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Papers by Nancy Borja-Hart

Research paper thumbnail of Chapter 28: Patient Assessment

Research paper thumbnail of Incorporation of a mock pharmacy and therapeutics committee as an entrustable professional activity supporting task

Currents in Pharmacy Teaching and Learning, Jul 1, 2021

INTRODUCTION Entrustable professional activities (EPAs) denote activities and tasks students shou... more INTRODUCTION Entrustable professional activities (EPAs) denote activities and tasks students should be able to perform by graduation irrespective of their practice setting. Formulary decision-making includes several core EPA related skills, such as utilization of drug information, written, and verbal skills. The objective of this study was to describe an EPA supporting task aimed at improving utilization of evidence-based medicine skills and its impact on student self-perceived confidence, rating of skills needed, and competence. METHODS Teams comprised of six to seven students were assigned a drug and instructed to complete the following activities: (1) background literature search, (2) drug monograph, (3) five-min presentation to simulate a live pharmacy and therapeutics (P&T) committee meeting, and (4) vote on a formulary drug in each drug class. Students completed a pre/post five-point Likert scale self-efficacy survey and a perceived importance survey. A scoring rubric assessed monograph and presentation elements (max points 30). Survey items were analyzed using Wilcoxon signed-rank test. Descriptive statistics were used for assignment grades. RESULTS One hundred ninety students completed the pre/post self-efficacy and perceived importance survey. Confidence showed statistically significant improvement (P < .001) in nine target skill areas. In ranking importance, all 12 assessed skills exhibited a statistically significant increase following the activity. CONCLUSIONS A mock P&T activity represents an innovative way to evaluate an EPA supporting task that allows students to improve their evidence-based analysis, written, and verbal communication skills.

Research paper thumbnail of Rabies vaccination update

Journal of the American Pharmacists Association, 2010

Rabies is a virus present in the saliva of rabid animals such as raccoons, foxes, dogs, cats, and... more Rabies is a virus present in the saliva of rabid animals such as raccoons, foxes, dogs, cats, and bats.1 In developing countries, dogs are a major source of rabies. Two categories of exposure should be considered: bite and nonbite. A bite or any skin penetration by teeth is considered a direct exposure and a potential risk. The risk of transmission increases based on the anatomic location of the bite, animal species involved, and severity of the wound. Contact of open wounds or abrasions with infectious material or saliva from a rabid animal is considered a nonbite exposure, which rarely causes rabies.1 In the early stages of the disease, patients may present with nonspecific symptoms such as pain and itching at the wound site. These symptoms can last 2 to 10 days. As the disease progresses, the clinical presentation develops into the furious (encephalitic) or dumb (paralytic) form of rabies.2 Dysphagia, confusion, paralysis, and hypersalivation are a few of the symptoms patients may experience.3 Death is almost inevitable after signs and symptoms occur. Vaccination has been key in primary prevention and postexposure prophylaxis. Preexposure prophylaxis is recommended only for certain populations at risk of exposure. Postexposure prophylaxis is warranted depending on the category of exposure and animal type (Table 1). Between 16,000 and 39,000 people receive rabies postexposure prophylaxis yearly in the United States.1

Research paper thumbnail of Preparation for a medical mission to Jamaica--pharmacy's perspective

PubMed, Mar 1, 2011

Objective: To describe preparation of a medical mission from a pharmacy team's perspective. Metho... more Objective: To describe preparation of a medical mission from a pharmacy team's perspective. Methods: Essential components of the medication planning process include the development of a separate medication budget, a medication formulary (based on needs assessment and availability) and acquisition of medications and medical supplies. Results: For the medical mission to Jamaica, medications are often purchased or donated from various locations, including retail pharmacies, drug wholesalers, medication drives, pharmaceutical companies, and medication assistance programmes specific to medical missions. It is essential to understand the policy associated with the importation of medications which can be found in the Approval Process for Food, Drugs, Cosmetics, Medical devices, Precursor Chemicals and Narcotics, a paper developed by the Ministry of Health, Jamaica. Conclusions: Elevated levels of planning and preparation are required for the medical mission to Jamaica to be a success; assistance and cooperation is necessary from all members of the interdisciplinary medical mission team. It is imperative to plan ahead, be organized and equipped to handle unexpected situations so that quality care can be delivered to the patients to be served.

Research paper thumbnail of Education plays a major role in a medical mission

Journal of the American Pharmacists Association, May 1, 2010

Research paper thumbnail of Training and retaining community pharmacy leaders: Career pathways after completing a PGY1 community pharmacy residency affiliated with a large supermarket chain

Journal of the American Pharmacists Association, 2017

Objective: To determine pharmacist career paths and resident perceptions after completion of a PG... more Objective: To determine pharmacist career paths and resident perceptions after completion of a PGY1 community pharmacy residency with a national supermarket pharmacy chain. Methods: Cross-sectional nationwide survey. Results: Overall, 65% (n ¼ 24) of residents who responded accepted a position with Kroger immediately after graduation. When asked about the degree of value the residency had on obtaining the resident's ideal position, 29 (76%) reported that it was "very valuable" and the remaining 9 (24%) reported that it was "somewhat valuable." Positions that these pharmacists held immediately after residency completion were: clinical pharmacist (clinical coordinators, patient care specialists, or patient care managers; 54%), staff pharmacist (21%), split/mixed (mixed clinical and staffing components; 21%), and pharmacy manager (4%). Conclusion: Residency trained pharmacists were retained by the pharmacy chain where they practiced, and the majority of those pharmacists held split or full-time clinical pharmacist roles within the chain supermarket pharmacy.

