Sara Griesbach - Academia.edu (original) (raw)

Papers by Sara Griesbach

Research paper thumbnail of Should organized clinical pharmacy promote a consistent process of patient care provided by clinical pharmacists that can apply to any clinical practice setting? Part IV: Model for discussion by the clinical pharmacy discipline

Research paper thumbnail of Preliminary outcomes of preemptive warfarin pharmacogenetic testing at a large rural healthcare center

American Journal of Health-system Pharmacy, Feb 21, 2019

Research paper thumbnail of Telephonic Monitoring and Optimization of Inhaler Technique

Telemedicine Journal and E-health, Nov 1, 2011

Introduction: Improper inhaler technique is a common problem affecting asthma control and healthc... more Introduction: Improper inhaler technique is a common problem affecting asthma control and healthcare costs. Telephonic asthma management can increase access to care while reducing costs and hospitalizations. However, no reliable method has been established for telephonically evaluating and correcting inhaler technique. Objective: The purpose of this study was to pilot test a method for assessing and correcting patient inhaler technique via telephone. Methods: Participants (n = 30) were adults with asthma using metered-dose inhalers (MDIs) and diskus inhalers. A pharmacist was located in one room and communicated via telephone with a participant in another room. The pharmacist telephonically assessed and taught inhaler technique. Participants were videorecorded, and videos were later examined by a second pharmacist to visually evaluate inhaler technique. Participants were assigned pre-and posteducation inhaler technique scores for the telephonic and video assessments. Scores were based on summated scales for MDI (0-9) and diskus (0-11) inhalers. Paired samples t-tests were used to compare telephone and video assessments. Results: Findings indicated a significant difference between the telephone and video assessments of MDI technique (p < 0.05); however, no difference was found for the diskus inhaler. Comparing pre-and posteducation inhaler technique for MDI and diskus, mean scores significantly improved from 5.7 to 7.8 (p < 0.05) and from 8.5 to 10.4 (p < 0.05), respectively. Conclusions: The telephonic method was able to improve and detect some deficiencies in patients' inhaler technique. However, modifications and further investigation will more clearly determine the role and value of such a telephonic intervention.

Research paper thumbnail of Should organized clinical pharmacy promote a consistent process of patient care provided by clinical pharmacists that can apply to any clinical practice setting? Part II: Current models of clinical pharmacy practice

Research paper thumbnail of Best Practices: An Electronic Drug Alert Program to Improve Safety in an Accountable Care Environment

Journal of managed care & specialty pharmacy, Apr 1, 2015

Research paper thumbnail of Should organized clinical pharmacy promote a consistent process of patient care provided by clinical pharmacists that can apply to any clinical practice setting? Part IIIB: Application of major practice models to sample cases

Research paper thumbnail of Designing a pharmacy residency program: Focus on a common accreditation challenge

American Journal of Health-system Pharmacy, Jun 15, 2013

One organization&amp;amp;amp;amp;#39;s stepwise approach to achieving full compliance in an a... more One organization&amp;amp;amp;amp;#39;s stepwise approach to achieving full compliance in an area often cited for improvement in pharmacy residency accreditation surveys is described. Principle 4 of the American Society of Health-System Pharmacists (ASHP) accreditation standard for postgraduate year 1 (PGY1) residencies lists requisite components of program design, conduct, and evaluation; many organizations seeking accreditation are evaluated as being in partial compliance with one or more elements of Principle 4. Several years ago, the Marshfield Clinic, a physician group practice in Wisconsin, launched an initiative to expand its postgraduate medical training program to include a PGY1 pharmacy residency. After a gap analysis of current practices and accreditation requirements, monthly meetings of pharmacy, faculty, and corporate leaders were conducted to address program development challenges, with ongoing input from the clinic&amp;amp;amp;amp;#39;s division of education. Strategies were developed for meeting all Principle 4 criteria. For example, with regard to component 4.2 (Program Delivery), the clinic developed a residency program handbook including standing operating procedures and a residency preceptor guide with a trainee evaluation scale, professional development resources, and guidance on providing resident feedback. After an internally conducted mock site visit to identify and resolve Principle 4 issues and other compliance issues, the clinic underwent an ASHP site visit and was subsequently accredited by the ASHP Commission on Credentialing. Marshfield Clinic used an efficient step-by-step process in the development of its PGY1 pharmacy residency program and achieved full compliance with all of the criteria outlined in Principle 4 of the ASHP accreditation standard.

