Pharmacy hydroxyurea education materials for patients with sickle cell disease: An environmental scan and assessment of accuracy

BACKGROUND

Hydroxyurea (HU) remains a cornerstone of sickle cell disease (SCD) therapy; however, its use is limited by poor patient adherence owing to concerns about side effects. Pharmacies routinely provide patients with handouts about HU, which, we hypothesized, contain inaccuracies that may contribute to negative patient perceptions of HU.

METHODS

We used a systematic approach to collect and review patient information handouts (PIHs) on HU from pharmacies in Ontario, Canada. PIHs were evaluated according to: i. Number of inaccurate statements, ii. Percentage of essential statements based on comparison with a reference standard PIH developed by the Canadian Haemoglobinopathy Association (CanHaem), and iii. Reading level.

RESULTS

PIHs were collected from 98% of chain and community pharmacies registered in Ontario. All PIHs contained inaccurate statements, most frequently relating to the risk of developing cancer. Only 33% of PIHs identified SCD as an indication for HU use. Pharmacy PIHs contained 45% of the essential statements present within the CanHaem HU PIH, neglecting to mention use of HU for management of SCD and benefits of HU in preventing SCD complications. Moreover, the reading level across pharmacy PIHs was 1.8 grades higher than that advised for written patient education materials.

CONCLUSION

Patients who are prescribed HU are likely to be provided with PIHs that contain inaccuracies that are weighted toward the risks of HU therapy and run contrary to published literature. This study identifies a gap in the care of patients with SCD and an opportunity to improve the quality of HU PIHs to help patients make well-informed decisions about their health.

Analysis of Real-World Experiences with the Ontario MedsCheck Program

ABSTRACTBackground: The Ontario MedsCheck program was introduced in April 2007, with enhancements to strengthen the program made in October 2016. Previous literature has characterized patients who received the service before the enhancements and described the experiences of community pharmacists and physicians, but the experiences of participants in the enhanced MedsCheck program and those of hospital pharmacists and pharmacy technicians have not been explored.Objectives: This study was designed to describe and compare the demographic and clinical characteristics of patients admitted to Sunnybrook Health Sciences Centre (SHSC) who had received a MedsCheck before and after the program enhancements of 2016. The study also aimed to describe the experiences of patients, hospital pharmacists, and pharmacy technicians with the MedsCheck program.Methods: Chart reviews were completed to identify and characterize patients who had received a MedsCheck and were admitted to SHSC between March and May 2016 (retrospective cohort) and between March and May 2017 (prospective cohort). Patients were interviewed and focus groups were conducted with pharmacy staff to explore their experiences with the MedsCheck program. Results: MedsChecks had been performed for 321 (14.5%) of 2216 patients in the retrospective cohort and 172 (6.8%) of 2547 patients in the prospective cohort, an absolute decline of 7.7% after the 2016 enhancements. Patient characteristics were similar between the 2 cohorts. Patients’ experiences were varied, but because of low enrolment in the interview process (n = 3), it was difficult to identify and summarize common themes. The analysis of focus groups involving pharmacy staff (n = 27 participants) revealed that the benefits of MedsChecks depended on quality and access, and also identified common barriers and oppor -tunities for future enhancements. Conclusions: Patient interviews revealed the features of the program that patients valued. Pharmacy staff identified several benefits and barriers encountered when using MedsChecks. These findings can guide clinicians in optimal application of the current MedsCheck program and can inform subsequent program revisions.RÉSUMÉContexte : En avril 2007, l’Ontario a introduit le programme MedsCheck assorti d’améliorations visant à renforcer le programme élaboré en octobre 2016. La documentation antérieure décrivait l’expérience des patients rece-vant le service ainsi que celle des pharmaciens et des médecins communau-taires avant les améliorations, mais les expériences des participants au programme MedsCheck amélioré ainsi que celles des techniciens en pharmacie et des pharmaciens d’hôpitaux n’avaient toutefois pas été étudiées.Objectifs : Cette étude a été conçue pour décrire et comparer les caractéristiques démographiques et cliniques des patients admis au Sunnybrook Health Sciences Centre (SHSC) qui ont reçu un MedsCheck avant et après les améliorations apportées au programme de 2016. L’étude vise également à décrire les expériences qu’ont faites les patients, les pharmaciens d’hôpitaux et les techniciens en pharmacie avec le programme MedsCheck amélioré.Méthodes : Des examens de graphiques ont permis d’identifier et de caractériser les patients admis au SHSC entre mars et mai 2016 (cohorte rétrospective) et entre mars et mai 2017 (cohorte prospective), ayant reçu un MedsCheck. Les patients ont été interrogés et des groupes de discussion avec le personnel de pharmacie ont été organisés pour étudier les expériences qu’ils ont faites avec le programme MedsCheck. Résultats : Des MedsChecks ont été effectués auprès de 321 patients (14,5 %) sur les 2216 dans la cohorte rétrospective, et de 172 patients (6,8 %) sur les 2547 dans la cohorte prospective : une diminution de 7,7 % après les améliorations apportées en 2016. Les caractéristiques des patients étaient similaires dans les deux cohortes. Les expériences des patients étaient variées, mais la faible inscription au processus d’entretien (n = 3) n’a pas permis de déterminer et de résumer les thèmes communs. L’analyse des groupes de discussion comprenant des membres du personnel de pharmacie (n = 27 participants) a révélé que les avantages du programme MedsChecks dépendaient de la qualité de l’information fournie par le programme et de l’accès à cette information, et elle a aussi permis de cibler les obstacles courants et des possibilités d’améliorations futures.Conclusions : Les entretiens avec les patients ont révélé les caractéristiques du programme que les patients appréciaient. Le personnel de pharmacie a relevé plusieurs avantages et quelques obstacles liés à l’utilisation du programme MedsChecks. Ces résultats peuvent faciliter l’application optimale du programme MedsCheck actuel par les cliniciens et orienter les révisions ultérieures.

