Cincinnati, OH, United States
Cincinnati, OH, United States

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Bright D.R.,Ferris State University | Kisor D.F.,Diebold | Smith A.,Ohio Northern University | Conaway M.,Kroger Pharmacy | Yu M.,Kroger Pharmacy
Personalized Medicine | Year: 2015

Aim: The purpose of this study was to pilot a multisite, proof-of-concept model where community pharmacists could engage patients and physicians to provide pharmacogenetic (PGt) testing and clinical decision support. Patients & methods: Patients with history of acute myocardial infarction and percutaneous coronary intervention with no prior history of CYP2C19 testing. Results: Four community pharmacies provided pharmacogenetic testing and medication therapy management services to 30 patients, resulting in eight recommendations for antiplatelet therapy adjustment. Conclusion: Pharmacists involved in the study were able to facilitate antiplatelet therapy adjustments based on PGt data regardless of baseline antiplatelet drug selection. Whereas prior literature largely revolved around PGt management in the inpatient setting, this project supports the involvement of the community pharmacist in making PGt-based recommendations. © 2015 Future Medicine Ltd.


Kisor D.F.,Ohio Northern University | Bright D.R.,Ohio Northern University | Conaway M.,Kroger Pharmacy | Bouts B.A.,Blanchard Valley Medical Assoc. | Gerschutz G.P.,Blanchard Valley Medical Assoc.
Journal of Pharmacy Practice | Year: 2014

Introduction: Although antiplatelet therapy is a mainstay of postpercutaneous coronary intervention therapy, pharmacogenetic (PGt) considerations of therapy are often ignored despite related Food and Drug Administration warnings. Pharmacists are well situated to provide PGt guidance, and the community pharmacy is one setting where PGt testing, interpretation, and recommendations can take place to ensure optimal therapeutic outcomes. Case Report: A 65-year-old man who had a myocardial infarction that was treated with PCI and stent placement was determined by a community pharmacist to be a candidate for PGt testing to ensure optimal antiplatelet therapy. The patient was seen in the pharmacy as a part of a medication therapy management encounter and underwent genetic testing. Results of the genetic testing indicated the need for modification of therapy. The community pharmacist interpreted the results and made the appropriate recommendation to the cardiologist who in turn modified antiplatelet therapy appropriately. Conclusion: This case describes the potential for collaboration between pharmacists and physicians to optimize antiplatelet therapy through PGt testing. Points of consideration for others looking to implement related PGt services are also discussed. © The Author(s) 2014 Reprints and permission: sagepub.com/journalsPermissions.nav.


Luder H.,University of Cincinnati | Frede S.,Kroger Pharmacy | Kirby J.,Kroger Co | King K.,University of Cincinnati | Heaton P.,University of Cincinnati
Journal of Pharmacy Practice | Year: 2016

Objectives: The purpose of this study was to survey new enrollees in a community pharmacy, employer-based diabetes and hypertension coaching program to describe the characteristics, health beliefs, and cues to action of newly enrolled participants. Methods: A 70-question, 5-point Likert-type survey was developed using constructs from the Health Belief Model (HBM), Theory of Planned Behavior (TPB), and Theory of Reasoned Action (TRA). New enrollees in the coaching programs completed the survey. Survey responses between controlled and uncontrolled patients and patient demographics were compared. Results: Between November 2011 and November 2012, 154 patients completed the survey. Patients were fairly well controlled with a mean hemoglobin A1C of 7.3% and a mean blood pressure of 134/82 mm Hg. The strongest cue to action for enrollment was the financial incentives offered by the employer (mean: 3.33, median: 4). White patients were significantly more motivated by financial incentives. More patients indicated they had not enrolled previously in the program because they were unaware it was available (mean: 2.89, median 3.0) and these patients were more likely to have an uncontrolled condition (P ≤ 0.050). Conclusion: A top factor motivating patients to enroll in a disease management coaching program was the receipt of financial incentives. Significant differences in HBM, TPB, and TRA responses were seen for patients with different demographics. © SAGE Publications.


