Effects of Framed Mobile Messages on Beliefs, Intentions, Adherence, and Asthma Control: A Randomized Trial

We aimed to examine the effects of framed mobile messages (messages emphasizing losses or gains because of a behavior) on young adults' beliefs about their daily Inhaled Corticosteroids (ICS), intentions to take their ICS, adherence, and asthma control. College students (18-29 years) who owned a mobile phone and had a diagnosis of asthma with a prescription for an ICS were recruited. Participants (n = 43) were randomized to receive either gain- or loss-framed mobile messages three times per week for eight weeks. Engagement rates with messages were calculated. Outcomes included beliefs, intentions, adherence, and asthma control. Data collection was performed at baseline, week 4, and week 8. Mixed-design ANOVA assessed whether outcomes improved differentially from baseline to week eight between gain- and loss-framed groups. Twenty-two participants were randomly assigned to the gain-framed group and 21 to the loss-framed group. There was a 100% retention rate. The engagement rate with the text messages was 85.9%. There was a significant difference in participants' intentions to take medication and asthma control from baseline. There were no significant changes in other outcomes from baseline. There was no difference in changes in all outcomes between participants receiving gain- versus loss-framed messages. Framed mobile messages improved young adults' asthma control and intentions to take their medication as prescribed.

Knowledge of Kratom among Alabama Pharmacists

Kratom (Mitragyna speciosa) is a botanical substance whose leaves produce stimulant- and opioid-like effects. Kratom use has increased precipitously in the United States (U.S.) over the last decade, yet, in our experience, many pharmacists are unfamiliar with this herb. The purpose of this study was to assess pharmacists' awareness and knowledge of kratom. This cross-sectional study used an online questionnaire to preferentially solicit community pharmacists' knowledge of kratom and collect demographic information. The survey was sent via email to approximately 10,000 pharmacists, targeting those in the state of Alabama, U.S. Data were analyzed using descriptive statistics, and the Chi Square test was used to compare nominal data. A total of 257 participants responded to the survey. Almost 50% of participants had heard of kratom, and 50% had not. Compared to females, males were more likely to have heard of kratom (64% vs. 42%; p = 0.0015), as were pharmacists who worked for an independent pharmacy vs. a chain (61% vs. 41%; p = 0.025). Of the participants who had heard of kratom, only 14% considered themselves knowledgeable or very knowledgeable about the herb, and only 44% knew it was illegal in Alabama. These data indicate a need to further kratom education among community pharmacists in Alabama.

Screening for clinically relevant drug-drug interactions between direct oral anticoagulants and antineoplastic agents: a pharmacovigilance approach

BACKGROUND

Use of direct oral anticoagulants (DOACs) in patients with cancer remains suboptimal due to the concern regarding potential drug-drug interactions (DDIs) with antineoplastic treatments. However, the clinical relevance of these DDIs is unknown.

METHODS

We conducted a pharmacovigilance study of adverse event (AE) reports from the US Food and Drug Administration Adverse Event Reporting System from 1/1/2004 to 12/31/2021. AE reports containing DOACs and antineoplastic agents with CYP3A4/P-gp inhibitory or inducing activity suggested by published pharmacokinetic studies were included (n = 36,066). The outcomes of interest were bleeding or stroke, identified by MedDRA dictionary version 25.0. We used disproportionality analyses (DPA), logistic regression models (LR), and Multi-item Gamma-Poisson Shrinker (MGPS) (Empirical Bayes Geometric Means (EBGM) and 90% credible intervals (90% CIs)) algorithms to identify the safety signal of DDIs.

RESULTS

The highest bleeding reporting rates for each drug class were the combination of DOACs with neratinib (39.08%, n = 34), tamoxifen (21.22%, n = 104), irinotecan (20.54%, n = 83), and cyclosporine (19.17%, n = 227). The highest rate of stroke was found for prednisolone (2.43%, n = 113). In the primary analysis, no signal of DDIs by the antineoplastic therapeutic class was detected by MGPS, DPA, and LR approaches. By individual antineoplastic drug, DOACs-neratinib was the only signal detected [EBGM (EB05-EB95) = 2.71 (2.03-3.54)].

CONCLUSION

No signal of DDIs between DOACs and antineoplastic agents was detected, except for DOAC-neratinib. Most DDIs between DOACs and antineoplastic agents may not be clinically relevant. The DDIs between DOACs and neratinib should be further examined in future research.