Analysis of Real-World Experiences with the Ontario MedsCheck Program

BACKGROUND

The Ontario MedsCheck program was introduced in April 2007, with enhancements to strengthen the program made in October 2016. Previous literature has characterized patients who received the service before the enhancements and described the experiences of community pharmacists and physicians, but the experiences of participants in the enhanced MedsCheck program and those of hospital pharmacists and pharmacy technicians have not been explored.

OBJECTIVES

This study was designed to describe and compare the demographic and clinical characteristics of patients admitted to Sunnybrook Health Sciences Centre (SHSC) who had received a MedsCheck before and after the program enhancements of 2016. The study also aimed to describe the experiences of patients, hospital pharmacists, and pharmacy technicians with the MedsCheck program.

METHODS

Chart reviews were completed to identify and characterize patients who had received a MedsCheck and were admitted to SHSC between March and May 2016 (retrospective cohort) and between March and May 2017 (prospective cohort). Patients were interviewed and focus groups were conducted with pharmacy staff to explore their experiences with the MedsCheck program.

RESULTS

MedsChecks had been performed for 321 (14.5%) of 2216 patients in the retrospective cohort and 172 (6.8%) of 2547 patients in the prospective cohort, an absolute decline of 7.7% after the 2016 enhancements. Patient characteristics were similar between the 2 cohorts. Patients' experiences were varied, but because of low enrolment in the interview process (n = 3), it was difficult to identify and summarize common themes. The analysis of focus groups involving pharmacy staff (n = 27 participants) revealed that the benefits of MedsChecks depended on quality and access, and also identified common barriers and opportunities for future enhancements.

CONCLUSIONS

Patient interviews revealed the features of the program that patients valued. Pharmacy staff identified several benefits and barriers encountered when using MedsChecks. These findings can guide clinicians in optimal application of the current MedsCheck program and can inform subsequent program revisions.

Community pharmacist-directed point-of-care group A Streptococcus testing: Evaluation of a Canadian program

OBJECTIVE

Streptococcus pyogenes is an aerobic, gram-positive bacterium responsible for a wide variety of infections including common pharyngitis. Novel rapid antigen detection tests allow for diagnosis of group A Streptococcus (GAS) at the point of care. The objective of the study is to evaluate the effects and feasibility of community pharmacist-directed GAS testing.

SETTING

A retrospective analysis of aggregate billing data was conducted using descriptive statistics to evaluate the acceptance and feasibility of a community pharmacist-directed Streptococcus testing program at Shoppers Drug Mart pharmacies in the Canadian provinces of British Columbia, Alberta, and Nova Scotia.