Research paper thumbnail of The prevalence of cardiovascular risk factors and diabetes increases with a body mass index of > or = 23 kg/m2 in Filipino American women

PubMed, 2014

Objective: Although elevated body mass index (BMI) increases the risk for cardiovascular disease ... more Objective: Although elevated body mass index (BMI) increases the risk for cardiovascular disease (CVD) and diabetes universally, the BMI associated with increased risk for these two diseases needs to be established for Filipino American women (FAW). The relationship of BMI with diabetes and other CVD risk factors in FAW was investigated to determine if BMI levels less than the conventional 25 kg/m2 are associated with increased CVD risk factors. Methods: In a cross-sectional study conducted in four cities, FAW (n=193), aged 40 to 65 years, were screened for CVD risk factors and diabetes. Mean concentrations and prevalence of CVD risk factors were examined as a function of BMI category (BMI < or =22.9 n=41, BMI 23-24.9 n=46, BMI 25-29.9 n=75, and BMI > or =30 n= 31). Results: Body mass index correlated significantly with waist circumference (P<.0001), systolic blood pressure (P<.0001), diastolic blood pressure (P<.001), fasting blood glucose (P<.05), hemoglobin A1c (P<.001), triglycerides (P<.001), high sensitivity C-reactive protein (P<.001) and high density lipoprotein -C (P<.001). The prevalence of diabetes, decreased levels of high density lipoprotein-cholesterol, hypertension, elevated triglycerides, and high sensitivity C-reactive protein increased significantly (P<.01-.001) with BMI categories starting at BMI 23-24.9 kg/m2. Conclusion: Body mass index was an excellent predictor of elevated CVD risk factors in this population and the prevalence of most of these factors increased at BMIs as low as 23-24.9 kg/m2 suggesting a need to investigate risk factors and CVD events as a function of BMI in larger studies of Filipino American women.

Research paper thumbnail of Management of hypertension with fixed-dose triple-combination treatments

Therapeutic Advances in Cardiovascular Disease, Aug 14, 2013

The objective of this review is to evaluate the role of fixed-dose triple-combination therapy for... more The objective of this review is to evaluate the role of fixed-dose triple-combination therapy for the management of hypertension. An assessment of clinical trials showed that half the patients with hypertension have uncontrolled blood pressure (BP), with underlying factors including therapeutic inertia and poor patient adherence. Many patients will require three antihypertensive agents to achieve BP goals, and current guidelines recommend combining drugs with complementary mechanisms of action. Three single-pill triple-combination treatments are available and each includes an agent affecting the renin-angiotensinaldosterone pathway (either a direct renin inhibitor or an angiotensin II receptor blocker) in combination with a calcium channel blocker and diuretic. These triple-combination therapies consistently demonstrated significantly greater BP reduction relative to the component dual combinations, with BP reductions documented across a range of patient populations. Triplecombination treatments were well tolerated in all clinical trials reviewed. The use of singlepill, triple-combination antihypertensive therapy has been shown to be an effective, welltolerated, and convenient treatment strategy that can help patients achieve BP control.

Research paper thumbnail of Screening for social determinants of health in community pharmacy: Identifying best practices, barriers, and strategies for success

Journal of the American Pharmacists Association, Sep 1, 2021

The social determinants of health (SDOH) play a key role in patients' access to health care a... more The social determinants of health (SDOH) play a key role in patients' access to health care and medications. There exists an area of opportunity to leverage community pharmacists to make a large impact in identifying and incorporating an understanding of a patient's SDOH into their treatment plan. Community pharmacies are accessible and trusted avenues for health care interventions. With the advancement of appointment-based models as well as the increased training of support personnel, community pharmacies may be well suited for this public health task. However, there are major challenges such as paradigm shifts in workflow, reimbursement, and training that must be addressed to make this endeavor successful. This commentary explores the sparse literature related to community pharmacists conducting screening for social risk factors to identify best practices and barriers to implementation and outlines how screening for social needs aligns with the Pharmacists' Patient Care Process.

Research paper thumbnail of Pharmacy resident third party credentialing and reimbursement in a Family Medicine clinic

JACCP: journal of the American College of Clinical Pharmacy, Feb 2, 2022

Research paper thumbnail of Drug Information Resources Used by Chain Community Pharmacists in Tennessee

The Journal of pharmacy technology, Aug 3, 2016

Background: Community pharmacists are a highly utilized drug information resource for patients an... more Background: Community pharmacists are a highly utilized drug information resource for patients and health care providers. Good retrieval skills and the availability of credible references are key to providing necessary information. Objective: This study aimed to identify the types of drug information resources used by chain community pharmacists in Tennessee. Methods: A phone survey was conducted by a trained pharmacy student to 39 pharmacists working at chain community pharmacies. Demographic questions, types of drug information resources available, Internet availability, smartphone applications (apps) used, and most common drug information questions received were identified. Results: Electronic tertiary drug resources were used by the majority of pharmacists, with the top 2 resources being Clinical Pharmacology and Facts and Comparisons. Seventy-four percent of pharmacists surveyed used smartphone apps to access information more quickly. Few pharmacists stated access to primary literature, while 4 pharmacists cited using the secondary resource PubMed. The 2 most commonly asked questions were concerning adverse drug reactions and side effects. Conclusions: Electronic drug information resources are widely available and utilized. In order to comply with all of the demands that a pharmacists comes across, these resources need to be very familiar and easy to operate from an efficiency standpoint .