Medication use and contextual factors associated with meeting guideline-based glycemic levels in diabetes among a nationally representative sample

Introduction

Based on the long-lasting diabetes management challenges in the United States, the objective was to examine glycemic levels among a nationally representative sample of people with diabetes stratified by prescribed antihyperglycemic treatment regimens and contextual factors.

Methods

This serial cross-sectional study used United States population-based data from the 2015 to March 2020 National Health and Nutrition Examination Surveys (NHANES). The study included non-pregnant adults (≥20 years old) with non-missing A1C and self-reported diabetes diagnosis from NHANES. Using A1C lab values, we dichotomized the outcome of glycemic levels into <7% versus ≥7% (meeting vs. not meeting guideline-based glycemic levels, respectively). We stratified the outcome by antihyperglycemic medication use and contextual factors (e.g., race/ethnicity, gender, chronic conditions, diet, healthcare utilization, insurance, etc.) and performed multivariable logistic regression analyses.

Results

The 2042 adults with diabetes had a mean age of 60.63 (SE = 0.50), 55.26% (95% CI = 51.39-59.09) were male, and 51.82% (95% CI = 47.11-56.51) met guideline-based glycemic levels. Contextual factors associated with meeting guideline-based glycemic levels included reporting an "excellent" versus "poor" diet (aOR = 4.21, 95% CI = 1.92-9.25) and having no family history of diabetes (aOR = 1.43, 95% CI = 1.03-1.98). Contextual factors associated with lower odds of meeting guideline-based glycemic levels included taking insulin (aOR = 0.16, 95% CI = 0.10-0.26), taking metformin (aOR = 0.66, 95% CI = 0.46-0.96), less frequent healthcare utilization [e.g., none vs. ≥4 times/year (aOR = 0.51, 95% CI = 0.27-0.96)], being uninsured (aOR = 0.51, 95% CI = 0.33-0.79), etc.

Discussion

Meeting guideline-based glycemic levels was associated with medication use (taking vs. not taking respective antihyperglycemic medication classes) and contextual factors. The timely, population-based estimates can inform national efforts to optimize diabetes management.

A systematic review of digital health technologies for the care of older adults during COVID-19 pandemic

Objective

During the Coronavirus Disease 2019 (COVID-19) pandemic, digital health technologies (DHTs) became increasingly important, especially for older adults. The objective of this systematic review was to synthesize evidence on the rapid implementation and use of DHTs among older adults during the COVID-19 pandemic.

Methods

A structured, electronic search was conducted on 9 November 2021, and updated on 5 January 2023, among five databases to select DHT interventional studies conducted among older adults during the pandemic. The bias of studies was assessed using Version 2 of the Cochrane Risk-of-Bias Tool for randomized trials (RoB 2) and Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I).

Results

Among 20 articles included in the review, 14 (70%) focused on older adults with chronic diseases or symptoms, such as dementia or cognitive impairment, type 2 diabetes, and obesity. DHTs included traditional telehealth interventions via telephone, video, and social media, as well as emerging technologies such as Humanoid Robot and Laser acupuncture teletherapy. Using RoB 2 and ROBINS-I, four studies (20%) were evaluated as high or serious overall risk of bias. DHTs have shown to be effective, feasible, acceptable, and satisfactory for older adults during the COVID-19 pandemic compared to usual care. In addition, some studies also highlighted challenges with technology, hearing difficulties, and communication barriers within the vulnerable population.

Conclusions

During the COVID-19 pandemic, DHTs had the potential to improve various health outcomes and showed benefits for older adults' access to health care services.

Determinants to immunization information system implementation in independent community pharmacies in rural Alabama

BACKGROUND

Immunization information systems (IISs) facilitate consolidated vaccination data within each state. Many have limited pharmacy participation, especially Alabama. As pharmacists increasingly engage in delivery of vaccines recommended across the life span, it is critical to understand the barriers to IIS implementation, particularly in rural community pharmacies where access to primary care may be limited.

OBJECTIVE

The purpose of this study was to identify barriers and facilitators to IIS implementation in rural, independent community pharmacies in Alabama.