PRACTICE DESCRIPTION

Pharmacists trained in sample collection offered the screening to patients with symptoms suggestive of Streptococcus species infection from November 28, 2015, to May 31, 2016. Throat swabs were collected and analyzed using the BD Veritor system for rapid detection of GAS.

PRACTICE INNOVATION

Pharmacist-directed point-of-care group A Streptococcus testing and management.

EVALUATION

Proportion of GAS-positive cases that resulted in the same day initiation of antibiotic therapy by pharmacists were collected. Patient satisfaction with the service was also evaluated.

RESULTS

Seven thousand and fifty patients were tested across 204 participating locations. The average age was 27.3 years, with children (age 5-14 years) representing 30.7% of the population; 25.5% of patients tested positive for GAS infection. Of the patients with positive results, antibiotic therapy was initiated within the same day in 68.7% of cases. In Alberta, where pharmacists have advanced prescribing authority, same-day initiation of therapy was 73.8% compared with a rate of 40.5% (P < 0.05) in the other jurisdictions.

CONCLUSION

These results highlight both the public readiness to access point-of-care services in community pharmacies and the ability of pharmacists to expedite management of patients with GAS. Pharmacy-based Streptococcus testing can facilitate prompt and appropriate access to antibiotic therapy, as was demonstrated in regions with advanced prescribing authority. Communication of recommendations to the physician remains a barrier.

Development and evaluation of a continuing pharmacy education (CPE) program in thrombosis management

BACKGROUND AND PURPOSE

A continuing education (CE) course in thrombosis management for pharmacists was developed through the Office of Continuing Professional Development (CPD) at the University of Toronto to address pharmacists' needs for the knowledge and skills to provide care to patients receiving anticoagulants. This article describes the development of the course as well as the evaluation designed to assess its impact on pharmacists' knowledge, attitudes, and changes in practice.

EDUCATIONAL ACTIVITY AND SETTING

A three-day course was developed. Outcomes were evaluated using a feedback questionnaire, pre- and post-session quizzes and semi-structured interviews conducted six months after course completion. Participant satisfaction, knowledge acquisition and perceived change in knowledge, skills and practice were evaluated.

FINDINGS

Thirty-seven pharmacists enrolled in the program, 21 of whom participated in a semi-structured interview. More than 90% reported that the program exceeded their expectations. Pharmacists' knowledge in thrombosis care improved significantly after each day of the course. Participants felt the greatest benefits of the program were increases in knowledge and confidence and the opportunity to network. The case-based discussions and practical tips gained from experts and peers were highly ranked. Participants strongly agreed that they were applying what they learned in the course to clinical practice, and they provided numerous examples of how their practice changed because of the program.

DISCUSSION AND SUMMARY

The development of this CE course demonstrates application of best practices in continuing education. The evaluation of the program suggests that a CE course in thrombosis improves pharmacist knowledge, confidence and ability to incorporate what was learned into practice. This course design and evaluation can serve as a model for other CE courses for pharmacists as this field continues to grow and encourages thoughtful use of theoretical principles and well-designed evaluation for continual improvement of CE.

Survey of Pharmacy Preceptors' Expectations and Experiences with Students on Rotations in an Inaugural Combined BScPhm/PharmD Class

BACKGROUND

In September 2011, the Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, began offering a combined BScPhm/PharmD program to third-year students and postbaccalaureate graduates. Learning consisted of in-class teaching and Advanced Pharmacy Practice Experience (APPE) rotations.

OBJECTIVE

To explore preceptors' expectations and perceptions of student performance in the APPE rotations of the new combined degree program.

METHODS

A survey was distributed via email to 132 pharmacists from the Toronto Academic Health Science Network who had acted as preceptors for the combined degree program in academic year 2011/2012. The 17 questions were designed to gather information on preceptors' demographic characteristics and their expectations and evaluations of the combined-program students. Responses were analyzed qualitatively for common themes and quantitatively using sums and means. Survey responses were compared to identify alignment and discrepancies between preceptors' expectations and evaluations of students.