Research paper thumbnail of Comparison of Prescribing Practices with Direct Acting Oral Anticoagulant Protocols

American Journal of Cardiovascular Drugs, Sep 8, 2017

BackgroundThe goal of anticoagulation management programs is to prevent thrombosis while minimizi... more BackgroundThe goal of anticoagulation management programs is to prevent thrombosis while minimizing the risks of hemorrhage. Direct acting oral anticoagulants (DOACs) selectively inhibit coagulation proteins to inhibit thrombosis. Previous studies suggest patient monitoring and education provided through anticoagulation services enhance adherence and decrease adverse outcomes in patients receiving DOAC therapy.ObjectiveThe objectives of this study were to describe DOAC prescribing adherence to anticoagulation service protocols and to observe whether enrollment in an anticoagulation service resulted in greater prescribing adherence to DOAC protocols.MethodsA retrospective cohort study evaluated all initial prescriptions of apixaban, dabigatran, and rivaroxaban at Marshfield Clinic from 19 October 2010 to 21 August 2014. Three algorithms analyzed patient and prescription data extracted from the organization’s electronic health record and classified prescriptions as per protocol or not per protocol. The algorithms classified not per protocol prescriptions as off-label indication, renal impairment [estimated glomerular filtration rate (eGFR) <30 ml/min], hepatic impairment (rivaroxaban and apixaban), advanced age >74 years (dabigatran), dose too low, or dose too high. The analysis assessed whether enrollment in the Marshfield Clinic Anticoagulation Service DOAC monitoring process was associated with increased adherence to protocols.ResultsIn aggregate, 72% of apixaban prescriptions, 52% of dabigatran prescriptions, and 70% of rivaroxaban prescriptions were per protocol. Off-label indications and dosage too low were the most common not per protocol reasons for apixaban and rivaroxaban prescriptions. Age ≥75 years and off-label indication were the most common not per protocol reasons for dabigatran prescriptions. Enrollment in the anticoagulation service process was not associated with increased adherence to protocols.ConclusionA significant proportion of DOAC prescriptions did not adhere to protocol expectations. While enrollment in DOAC management through the Marshfield Clinic Anticoagulation Service was not associated with increased adherence to protocols, opportunities exist to optimize DOAC prescribing. Defining ideal DOAC management requires additional research.

Research paper thumbnail of Interdisciplinary Deprescribing of Aspirin Through Prescriber Education and Provision of Patient-Specific Recommendations

WMJ : official publication of the State Medical Society of Wisconsin, Oct 1, 2022

Research paper thumbnail of Should organized clinical pharmacy promote a consistent process of patient care provided by clinical pharmacists that can apply to any clinical practice setting? Part IIIA: Comparative analysis of current practice models: strengths, weaknesses, similarities, differences, and applicability to diff...

Research paper thumbnail of Evaluating the Impact of Health Literacy on Medication Adherence and Outcomes in Patients with Heart Failure

O ne of the core concepts of the Patient Centered Medical Home (PCMH) is to facilitate a partners... more O ne of the core concepts of the Patient Centered Medical Home (PCMH) is to facilitate a partnership between patients and practitioners to help ensure patients have the knowledge and feel empowered to actively participate in setting goals for their own health care.1 An integral component to success of this partnership is understanding the barriers that prevent a patient from reaching specific treatment goals. One such barrier may include poor health literacy, which is defined by the Institute of Medicine as “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.”2 Health literacy is not regularly assessed by health care practitioners, even though low health literacy, including its effect on medication adherence, has a potential negative effect on health outcomes. For example, patients who have poorer understanding about disease processes and medications used to treat them...

Research paper thumbnail of Should organized clinical pharmacy promote a consistent process of patient care provided by clinical pharmacists that can apply to any clinical practice setting? Part IV: Model for discussion by the clinical pharmacy discipline

Research paper thumbnail of Evaluation of a pharmacist‐led intervention on naloxone co‐prescribing in patients receiving chronic opioid therapy

JACCP: JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY, 2021

IntroductionAlthough both the 2016 Centers for Disease Control and Prevention (CDC) guidelines an... more IntroductionAlthough both the 2016 Centers for Disease Control and Prevention (CDC) guidelines and the 2020 Food and Drug Administration (FDA) safety announcement recommend naloxone co‐prescribing to patients receiving long‐term opioid therapy (LTOT) for non‐cancer pain, the rate of naloxone co‐prescription in this population remains low.ObjectivesThe primary objective of this project was to determine whether a pharmacist intervention would lead to increased rates of naloxone co‐prescribing among providers.MethodsThis was a before‐and‐after interventional study to evaluate changes in naloxone co‐prescribing rates in response to clinical pharmacist recommendation of naloxone for LTOT patients to providers. The primary end point was rate of naloxone co‐prescription after pharmacist intervention. Providers of LTOT patients were emailed patient‐specific recommendations. Additional end points included calculation of the naloxone possession rate among patients and identification of patien...

