Category: Original Research
Title: Investigation of factors associated with influenza vaccination uptake in rural Columbus County, NC
Authors: Amber Hooks B.S., Hillary Best B.S., Ashley Rankin B.S., Peter Ahiawodzi Ph.D.
Objective: The purpose of this study was to determine which demographics are less likely to vaccinate in a rural healthcare setting. This information can help rural pharmacists target methods and approaches to increase influenza vaccine uptake in these populations.
Methods: One hundred patients, 18 years or older, consented to and completed surveys that were distributed upon their visit to one of the three Walgreens Pharmacy locations in Columbus County, NC between June 1 – July 31, 2016. Information collected included age, sex, race, marital status, education, distance to doctor, distance to Walgreens, and their influenza vaccine uptake within the past year. Logistic regression was used to analyze associations between the various factors and vaccine uptake in the past year.
Results: The results indicated patients less than or equal to 35 years old and patients 36-50 years old are 2.07 and 2.52 times more likely, respectively, to not get vaccinated when compared with patients over age 50. Patients with a high school education or less were 1.87 times more likely to not get vaccinated compared to those with more than a high school education. Males were 1.96 times more likely to not get vaccinated when compared to women. The study also indicated that patients who live fifteen minutes or less from their doctor’s office were 2.33 times more likely to get vaccinated compared to patients with over a fifteen minute drive. Patients less than a five minute drive from Walgreens were 1.64 times more likely to get vaccinated compared to those patients who live over 15 minutes from a Walgreens.
Conclusion: In conclusion, patients younger than 50 years old, males, and those with education only up to high school level were less likely to vaccinate. Nearness to a doctor’s office or Walgreens Pharmacy was also noted to influence patients’ influenza vaccine uptake.
Category: Original Research
Title: Educating Future Pharmacists on the Impact of Pharmacogenomics
Authors: Aparna Krishnamurthy, Pharm.D. Candidate 2019; Olivia Dong, M.P.H.; Oscar Suzuki, Ph.D.; Rachel Howard, B.S.; Cristina Benton, Pharm.D., Ph.D.; Robert Dupuis, Pharm.D.; Tim Wiltshire, Ph.D.; Amber Frick, Pharm.D., Ph.D.
Institution: UNC Eshelman School of Pharmacy, Chapel Hill, NC
Objective: Pharmacogenomics is being increasingly used and practiced in various clinical settings. The success of pharmacogenomics relies heavily on healthcare providers who interpret results and discuss their impact with patients. More education for healthcare providers is needed to expand the practice and overcome barriers of pharmacogenomics implementation.
Methods: We surveyed 147 second year student pharmacists enrolled in a clinical pharmacology course about their individual perceptions towards pharmacogenomics prior to and following an educational intervention. This intervention included optional personalized genotyping with a novel sequencing assay using molecular inversion probes. Only the pharmacogenes with variants used to make therapeutic recommendations were analyzed (e.g., CYP2C19, CYP2C9, CYP3A5, G6PD, RYR1, SLCO1B1). The results of this educational intervention were compared to those previously obtained using 23andMe. Paired pre- and post-intervention responses were analyzed with the Wilcoxon signed-rank test for Likert items. Results obtained with 23andMe and the sequencing assay were compared using Fisher’s Exact test.
Results: Out of 123 (87%) student pharmacists who received results from the sequencing assay, 91% felt they had a better understanding of pharmacogenomics on the basis of undergoing genotyping. Of the 73 students who provided open-ended responses within the post-survey, 65% of students believed that though the feasibility of pharmacogenomic testing in clinics is limited due to cost and accessibility issues, the practice of pharmacogenomics can have a significant part of clinical decision making and will be important for the future of pharmacy practice. Perceptions from these student pharmacists were compared to those from students who historically received genotyping from 23andMe, and interestingly, attitudes in several indicators related to personal reflections on pharmacogenomics were decreased.
Conclusion: Opportunities for pharmacogenomics learning should be implemented in various healthcare curricula and environments. Future follow-up questionnaires will qualitatively focus on differences between data obtained from the two genotyping exercises.
Category: Original Research
Title: An Analysis of US Childhood Vaccination Uptake and Associated Predictors Utilizing the National Immunization Survey for Years 2008 through 2015
Authors: Meredith McSwain, BS, Ashley Holombo, BS, Michael Jiroutek, DrPH, MS, Melissa Holland, PharmD, MSCR
Institution: Department of Clinical Research, Campbell University College of Pharmacy and Health Sciences, Buies Creek, NC
Introduction: Vaccines prevent 14 million cases of disease and reduce healthcare costs by $9.9 billion for each birth cohort following the recommended vaccination schedule. Approximately 300 children in the US die annually from vaccine preventable diseases. Prior studies have found varying rates of vaccination in young children, possibly due in part to the highly-publicized Wakefield study (1998) which was subsequently retracted (2010).
