Journal of Pharmacy Technology

Health screenings can identify patients at risk for chronic medical conditions. Additionally, screenings may influence behavior changes as depicted by the Health Belief Model.

To examine the perceptions of state employees regarding their health and risk for medical conditions, assess whether unexpected or abnormal screening results will impact perceptions, and identify barriers to scheduling an annual physical examination.

State employees participated in screenings for diabetes, dyslipidemia, and osteoporosis. Participants were asked to complete a pre- and post-survey. Pre-survey questions gathered information on demographics, chronic medical conditions, perception of overall health, and willingness to have an annual physical examination. The post-survey assessed self-health perceptions based on screening results, their risk for chronic medical conditions, and the likelihood that the screening results would encourage scheduling a provider appointment.

One hundred twenty-six of 128 (98.4%) employees completed the survey. Thirty-five percent of employees had cholesterol levels >200 mg/dL and 23% had T-scores less than or equal to −1.0. When asked about preexisting medical conditions, 40% of those with elevated cholesterol levels reported that they had high cholesterol, and 5% with low T-scores stated that they had osteoporosis. Following the screenings 54% and 55% responded that they were at risk for high cholesterol (p = 0.02) and osteoporosis (p < 0.001), respectively. Participants who reported having had no annual physical examination but who planned to schedule a visit as a result of their screening had a higher total cholesterol level than those who reported annual physical examinations prior to the screening (207 ± 42.6 mg/dL vs 189 ± 33.2 mg/dL; p = 0.03).

Health screenings increased awareness of dyslipidemia and osteoporosis among state employees. Higher than normal cholesterol results influenced health perceptions and encouraged respondents to schedule a provider visit.

To report a case of—and review the literature supporting—rifabutin-induced thrombocytopenia from concurrent use of high-dose fluconazole.

A 34-year-old man with AIDS, on a stable regimen that included rifabutin and fluconazole for the previous 3 months, was admitted to the hospital with symptoms of oropharyngeal candidiasis. He was treated with increased doses of fluconazole 200 mg to 800 mg daily over a 9-day hospital admission. During this time, his platelet count decreased from 441,000 cells/mm³ to 24,000 cells/mm³, with no signs of bleeding. He was discharged on day 9 and instructed to omit 1 dose of rifabutin and continue fluconazole 200 mg daily. On day 12, his platelet count was 118,000 cells/mm³. About 1 month after discharge, his platelet count was 151,000 cells/mm³.

Rifabutin is known to cause thrombocytopenia. Results from initial studies evaluating various doses of rifabutin were not conclusive as to whether rifabutin-induced thrombocytopenia is a dose-dependent effect. With increased use of rifabutin, often in combination with potentially interacting medications, reports of thrombocytopenia have gained frequency. One study showed that patients on higher doses of rifabutin experienced thrombocytopenia significantly more often than did those on lower doses. When rifabutin is administered with fluconazole, there is a clear pharmacokinetic interaction, showing a 76–82% increase in the rifabutin area under the concentration curve, with only uveitis and leukopenia reported. An objective causality assessment of this case classified the interaction between fluconazole and rifabutin, resulting in thrombocytopenia, as probable. Other causes of thrombocytopenia in our patient, including AIDS, Mycobacterium avium complex, fluconazole, famotidine, and ritonavir, are less likely.

We describe the first case of rifabutin-induced thrombocytopenia from concurrent use of high-dose fluconazole. There is evidence to support this interaction and practitioners should be aware of this potential adverse effect.

Investigators have employed a number of different methods to calculate adherence estimates for patients taking lipid-modifying therapy (LMT), including measures with different numerator and denominator options. Although at least one method is known to correlate well with cardiovascular outcomes, most have not been evaluated in outcomes studies.

To evaluate different methods for measuring adherence, using LMT as a case example, and to determine whether estimates for adherence differ statistically and/or whether different methods can lead to different conclusions about patient adherence.

Adherence ratios were calculated using 8 different methods for 12,448 patients who were in a managed-care system and were considered new starts with statin therapy. The calculated measures were compared and tested for differences. Patients were categorized as adherent by each method, using a threshold of 0.8, and the proportions of patients categorized as adherent were compared for differences between adherence calculation methods.

Adherence ratios calculated with like observation intervals did not vary substantially, regardless of which method for measuring medication availability was used. Those calculated with different observation intervals had substantial variability. Mean adherence ratios ranged between 0.777 and 0.798 for difference in days' observation intervals; they ranged between 0.618 and 0.630 for the predefined interval. Differences between ratios calculated using these different denominators were statistically significant (p < 0.008). Correlations between ratios were statistically significant for all comparisons (p < 0.001). Correlation coefficients (r) were 0.64 for comparisons between ratios with different denominators versus 1.0 for comparisons with like denominators. Categorization as adherent or nonadherent differed between the methods for about 20% of patients.