Research paper thumbnail of Preliminary outcomes of preemptive warfarin pharmacogenetic testing at a large rural healthcare center

American Journal of Health-System Pharmacy, 2019

Purpose As a preliminary evaluation of the outcomes of implementing pharmacogenetic testing withi... more Purpose As a preliminary evaluation of the outcomes of implementing pharmacogenetic testing within a large rural healthcare system, patients who received pre-emptive pharmacogenetic testing and warfarin dosing were monitored until June 2017. Summary Over a 20-month period, 749 patients were genotyped for VKORC1 and CYP2C9 as part of the electronic Medical Records and Genomics Pharmacogenetics (eMERGE PGx) study. Of these, 27 were prescribed warfarin and received an alert for pharmacogenetic testing pertinent to warfarin; 20 patients achieved their target international normalized ratio (INR) of 2.0–3.0, and 65% of these patients achieved target dosing within the recommended pharmacogenetic alert dose (± 0.5 mg/day). Of these, 10 patients had never been on warfarin prior to the alert and were further evaluated with regard to time to first stable target INR, bleeds and thromboembolic events, hospitalizations, and mortality. There was a general trend of faster time to first stable targe...

Research paper thumbnail of Comparison of Prescribing Practices with Direct Acting Oral Anticoagulant Protocols

American Journal of Cardiovascular Drugs, 2017

BackgroundThe goal of anticoagulation management programs is to prevent thrombosis while minimizi... more BackgroundThe goal of anticoagulation management programs is to prevent thrombosis while minimizing the risks of hemorrhage. Direct acting oral anticoagulants (DOACs) selectively inhibit coagulation proteins to inhibit thrombosis. Previous studies suggest patient monitoring and education provided through anticoagulation services enhance adherence and decrease adverse outcomes in patients receiving DOAC therapy.ObjectiveThe objectives of this study were to describe DOAC prescribing adherence to anticoagulation service protocols and to observe whether enrollment in an anticoagulation service resulted in greater prescribing adherence to DOAC protocols.MethodsA retrospective cohort study evaluated all initial prescriptions of apixaban, dabigatran, and rivaroxaban at Marshfield Clinic from 19 October 2010 to 21 August 2014. Three algorithms analyzed patient and prescription data extracted from the organization’s electronic health record and classified prescriptions as per protocol or not per protocol. The algorithms classified not per protocol prescriptions as off-label indication, renal impairment [estimated glomerular filtration rate (eGFR) <30 ml/min], hepatic impairment (rivaroxaban and apixaban), advanced age >74 years (dabigatran), dose too low, or dose too high. The analysis assessed whether enrollment in the Marshfield Clinic Anticoagulation Service DOAC monitoring process was associated with increased adherence to protocols.ResultsIn aggregate, 72% of apixaban prescriptions, 52% of dabigatran prescriptions, and 70% of rivaroxaban prescriptions were per protocol. Off-label indications and dosage too low were the most common not per protocol reasons for apixaban and rivaroxaban prescriptions. Age ≥75 years and off-label indication were the most common not per protocol reasons for dabigatran prescriptions. Enrollment in the anticoagulation service process was not associated with increased adherence to protocols.ConclusionA significant proportion of DOAC prescriptions did not adhere to protocol expectations. While enrollment in DOAC management through the Marshfield Clinic Anticoagulation Service was not associated with increased adherence to protocols, opportunities exist to optimize DOAC prescribing. Defining ideal DOAC management requires additional research.

Research paper thumbnail of Telephonic Monitoring and Optimization of Inhaler Technique

Telemedicine and e-Health, 2011

Introduction: Improper inhaler technique is a common problem affecting asthma control and healthc... more Introduction: Improper inhaler technique is a common problem affecting asthma control and healthcare costs. Telephonic asthma management can increase access to care while reducing costs and hospitalizations. However, no reliable method has been established for telephonically evaluating and correcting inhaler technique. Objective: The purpose of this study was to pilot test a method for assessing and correcting patient inhaler technique via telephone. Methods: Participants (n = 30) were adults with asthma using metered-dose inhalers (MDIs) and diskus inhalers. A pharmacist was located in one room and communicated via telephone with a participant in another room. The pharmacist telephonically assessed and taught inhaler technique. Participants were videorecorded, and videos were later examined by a second pharmacist to visually evaluate inhaler technique. Participants were assigned pre-and posteducation inhaler technique scores for the telephonic and video assessments. Scores were based on summated scales for MDI (0-9) and diskus (0-11) inhalers. Paired samples t-tests were used to compare telephone and video assessments. Results: Findings indicated a significant difference between the telephone and video assessments of MDI technique (p < 0.05); however, no difference was found for the diskus inhaler. Comparing pre-and posteducation inhaler technique for MDI and diskus, mean scores significantly improved from 5.7 to 7.8 (p < 0.05) and from 8.5 to 10.4 (p < 0.05), respectively. Conclusions: The telephonic method was able to improve and detect some deficiencies in patients' inhaler technique. However, modifications and further investigation will more clearly determine the role and value of such a telephonic intervention.