Research Question: Is there evidence of an effect of the Wakefield study retraction or other key socio-demographic variables on the receipt of the CDC standard vaccination series?
Methods: This retrospective, cross-sectional study examined children 19-35 months old with adequate provider data in the National Immunization Survey from 2008 to 2015. Children were assessed for up-to-date (UTD) status of the standard vaccination series. Individual chi-square tests and a multivariable logistic regression model were utilized to determine predictors of UTD status. Per the complex survey design, data were appropriately weighted and clustered to generate average, annual population estimates.
60.0% (2015). From the multivariab
Results: Data from 131,783 children were included, representing an extrapolated national estimate of 5,945,295. The percentage of children UTD increased over the study years from 9.2% (2008) to le model, adjusting for factors of interest, being UTD was significantly more likely in the 2011-2015 year group, Hispanics, 24-29 month olds, mother’s age ≥30, and the census regions West, South and Midwest. UTD status was significantly less likely in 30-35 month olds, non-Hispanic blacks, families with four or more children, non-firstborns, two or more vaccine providers, mothers with less than a college degree, those with multiple insurance types and those with Medicaid/SCHIP, and those not receiving a flu shot.
Conclusions: Receipt of the CDC recommended standard vaccination series has increased dramatically over the study years. Statistically significant predictors of vaccine uptake corroborate older studies and suggest disparities still exist.
Category: Original Research
Title: Utilization of Serum Uric Acid Levels for Gout Management in an Internal Medicine Clinic
Authors: Alison L.P. Compton, PharmD Candidate, Jamie Cavanaugh, PharmD, CPP, BCPS, Timothy J. Ives, PharmD, MPH, FCCP, CPP, Betsy Shilliday, PharmD, CDE, CPP, BCACP, FASHP
Institution: Eshelman School of Pharmacy, and Division of General Medicine and Clinical Epidemiology, Department of Medicine, School of Medicine, The University of North Carolina at Chapel Hill
Objective: To compare gout management using serum uric acid monitoring and subsequent presence of pharmacotherapy within an academic internal medicine clinic to the American College of Rheumatology 2012 Guidelines. Comparison was made to the minimum frequency interval of every 6 months and a serum uric acid goal of ≤ 6 mg/dL.
Methods: This retrospective chart review study was approved by the UNC Office of Human Research Ethics. Patients diagnosed with gout that had ≥ 1 clinic visit(s) and ≥ 1 serum uric acid level(s) during the study period (May 2014 - May 2016) were included. Exclusion criteria were pregnancy during the study period, or allergy to allopurinol or febuxostat. For uric acid results > 6 mg/dL, the medication list was evaluated for the presence of a urate lowering therapy (ULT) within 5 weeks of the result.
Results: 454 patients had a diagnosis of gout, of which 170 had ≥ 1 serum uric acid level(s). 163 were included after application of exclusion criteria. The most recent serum uric acid level was > 6 mg/dL in 111 patients (71.8%). ULT was present on the medication list within 5 weeks of a serum uric acid level result > 6 mg/dL in 56.3% (112/199) of cases. Allopurinol was the ULT agent in 85.7% (96/112) of cases at a mode dose of 100 mg and a median of 186 mg. Among those with a level > 6 mg/dL during the study period, the frequency of serum uric acid monitoring was 0.5 checks per patient per 6 months.
Conclusion: Serum uric acid monitoring was less frequent in this study population than guideline recommendations, and a ULT was not present nearly half of the time, providing opportunities for optimizing management of gout.
Title: Medical Management of a Case of Escherichia coli Infective Endocarditis
Authors: Justin Jones, PharmD Candidate1; Kristopher Kindborg, PharmD Candidate1, Dustin Wilson, PharmD, BCPS1,2
1. Campbell University College of Pharmacy & Health Sciences, Buies Creek, NC
2. Duke University Hospital, Durham, NC
Abstract
Introduction: Infective endocarditis (IE) caused by Escherichia coli is rare. In a multinational database, non-HACEK Gram-negative bacilli caused 1.8 percent (49/2761) of the reported IE cases. Of those, E. coli was the causative pathogen in 14 (29 percent) cases. The current guidelines recommend treating non-HACEK Gram-negative bacilli IE with a beta-lactam, and either an aminoglycoside or fluoroquinolone for a minimum of 6 weeks with or without surgery. Here we report a patient diagnosed with E. coli IE treated with ceftriaxone and gentamicin.