Research paper thumbnail of Use of virtual patient software to assess student confidence and ability in communication skills and virtual patient impression: A mixed-methods approach

Currents in Pharmacy Teaching and Learning, Jul 1, 2019

Background and purpose: Knowledge related to the use of virtual patients (VP) in pharmacy educati... more Background and purpose: Knowledge related to the use of virtual patients (VP) in pharmacy education is limited in relation to student satisfaction with this learning technique. This project aimed to assess students' confidence and impressions in using their communication skills with a VP and to evaluate their skills using this technology. Educational activity and setting: This explanatory mixed-methods study was conducted with firstyear doctor of pharmacy students. Fourteen survey items that addressed confidence in student abilities and VP impressions were analyzed. Mann-Whitney U tests were conducted to compare pre-and post-scores. Student reflections were reviewed to obtain primary themes and concerns. Descriptive statistics were used for student grades. Findings: Out of 205 students, 203 completed the pre-survey and 163 completed the post-survey. Responses regarding pre-post confidence indicated statistically significant improvement (p < 0.001) for 8 of 10 survey items as follows: understand history taking, conduct an organized interview, elicit subjective information, ask follow-up questions, ask questions related to severity, document subjective data, document objective data, and organize an interview. Regarding their impressions toward VPs, student responses were improved and statistically significant (p < 0.001) for 1 of 4 survey items (tools are easy to use). Forty-two students stressed the need to improve their written communication skills in the self-reflection. The average grade for subjective data was 31.48% and for objective data was 93.66%. Summary: This VP program improved student confidence in their verbal and written communication skills despite low subjective data scores. Background and purpose Simulation in the form of standardized patients, mannequins/manikins, and virtual patients has been used nationwide as a critical aspect of health care education. 1 Human standardized patients (SPs) provide the ideal practice experience for teaching and testing communication skills, but they are an expensive and time intensive resource with some limitations. 2,3 They are formally trained for student interviews and need accommodations to allow for professional interactions. Interactions with SPs can be inconsistent, with

Research paper thumbnail of Comparison of body mass index, waist circumference, and waist to height ratio in the prediction of hypertension and diabetes mellitus: Filipino-American women cardiovascular study

Preventive medicine reports, Dec 1, 2016

The relative ability of three obesity indices to predict hypertension (HTN) and diabetes (DM) and... more The relative ability of three obesity indices to predict hypertension (HTN) and diabetes (DM) and the validity of using Asian-specific thresholds of these indices were examined in Filipino-American women (FAW). Filipino-American women (n = 382), 40-65 years of age were screened for hypertension (HTN) and diabetes (DM) in four major US cities. Body mass index (BMI), waist circumference (WC) and waist circumference to height ratio (WHtR) were measured. ROC analyses determined that the three obesity measurements were similar in predicting HTN and DM (AUC: 0.6-0.7). The universal WC threshold of ≥35 in. missed 13% of the hypertensive patients and 12% of the diabetic patients. The Asian WC threshold of ≥31.5 in. increased detection of HTN and DM but with a high rate of false positives. The traditional BMI ≥ 25 kg/m 2 threshold missed 35% of those with hypertension and 24% of those with diabetes. The Asian BMI threshold improved detection but resulted in a high rate of false positives. The suggested WHtR cutoff of ≥0.5 missed only 1% of those with HTN and 0% of those with DM. The three obesity measurements had similar but modest ability to predict HTN and DM in FAW. Using Asian-specific thresholds increased accuracy but with a high rate of false positives. Whether FAW, especially at older ages, should be encouraged to reach these lower thresholds needs further investigation because of the high false positive rates.

Research paper thumbnail of Osteoporosis screenings: A proposed model for management

Journal of the American Pharmacists Association, Nov 1, 2012

Research paper thumbnail of Defining the role of pharmacists in addressing the social determinants of health

Research in Social & Administrative Pharmacy, Sep 1, 2022

As one of the overreaching goals of Healthy People 2030, addressing the social determinants of he... more As one of the overreaching goals of Healthy People 2030, addressing the social determinants of health (SDOH) to reduce health disparities is a nationwide concern, with objectives informed by interdisciplinary teams of experts. However, there remains much discussion regarding the roles of healthcare providers in addressing SDOH. While current guidance suggests that all members of the healthcare team must be empowered to address SDOH, current guidance explicitly references physicians, nurses, social workers and staff, and do not specifically include pharmacists. While pharmacists are taught about the impact of SDOH in pharmacy curricula, actionable strategies for pharmacists to address SDOH in practice have not been clearly outlined. Pharmacists have multifaceted interactions with patients and may be influential in meeting individual patient needs, identifying social risk factors, and addressing upstream causes of health disparities. This paper proposes a framework for the role of pharmacists in addressing the SDOH through strategies at the patient, practice, and community levels. The concepts presented in this paper are meant to serve as a launch point for discussion and to promote the inclusion of pharmacists in the conversations around sustainable efforts to achieve health equity. This framework is not intended to limit the scope of pharmacists in addressing SDOH - on the contrary, it is our hope that this outline may be used to expand the education of future healthcare professionals regarding their role in addressing the social determinants of health.