Research paper thumbnail of Designing a pharmacy residency program: Focus on a common accreditation challenge

American Journal of Health-System Pharmacy, 2013

One organization&amp;amp;amp;amp;#39;s stepwise approach to achieving full compliance in an a... more One organization&amp;amp;amp;amp;#39;s stepwise approach to achieving full compliance in an area often cited for improvement in pharmacy residency accreditation surveys is described. Principle 4 of the American Society of Health-System Pharmacists (ASHP) accreditation standard for postgraduate year 1 (PGY1) residencies lists requisite components of program design, conduct, and evaluation; many organizations seeking accreditation are evaluated as being in partial compliance with one or more elements of Principle 4. Several years ago, the Marshfield Clinic, a physician group practice in Wisconsin, launched an initiative to expand its postgraduate medical training program to include a PGY1 pharmacy residency. After a gap analysis of current practices and accreditation requirements, monthly meetings of pharmacy, faculty, and corporate leaders were conducted to address program development challenges, with ongoing input from the clinic&amp;amp;amp;amp;#39;s division of education. Strategies were developed for meeting all Principle 4 criteria. For example, with regard to component 4.2 (Program Delivery), the clinic developed a residency program handbook including standing operating procedures and a residency preceptor guide with a trainee evaluation scale, professional development resources, and guidance on providing resident feedback. After an internally conducted mock site visit to identify and resolve Principle 4 issues and other compliance issues, the clinic underwent an ASHP site visit and was subsequently accredited by the ASHP Commission on Credentialing. Marshfield Clinic used an efficient step-by-step process in the development of its PGY1 pharmacy residency program and achieved full compliance with all of the criteria outlined in Principle 4 of the ASHP accreditation standard.

Research paper thumbnail of Clinical Pharmacy Should Adopt a Consistent Process of Direct Patient Care

Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy, 2014

Research paper thumbnail of Best practices: an electronic drug alert program to improve safety in an accountable care environment

Journal of managed care & specialty pharmacy, 2015

The accountable care organization (ACO), one of the most promising and talked about new models of... more The accountable care organization (ACO), one of the most promising and talked about new models of care, focuses on improving communication and care transitions by tying potential shared savings to specific clinical and financial benchmarks. An important factor in meeting these benchmarks is an ACO's ability to manage medications in an environment where medical and pharmacy care has been integrated. The program described in this article highlights the critical components of Marshfield Clinic's Drug Safety Alert Program (DSAP), which focuses on prioritizing and communicating safety issues related to medications with the goal of reducing potential adverse drug events. Once the medication safety concern is identified, it is reviewed to evaluate whether an alert warrants sending prescribers a communication that identifies individual patients or a general communication to all physicians describing the safety concern. Instead of basing its decisions regarding clinician notification...

Research paper thumbnail of Patient And phaRmacist Telephonic Encounters (PARTE) in an Underserved Rural Patient Population with Asthma: Results of a Pilot Study

Telemedicine and e-Health, 2012

To assess the feasibility, acceptability, and preliminary impact of a telepharmacy intervention i... more To assess the feasibility, acceptability, and preliminary impact of a telepharmacy intervention in an underserved, rural asthma patient population. Patients with asthma were randomized to receive either standard care or telephone consultations from pharmacists regarding asthma self-management over a 3-month period. Qualitative interviews were conducted to identify participants&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; attitudes/opinions regarding the intervention. Baseline and follow-up surveys assessed asthma control, patient activation, and medication utilization. Ninety-eight adults were recruited (78% accrual); 83 completed the study (15% dropout). Participants reported positive opinions and believed the intervention improved their asthma self-management. The intervention group had significantly higher patient activation compared with the control (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.05). There were no significant between-group differences regarding asthma control. However, within-group analyses of the intervention group showed an improvement in asthma control (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.01) and medication adherence (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.01). No within-group differences were found for the control group. This telepharmacy intervention is feasible and showed indicators of effectiveness, suggesting the design is well suited for a robust study to evaluate its impact in uncontrolled asthma patients. Pharmacists helping patients manage asthma through telecommunications may resolve access barriers and improve care.