Patient: A 50 year-old male with a past medical history significant for aortic valve regurgitation status post mechanical aortic valve replacement presented to the emergency department with a two-day history of chest pain, fatigue, and fever. He was admitted and started on empiric therapy with vancomycin and piperacillin/tazobactam. On day two of hospitalization, patient underwent a transthoracic echocardiogram which showed no evidence of IE. However, 3/3 blood cultures returned positive for Gram-negative rods which subsequently were identified as E. coli. A transesophageal echocardiogram was ordered and showed abnormal echodensity on the aortic leaflet concerning for vegetation. The Infectious Diseases consult service recommended to treat the patient as an E. coli IE with ceftriaxone and gentamicin for six weeks. The patient was discharged from the hospital, but unfortunately, was readmitted for acute kidney injury secondary to gentamicin therapy. The patient completed the remaining two weeks with ceftriaxone monotherapy.
Discussion: Limited literature exists on the treatment of E. coli IE. The patient reported here was treated with ceftriaxone and gentamicin based on the susceptibility profile of the pathogen. Surgery was not considered since the patient cleared the bacteremia so quickly and showed rapid clinical improvement. Unfortunately, the patient was not able to tolerate the full six weeks of gentamicin therapy and had to complete treatment with ceftriaxone monotherapy.
Category: Quality Improvement Evaluations
Title: Interprofessional quality initiative to reduce cardiovascular risk in underserved patients
Authors: Tanya Makhlouf, PharmD Candidate; Jennifer Kim, PharmD, BCPS, BCACP, CPP; Chasta Hopkins, CPhT
Institution: Cone Health Internal Medicine Center, Greensboro NC
Objective: Cardiovascular disease (CVD) risk can be reduced through pharmacologic agents and lifestyle modifications. There is currently a lack of literature published regarding efforts to reduce CVD risk in underserved populations. The primary purpose of this study was to evaluate the effects of reducing CVD risk in indigent patients. Secondary outcomes include reduction in blood pressure and A1C measurements.
Methods: This was a prospective, interprofessional, IRB approved, quality initiative to improve medication access for underserved adult patients. Indigent patients with CVD or CVD risk scores ≥ 10% based on Pooled Cohort Equations, with a no-show rate of ≤ 25% were identified by pharmacy staff. Pharmacy staff worked with nurses, financial counselor, social worker, dietician, and physicians to implement strategies addressing any medication cost barriers, patient education, and therapy recommendations that may increase adherence. Patients were contacted by phone for follow-up to address any ongoing medications challenges.
Results: To date, 16 patients with a mean age of 54 have been enrolled, 2 of which were receiving federal healthcare (12.5%), 5 were enrolled in a program to help with medication cost (31.3%), and 9 were uninsured and not receiving any medication assistance (56.3%). The average household yearly income was $4,968 and average household size was 1.2. The mean baseline CVD risk score was 24.8% and the mean risk scores at 1 and 3 months were 18.6% (N=14) and 15% (N=5), respectively. The mean baseline SBP was 159 mm Hg, mean SBP at 1 month was 146 mm Hg, and mean SBP at 3 months was 130 mm Hg. Thus far, only 4 patients have A1C follow-up data, with a mean baseline A1C of 12% and 3-month mean A1C of 9.8%.
Conclusion: Interprofessional collaboration in the indigent population is showing reduction in CVD risk.
Category: Original Research
Title: Emergency providers’ opioid prescribing behaviors among Medicare Part D beneficiaries in North Carolina, 2013-2014: medication utilization and costs
Authors: Michelle DeGeeter, PharmD, CDE, Chris Gillette, PhD, Geoffrey Mospan, PharmD, BCPS, Rebecca Seabock, PharmD Candidate, Brittany Williams, PharmD
Institution: Wingate University School of Pharmacy, Wingate NC
Objective: This study sought to quantify utilization and costs associated with opioid prescribing by emergency providers for Medicare Part D beneficiaries in North Carolina (NC) and United States (US) from 2013-2014.
Methods: This was a retrospective examination of the Medicare Provider Utilization and Payment Data: Part D Prescriber datasets from 2013-2014. The main variables of interest were total number of prescription claims and total Medicare Part D medication costs for opioid analgesic medications. Generalized estimating equations (GEE) were used to analyze the data.
Results: Excluding NC, there were more than 2,030,108 (662 claims per 100,000) opioid claims in the US, costing more than $28.3 million in 2013. In 2014, also excluding NC, there were 2,061,992 (667 claims per 100,000) claims for opioids, costing almost $35.8 million. In NC, there were 67,570 (686 claims per 100,000) opioid claims from emergency providers in 2013 and 72,881 (733 claims per 100,000) opioid claims in 2014 for Part D beneficiaries. Total Part D drug costs associated with opioids from NC increased from $545,574 to $764,016, more than a 40% increase. In NC, there was a statistically significant increase in costs (p<0.001) but not a significant increase in numbers of claims (p=0.051).
Limitations: This study did not examine patient-level data and could not examine diagnoses leading to opioid prescriptions as well as opioid misuse or overdoses.