Digital Commons Network^™

Costs And Effectiveness Of Pharmacist-Led Group Medical Visits For Type-2 Diabetes: A Multi-Center Randomized Controlled Trial, Wen-Chih Wu, H. Taveira, Sean Jeffery, Lan Jiang, Lisa Tokuda, Joanna Musial, Lisa B. Cohen, Fred Uhrle

Pharmacy Practice and Clinical Research Faculty Publications

Objectives

The effectiveness and costs associated with addition of pharmacist-led group medical visits to standard care for patients with Type-2 Diabetes Mellitus (T2DM) is unknown.

Methods

Randomized-controlled-trial in three US Veteran Health Administration (VHA) Hospitals, where 250 patients with T2DM, HbA1c >7% and either hypertension, active smoking or hyperlipidemia were randomized to either (1) addition of pharmacist-led group-medical-visits or (2) standard care alone for 13 months. Group (4–6 patients) visits consisted of 2-hour, education and comprehensive medication management sessions once weekly for 4 weeks, followed by quarterly visits. Change from baseline in cardiovascular risk estimated by the UKPDS-risk-score, health-related quality-of-life …

Antibiotic Resistance Rates For Pseudomonas Aeruginosa Clinical Respiratory And Bloodstream Isolates Among The Veterans Affairs Healthcare System From 2009 To 2013, Haley J. Appaneal, R. Caffrey, Lan Jiang, David Dosa, Leonard A. Mermel, Kerry L. Laplante

Pharmacy Practice and Clinical Research Faculty Publications

Pseudomonas aeruginosa is a major cause of healthcare-associated infections and resistance among isolates is an increasing burden. The study purpose was to describe national resistance rates for clinical P. aeruginosa respiratory and bloodstream cultures and the prevalence of multidrug-resistant (MDR) P. aeruginosa within the Veterans Affairs (VA). MDR was defined as non-susceptibility to at least one drug in at least 3 of the following 5 categories: carbapenems, extended-spectrum cephalosporins, aminoglycosides, and piperacillin/tazobactam. We reviewed 24,562 P. aeruginosa respiratory and bloodstream isolates across 126 VA facilities between 2009 to 2013. Most isolates were collected from inpatient settings (82%). Resistance was highest …

Retention Of Student Pharmacists' Knowledge And Skills Regarding Overdose Management With Naloxone, Anita Jackson, P. Bratberg, M Monk, J Ferrentino

Pharmacy Practice and Clinical Research Faculty Publications

BACKGROUND:

Overdose education and naloxone training was recently implemented into the required curriculum of the College of Pharmacy at the University of Rhode Island. The objective of this study was to compare the retention of knowledge between student pharmacists who received a didactic lecture only versus student pharmacists who received the same lecture plus a skills-based objective structured clinical examination (OSCE) with a standardized patient actor.

METHODS:

Students in their first-professional year (P1) of the Doctor of Pharmacy program (n = 129) and students in their second-professional (P2) year (n = 123) attended a required lecture on opioid overdose, including …

A Review Of Combination Antimicrobial Therapy For Enterococcus Faecalis Bloodstream Infections And Infective Endocarditis, Maya Beganovic, K. Luther, Louis B. Rice, Cesar A. Arias, Michael J. Rybak, Kerry L. Laplante

Pharmacy Practice and Clinical Research Faculty Publications

Enterococci, one of the most common causes of hospital-associated infections, are responsible for substantial morbidity and mortality. Enterococcus faecalis, the more common and virulent species, cause serious high-inoculum infections, namely infective endocarditis, that are associated with cardiac surgery and mortality rates that remained unchanged for the last 30 years. The best cure for these infections are observed with combination antibiotic therapy; however, optimal treatment has not been fully elucidated. It is the purpose of this review to highlight treatment options, their limitations, and provide direction for future investigative efforts to aid in the treatment of these severe infections. While ampicillin …

Generalizing Evidence From Randomized Trials Using Inverse Probability Of Sampling Weights, Ashley L. Buchanan, G. Hudgens, Stephen R. Cole, Katie R. Mollan, Paul E. Sax, Eric S. Daar, Adaora A. Adimora, Joseph J. Eron, Michael J. Mugavero

Pharmacy Practice and Clinical Research Faculty Publications

Results obtained in randomized trials may not easily generalize to target populations. Whereas in randomized trials the treatment assignment mechanism is known, the sampling mechanism by which individuals are selected to participate in the trial is typically not known and assuming random sampling from the target population is often dubious. We consider an inverse probability of sampling weighted (IPSW) estimator for generalizing trial results to a target population. The IPSW estimator is shown to be consistent and asymptotically normal. A consistent sandwich-type variance estimator is derived and simulation results are presented comparing the IPSW estimator to a previously proposed stratified …

Assessing Individual And Disseminated Effects In Network-Randomized Studies, Ashley L. Buchanan, H. Vermund, Samuel R. Friedman, Donna Spiegelman