METHODS

Qualitative interviews with rural, independent community pharmacy personnel and IIS experts in both states with high IIS participation and Alabama (state with low IIS participation) were conducted. States with high participation were identified as those with ≥75% of adults recorded in their respective state IIS. Less than 25% of Alabama adults were recorded in the state IIS at the time of this study. Deductive coding using CFIR constructs was conducted with a second coder to ensure inter-rater reliability. CFIR Rating Rules were applied to the coded data to allow for identification of constructs that have the greatest impact on implementation.

RESULTS

A total of twenty-five participants (16 pharmacy personnel; 9 IIS experts) were interviewed. During interviews, 32 of 39 CFIR constructs were mentioned and 11 constructs with a strong influence (+2 or -2) were identified. These included, "adaptability", "complexity", "compatibility", "available resources", "access to knowledge and information", "needs and resources of those served by the organization", "peer pressure", "external policy and initiatives", "knowledge and beliefs about the innovation", "engaging key stakeholders", and "engaging innovation participants".

CONCLUSIONS

This qualitative study explored perceived barriers and facilitators to IIS implementation in the rural, independent community pharmacy setting from the perspectives of pharmacy personnel and IIS experts. Factors identified can be used to inform the development of resources and implementation strategies to improve IIS uptake and participation.

Impact of a Multicomponent Educational Intervention on Community Pharmacy-Based Naloxone Services Implementation: A Pragmatic Randomized Controlled Trial

BACKGROUND

Despite US naloxone access laws, community pharmacists lack training and confidence in providing naloxone.

OBJECTIVE

To assess the impact of the Empowering Community Pharmacists program on pharmacists' knowledge, perceived barriers, attitudes, confidence, and intentions regarding naloxone services implementation, as well as naloxone prescriptions dispensed.

METHODS

A 3-month pragmatic randomized controlled trial was conducted from December 2018 to March 2019. Alabama community pharmacists were recruited by mail, email, phone, and fax and randomized to intervention (monthly resources/reminders + educational webinar) or control (monthly reminders only). Outcome measures were assessed via online surveys at baseline (T1), immediately post-intervention (T2), and 3 months post-intervention (T3), including naloxone knowledge (%correct); perceived barriers, attitudes, confidence, and intention regarding naloxone services implementation (7-point Likert-type scale; 1 = strongly disagree, 7 = strongly agree); and number of naloxone prescriptions dispensed. Mean differences between control and intervention from T1 to T3 were assessed using 2-way mixed analysis of variance and adjusted analyses were conducted using generalized estimating equations with negative binomial distribution to assess associations between variables.

RESULTS

Of 55 participants (n = 27 intervention, n = 28 control), most were female (80.3%), white (80.6%), in independently owned pharmacies (39.1%). Increases in mean [SD] confidence (5.52 [1.03]-6.16 [0.74], P < 0.0005) and intention (5.35 [1.51]-6.10 [0.96], P = 0.023) occurred from pre- to post-program within the intervention group and were statistically significant compared with control (confidence P = 0.016, intention P = 0.014). Confidence (exp(β) = 1.46, P = 0.031) and perceived barriers (exp(β) = 0.75, P = 0.022) were associated with number of naloxone prescriptions dispensed.

CONCLUSION AND RELEVANCE

The Empowering Community Pharmacists program improved community pharmacists' confidence and intention regarding naloxone services implementation. Other states can adapt program elements according to their laws.

CLINICALTRIALS.GOV IDENTIFIER

NCT05093309.

Evaluation of the impact of enhanced virtual forms and gamification on intervention identification in a pharmacist-led ambulatory care clinic

Background

Adoption of healthcare technology in the ambulatory care setting is nearly universal. Clinical decision support system (CDSS)2 technologies improve patient care through the identification of additional care opportunities. With the movement from paper-based to electronic clinical intake forms, the opportunity to improve identification of gaps in care utilizing CDSS in the ambulatory care setting exists.

Objective

To evaluate the impact of CDSS-enhanced digital intake forms, with- and without aspects of gamification, on the identification of intervention opportunities in an ambulatory care pharmacy setting.

Methods

Patients were invited to complete visit intake paperwork via virtual forms as part of a CDSS-enhanced mobile application designed to identify potential interventions based on patient age, sex, disease state(s), and user-provided information. Patients were randomized to receive optional patient-specific health questions 1) with or 2) without elements of gamification. Gamification elements included trivia questions, fun facts, and the chance to win a prize. A retrospective review was used to assess interventions identified for a random sample of patients seen within the same time frame who did not utilize the mobile application. Interventions were compared across groups utilizing ANOVA. t-tests were used for a subgroup analysis.

