma exacerbations. Pharmacists can use their knowledge about medications, cost coverage and managing disease states, in order to help adults improve medication adherence.

Sheenu Joseph, PharmD '15

03/18/2014

USciences to Host Free Community Discussion on Obamacare on March 25

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Rep. Roebuck

As the Affordable Care Act’s March 31 enrollment deadline draws near, University of the Sciences, in conjunction with state Rep. James Roebuck (D-Philadelphia), will host a discussion regarding this complex law on Tuesday, March 25, from 7-8 p.m., at the University’s Rosenberger Hall, Room 101, located at 45th Street and Woodland Avenue.

During the event, Alicia C. Miller, health information data analyst in the University’s Student Health and Counseling Center; and Andrew Peterson PharmD, PhD, John Wyeth Dean of the University’s Mayes College of Healthcare Business and Policy, will present data to help individuals make informed choices about the new health insurance options that are available to them.

The topics covered in the presentation will include:

  • Identifying the different health plan options now available for U.S. citizens under the Affordable Care Act.
  • Understanding the process for applying to the program and the eligibility criteria.
  • Detecting resources for understanding the Affordable Care Act, and navigating the system.
Peterson
Dr. Peterson

“West Philadelphia is home to many uninsured and underserved residents who will benefit from the healthcare law,” said Dr. Peterson. “Our goal is to ensure attendees leave our event feeling more comfortable with the healthcare changes, as well as more aware of the different options available to them, and more familiar with navigating the website to apply for a healthcare plan.”

This event is free to attend, and advanced registration is not required. The University is easily accessed via public transportation, and visitor parking is also available to attendees. For more information regarding this event, contact Dr. Peterson at a.peters@usciences.edu or (215) 596-8877(215) 596-8877.215.596

At University of the Sciences, students embark on a challenging learning experience in a proving ground for successful professionals in the science and healthcare-related fields. A private institution dedicated to education, research, and service, and distinguished as the North America’s first college of pharmacy, the University has produced leaders in the science and healthcare marketplaces since its founding in 1821. Students in USciences’ five colleges learn to excel in scientific analysis and to apply their skills to improving healthcare in the lives of people worldwide through such disciplines as pharmacy, biology, chemistry, psychology, physics, physical therapy, healthcare business, and health policy. For more information, visit usciences.edu or follow us on Twitter @USciences.

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