Research paper thumbnail of One size does not fit all: cardiovascular health disparities as a function of ethnicity in Asian-American women

Applied Nursing Research, May 1, 2015

Although few studies have examined cardiovascular disease in Asian-American subgroups separately,... more Although few studies have examined cardiovascular disease in Asian-American subgroups separately, limited data in Asian Americans strongly suggest that some subgroups are at increased risk. The present study examined modifiable cardiovascular risk factor profiles as a function of Asian ethnicity. This descriptive cross-sectional pilot study recruited Asian-American women (N=147) in northeast Florida including Cambodians (n=39), Chinese (n=36), Filipinos (n=49), and Vietnamese (n=23). Risk factors included blood pressure, body mass index, waist circumference and blood lipids. Filipino participants (41%) had ≥4 risk factors compared to 21% Cambodian, 13% Vietnamese and 0% Chinese. The Chinese had significantly more participants (44%) with the absence of CVD risk factors compared to all other subgroups. Obesity rate (18%), mean BMI: 26±5kg/m(2) and mean triglycerides (173±103mg/dL) were highest in Filipinas (n=49). The Chinese (n=36) had a low rate (4%) of obesity with a mean BMI of 23±3kg/m(2) and the least risk factors along with the lowest triglycerides (88±44mg/dL). Cambodians (n=39; BMI of 24±3kg/m(2)) and Vietnamese (n=23; BMI: 22±3kg/m(2)) had low rates of obesity with comparable rates of unhealthy lipids and hypertension as the Filipinas. Modifiable CVD risk factor profiles significantly differed as a function of ethnicity supporting the premise that Asian-American women cannot be categorized as one group and the traditional &amp;amp;amp;amp;amp;amp;amp;amp;quot;one size fits all&amp;amp;amp;amp;amp;amp;amp;amp;quot; prevention or treatment of CVD risk factors should be re-considered.

Research paper thumbnail of Impact of Prior Authorization Delays on Hepatitis C Treatment Completion Rates and Sustained Virologic Response

Research in Social & Administrative Pharmacy, Jun 1, 2019

Research paper thumbnail of Develop a Plan to Increase Access to Medications for A Lower-Income Family

The American Pharmacists Association eBooks, Sep 1, 2021

Research paper thumbnail of Pharmacovigilance of Sodium-Glucose Cotransporter-2 Inhibitors for Genital Fungal Infections and Urinary Tract Infections: A Review of the Food and Drug Administration Adverse Event Reporting System Database

The Journal of pharmacy technology, Feb 23, 2018

Background: Postmarketing surveillance had previously identified the need for revisions in the la... more Background: Postmarketing surveillance had previously identified the need for revisions in the labeling of the sodium-glucose cotransporter-2 (SGLT2) inhibitors drug class related to the risk of diabetic ketoacidosis. Other adverse events have been reported. Objective: To examine postmarketing surveillance data of the SGLT2 inhibitors, using the Food and Drug Administration Adverse Event Reporting System (FAERS) database, specifically to assess prevalence of urinary tract infections (UTIs) and genital fungal infections. Methods: FAERS case reports submitted between March 2013 and November 2015 were reviewed for 6 SGLT2 inhibitors (mono and combo therapies). The Medical Dictionary for Regulatory Activities (MedDRA) was used to define preferred terms (genital fungal infections: vulvovaginal mycotic infection, vulvovaginal candidiasis, urinary tract infection fungal, and genital candidiasis; UTI: urinary tract infection, genitourinary tract infection, kidney infection, cystitis, and pyelonephritis). Word frequencies were queried using the qualitative data analysis software NVivo 11 (QSR International), and results were then individually reviewed. Results: A total of 12 581 cases were received, but 466 were excluded (total n = 12 115). A total of 348 cases related to genital fungal infections were reported (2.9% of reports submitted): dapagliflozin = 53, empagliflozin/linagliptin = 6, canagliflozin = 267, canagliflozin/metformin = 3, empagliflozin = 17, and dapagliflozin/metformin HCl ER = 2. A total of 727 cases related to UTIs were reported (6% of reports submitted): dapagliflozin = 168, empagliflozin/linagliptin = 5, canagliflozin/metformin = 8, canagliflozin = 503, empagliflozin = 38, and dapagliflozin/metformin HCl ER = 5. Conclusions: A causal relationship between SGLT2 inhibitors and the adverse events reported cannot be established due to the nature of postmarketing surveillance. However, health care providers should counsel patients about these potential adverse events.

Research paper thumbnail of Availability of drug information on community pharmacy websites in Tennessee

International Journal of Pharmacy Practice, Feb 9, 2017

Objective This study reports the availability and type of drug information resources on community... more Objective This study reports the availability and type of drug information resources on community pharmacy websites in Tennessee. Methods A list of pharmacies was obtained from the Tennessee Board of Pharmacy. All community pharmacies located in Tennessee with a website were evaluated. Community pharmacy websites that listed a drug information resource were further analysed into pharmacy type and drug information provider. Key Findings One hundred and sixty-nine websites were evaluated. Thirty-six websites listed a drug information resource. Fifty per cent of those sites used the drug information provider RxWiki. Other providers included drugs.com, First Data Bank, A.D.A.M., RxList, Gold Standard Multimedia and Express Scripts. Conclusion Community pharmacy websites are underutilized as a provider for credible drug information for the public.