Results

From January to May 2019, 353 potential interventions were identified for 220 study participants. 0.44 (±0.82), 1.8 (±2.0) and 2.1 (±1.8) interventions per participant were identified for the control, virtual forms, and virtual forms + gamification groups, respectively. Significant differences in intervention identification across groups were found using a one-way ANOVA (F = 17.46, p < .001). Post hoc analysis demonstrated a significant difference in interventions identified for those completing 50–100% (n = 32) and those completing less than 50% (n = 18; p < .001) of the optional health questions in the virtual forms + gamification group.

Conclusions

Utilization of CDSS-enhanced clinical intake forms increased identification of potential interventions, though gamification did not significantly impact this identification.

Pharmacy students' personal and professional use of social media

INTRODUCTION

Current literature does not describe behaviors or the overarching opinion of pharmacy students on the use of different types of social media for personal and professional purposes. The objectives of this study were to identify predominant beliefs among pharmacy students regarding use of social media for professional and personal purposes, characterize pharmacy students' opinions on the effects of social media on their professional career, and determine pharmacy students' perceptions of using social media as tools for learning and discovery.

METHODS

A self-administered questionnaire was administered to pharmacy students at Auburn University (N = 450) and Lipscomb University (N = 212). Linear regression was performed to predict students' perceptions of the importance of social media to their future professional life.

RESULTS

The leading platforms commonly used by students for personal reasons were Facebook (92.5%), Instagram (70.5%), and Snapchat (70.5%). The most popular platforms used for professional reasons included LinkedIn (40.4%), Facebook (35.4%), and YouTube (29.2%). About 50% of respondents perceived social media to be important to their future professional life as pharmacists. Most students used YouTube and Wikipedia while studying or learning. The regression model predicting students' perceptions of the importance of social media to their future professional life was significant.

CONCLUSIONS

Pharmacy students most commonly use Facebook, Instagram, and Snapchat for personal reasons, and LinkedIn, Facebook, and YouTube for professional reasons. Educators may leverage YouTube and wikis to support the education of pharmacy students. Pharmacy students appear to be more aware and active with security settings than previously reported.

Assessing barriers and increasing use of immunization information systems in independent community pharmacies: Study protocol for a randomized controlled trial

BACKGROUND

As the number of providers administering vaccines increases, including pharmacists, there is a concern of fragmented immunization records in state and regional immunization information systems (IIS). In order for IIS to have complete records, it is critical that each provider administering vaccines, including pharmacists, participate and update the IIS each time a vaccine is administered to a patient. In Alabama, provider participation in the state IIS is not mandatory; as a result, less than 25% of adults over the age of 19 have immunization data recorded. IIS participation among independent pharmacies is of particular concern as approximately 40% of Alabama pharmacies are independently owned, but only 27% of these are enrolled in the IIS.

OBJECTIVE

The objective of this report is to describe a study protocol to assess the impact of an IIS training program among community pharmacies' IIS enrollment and actual participation rates.

METHODS

The research design is a randomized controlled trial. Study participants are Alabama pharmacists who work in independently owned pharmacies that currently provide at least one type of non-seasonal vaccine and are not currently enrolled in the Alabama IIS. Multiple outcomes including awareness, knowledge, attitudes, intention, IIS enrollment, and IIS participation will be compared between intervention and control groups across three time points (baseline, one-month, and three-months). Individual and organizational factors will be measured to identify any possible associations with outcomes.

IMPLICATIONS

The expected outcome is to create an effective training program that is scalable and ready for dissemination. If successful, this training program can be replicated and used to significantly impact the completeness and accuracy of IIS across the U.S., providing the potential for IIS to be used consistently in assessing immunization status and recommending additional vaccines in the pharmacy setting, thereby improving vaccination coverage and making the provision of immunizations safe and efficient.

Developing a Theoretical Framework for Evaluating the Quality of mHealth Apps for Adolescent Users: A Systematic Review

OBJECTIVE

To assess adolescents' preferred mobile app features and to propose a framework for evaluating health-related mobile apps for adolescents.