Research paper thumbnail of Should organized clinical pharmacy promote a consistent process of patient care provided by clinical pharmacists that can apply to any clinical practice setting? Part IV: Model for discussion by the clinical pharmacy discipline

Research paper thumbnail of Preliminary outcomes of preemptive warfarin pharmacogenetic testing at a large rural healthcare center

American Journal of Health-system Pharmacy, Feb 21, 2019

Research paper thumbnail of Telephonic Monitoring and Optimization of Inhaler Technique

Telemedicine Journal and E-health, Nov 1, 2011

Introduction: Improper inhaler technique is a common problem affecting asthma control and healthc... more Introduction: Improper inhaler technique is a common problem affecting asthma control and healthcare costs. Telephonic asthma management can increase access to care while reducing costs and hospitalizations. However, no reliable method has been established for telephonically evaluating and correcting inhaler technique. Objective: The purpose of this study was to pilot test a method for assessing and correcting patient inhaler technique via telephone. Methods: Participants (n = 30) were adults with asthma using metered-dose inhalers (MDIs) and diskus inhalers. A pharmacist was located in one room and communicated via telephone with a participant in another room. The pharmacist telephonically assessed and taught inhaler technique. Participants were videorecorded, and videos were later examined by a second pharmacist to visually evaluate inhaler technique. Participants were assigned pre-and posteducation inhaler technique scores for the telephonic and video assessments. Scores were based on summated scales for MDI (0-9) and diskus (0-11) inhalers. Paired samples t-tests were used to compare telephone and video assessments. Results: Findings indicated a significant difference between the telephone and video assessments of MDI technique (p < 0.05); however, no difference was found for the diskus inhaler. Comparing pre-and posteducation inhaler technique for MDI and diskus, mean scores significantly improved from 5.7 to 7.8 (p < 0.05) and from 8.5 to 10.4 (p < 0.05), respectively. Conclusions: The telephonic method was able to improve and detect some deficiencies in patients' inhaler technique. However, modifications and further investigation will more clearly determine the role and value of such a telephonic intervention.

Research paper thumbnail of Should organized clinical pharmacy promote a consistent process of patient care provided by clinical pharmacists that can apply to any clinical practice setting? Part II: Current models of clinical pharmacy practice

Research paper thumbnail of Best Practices: An Electronic Drug Alert Program to Improve Safety in an Accountable Care Environment

Journal of managed care & specialty pharmacy, Apr 1, 2015

Research paper thumbnail of Should organized clinical pharmacy promote a consistent process of patient care provided by clinical pharmacists that can apply to any clinical practice setting? Part IIIB: Application of major practice models to sample cases

Research paper thumbnail of Designing a pharmacy residency program: Focus on a common accreditation challenge

American Journal of Health-system Pharmacy, Jun 15, 2013

One organization&amp;amp;amp;amp;#39;s stepwise approach to achieving full compliance in an a... more One organization&amp;amp;amp;amp;#39;s stepwise approach to achieving full compliance in an area often cited for improvement in pharmacy residency accreditation surveys is described. Principle 4 of the American Society of Health-System Pharmacists (ASHP) accreditation standard for postgraduate year 1 (PGY1) residencies lists requisite components of program design, conduct, and evaluation; many organizations seeking accreditation are evaluated as being in partial compliance with one or more elements of Principle 4. Several years ago, the Marshfield Clinic, a physician group practice in Wisconsin, launched an initiative to expand its postgraduate medical training program to include a PGY1 pharmacy residency. After a gap analysis of current practices and accreditation requirements, monthly meetings of pharmacy, faculty, and corporate leaders were conducted to address program development challenges, with ongoing input from the clinic&amp;amp;amp;amp;#39;s division of education. Strategies were developed for meeting all Principle 4 criteria. For example, with regard to component 4.2 (Program Delivery), the clinic developed a residency program handbook including standing operating procedures and a residency preceptor guide with a trainee evaluation scale, professional development resources, and guidance on providing resident feedback. After an internally conducted mock site visit to identify and resolve Principle 4 issues and other compliance issues, the clinic underwent an ASHP site visit and was subsequently accredited by the ASHP Commission on Credentialing. Marshfield Clinic used an efficient step-by-step process in the development of its PGY1 pharmacy residency program and achieved full compliance with all of the criteria outlined in Principle 4 of the ASHP accreditation standard.