Luder H.R.,University of Cincinnati | Frede S.M.,Kroger Pharmacy | Kirby J.A.,Kroger Co. | Epplen K.,University of Cincinnati | And 5 more authors.
Journal of the American Pharmacists Association | Year: 2015

Objectives: To determine if a community pharmacy-based transition of care (TOC) program that included the full scope of medication therapy management (MTM) services (TransitionRx) decreased hospital readmissions, resolved medication-related problems, and increased patient satisfaction. Design: Prospective, quasi-experimental study. Setting: Nine Kroger Pharmacies located in Western Cincinnati. Patients: Patients older than 18 years of age and discharged from two local hospitals with a diagnosis of congestive heart failure, chronic obstructive pulmonary disease, or pneumonia. Patients were recruited from two local hospitals and referred to the community pharmacy for MTM services with the pharmacist within 1 week of discharge. Main outcome measures: Pharmacists reconciled the patients' medications, identified drug therapy problems, recommended changes to therapy, and provided self-management education. At 30 days after discharge, research personnel conducted telephone surveys, using a previously validated survey instrument, to assess hospital readmissions and patient satisfaction. Pharmacist interventions and medication-related problems were documented. Results: A total of 90 patients completed the study. Of these, 20% of patients in the usual care group were admitted to the hospital within 30 days compared with 6.9% of patients in the intervention group (P = 0.019). In the 30 patients who received MTM services from the pharmacist, 210 interventions were made. The overall mean patient satisfaction with the TOC process was not significantly different between patients who were seen by the pharmacist and those who were not seen by the pharmacist. Conclusion: Community pharmacies successfully collaborated with hospitals to develop a referral process for TOC interventions. Patients who received MTM services from the pharmacist experienced significantly fewer readmissions than patients who received usual care. © 2015, American Pharmacists Association. All rights reserved.


Sevin A.M.,Ohio State University | Romeo C.,BTG | Gagne B.,Kroger Pharmacy | Brown N.V.,Ohio State University | Rodis J.L.,Ohio State University
BMC Public Health | Year: 2016

Background: Adult vaccination rates in the United States are well below recommendations with disparities in race, ethnicity, and education level resulting in even lower rates for these populations. This study aimed to identify the barriers to and perceptions of immunizations in adults in an urban, underserved, multicultural community. Understanding the factors that influence adults' decisions to receive routinely recommended vaccines will aid health care providers and public health officials to design programs to improve vaccination rates. Methods: This cross-sectional, survey-based study was conducted in January 2014 in Columbus, Ohio. Participants were recruited from four urban federally-qualified health centers and four grocery stores affiliated with those clinics. The survey gathered self-reported receipt of immunizations, knowledge about indications for immunizations, and factors influencing decisions to receive an immunization. Data was analyzed in 2014. Descriptive statistics were generated for all survey items and Chi-Square or Fisher's Exact tests were used as appropriate to test for associations between demographic characteristics and factors influencing immunization decisions. Results: The top five factors likely to affect the decision to receive an immunization among the 304 respondents were: "doctor's recommendation" (80.6 %), "knowing why I should get a vaccine" (78.2 %), "knowing which vaccines I need" (75.5 %), cost (54.2 %), and "concern about getting sick if I get a vaccine" (54.0 %). Significant differences in factors influencing the immunization decision exist among respondents based on ethnicity and education level. For those participants with self-identified diabetes, heart disease, or asthma, less than half were aware that certain immunizations could reduce the risk of complications associated with their disease(s). Conclusions: Data from this study may inform and shape patient education programs conducted in clinics, retailers, and communities, as well as advocacy efforts for adult immunizations. Results from this study suggest that patients would respond to programs for promoting vaccine uptake if they focused on benefits and indications for vaccines. The results also highlighted the need for education regarding immunizations for patients with chronic diseases and special indications. The differences in perceptions found between groups can be used to create targeted interventions based on the needs of those patient populations. © 2016 Sevin et al.