METHODS

PubMed, CINAHL, PsycINFO, ERIC, HealthIT.gov, and ClinicalTrials.gov were systematically searched in August 2017. Studies pertaining to app development, feasibility, or usability that reported preferred app features and rating criteria on mHealth (mobile health) apps intended for adolescents were included. Quality assessment was performed using the Mixed Methods Appraisal Tool. Qualitative synthesis was performed to develop themes reflecting best practices for evaluating the quality of mHealth apps for adolescents. Using a grounded theory approach, we constructed a theoretical framework of rating criteria that can be used to inform development of an evaluation tool for mHealth apps targeted to adolescents.

RESULTS

Thirteen articles were included. Most commonly preferred features include ability to track test results or self-management progress, connect to social media, and gain points or prizes through app gamification. Common rating criteria include degree of app customizability, ease of use, visual appeal, and interactivity. Five emerging dimensions were used in the theoretical framework: Technical Quality; Engagement; Support System; Autonomy; and Safety, Privacy, and Trust.

CONCLUSIONS

We found that adolescents prefer mHealth apps that are customizable, offer peer support through social media, sustain engagement via gamification, and support the ability to visualize health trends via simplified graphs. Findings may help in the development of mHealth apps that are preferred by adolescents, as well as the development of a quality evaluation tool for mHealth apps targeted to this population.

Impact of eHealth on medication adherence among patients with asthma: A systematic review and meta-analysis

BACKGROUND

Asthma is an important public health issue in the United States. eHealth technology offers a potential solution to asthma treatment adherence, but the relative effect of various types of eHealth interventions has not been systematically studied.

OBJECTIVES

To systematically review the effectiveness of eHealth in improving adherence to inhaled corticosteroids (ICS) among patients with persistent asthma, as well as the satisfaction of patients undergoing eHealth interventions.

METHODS

Literature searches were conducted in five databases in August 2018. Included studies were randomized controlled trials comparing eHealth interventions versus usual care in improving adherence among patients prescribed ICS for persistent asthma. Quantitative synthesis was performed using a random effects model.

RESULTS

Eighty records were identified after removal of duplicates. Fifteen trials were eligible for qualitative synthesis. Included trials utilized: social media (n = 1), electronic health records (n = 1), telehealth (n = 6), and mHealth (n = 7). Twelve trials were eligible for quantitative synthesis. Results show a small but significant overall effect of eHealth interventions on adherence to ICS (Standardized Mean Difference (SMD) = 0.41, 95%CI = 0.02-0.79). Among the different types of eHealth interventions, a significant improvement in adherence was observed for mHealth interventions compared to usual care in a pooled analysis of 4 trials (SMD = 0.96, 95%CI = 0.28-1.64). However, there was considerable heterogeneity among studies. Patient satisfaction was evaluated in 5 trials comparing telehealth (n = 2) and mHealth (n = 3) with usual care. Participants found the interventions to be helpful and satisfactory.

CONCLUSION

eHealth interventions, especially mHealth interventions, are effective and acceptable in improving patient adherence to ICS.

Cognitive Computing and Watson: Implications for Hospital Pharmacy

This installment explores the domain of cognitive computing, using the well-known Watson as an example. The migration of computer manufacturers from a focus on hardware to a focus on services suggests the potential of these tools. Considerations for use of these tools in the health care system are provided.

An Approach for Some in Advanced Pharmacy Informatics Education

Computerization is transforming health care while the quantity and complexity of biomedical knowledge rapidly grows. Today, all clinicians use health information technology (HIT), but only some pharmacists need to be cross-trained in "all" that advanced informatics entails so they can devise new and better information systems to support the pharmacy practice of the future. We propose a dual approach to informatics education in pharmacy: incorporate fundamental informatics education into pharmacy curricula for all students; and train some students interested in becoming informatics experts to design, develop, implement, and evaluate novel HIT for pharmacy. This commentary focuses specifically on the latter. It discusses the advanced pharmacy informatics training needed by some pharmacists to support innovation of HIT and to enable a shift to a more fully system-supported pharmacy practice.

The Case for the Personal Digital Assistant (PDA)

This continuing series will be a valuable resource for both experienced and novice users of handheld computer technology. Topics will include how to evaluate hardware and software, clinical and business applications, and the development of a “digital peripheral brain.” The authors will also discuss PDA organization skills that can maximize professional and personal efficiency.