Research paper thumbnail of Comparison of Prescribing Practices with Direct Acting Oral Anticoagulant Protocols

American Journal of Cardiovascular Drugs, Sep 8, 2017

BackgroundThe goal of anticoagulation management programs is to prevent thrombosis while minimizi... more BackgroundThe goal of anticoagulation management programs is to prevent thrombosis while minimizing the risks of hemorrhage. Direct acting oral anticoagulants (DOACs) selectively inhibit coagulation proteins to inhibit thrombosis. Previous studies suggest patient monitoring and education provided through anticoagulation services enhance adherence and decrease adverse outcomes in patients receiving DOAC therapy.ObjectiveThe objectives of this study were to describe DOAC prescribing adherence to anticoagulation service protocols and to observe whether enrollment in an anticoagulation service resulted in greater prescribing adherence to DOAC protocols.MethodsA retrospective cohort study evaluated all initial prescriptions of apixaban, dabigatran, and rivaroxaban at Marshfield Clinic from 19 October 2010 to 21 August 2014. Three algorithms analyzed patient and prescription data extracted from the organization’s electronic health record and classified prescriptions as per protocol or not per protocol. The algorithms classified not per protocol prescriptions as off-label indication, renal impairment [estimated glomerular filtration rate (eGFR) <30 ml/min], hepatic impairment (rivaroxaban and apixaban), advanced age >74 years (dabigatran), dose too low, or dose too high. The analysis assessed whether enrollment in the Marshfield Clinic Anticoagulation Service DOAC monitoring process was associated with increased adherence to protocols.ResultsIn aggregate, 72% of apixaban prescriptions, 52% of dabigatran prescriptions, and 70% of rivaroxaban prescriptions were per protocol. Off-label indications and dosage too low were the most common not per protocol reasons for apixaban and rivaroxaban prescriptions. Age ≥75 years and off-label indication were the most common not per protocol reasons for dabigatran prescriptions. Enrollment in the anticoagulation service process was not associated with increased adherence to protocols.ConclusionA significant proportion of DOAC prescriptions did not adhere to protocol expectations. While enrollment in DOAC management through the Marshfield Clinic Anticoagulation Service was not associated with increased adherence to protocols, opportunities exist to optimize DOAC prescribing. Defining ideal DOAC management requires additional research.

Research paper thumbnail of Interdisciplinary Deprescribing of Aspirin Through Prescriber Education and Provision of Patient-Specific Recommendations

WMJ : official publication of the State Medical Society of Wisconsin, Oct 1, 2022

Research paper thumbnail of Should organized clinical pharmacy promote a consistent process of patient care provided by clinical pharmacists that can apply to any clinical practice setting? Part IIIA: Comparative analysis of current practice models: strengths, weaknesses, similarities, differences, and applicability to diff...

Research paper thumbnail of Evaluating the Impact of Health Literacy on Medication Adherence and Outcomes in Patients with Heart Failure

O ne of the core concepts of the Patient Centered Medical Home (PCMH) is to facilitate a partners... more O ne of the core concepts of the Patient Centered Medical Home (PCMH) is to facilitate a partnership between patients and practitioners to help ensure patients have the knowledge and feel empowered to actively participate in setting goals for their own health care.1 An integral component to success of this partnership is understanding the barriers that prevent a patient from reaching specific treatment goals. One such barrier may include poor health literacy, which is defined by the Institute of Medicine as “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.”2 Health literacy is not regularly assessed by health care practitioners, even though low health literacy, including its effect on medication adherence, has a potential negative effect on health outcomes. For example, patients who have poorer understanding about disease processes and medications used to treat them...

Research paper thumbnail of Should organized clinical pharmacy promote a consistent process of patient care provided by clinical pharmacists that can apply to any clinical practice setting? Part IV: Model for discussion by the clinical pharmacy discipline

Research paper thumbnail of Evaluation of a pharmacist‐led intervention on naloxone co‐prescribing in patients receiving chronic opioid therapy

JACCP: JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY, 2021

IntroductionAlthough both the 2016 Centers for Disease Control and Prevention (CDC) guidelines an... more IntroductionAlthough both the 2016 Centers for Disease Control and Prevention (CDC) guidelines and the 2020 Food and Drug Administration (FDA) safety announcement recommend naloxone co‐prescribing to patients receiving long‐term opioid therapy (LTOT) for non‐cancer pain, the rate of naloxone co‐prescription in this population remains low.ObjectivesThe primary objective of this project was to determine whether a pharmacist intervention would lead to increased rates of naloxone co‐prescribing among providers.MethodsThis was a before‐and‐after interventional study to evaluate changes in naloxone co‐prescribing rates in response to clinical pharmacist recommendation of naloxone for LTOT patients to providers. The primary end point was rate of naloxone co‐prescription after pharmacist intervention. Providers of LTOT patients were emailed patient‐specific recommendations. Additional end points included calculation of the naloxone possession rate among patients and identification of patien...