Pharmacy Practice and Clinical Research Faculty Publications

Implementation trials often involve clustering via risk networks, where only some participants directly received the intervention. The individual effect is that among directly treated persons beyond being in an intervention network; the disseminated effect is that among persons engaged with those directly treated. We employ a causal inference framework and discuss assumptions and estimators for individual and disseminated effects and apply them to HIV Prevention Trials Network 037. HIV Prevention Trials Network 037 was a Phase III, network-level, randomized controlled HIV prevention trial conducted in the US and Thailand from 2002 to 2006 that recruited persons who injected drugs, who …

A Claims Analysis Of The Utilization Of Tramadol For Acute Pain In Patients Prescribed Buprenorphine/Naloxone For Opioid Use Disorder, Kellye Donovan, Jon Kogut, Ashley L. Buchanan, Xuerong Wen, Robert Crausman

Pharmacy Practice and Clinical Research Faculty Publications

Objective: To determine the prevalence of tramadol prescribing among commercially insured adults receiving medication assisted therapy (MAT) with buprenorphine/naloxone.

Design: We conducted a cross-sectional descriptive study to evaluate the use of tramadol among patients prescribed buprenorphine/suboxone for MAT.

Setting: This study utilized data from 2010 to 2013 Optum Clinformatics Data Mart (OptumInsight, Eden Prairie, MN). This cohort is an administrative health claims database from a large national insurer. This data included pharmacy and medical care utilization and information describing patient enrollment.

Patients, Participants: Patients were 12 to 64 years of age and had complete and available …

Impact Of A Yoga And Meditation Intervention On Students' Stress And Anxiety Levels, Virginia Lemay, Hoolahan, Ashley L. Buchanan

Pharmacy Practice and Clinical Research Faculty Publications

Objective: To evaluate the impact of a 6-week yoga and meditation intervention on college students’ stress perception, anxiety levels and mindfulness skills.

Methods. College students participated in a 6-week pilot program consisting of a 60-minute vinyasa yoga class followed by guided meditation once weekly, delivered by trained faculty at the University of Rhode Island College of Pharmacy. Students completed pre- and post-questionnaires to evaluate changes in the following outcomes: stress levels, anxiety levels, and mindfulness skills. The questionnaire was comprised of three self reporting tools: Beck Anxiety Inventory (BAI), Perceived Stress Scale (PSS), and Five Facet Mindfulness Questionnaire (FFMQ). …

Clinical And Genetic Risk Factors For Biofilm-Forming Staphylococcus Aureus, Megan Luther, M. Parente, Aisling R. Caffrey, Katie Daffinee, Vrishali V. Lopes, Emily T. Martin, Kerry L. Laplante

Pharmacy Practice and Clinical Research Faculty Publications

The molecular and clinical factors associated with biofilm-forming methicillin-resistant Staphylococcus aureus (MRSA) are incompletely understood. Biofilm production for 182 MRSA isolates obtained from clinical culture sites (2004 to 2013) was quantified. Microbiological toxins, pigmentation, and genotypes were evaluated, and patient demographics were collected. Logistic regression was used to quantify the effect of strong biofilm production (versus weak biofilm production) on clinical outcomes and independent predictors of a strong biofilm. Of the isolates evaluated, 25.8% (47/182) produced strong biofilms and 40.7% (74/182) produced weak biofilms. Strong biofilm-producing isolates were more likely to be from multilocus sequence typing (MLST) clonal complex 8 …

Effectiveness Of A Multivitamin Supplementation Program Among Hiv-Infected Adults In Tanzania, Christopher R. Sudfeld, L. Buchanan, Nzovu Ulenga, Donna Spiegelman, Expeditho Mtisi, Ellen Hertzmark, Aisa N. Muya, David Sando, Ester Mungure, Mucho Mizinduko, Wafaie W. Fawzi

Pharmacy Practice and Clinical Research Faculty Publications

Objective: The objective of this study was to assess the effectiveness of a routine multivitamin supplementation program for adults living with HIV in Tanzania.

Design: We conducted a retrospective cohort study of 67,707 adults enrolled in the Dar es Salaam HIV care and treatment program during 2004-2012.

Methods: The Dar es Salaam HIV care and treatment program intended to provide all adult patients with multivitamin supplements (vitamins B-complex, C, and E) free of charge; however, intermittent stockouts and other implementation issues did not afford universal coverage. We use Cox proportional hazard models to assess the time-varying association of multivitamin supplementation …

What Is The Role For Metronidazole In The Treatment Of Clostridium Difficile Infection? Results From A National Cohort Study Of Veterans With Initial Mild Disease, Haley J. Appaneal, R. Caffrey, Kerry L. Laplante

Pharmacy Practice and Clinical Research Faculty Publications

Background: Metronidazole may still be an appropriate therapeutic option for mild Clostridium difficile infection (CDI) in select patients, but data is limited to guide clinicians in identifying these patients.