Creating the Digital Peripheral Brain

Earlier installments in this series focused on PDA fundamentals: hardware, basic functions, software categories. This month, we begin a discussion of advanced clinical applications with an introduction to the Digital Peripheral Brain and its components. Questions or comments should be directed to Bill G. Felkey ( foxbren@auburn.edu ) or Brent I. Fox ( foxbren@auburn.edu ). Address mail to either author at Auburn University Harrison School of Pharmacy, Pharmacy Care Systems, 128 Miller Hall, Auburn University AL 36849-5506.

Privacy, Confidentiality, and Security for PDAs

The American Heritage Dictionary of the English Language defines the terms that are the subjects of this article. Privacy is defined as the quality or condition of being secluded from the presence or view of others. Confidentiality involves preventing the unauthorized disclosure of private information to others. Security seeks freedom from risk or danger, in a word, safety. In this article, we discuss these terms in relation to PDA technology.

How to Get the Best Deal Online or Anywhere

You've been following our series and have now settled on a PDA operating system and a particular hardware product. We will now help you get the best deal nationwide on your new PDA. An upcoming issue will feature readers' own experiences with PDAs in the health care setting.

Development and delivery of an interdisciplinary course in mobile health (mHealth)

BACKGROUND

Interdisciplinary practice is a primary focus within the United States health care system. Despite the existence of interdisciplinary educational efforts in pharmacy for many years, the practice only recently entered mainstream health care education. Informatics offers interdisciplinary educational opportunities. Mobile health (mHealth), an informatics sub-discipline, is the use of mobile devices for health and wellness activities. We used the mHealth domain as the context for an interdisciplinary learning experience for pharmacy and computer science and software engineering (CSSE) students.

EDUCATIONAL ACTIVITY

Educational activities focused on creating an mHealth course sequence and an mHealth application (app). Students worked in teams to complete various assignments, including developing and presenting a course proposal, building a purchase plan for mHealth equipment, developing an mHealth app prototype, delivering a disease state presentation (pharmacy students only), developing use case scenarios (CSSE students only), and completing peer evaluations.

CRITICAL ANALYSIS OF THE EDUCATIONAL ACTIVITY

Course evaluations were only available from pharmacy students. They indicated an overall favorable rating (mean 3.27-3.55; 4=strongly agree). Survey data collected after students entered the workforce indicated that students felt better prepared than their colleagues to work with individuals from other disciplines (mean 4.82; 5=strongly agree). Students also indicated using the knowledge from course proposal development in their careers (mean 4.27; 5=strongly agree). Through team interactions, students learned from each other while overcoming challenges related to terminology and content areas. Skills learned through team interactions reflect real-world processes and are expected to support students' future professional responsibilities.

Hospital Participation in Prescription Drug Monitoring Programs

The prescription drug abuse epidemic continues to grow. This multifaceted problem requires a multifaceted solution. In this installment, we discuss prescription drug monitoring programs and their relevance to hospital pharmacies.

An Approach for All in Pharmacy Informatics Education

Computerization is transforming health care. All clinicians are users of health information technology (HIT). Understanding fundamental principles of informatics, the field focused on information needs and uses, is essential if HIT is going to support improved patient outcomes. Informatics education for clinicians is a national priority. Additionally, some informatics experts are needed to bring about innovations in HIT. A common approach to pharmacy informatics education has been slow to develop. Meanwhile, accreditation standards for informatics in pharmacy education continue to evolve. A gap remains in the implementation of informatics education for all pharmacy students and it is unclear what expert informatics training should cover. In this article, we propose the first of two complementary approaches to informatics education in pharmacy: to incorporate fundamental informatics education into pharmacy curricula for all students. The second approach, to train those students interested in becoming informatics experts to design, develop, implement, and evaluate HIT, will be presented in a subsequent issue of the Journal.

Virtual Reality and Pharmacy: Opportunities and Challenges

We often find inspiration in tech happenings. This month, we explore the opportunities and challenges for using one of the most popular tech gifts of 2016 to advance safe and efficacious medication use.

Are Pharmacists Participating in Postdischarge Patient Reminders?