Research paper thumbnail of Chapter 28: Patient Assessment

Research paper thumbnail of Incorporation of a mock pharmacy and therapeutics committee as an entrustable professional activity supporting task

Currents in Pharmacy Teaching and Learning, Jul 1, 2021

INTRODUCTION Entrustable professional activities (EPAs) denote activities and tasks students shou... more INTRODUCTION Entrustable professional activities (EPAs) denote activities and tasks students should be able to perform by graduation irrespective of their practice setting. Formulary decision-making includes several core EPA related skills, such as utilization of drug information, written, and verbal skills. The objective of this study was to describe an EPA supporting task aimed at improving utilization of evidence-based medicine skills and its impact on student self-perceived confidence, rating of skills needed, and competence. METHODS Teams comprised of six to seven students were assigned a drug and instructed to complete the following activities: (1) background literature search, (2) drug monograph, (3) five-min presentation to simulate a live pharmacy and therapeutics (P&T) committee meeting, and (4) vote on a formulary drug in each drug class. Students completed a pre/post five-point Likert scale self-efficacy survey and a perceived importance survey. A scoring rubric assessed monograph and presentation elements (max points 30). Survey items were analyzed using Wilcoxon signed-rank test. Descriptive statistics were used for assignment grades. RESULTS One hundred ninety students completed the pre/post self-efficacy and perceived importance survey. Confidence showed statistically significant improvement (P < .001) in nine target skill areas. In ranking importance, all 12 assessed skills exhibited a statistically significant increase following the activity. CONCLUSIONS A mock P&T activity represents an innovative way to evaluate an EPA supporting task that allows students to improve their evidence-based analysis, written, and verbal communication skills.

Research paper thumbnail of Rabies vaccination update

Journal of the American Pharmacists Association, 2010

Rabies is a virus present in the saliva of rabid animals such as raccoons, foxes, dogs, cats, and... more Rabies is a virus present in the saliva of rabid animals such as raccoons, foxes, dogs, cats, and bats.1 In developing countries, dogs are a major source of rabies. Two categories of exposure should be considered: bite and nonbite. A bite or any skin penetration by teeth is considered a direct exposure and a potential risk. The risk of transmission increases based on the anatomic location of the bite, animal species involved, and severity of the wound. Contact of open wounds or abrasions with infectious material or saliva from a rabid animal is considered a nonbite exposure, which rarely causes rabies.1 In the early stages of the disease, patients may present with nonspecific symptoms such as pain and itching at the wound site. These symptoms can last 2 to 10 days. As the disease progresses, the clinical presentation develops into the furious (encephalitic) or dumb (paralytic) form of rabies.2 Dysphagia, confusion, paralysis, and hypersalivation are a few of the symptoms patients may experience.3 Death is almost inevitable after signs and symptoms occur. Vaccination has been key in primary prevention and postexposure prophylaxis. Preexposure prophylaxis is recommended only for certain populations at risk of exposure. Postexposure prophylaxis is warranted depending on the category of exposure and animal type (Table 1). Between 16,000 and 39,000 people receive rabies postexposure prophylaxis yearly in the United States.1

Research paper thumbnail of Preparation for a medical mission to Jamaica--pharmacy's perspective

PubMed, Mar 1, 2011

Objective: To describe preparation of a medical mission from a pharmacy team's perspective. Metho... more Objective: To describe preparation of a medical mission from a pharmacy team's perspective. Methods: Essential components of the medication planning process include the development of a separate medication budget, a medication formulary (based on needs assessment and availability) and acquisition of medications and medical supplies. Results: For the medical mission to Jamaica, medications are often purchased or donated from various locations, including retail pharmacies, drug wholesalers, medication drives, pharmaceutical companies, and medication assistance programmes specific to medical missions. It is essential to understand the policy associated with the importation of medications which can be found in the Approval Process for Food, Drugs, Cosmetics, Medical devices, Precursor Chemicals and Narcotics, a paper developed by the Ministry of Health, Jamaica. Conclusions: Elevated levels of planning and preparation are required for the medical mission to Jamaica to be a success; assistance and cooperation is necessary from all members of the interdisciplinary medical mission team. It is imperative to plan ahead, be organized and equipped to handle unexpected situations so that quality care can be delivered to the patients to be served.

Research paper thumbnail of Education plays a major role in a medical mission

Journal of the American Pharmacists Association, May 1, 2010

Research paper thumbnail of Training and retaining community pharmacy leaders: Career pathways after completing a PGY1 community pharmacy residency affiliated with a large supermarket chain

Journal of the American Pharmacists Association, 2017

Objective: To determine pharmacist career paths and resident perceptions after completion of a PG... more Objective: To determine pharmacist career paths and resident perceptions after completion of a PGY1 community pharmacy residency with a national supermarket pharmacy chain. Methods: Cross-sectional nationwide survey. Results: Overall, 65% (n ¼ 24) of residents who responded accepted a position with Kroger immediately after graduation. When asked about the degree of value the residency had on obtaining the resident's ideal position, 29 (76%) reported that it was "very valuable" and the remaining 9 (24%) reported that it was "somewhat valuable." Positions that these pharmacists held immediately after residency completion were: clinical pharmacist (clinical coordinators, patient care specialists, or patient care managers; 54%), staff pharmacist (21%), split/mixed (mixed clinical and staffing components; 21%), and pharmacy manager (4%). Conclusion: Residency trained pharmacists were retained by the pharmacy chain where they practiced, and the majority of those pharmacists held split or full-time clinical pharmacist roles within the chain supermarket pharmacy.