Significant differences were found to be based on observation period but not on medication availability. Studies of adherence should be interpreted with caution depending on which method is used, and particular interest should be paid to whether the choice of methods is consistent with study objectives and to the observation interval, as different methods may lead to different conclusions about patient adherence. Further research in LMT and other therapeutic areas is needed to determine which methods correlate best with positive patient outcomes, such as reductions in low-density lipoprotein cholesterol and cardiovascular events.

Diabetes is the third most expensive physical health condition for US employers. Thus, there is a need for employers to engage in disease management programs for their diabetic employees in order to ensure long-term benefits.

To evaluate the clinical outcomes of successful implementation of an employer-initiated pharmacist-based disease management program for diabetic patients.

This was a longitudinal retrospective study analyzing clinical indicators in diabetic employees after a community pharmacist-based diabetes disease management (DDM) program in a rural setting. The program involved comprehensive drug therapy assessment and individualized disease management education. Outcomes measured in this study were fasting serum glucose (FSG) levels, glycated hemoglobin (A1C) levels, diastolic blood pressure (DBP), systolic blood pressure (SBP), body mass index (BMI), and complete lipid profiles including high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglyceride (TG), and total cholesterol (TC) levels.

A total of 137 patients were enrolled in this program. Significant improvement in mean clinical outcome scores was achieved for FSG (p = 0.004), DBP (p = 0.018), and SBP (p = 0.044). At the end of the 1-year intervention, targeted FSG and A1C goals were attained by 39.1% (p = 0.029) and 39.4% of patients, respectively. Also, targeted DBP, SBP, BMI, LDL, HDL, TG, and TC levels were achieved by 54.8% (p < 0.001), 38.5%, 38.3%, 56.8%, 38.2%, 37.5%, and 52.4% of patients, respectively.

This study establishes a need for implementation of long-term employer-initiated pharmacist-based DDM programs that improve clinical outcomes for employees. Further studies evaluating outcomes for a longer time period would provide more conclusive results.

To review the mechanism of action, indication, pharmacokinetics, clinical efficacy, safety and tolerability, dosing, availability, and place in therapy for aztreonam lysine in the chronic management of cystic fibrosis (CF).

PubMed/MEDLINE (1966–December 2011) was searched to identify articles addressing aztreonam lysine use for CF using the terms aztreonam, cystic fibrosis, and inhaled antibiotics. Reference lists of review articles, guidelines, and unpublished data from the manufacturer were also utilized.

Limits were set for the English language and humans. Three placebo-controlled trials and 1 active-comparator trial evaluating the efficacy and safety of aztreonam lysine were reviewed for inclusion. Data were also extracted from review articles and the manufacturer's Web site.

Pseudomonas aeruginosa is associated with significant morbidity and mortality in patients with CF; therefore, treatment is imperative. Current guidelines for chronic maintenance therapy recommend using chronic inhaled anti-pseudomonal antibiotics. Tobramycin (Tobi) is the only inhaled antibiotic approved by the FDA for management of CF patients with P. aeruginosa. Tobramycin treatment failures in P. aeruginosa infection have been increasing over the past decade; therefore, other treatment options are needed. Aztreonam lysine (Cayston) was approved by the FDA on February 22, 2010, as an inhaled antibiotic to help improve respiratory symptoms in patients 7 years of age or older with CF and known P. aeruginosa infection.

Aztreonam lysine is a newer inhaled antibiotic that improves forced expiratory volume in 1 second, respiratory symptoms, and quality of life measures when used as maintenance therapy in patients with CF and chronic P. aeruginosa infection. Availability of aztreonam lysine only from specialty pharmacies may limit its use.

As pharmacy educators, it is the responsibility of the faculty to prepare student pharmacists, through education, for the variety of opportunities that will be available to them after graduation. This education can be provided by incorporating standards set forth by the Accreditation Council on Pharmacy Education (ACPE), as well as by working with fellow educators at other schools of pharmacy within the region or across the country. This article summarizes data collected regarding physical assessment skills from pharmacy practice faculty within the Northeast region.

To identify how often physical assessment skills are applied and their importance to pharmacy practice faculty practicing in various pharmacy settings, to use the data collected from pharmacy practice faculty to standardize which physical assessment skills should be used for training student pharmacists, and to use the collected data to assist in the development of guidelines that highlight core competencies in physical assessment that are in accordance with ACPE Accreditation Standards and Guidelines and that student pharmacists should be able to perform upon graduation.

A physical assessment survey was mailed to pharmacy practice faculty at schools of pharmacy in the Northeast region. The survey asked faculty members to rate 2 parameters for each skill: how often a skill is used at their own practice site, and the importance of that skill to teach student pharmacists to use in the future.

A total of 238 surveys were mailed to pharmacy practice faculty in the Northeast region; 81 surveys were returned to the primary investigator. The data collected indicated a wide spread of opinions among faculty members regarding physical assessment.

Although physical assessment skill is a required competency set forth by the ACPE Accreditation Standards and Guidelines, there is a wide variety of skills that pharmacy practice faculty feel are important to teach student pharmacists.