In this column, we are making a short revisit to the technology that can assist in satisfaction of Meaningful Use criteria and can assist health systems that are increasing their population health initiatives to help improve outcomes while containing costs.

Are You Practicing in a Learning Health System?

Learning never ceases. While continuing education is important for all of us, we are not speaking of licensure requirements. We are speaking of learning within your health system that systematically incorporates knowledge gained through research and clinical care into individual care.

Precision Medicine: Considerable Potential Combined with Important Challenges

While not necessarily a new idea, precision medicine has recently gained traction as the future of health care. The potential benefits are almost difficult to believe, while the challenges are multifaceted. We provide an overview of the current state of precision medicine.

Does Your Department Have a Technology Innovation Strategy?

There are ways to facilitate the successful implementation of technological innovations. These are especially important in a time of rapid development of new tools to support safe and effective medication therapy. This installment addresses some of the key components of a successful technology innovation strategy.

Exploring the ONC's Health IT Dashboard

Readers are living the reality of the government's efforts to move the United States health care system into an electronic environment. It is often easy to develop tunnel vision and focus on efforts at your home institution. In this column, we explore a big picture perspective using an online resource that provides national-level data focused on specific areas of interest.

Consider Adopting Collaborative Project Management Software

Pharmacy administrators are often tasked with a range of responsibilities, from strategic planning and human resources to information systems management. Because of this, tools to support administrators' efficient and appropriate attention to everything on their plate can be valuable. Identification and evaluation of the available tools should be guided by careful consideration of the department's needs.

Clinical and Business Intelligence: Why It's Important to Your Pharmacy

According to the Healthcare Information Management and Systems Society, "Clinical & Business Intelligence (C&BI) is the use and analysis of data captured in the healthcare setting to directly inform decision-making" (http://www.himss.org/library/clinical-business-intelligence). Some say that it is the right information given to the right person at the right time in the right way. No matter how you define it, the fact remains that timely access, synthesis, and visualization of clinical data have become key to how health professionals make patient care decisions and improve care delivery.

Community pharmacy owners' views of star ratings and performance measurement: In-depth interviews

OBJECTIVES

The star rating system implemented by Medicare has the potential to positively affect patient health and may have financial implications for community pharmacies. Learning from owners of community pharmacies with high performance on these quality measures may help us to identify and further understand factors contributing to their success. This study described high-performing community pharmacy owners' current awareness and knowledge of star ratings, attitudes toward star ratings and performance measurement, and initiatives being offered in pharmacies that aim to improve the quality of care.

METHODS

Qualitative interviews with owners of independent community pharmacies were conducted in Spring 2015. Fifteen community pharmacies with high performance on the star rating measures were invited to participate. Recruitment did not end until the saturation point had been reached. All interviews were transcribed verbatim. Interview data were analyzed with the use of ATLAS.ti by 2 coders trained in thematic analysis. Krippendorf's alpha was calculated to assess intercoder reliability.

RESULTS

Ten high-performing pharmacy owners participated. Analysis identified 8 themes, which were organized into the following categories: 1) current awareness and knowledge (i.e., superficial or advanced knowledge); 2) attitudes toward star ratings (positive perceptions, skeptical of performance rewards, and lack a feeling of control); and 3) pharmacy initiatives (personal patient relationships, collaborative employee relationships, and use of technology). Intercoder reliability was good overall.

CONCLUSION

Interviews with high-performing pharmacies suggested that awareness of the star rating measures, overall positive attitudes toward the star ratings, the relationships that pharmacy owners have with their patients and their employees, and the use of technology as a tool to enhance patient care may contribute to high performance on the star rating measures. Future research is needed to determine if and how these constructs are associated with pharmacy performance in a larger population.

Digital Health Solutions: An Important Tool in Patient Engagement

Hospitals and health systems are facing increased pressure to improve quality and outcomes while reducing expense. Quality-based reimbursement models are providing the necessary incentives for health care institutions to focus on issues such as avoidable hospital-acquired conditions and 30-day readmission rates. While our health care facilities certainly play a vital role in achieving optimal outcomes, patient engagement remains at the center of these efforts.

Patient-Centered Technology to Enhance Population Health Management

Take a little walk with us this month as we explore how things such as reimbursement systems are changing. Health systems are adopting population health strategies and performing experiments in rendering this type of care. Many health systems start with the care of their own employees, if they are self-insured. Perhaps you are already seeing this change and experiencing how your care is being impacted.