Research paper thumbnail of The prevalence of cardiovascular risk factors and diabetes increases with a body mass index of > or = 23 kg/m2 in Filipino American women

PubMed, 2014

Objective: Although elevated body mass index (BMI) increases the risk for cardiovascular disease ... more Objective: Although elevated body mass index (BMI) increases the risk for cardiovascular disease (CVD) and diabetes universally, the BMI associated with increased risk for these two diseases needs to be established for Filipino American women (FAW). The relationship of BMI with diabetes and other CVD risk factors in FAW was investigated to determine if BMI levels less than the conventional 25 kg/m2 are associated with increased CVD risk factors. Methods: In a cross-sectional study conducted in four cities, FAW (n=193), aged 40 to 65 years, were screened for CVD risk factors and diabetes. Mean concentrations and prevalence of CVD risk factors were examined as a function of BMI category (BMI < or =22.9 n=41, BMI 23-24.9 n=46, BMI 25-29.9 n=75, and BMI > or =30 n= 31). Results: Body mass index correlated significantly with waist circumference (P<.0001), systolic blood pressure (P<.0001), diastolic blood pressure (P<.001), fasting blood glucose (P<.05), hemoglobin A1c (P<.001), triglycerides (P<.001), high sensitivity C-reactive protein (P<.001) and high density lipoprotein -C (P<.001). The prevalence of diabetes, decreased levels of high density lipoprotein-cholesterol, hypertension, elevated triglycerides, and high sensitivity C-reactive protein increased significantly (P<.01-.001) with BMI categories starting at BMI 23-24.9 kg/m2. Conclusion: Body mass index was an excellent predictor of elevated CVD risk factors in this population and the prevalence of most of these factors increased at BMIs as low as 23-24.9 kg/m2 suggesting a need to investigate risk factors and CVD events as a function of BMI in larger studies of Filipino American women.

Research paper thumbnail of Management of hypertension with fixed-dose triple-combination treatments

Therapeutic Advances in Cardiovascular Disease, Aug 14, 2013

The objective of this review is to evaluate the role of fixed-dose triple-combination therapy for... more The objective of this review is to evaluate the role of fixed-dose triple-combination therapy for the management of hypertension. An assessment of clinical trials showed that half the patients with hypertension have uncontrolled blood pressure (BP), with underlying factors including therapeutic inertia and poor patient adherence. Many patients will require three antihypertensive agents to achieve BP goals, and current guidelines recommend combining drugs with complementary mechanisms of action. Three single-pill triple-combination treatments are available and each includes an agent affecting the renin-angiotensinaldosterone pathway (either a direct renin inhibitor or an angiotensin II receptor blocker) in combination with a calcium channel blocker and diuretic. These triple-combination therapies consistently demonstrated significantly greater BP reduction relative to the component dual combinations, with BP reductions documented across a range of patient populations. Triplecombination treatments were well tolerated in all clinical trials reviewed. The use of singlepill, triple-combination antihypertensive therapy has been shown to be an effective, welltolerated, and convenient treatment strategy that can help patients achieve BP control.

Research paper thumbnail of Screening for social determinants of health in community pharmacy: Identifying best practices, barriers, and strategies for success

Journal of the American Pharmacists Association, Sep 1, 2021

The social determinants of health (SDOH) play a key role in patients' access to health care a... more The social determinants of health (SDOH) play a key role in patients' access to health care and medications. There exists an area of opportunity to leverage community pharmacists to make a large impact in identifying and incorporating an understanding of a patient's SDOH into their treatment plan. Community pharmacies are accessible and trusted avenues for health care interventions. With the advancement of appointment-based models as well as the increased training of support personnel, community pharmacies may be well suited for this public health task. However, there are major challenges such as paradigm shifts in workflow, reimbursement, and training that must be addressed to make this endeavor successful. This commentary explores the sparse literature related to community pharmacists conducting screening for social risk factors to identify best practices and barriers to implementation and outlines how screening for social needs aligns with the Pharmacists' Patient Care Process.

Research paper thumbnail of Pharmacy resident third party credentialing and reimbursement in a Family Medicine clinic

JACCP: journal of the American College of Clinical Pharmacy, Feb 2, 2022

Research paper thumbnail of Drug Information Resources Used by Chain Community Pharmacists in Tennessee

The Journal of pharmacy technology, Aug 3, 2016

Background: Community pharmacists are a highly utilized drug information resource for patients an... more Background: Community pharmacists are a highly utilized drug information resource for patients and health care providers. Good retrieval skills and the availability of credible references are key to providing necessary information. Objective: This study aimed to identify the types of drug information resources used by chain community pharmacists in Tennessee. Methods: A phone survey was conducted by a trained pharmacy student to 39 pharmacists working at chain community pharmacies. Demographic questions, types of drug information resources available, Internet availability, smartphone applications (apps) used, and most common drug information questions received were identified. Results: Electronic tertiary drug resources were used by the majority of pharmacists, with the top 2 resources being Clinical Pharmacology and Facts and Comparisons. Seventy-four percent of pharmacists surveyed used smartphone apps to access information more quickly. Few pharmacists stated access to primary literature, while 4 pharmacists cited using the secondary resource PubMed. The 2 most commonly asked questions were concerning adverse drug reactions and side effects. Conclusions: Electronic drug information resources are widely available and utilized. In order to comply with all of the demands that a pharmacists comes across, these resources need to be very familiar and easy to operate from an efficiency standpoint .

