Browsing by Subject "Pharmacists"
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Item Improving asthma management : patient-pharmacist partnership program in enhancing therapy adherence(2016-08-16) Makhinova, Tatiana Victorovna; Barner, Jamie C.; Brown, Carolyn M; Rascati, Karen L; Richards, Kristin M; Nag, ArpitaAdherence to long-term asthma controller medications is an important factor in effective asthma management. Suboptimal adherence to asthma controller medications is prevalent. This three-study dissertation presents a patient-pharmacist partnership program designed to enhance therapy adherence and provides preliminary results on the effectiveness of this program. Study one consists of two parts. First, patient-centered, asthma-specific tools addressing key asthma adherence barriers in community pharmacy settings were developed. Second, five interviews with community pharmacists were conducted and three main topics were covered. In the first topic, “use of tools and overall approach”, pharmacists reported the need for the identification of patients’ barriers and that they found the proposed tools to be helpful in identifying and addressing patients’ concerns. In the second topic pharmacists reported “barriers to implementation”, such as time and workflow, patients’ perception of the pharmacists and absence of reimbursement. The last topic included “facilitators and suggestions for implementation” and the following were suggested: identifying patients upfront based on their refill history, placing a note on filled prescriptions, raising awareness among patients, involving technicians in the process of identifying patients, having a dedicated pharmacist staff and adding the proposed approach into in-store health clinics/fairs. Study two was a cross-sectional pilot test of the developed tool for identification of patients’ barriers to adherence in community pharmacy settings. The objective was to examine the association between asthma control, adherence barriers and asthma management characteristics. Significant (p<0.05) associations were found between the Morisky adherence scale score and the modified ASK instrument barriers score, as well as with the reported number of barriers, but not between adherence and asthma control. Possession of an asthma action plan was found to be a significant (p=0.001) predictor of a higher level of adherence, although less than half of the patients had such a plan. In study three, the developed tools were pilot-tested in community pharmacies to assess effectiveness. Adult patients with persistent asthma in both the intervention and control groups were evaluated for asthma medication adherence, barriers to adherence and asthma control at baseline and 3 months later. While patients in the control group received usual care, those in the intervention group were provided with patient-specific education and counseling pertaining to their adherence issues. At 3 months, patients’ were evaluated again and the analyses showed a significant improvement in barrier score between the pre and post period (increase by 3.9±6.9, p=0.035) and a clinically meaningful increase (by 2.7 points) in asthma control in the intervention group only. There were no significant changes in adherence pre to post in either the intervention group or control group. These studies provide insight into adherence behavior of patients with asthma and demonstrate how suboptimal asthma management can be addressed in community pharmacy settings. Pharmacists can effectively target common reasons for poor asthma adherence and management, such as lack of understanding how medications work and not knowing the goals of therapy.Item Using the theory of planned behavior to examine Texas community pharmacists’ intentions to utilize a prescription drug monitoring program(2012-08) Fleming, Marc L., 1971-; Barner, Jamie C.; Brown, Carolyn M.; Shepherd, Marvin D.; Strassels, Scott A.; Novak, SuzanneThe purpose of this study was to determine the predictive utility of the theory of planned behavior (TPB) in predicting and explaining pharmacists’ intention to utilize a prescription drug monitoring program (PDMP) database, when the validity of the prescription/patient need is in question. The study tested the significance of each TPB model construct variable (attitude [A], subjective norm [SN], and perceived behavioral control [PBC]) in predicting pharmacists’ high intention, compared to non-high intention (dichotomous variable). In addition, the study examined the additional contribution of pharmacists’ perception of prescription (PPDA) drug abuse and perceived obligation (PO) to the TPB model. Demographic and practice characteristics were also explored in relation to the TPB model predictors, A, SN and PBC. A mail questionnaire was sent to a random sample of 998 Texas community pharmacists with active licenses. Three focus groups were conducted to collect information regarding pharmacists’ beliefs toward PDMP database utilization. The usable survey response rate was 26.2%. Due to data that were not normally distributed, intention was dichotomized into high intention and non-high intention. The TPB constructs were significant predictors of pharmacists’ high intention. Pharmacists with positive attitudes were almost twice as likely to have high intention (odds ratio [OR] = 1.8, 95% confidence interval [CI] = 1.2 – 2.8). However, SN was the strongest predictor of pharmacists’ high intention (OR = 2.2, 95% CI = 1.4 – 3.3). Pharmacists who reported substantial PBC were also twice as likely to have high intention (OR = 1.9, 95% CI = 1.2 – 3.0). PPDA was not significantly related to pharmacists’ high intention. However, pharmacists’ PO was shown to predict high intention above that explained by the TPB model (OR = 1.8, 95% CI = 1.0 – 3.1). The results of this study support the utility of the TPB model with PO in predicting pharmacists’ high intention to utilize a PDMP database. Interventions that address pharmacists’ A, SN, PBC, and PO may be necessary to increase pharmacists’ high intention to utilize a PDMP database when it becomes available. Future studies using intention as a predictor of pharmacists’ behavior are needed to assess the influence of intention on PDMP utilization.