Keeping up with Advancements in Health Information Technology

We all face an onslaught of information on a daily basis in our personal and professional lives. We view it as a significant part of our professional responsibility to help our colleagues stay abreast of the latest advancements related to health information technology (HIT). This month we explore some of the key resources that we find helpful for keeping up-to-date with emerging and disruptive technology.

Moving to an Information Technology–Driven Health Care Environment

Do you remember when 2020 was the date used as the distant future when our lives would be totally transformed by the technologies that were going to be part of our daily routines? Do you recall that Popular Science magazine predicted in the 1950s that our biggest problem in the year 2000 would be the crowded airspace from our personal helicopters? Who was the thought leader who said no household in America would buy a computer or need one? We believe there are funny predictions that were made years ago that haven't yet come to fruition. We are also convinced that health care is rapidly becoming primarily information technology-driven, including big data, little data, and some pretty exciting technologies that are rapidly emerging and are already beyond the “showing promise” stage.

How Population Health Management and Big Data Can Rock Your World

Hospitals and health systems like yours have been aggressively pursuing a range of information systems over the last several decades. Cited goals are often efficiency, lower costs, better decisions, and better patient outcomes. But how do these systems purportedly lead to population-level improvements in care? In this column, we address the connections that are anticipated as well as challenges to be expected along the way.

The Quantified Self

Health systems are complex organizations with many moving parts. Ultimately, however, each patient views the health system as a place that should address his or her health needs. Increasingly, patients are bringing more information to the care process, adding complexity and potentially both useful and erroneous input to the process. We focus on the movement by the general public to document important daily activities and how this practice may impact an individual's care.

Is This the First Adherence-Focused Multidisciplinary Care Team App?

We have mentioned the need for a multidisciplinary app in health care in at least 3 of our previous columns. We have also written about the Internet of Things (IoT) and how this exploding technology change will impact us all. In case you need a refresher, we believe that there are 5 new rights in health care that can be supported by mobile connectivity.

Bringing Home Participatory Health Care

Following another hospital stay, we have new observations on what it means to address patient needs. Some efforts are founded in technology, while others focus on the process of care. As a member of the broader care team, pharmacy should be aware of and engaged in institutional efforts focused on the patient experience.

Advancements in Adherence Monitoring

Some things really never change. For example, medication adherence remains a critical factor that influences the effectiveness of our modern health care system. Is there a magic bullet to solve the problem of nonadherence? We don't think there is. We do believe, however, that tools to monitor adherence continue to improve in their utility.

Opportunities for Health System Pharmacies in Patient Care

It's been said that the best hospital stay is the one that doesn't occur. Certainly, Hospital Pharmacy's readers know that we are still working toward a completely safe health care delivery experience. In this installment, medication errors experienced during a hospital stay bring to light opportunities for health system pharmacies to create new points of engagement with their patients and increase patients' involvement in their care.

Technology Is Becoming Integral to the Success of Patient Engagement

Health systems can adopt the most advanced information systems and employ a facility full of progressive providers, but many of their efforts may fail if patients are not engaged. Blending the outputs of electronic health records in every transition, sharing and exchanging health information, and populating personal health records are among the technologies that are increasingly being used to bring patients inside the process and participating in the circle of care.

Health Information Technology Risks, Errors, External Threats, and Human Complacency

It may seem that our position is one of unwavering support for all things health information technology (HIT). However, we like to believe that we are cautious and deliberate in our evaluation of HIT. This month, we explore some of the common overt and covert challenges to optimal use of HIT.

Where Are Patients Positioned in Your Seamless Care Strategies?

In our earliest thoughts of how to engage patients in self-care management, we found online banking and finance to be the best model for health care to follow. This model is still right for today. Although no digital approach will apply to 100% of any population, there is evidence that older patient populations see the benefit of being able to access their health care providers online and on mobile devices. It's all about the data, the systems, and the people.

IT Maximization for Population Health Management

Those of you who have been in the health-system setting for several decades have seen many changes. Some of the changes originate within the care setting, whereas many others are brought on by external circumstances. Even those who have been in health systems for only 5 years can recall a recent change in the organization that greatly impacted pharmacy. More change is coming. In this installment, we explore critical technology-related changes of which you should be aware.