Research paper thumbnail of Preliminary outcomes of preemptive warfarin pharmacogenetic testing at a large rural healthcare center

American Journal of Health-System Pharmacy, 2019

Purpose As a preliminary evaluation of the outcomes of implementing pharmacogenetic testing withi... more Purpose As a preliminary evaluation of the outcomes of implementing pharmacogenetic testing within a large rural healthcare system, patients who received pre-emptive pharmacogenetic testing and warfarin dosing were monitored until June 2017. Summary Over a 20-month period, 749 patients were genotyped for VKORC1 and CYP2C9 as part of the electronic Medical Records and Genomics Pharmacogenetics (eMERGE PGx) study. Of these, 27 were prescribed warfarin and received an alert for pharmacogenetic testing pertinent to warfarin; 20 patients achieved their target international normalized ratio (INR) of 2.0–3.0, and 65% of these patients achieved target dosing within the recommended pharmacogenetic alert dose (± 0.5 mg/day). Of these, 10 patients had never been on warfarin prior to the alert and were further evaluated with regard to time to first stable target INR, bleeds and thromboembolic events, hospitalizations, and mortality. There was a general trend of faster time to first stable targe...

Research paper thumbnail of Comparison of Prescribing Practices with Direct Acting Oral Anticoagulant Protocols

American Journal of Cardiovascular Drugs, 2017

BackgroundThe goal of anticoagulation management programs is to prevent thrombosis while minimizi... more BackgroundThe goal of anticoagulation management programs is to prevent thrombosis while minimizing the risks of hemorrhage. Direct acting oral anticoagulants (DOACs) selectively inhibit coagulation proteins to inhibit thrombosis. Previous studies suggest patient monitoring and education provided through anticoagulation services enhance adherence and decrease adverse outcomes in patients receiving DOAC therapy.ObjectiveThe objectives of this study were to describe DOAC prescribing adherence to anticoagulation service protocols and to observe whether enrollment in an anticoagulation service resulted in greater prescribing adherence to DOAC protocols.MethodsA retrospective cohort study evaluated all initial prescriptions of apixaban, dabigatran, and rivaroxaban at Marshfield Clinic from 19 October 2010 to 21 August 2014. Three algorithms analyzed patient and prescription data extracted from the organization’s electronic health record and classified prescriptions as per protocol or not per protocol. The algorithms classified not per protocol prescriptions as off-label indication, renal impairment [estimated glomerular filtration rate (eGFR) <30 ml/min], hepatic impairment (rivaroxaban and apixaban), advanced age >74 years (dabigatran), dose too low, or dose too high. The analysis assessed whether enrollment in the Marshfield Clinic Anticoagulation Service DOAC monitoring process was associated with increased adherence to protocols.ResultsIn aggregate, 72% of apixaban prescriptions, 52% of dabigatran prescriptions, and 70% of rivaroxaban prescriptions were per protocol. Off-label indications and dosage too low were the most common not per protocol reasons for apixaban and rivaroxaban prescriptions. Age ≥75 years and off-label indication were the most common not per protocol reasons for dabigatran prescriptions. Enrollment in the anticoagulation service process was not associated with increased adherence to protocols.ConclusionA significant proportion of DOAC prescriptions did not adhere to protocol expectations. While enrollment in DOAC management through the Marshfield Clinic Anticoagulation Service was not associated with increased adherence to protocols, opportunities exist to optimize DOAC prescribing. Defining ideal DOAC management requires additional research.

Research paper thumbnail of Telephonic Monitoring and Optimization of Inhaler Technique

Telemedicine and e-Health, 2011

Introduction: Improper inhaler technique is a common problem affecting asthma control and healthc... more Introduction: Improper inhaler technique is a common problem affecting asthma control and healthcare costs. Telephonic asthma management can increase access to care while reducing costs and hospitalizations. However, no reliable method has been established for telephonically evaluating and correcting inhaler technique. Objective: The purpose of this study was to pilot test a method for assessing and correcting patient inhaler technique via telephone. Methods: Participants (n = 30) were adults with asthma using metered-dose inhalers (MDIs) and diskus inhalers. A pharmacist was located in one room and communicated via telephone with a participant in another room. The pharmacist telephonically assessed and taught inhaler technique. Participants were videorecorded, and videos were later examined by a second pharmacist to visually evaluate inhaler technique. Participants were assigned pre-and posteducation inhaler technique scores for the telephonic and video assessments. Scores were based on summated scales for MDI (0-9) and diskus (0-11) inhalers. Paired samples t-tests were used to compare telephone and video assessments. Results: Findings indicated a significant difference between the telephone and video assessments of MDI technique (p < 0.05); however, no difference was found for the diskus inhaler. Comparing pre-and posteducation inhaler technique for MDI and diskus, mean scores significantly improved from 5.7 to 7.8 (p < 0.05) and from 8.5 to 10.4 (p < 0.05), respectively. Conclusions: The telephonic method was able to improve and detect some deficiencies in patients' inhaler technique. However, modifications and further investigation will more clearly determine the role and value of such a telephonic intervention.