Fuller L.,Kroger Pharmacy | Fuller L.,University of Cincinnati | Conrad W.F.,University of Cincinnati | Heaton P.C.,University of Cincinnati | And 3 more authors.
Journal of the American Pharmacists Association | Year: 2012

Objectives: To implement a spirometry-based chronic obstructive pulmonary disease (COPD) screening in a community pharmacy chain, determine whether pharmacists can accurately perform spirometry screenings and interpret results, and determine whether performing screenings improved enrollment in smoking cessation programs. Design: Prospective study. Setting: Kroger pharmacies in the Cincinnati-Dayton Kroger Marketing Area and off-site screening events in Cincinnati, OH, from March to December 2010. Patients: Consenting individuals older than 35 years who met inclusion and exclusion criteria. Intervention: Specially trained community pharmacists administered a validated COPD screening questionnaire and performed spirometry. The results were interpreted, given to the patient, and faxed to the primary care physician. Any patient who was currently smoking was offered smoking cessation counseling. Main outcome measures: Spirometry technical quality and interpretation accuracy, screening questionnaire scores in relationship to spirometry results, number of patients enrolled in smoking cessation programs. Results: Of the 185 patients, 10 were excluded due to inability to perform spirometry. After review, 174 (99%) of the spirometries were judged acceptable and 157 (90%) demonstrated reproducible results. The mean (±SD) score on the COPD Population Screener questionnaire was 2.3 ± 1.6 (range 0-8). Airflow limitation (defined as forced expiratory volume in 1 second/forced vital capacity < lower limit of normal) was detected in 16 (9%) of the patients. Although 12 (75%) of these patients were former or current smokers, only 3 (19%) were at increased risk for COPD based on their screening questionnaire scores. Of the nine current smokers who participated in a follow-up interview, two had successfully abstained from smoking for 6 months after the screening and five others had made an attempt to quit. Conclusion: This study demonstrated that pharmacists are able to perform accurate and reproducible spirometry in a community pharmacy setting.


PubMed | Blanchard Valley Medical Associates, Ohio Northern University and Kroger Pharmacy
Type: Journal Article | Journal: Journal of pharmacy practice | Year: 2016

Although antiplatelet therapy is a mainstay of post-percutaneous coronary intervention therapy, pharmacogenetic (PGt) considerations of therapy are often ignored despite related Food and Drug Administration warnings. Pharmacists are well situated to provide PGt guidance, and the community pharmacy is one setting where PGt testing, interpretation, and recommendations can take place to ensure optimal therapeutic outcomes.A 65-year-old man who had a myocardial infarction that was treated with PCI and stent placement was determined by a community pharmacist to be a candidate for PGt testing to ensure optimal antiplatelet therapy. The patient was seen in the pharmacy as a part of a medication therapy management encounter and underwent genetic testing. Results of the genetic testing indicated the need for modification of therapy. The community pharmacist interpreted the results and made the appropriate recommendation to the cardiologist who in turn modified antiplatelet therapy appropriately.This case describes the potential for collaboration between pharmacists and physicians to optimize antiplatelet therapy through PGt testing. Points of consideration for others looking to implement related PGt services are also discussed.


Winfrey C.,Kroger Pharmacy | Wortman S.,Kroger Pharmacy | Frede S.,Kroger Pharmacy | Kunze N.,Kroger Pharmacy | And 2 more authors.
Journal of the American Pharmacists Association | Year: 2011