Research paper thumbnail of Use of virtual patient software to assess student confidence and ability in communication skills and virtual patient impression: A mixed-methods approach

Currents in Pharmacy Teaching and Learning, Jul 1, 2019

Background and purpose: Knowledge related to the use of virtual patients (VP) in pharmacy educati... more Background and purpose: Knowledge related to the use of virtual patients (VP) in pharmacy education is limited in relation to student satisfaction with this learning technique. This project aimed to assess students' confidence and impressions in using their communication skills with a VP and to evaluate their skills using this technology. Educational activity and setting: This explanatory mixed-methods study was conducted with firstyear doctor of pharmacy students. Fourteen survey items that addressed confidence in student abilities and VP impressions were analyzed. Mann-Whitney U tests were conducted to compare pre-and post-scores. Student reflections were reviewed to obtain primary themes and concerns. Descriptive statistics were used for student grades. Findings: Out of 205 students, 203 completed the pre-survey and 163 completed the post-survey. Responses regarding pre-post confidence indicated statistically significant improvement (p < 0.001) for 8 of 10 survey items as follows: understand history taking, conduct an organized interview, elicit subjective information, ask follow-up questions, ask questions related to severity, document subjective data, document objective data, and organize an interview. Regarding their impressions toward VPs, student responses were improved and statistically significant (p < 0.001) for 1 of 4 survey items (tools are easy to use). Forty-two students stressed the need to improve their written communication skills in the self-reflection. The average grade for subjective data was 31.48% and for objective data was 93.66%. Summary: This VP program improved student confidence in their verbal and written communication skills despite low subjective data scores. Background and purpose Simulation in the form of standardized patients, mannequins/manikins, and virtual patients has been used nationwide as a critical aspect of health care education. 1 Human standardized patients (SPs) provide the ideal practice experience for teaching and testing communication skills, but they are an expensive and time intensive resource with some limitations. 2,3 They are formally trained for student interviews and need accommodations to allow for professional interactions. Interactions with SPs can be inconsistent, with

Research paper thumbnail of Comparison of body mass index, waist circumference, and waist to height ratio in the prediction of hypertension and diabetes mellitus: Filipino-American women cardiovascular study

Preventive medicine reports, Dec 1, 2016

The relative ability of three obesity indices to predict hypertension (HTN) and diabetes (DM) and... more The relative ability of three obesity indices to predict hypertension (HTN) and diabetes (DM) and the validity of using Asian-specific thresholds of these indices were examined in Filipino-American women (FAW). Filipino-American women (n = 382), 40-65 years of age were screened for hypertension (HTN) and diabetes (DM) in four major US cities. Body mass index (BMI), waist circumference (WC) and waist circumference to height ratio (WHtR) were measured. ROC analyses determined that the three obesity measurements were similar in predicting HTN and DM (AUC: 0.6-0.7). The universal WC threshold of ≥35 in. missed 13% of the hypertensive patients and 12% of the diabetic patients. The Asian WC threshold of ≥31.5 in. increased detection of HTN and DM but with a high rate of false positives. The traditional BMI ≥ 25 kg/m 2 threshold missed 35% of those with hypertension and 24% of those with diabetes. The Asian BMI threshold improved detection but resulted in a high rate of false positives. The suggested WHtR cutoff of ≥0.5 missed only 1% of those with HTN and 0% of those with DM. The three obesity measurements had similar but modest ability to predict HTN and DM in FAW. Using Asian-specific thresholds increased accuracy but with a high rate of false positives. Whether FAW, especially at older ages, should be encouraged to reach these lower thresholds needs further investigation because of the high false positive rates.

Research paper thumbnail of Osteoporosis screenings: A proposed model for management

Journal of the American Pharmacists Association, Nov 1, 2012

Research paper thumbnail of Defining the role of pharmacists in addressing the social determinants of health

Research in Social & Administrative Pharmacy, Sep 1, 2022

As one of the overreaching goals of Healthy People 2030, addressing the social determinants of he... more As one of the overreaching goals of Healthy People 2030, addressing the social determinants of health (SDOH) to reduce health disparities is a nationwide concern, with objectives informed by interdisciplinary teams of experts. However, there remains much discussion regarding the roles of healthcare providers in addressing SDOH. While current guidance suggests that all members of the healthcare team must be empowered to address SDOH, current guidance explicitly references physicians, nurses, social workers and staff, and do not specifically include pharmacists. While pharmacists are taught about the impact of SDOH in pharmacy curricula, actionable strategies for pharmacists to address SDOH in practice have not been clearly outlined. Pharmacists have multifaceted interactions with patients and may be influential in meeting individual patient needs, identifying social risk factors, and addressing upstream causes of health disparities. This paper proposes a framework for the role of pharmacists in addressing the SDOH through strategies at the patient, practice, and community levels. The concepts presented in this paper are meant to serve as a launch point for discussion and to promote the inclusion of pharmacists in the conversations around sustainable efforts to achieve health equity. This framework is not intended to limit the scope of pharmacists in addressing SDOH - on the contrary, it is our hope that this outline may be used to expand the education of future healthcare professionals regarding their role in addressing the social determinants of health.