RESULTS

The survey response rate was 48% (63/132). Most respondents (46 [73%]) were from a teaching hospital, and the same proportion (46 [73%]) reported being preceptors for a direct patient care rotation. Forty-four (70%) of the respondents expected students to be at the level of traditional PharmD students, hospital residents, or advanced-level Structured Practical Experience Program students, and 35 (80%) of these 44 respondents reported that their students met or exceeded expectations. According to survey responses, 31% of respondents (18/58) ranked students at the corresponding level of performance on the faculty's assessment form, while 62% (36/58) ranked students at a higher level (5 respondents did not complete the question). Only one-third of respondents felt that they personally had received adequate training before taking on preceptor duties for combined-program students.

CONCLUSIONS

Preceptors' perceptions of the rotation and their expectations of students varied widely and were influenced by prior teaching and learning experiences. There was a disconnect between preceptor-specific expectations and preceptors' final evaluations of students. Training to standardize the expected level of performance and additional training for preceptors would further enhance the APPE rotations of the combined degree program.

Application of a trigger tool in near real time to inform quality improvement activities: a prospective study in a general medicine ward

Background

Retrospective record review using trigger tools remains the most widely used method for measuring adverse events (AEs) to identify targets for improvement and measure temporal trends. However, medical records often contain limited information about factors contributing to AEs. We implemented an augmented trigger tool that supplemented record review with debriefing front-line staff to obtain details not included in the medical record. We hypothesised that this would foster the identification of factors contributing to AEs that could inform improvement initiatives.

Method

A trained observer prospectively identified events in consecutive patients admitted to a general medical ward in a tertiary care academic medical centre (November 2010 to February 2011 inclusive), gathering information from record review and debriefing front-line staff in near real time. An interprofessional team reviewed events to identify preventable and potential AEs and characterised contributing factors using a previously published taxonomy.

Results

Among 141 patients, 14 (10%; 95% CI 5% to 15%) experienced at least one preventable AE; 32 patients (23%; 95% CI 16% to 30%) experienced at least one potential AE. The most common contributing factors included policy and procedural problems (eg, routine protocol violations, conflicting policies; 37%), communication and teamwork problems (34%), and medication process problems (23%). However, these broad categories each included distinct subcategories that seemed to require different interventions. For instance, the 32 identified communication and teamwork problems comprised 7 distinct subcategories (eg, ineffective intraprofessional handovers, poor interprofessional communication, lacking a shared patient care, paging problems). Thus, even the major categories of contributing factors consisted of subcategories that individually related to a much smaller subset of AEs.

Conclusions

Prospective application of an augmented trigger tool identified a wide range of factors contributing to AEs. However, the majority of contributing factors accounted for a small number of AEs, and more general categories were too heterogeneous to inform specific interventions. Successfully using trigger tools to stimulate quality improvement activities may require development of a framework that better classifies events that share contributing factors amenable to the same intervention.

Pharmacotherapy of alcoholism in patients with co-morbid psychiatric disorders

There has been an exponential increase in recent years of literature pertaining to the treatment of individuals with alcohol use disorders and co-morbid psychiatric disorders. Patients with mood and anxiety disorders in particular have a very high prevalence of alcoholism. Alcoholism confers significant morbid risks to patients with psychiatric disorders, and vice versa, including markedly increased risk of suicide. Only recently have studies examined the impact of various psychiatric medications on alcohol use among patients with these disorders. Evidence supporting the benefits of antidepressants for co-morbid alcoholism and depression continues to mount. Although these studies have demonstrated benefits in terms of quantitative decreases in the volume and frequency of consumption, the benefits in terms of remission from alcoholism have yet to be shown conclusively. The first randomised, controlled trial involving subjects with co-morbid alcoholism and bipolar disorder was recently conducted, yielding promising results for valproate in this population. The literature regarding co-morbid alcoholism and anxiety disorders has also seen recent progress, particularly in the study of post-traumatic stress disorder (PTSD). A placebo-controlled study of sertraline suggests some benefit in terms of alcohol use among individuals with early-onset PTSD and less severe alcohol dependence. Atypical antipsychotics such as olanzapine and quetipaine have been examined in several open studies of subjects with alcoholism co-morbid with a variety of psychiatric conditions including bipolar disorder, PTSD and schizophrenia. This paper selectively reviews the evidence that is currently available for the pharmacological management of alcoholism among persons with co-morbid psychiatric illness. Effectiveness, safety and tolerability are considered, and directions for future study are discussed.