Research paper thumbnail of Designing a pharmacy residency program: Focus on a common accreditation challenge

American Journal of Health-System Pharmacy, 2013

One organization&amp;amp;amp;amp;#39;s stepwise approach to achieving full compliance in an a... more One organization&amp;amp;amp;amp;#39;s stepwise approach to achieving full compliance in an area often cited for improvement in pharmacy residency accreditation surveys is described. Principle 4 of the American Society of Health-System Pharmacists (ASHP) accreditation standard for postgraduate year 1 (PGY1) residencies lists requisite components of program design, conduct, and evaluation; many organizations seeking accreditation are evaluated as being in partial compliance with one or more elements of Principle 4. Several years ago, the Marshfield Clinic, a physician group practice in Wisconsin, launched an initiative to expand its postgraduate medical training program to include a PGY1 pharmacy residency. After a gap analysis of current practices and accreditation requirements, monthly meetings of pharmacy, faculty, and corporate leaders were conducted to address program development challenges, with ongoing input from the clinic&amp;amp;amp;amp;#39;s division of education. Strategies were developed for meeting all Principle 4 criteria. For example, with regard to component 4.2 (Program Delivery), the clinic developed a residency program handbook including standing operating procedures and a residency preceptor guide with a trainee evaluation scale, professional development resources, and guidance on providing resident feedback. After an internally conducted mock site visit to identify and resolve Principle 4 issues and other compliance issues, the clinic underwent an ASHP site visit and was subsequently accredited by the ASHP Commission on Credentialing. Marshfield Clinic used an efficient step-by-step process in the development of its PGY1 pharmacy residency program and achieved full compliance with all of the criteria outlined in Principle 4 of the ASHP accreditation standard.

Research paper thumbnail of Clinical Pharmacy Should Adopt a Consistent Process of Direct Patient Care

Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy, 2014

Research paper thumbnail of Best practices: an electronic drug alert program to improve safety in an accountable care environment

Journal of managed care & specialty pharmacy, 2015

The accountable care organization (ACO), one of the most promising and talked about new models of... more The accountable care organization (ACO), one of the most promising and talked about new models of care, focuses on improving communication and care transitions by tying potential shared savings to specific clinical and financial benchmarks. An important factor in meeting these benchmarks is an ACO's ability to manage medications in an environment where medical and pharmacy care has been integrated. The program described in this article highlights the critical components of Marshfield Clinic's Drug Safety Alert Program (DSAP), which focuses on prioritizing and communicating safety issues related to medications with the goal of reducing potential adverse drug events. Once the medication safety concern is identified, it is reviewed to evaluate whether an alert warrants sending prescribers a communication that identifies individual patients or a general communication to all physicians describing the safety concern. Instead of basing its decisions regarding clinician notification...

Research paper thumbnail of Patient And phaRmacist Telephonic Encounters (PARTE) in an Underserved Rural Patient Population with Asthma: Results of a Pilot Study

Telemedicine and e-Health, 2012

To assess the feasibility, acceptability, and preliminary impact of a telepharmacy intervention i... more To assess the feasibility, acceptability, and preliminary impact of a telepharmacy intervention in an underserved, rural asthma patient population. Patients with asthma were randomized to receive either standard care or telephone consultations from pharmacists regarding asthma self-management over a 3-month period. Qualitative interviews were conducted to identify participants&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; attitudes/opinions regarding the intervention. Baseline and follow-up surveys assessed asthma control, patient activation, and medication utilization. Ninety-eight adults were recruited (78% accrual); 83 completed the study (15% dropout). Participants reported positive opinions and believed the intervention improved their asthma self-management. The intervention group had significantly higher patient activation compared with the control (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.05). There were no significant between-group differences regarding asthma control. However, within-group analyses of the intervention group showed an improvement in asthma control (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.01) and medication adherence (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.01). No within-group differences were found for the control group. This telepharmacy intervention is feasible and showed indicators of effectiveness, suggesting the design is well suited for a robust study to evaluate its impact in uncontrolled asthma patients. Pharmacists helping patients manage asthma through telecommunications may resolve access barriers and improve care.