Objectives: To evaluate the feasibility of implementing a pharmacist-initiated peripheral arterial disease (PAD) screening program in the community setting and to determine the ability of this screening to increase the number of patients identified with PAD. Design: Prospective study. Setting: Three locations of a large pharmacy grocery chain in the Cincinnati and Dayton, OH, area, from February 3, 2009, to May 31, 2009. Patients: 39 patients 50 years or older with a diagnosis of hypertension, dyslipidemia, and/or diabetes. Intervention: PAD screening, including an assessment of PAD symptoms and an ankle-brachial index (ABI) calculation using a handheld Doppler. Patients who screened positive were provided with appropriate counseling on possible treatments, medications, and lifestyle modifications and referred to their primary care physician for further evaluation. Main outcome measures: Successful implementation of program, number of patients referred to their physician for follow-up, and number of patients with ABI scores indicating PAD. Results: 17 of the 39 patients screened (44%) were referred to their physician for follow-up because they had ABI scores indicating PAD, symptoms indicating PAD, or noncompressible vessels. Using ABI scores, PAD was detected in nine patients (23.1%). Pharmacists implemented the program successfully. Conclusion: This study successfully demonstrated the feasibility of implementing a pharmacist-initiated PAD screening program in the community setting. The implementation of this screening program included the acquisition of affordable equipment, training of pharmacists, and access to the appropriate patient population. This study also was effective in increasing the recognition of PAD in patients screened in the community setting.


Hui-Callahan B.C.,Kroger Pharmacy | Luder H.R.,University of Cincinnati | Frede S.M.,Kroger Pharmacy
Journal of the American Pharmacists Association | Year: 2013

Objectives: To determine whether patients with diabetes who used a financial rewards program in a grocery chain pharmacy had increased rates of self-reported healthy behaviors, to measure the impact of the program on glycosylated hemoglobin (A1C), and to measure the impact of the program on grocery store sales. Methods: This prospective study took place at one location of a grocery chain pharmacy in Cincinnati, OH. Adult patients with diabetes on at least one diabetes medication were eligible to participate. Participants received a $5 incentive for each weeklong behavior log completed and reviewed with the pharmacist, who provided counseling on improving healthy behaviors. Change in self-reported healthy behaviors, A1C, grocery store expenditure, and program satisfaction were measured. Results: During the 12-week study, 25 patients enrolled in the program. A total of 13 participants completed the poststudy survey and reported increased rates of self-monitoring of blood glucose and blood pressure and increased exercise frequency. Differences in A1C and grocery store expenditures were unable to be detected. Satisfaction with the pay-for-performance-for-patients (P4P4P) program was favorable (8.6 on a 10-point scale). Conclusion: Participants given small, frequent financial incentives had increased frequency of healthy behaviors and were satisfied with the P4P4P program.


Metzger A.,University of Cincinnati | Nagaraj T.,Kroger Pharmacy
Consultant Pharmacist | Year: 2015

OBJECTIVE: This article serves as a resource for health care professionals by providing a summary of primary literature and guidelines for use of the available oral anticoagulant agents. The cost vs. efficacy aspects and reversibility of these medications are also addressed. DATA SOURCES, STUDY SELECTION, AND DATA SYNTHESIS: A PubMed search and Cochrane database review were conducted between June 15 and June 30, 2014, to find appropriate primary literature on each of the new oral anticoagulants. All phase 3 trials for apixaban, rivaroxaban, dabigatran, and edoxaban for the treatment of stroke prevention in atrial fibrillation (AF) and venous thromboembolism (VTE) were included. The American College of Chest Physicians guideline recommendations for stroke prevention in AF and VTE treatment, and the American Heart Association/American College of Cardiology guidelines for AF were reviewed, and pertinent information regarding the new anticoagulants from these guidelines is included in this review. A PubMed search was also used to identify cost-efficacy references and articles on reversibility of bleeding discussed in this paper. For all these articles, no further data analysis was performed; rather summaries and discussions of all of the articles included are provided in this review. CONCLUSION: The new oral anticoagulant agents have great potential in becoming standard therapy in both VTE and stroke prevention with AF. Initial clinical evidence proves they are clinically effective and potentially cost-effective for patients searching for an alternative for warfarin. Once reversal agents are developed and long-term use data become available, these agents will likely become common in many clinical practices. © 2015 American Society of Consultant Pharmacists, Inc. All rights reserved.

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