Research paper thumbnail of One size does not fit all: cardiovascular health disparities as a function of ethnicity in Asian-American women

Applied Nursing Research, May 1, 2015

Although few studies have examined cardiovascular disease in Asian-American subgroups separately,... more Although few studies have examined cardiovascular disease in Asian-American subgroups separately, limited data in Asian Americans strongly suggest that some subgroups are at increased risk. The present study examined modifiable cardiovascular risk factor profiles as a function of Asian ethnicity. This descriptive cross-sectional pilot study recruited Asian-American women (N=147) in northeast Florida including Cambodians (n=39), Chinese (n=36), Filipinos (n=49), and Vietnamese (n=23). Risk factors included blood pressure, body mass index, waist circumference and blood lipids. Filipino participants (41%) had ≥4 risk factors compared to 21% Cambodian, 13% Vietnamese and 0% Chinese. The Chinese had significantly more participants (44%) with the absence of CVD risk factors compared to all other subgroups. Obesity rate (18%), mean BMI: 26±5kg/m(2) and mean triglycerides (173±103mg/dL) were highest in Filipinas (n=49). The Chinese (n=36) had a low rate (4%) of obesity with a mean BMI of 23±3kg/m(2) and the least risk factors along with the lowest triglycerides (88±44mg/dL). Cambodians (n=39; BMI of 24±3kg/m(2)) and Vietnamese (n=23; BMI: 22±3kg/m(2)) had low rates of obesity with comparable rates of unhealthy lipids and hypertension as the Filipinas. Modifiable CVD risk factor profiles significantly differed as a function of ethnicity supporting the premise that Asian-American women cannot be categorized as one group and the traditional &amp;amp;amp;amp;amp;amp;amp;amp;quot;one size fits all&amp;amp;amp;amp;amp;amp;amp;amp;quot; prevention or treatment of CVD risk factors should be re-considered.

Research paper thumbnail of Impact of Prior Authorization Delays on Hepatitis C Treatment Completion Rates and Sustained Virologic Response

Research in Social & Administrative Pharmacy, Jun 1, 2019

Research paper thumbnail of Develop a Plan to Increase Access to Medications for A Lower-Income Family

The American Pharmacists Association eBooks, Sep 1, 2021

Research paper thumbnail of Pharmacovigilance of Sodium-Glucose Cotransporter-2 Inhibitors for Genital Fungal Infections and Urinary Tract Infections: A Review of the Food and Drug Administration Adverse Event Reporting System Database

The Journal of pharmacy technology, Feb 23, 2018

Background: Postmarketing surveillance had previously identified the need for revisions in the la... more Background: Postmarketing surveillance had previously identified the need for revisions in the labeling of the sodium-glucose cotransporter-2 (SGLT2) inhibitors drug class related to the risk of diabetic ketoacidosis. Other adverse events have been reported. Objective: To examine postmarketing surveillance data of the SGLT2 inhibitors, using the Food and Drug Administration Adverse Event Reporting System (FAERS) database, specifically to assess prevalence of urinary tract infections (UTIs) and genital fungal infections. Methods: FAERS case reports submitted between March 2013 and November 2015 were reviewed for 6 SGLT2 inhibitors (mono and combo therapies). The Medical Dictionary for Regulatory Activities (MedDRA) was used to define preferred terms (genital fungal infections: vulvovaginal mycotic infection, vulvovaginal candidiasis, urinary tract infection fungal, and genital candidiasis; UTI: urinary tract infection, genitourinary tract infection, kidney infection, cystitis, and pyelonephritis). Word frequencies were queried using the qualitative data analysis software NVivo 11 (QSR International), and results were then individually reviewed. Results: A total of 12 581 cases were received, but 466 were excluded (total n = 12 115). A total of 348 cases related to genital fungal infections were reported (2.9% of reports submitted): dapagliflozin = 53, empagliflozin/linagliptin = 6, canagliflozin = 267, canagliflozin/metformin = 3, empagliflozin = 17, and dapagliflozin/metformin HCl ER = 2. A total of 727 cases related to UTIs were reported (6% of reports submitted): dapagliflozin = 168, empagliflozin/linagliptin = 5, canagliflozin/metformin = 8, canagliflozin = 503, empagliflozin = 38, and dapagliflozin/metformin HCl ER = 5. Conclusions: A causal relationship between SGLT2 inhibitors and the adverse events reported cannot be established due to the nature of postmarketing surveillance. However, health care providers should counsel patients about these potential adverse events.

Research paper thumbnail of Availability of drug information on community pharmacy websites in Tennessee

International Journal of Pharmacy Practice, Feb 9, 2017

Objective This study reports the availability and type of drug information resources on community... more Objective This study reports the availability and type of drug information resources on community pharmacy websites in Tennessee. Methods A list of pharmacies was obtained from the Tennessee Board of Pharmacy. All community pharmacies located in Tennessee with a website were evaluated. Community pharmacy websites that listed a drug information resource were further analysed into pharmacy type and drug information provider. Key Findings One hundred and sixty-nine websites were evaluated. Thirty-six websites listed a drug information resource. Fifty per cent of those sites used the drug information provider RxWiki. Other providers included drugs.com, First Data Bank, A.D.A.M., RxList, Gold Standard Multimedia and Express Scripts. Conclusion Community pharmacy websites are underutilized as a provider for credible drug information for the public.