Methods: Our two-stage study included a national cohort of Veterans with a first episode of mild CDI (2010–2014). First, among those treated with metronidazole, we identified predictors of success, defined as absence of all-cause mortality or recurrence 30-days post-treatment, using multivariable unconditional logistic regression. Second, among a subgroup of patients with characteristic/s predictive of success identified in the first-stage, we compared clinical outcomes among those treated with metronidazole compared …

Optimal Duration For Continuation Of Statin Therapy In Bacteremic Patients, Ajinkya M. Pawar, L. Laplante, Tristan T. Timbrook, Aisling R. Caffrey

Pharmacy Practice and Clinical Research Faculty Publications

Background: Evidence suggests statins may improve survival in patients with bloodstream infections. However, there is no consensus on optimal timing and duration of exposure.

Objectives: To quantify statin therapy duration associated with decreased mortality in bacteremic statin users.

Methods: We conducted a case-control study using OptumClinformatics™ with matched Premier hospital data (1 October 2009–31 March 2013). Cases who died during the hospitalization were matched 1:1 to survivors on disease risk scores (DRSs). Post-admission statin therapy duration was evaluated in patients with at least 90 days of pre-admission continuous statin use. Classification and regression tree (CART) analysis was …

Rx For Addiction And Medication Safety: An Evaluation Of Teen Education For Opioid Misuse Prevention, Emily Patry, P. Bratberg, Ashley L. Buchanan, Andrea L. Paiva, Sara Balestrieri, Kelly L. Matson

Pharmacy Practice and Clinical Research Faculty Publications

Background: Rhode Island (RI) ninth graders report lifetime nonmedical use of prescription opioids (NMUPO) of 8.9%. NMUPO is associated with transition to heroin use, opioid overdose, and death.

Objectives: Measure changes in 9^th grade students' knowledge, confidence, perceptions of opioid use disorder prevention, overdose response with naloxone, treatment, and recovery, following the delivery of an interactive substance use disorder curriculum.

Methods: Eight RI public high schools were recruited to participate. Freshman in each school were administered identical surveys that collected demographic data, substance use and misuse knowledge, students' perceptions of substance misuse harm, reported drug use, and risk and …

1238. A National Comparison Of Antibiograms Between Veterans Affairs Long-Term Care Facilities And Affiliated Hospitals, Maria-Stephanie Tolg, R. Caffrey, Haley Appaneal, Robin Jump, Vrishali Lopes, David Dosa, Kerry L. Laplante

Pharmacy Practice and Clinical Research Faculty Publications

Background: Long-term care facilities (LTCFs) face several barriers to creating antibiograms. Here, we evaluate if LTCFs can use antibiograms from affiliated hospitals as their own antibiogram.

Methods: Facility-specific antibiograms were created for all Veterans Affairs (VA) LTCFs and VA Medical Centers (VAMCs) for 2017. LTCFs and affiliated VAMCs were paired and classified as being on the same campus or geographically distinct campuses based on self-report. For each pair, Escherichia colisusceptibility rates (%S) to cefazolin, ceftriaxone, cefepime, ciprofloxacin, nitrofurantoin, sulfamethoxazole/trimethoprim, ampicillin/sulbactam, piperacillin/tazobactam, and imipenem were compared. As guidelines discourage empiric use of antibiotics if susceptibility rates are

Results …

1067. Comparative Effectiveness Of Nafcillin Or Oxacillin, Cefazolin, And Piperacillin/Tazobactam In Methicillin-Sensitive Staphylococcus Aureus Bacteremia, Maya Beganovic, Cusumano, Vrishali Lopes, Kerry L. Laplante, Aisling R. Caffrey

Pharmacy Practice and Clinical Research Faculty Publications

Background: β-Lactam antibiotics are recommended as first line for treatment of methicillin-sensitive Staphylococcus aureus (MSSA) bacteremia. The objective of this study was to compare effectiveness among β-lactam therapies in MSSA bacteremia patients that were exclusively treated with one antibiotic.

Methods: This was a retrospective cohort study of patients hospitalized at Veterans Affairs (VA) medical centers with MSSA bacteremia from January 1, 2002 to October 1, 2015. Patients were included if they were treated exclusively with nafcillin, oxacillin, cefazolin, or piperacillin/tazobactam (i.e., monotherapy with no changes in therapy). The primary outcome was 30-day mortality, and secondary outcomes were time to discharge, …

Real World Evidence - What It Is And What It Can Tell Us According To The International Society For Pharmacoepidemiology (Ispe) Comparative Effectiveness Research (Cer) Special Interest Group (Sig), Hongbo Yuan, Sanni Ali, Emily S. Brouwer, Cynthis J. Girman, Jeff J. Guo, Jennifer L. Lund, Elisabetta Patorno, Jonathan L. Slaughter, Xuerong Wen, Dimitri Bennett

Pharmacy Practice and Clinical Research Faculty Publications

On December 8, 2016, the New England Journal of Medicine published a sounding board on Real World Evidence (RWE)¹ by the US Food and Drug Administration (FDA) leadership. While the value of RWE based on nonrandomized observational studies was appreciated, such as for hypothesis generating, safety, and measuring quality in healthcare delivery, the authors expressed concerns on the quality of data sources and the ability of methodologies to control for confounding. In response, we offer a few considerations regarding these concerns.