B.S. in Pharmaceutical Sciences, University of Toledo, 2011, Pharmaceutics

OBJECTIVES: The study objectives are to (1) evaluate the impact of expanding access to care on, and (2) examine the trends between, medication adherence and other patient outcomes for a safety net patient population participating in an urban Medication Therapy Management program. METHODS: Patients with diabetes, hypertension, and/or hyperlipidemia were enrolled in a pharmacist led MTM program through CareNet, a Toledo, OH safety net organization. This one year prospective pre-post funded study provided patients with access to health care providers, educational material, covered prescription drugs and testing supplies for the study period. Clinical and humanistic outcomes were measured at staggered intervals and analyzed to evaluate the impact of MTM care. The Morisky scale was used to measure patients' adherence to medications. The change in adherence was correlated with treatment outcomes to determine the significance of adherence in safety net patients. RESULTS: A significant decrease was reported in diastolic blood pressure (p < .016) and in systolic and diastolic blood pressure in patients with BP > 140/90 mmHg (p < .038, .043, respectively) as well as in hypoglycemic events (p < .018) at 12 months. There was also a significant increase in patient satisfaction for the pharmacist (p < .017) over the course of enrollment. Of the 72 diabetic patients enrolled at baseline, only 16 remained in the program at the end of the one-year time period. Thirty-four patients had substantial data to analyze the impact of adherence on treatment outcomes. The average baseline adherence per patience was 1.88 and improved by 0.118 on the Morisky scale (1 = good and 5 = poor). There were no significant correlations between collective adherence and the other outcome measures. However, patients who reported improved adherence were significantly correlated to a decreasing systolic blood pressure (p < .003), while patients showing no improvement were significantly correlated to an impro (open full item for complete abstract)

Committee: Sharrel Pinto PhD (Advisor) Subjects: Pharmacy Sciences

Master of Science (MS), University of Toledo, 2018, Pharmaceutical Sciences (Health Outcomes and Socioeconomic Sciences)

Background: Medication therapy management (MTM) is a set of services that have proven to optimize therapeutic outcomes and be extremely beneficial to patients. However, evidence suggests that pharmacists are not providing MTM services at the rate that they could be. While studies have elucidated on the facilitators and barriers for pharmacists when providing MTM, few have offered a comprehensive explanation that encompasses both physical and psychosocial factors. The Theory of Reasoned Action can be used to assess the attitudes, self-efficacy, and intent of pharmacists in the provision of MTM services (MTMS). Methods: This is a cross-sectional, survey-based study. The survey contains five sections and 48 items that measure constructs relating to a modified Theory of Reasoned Action (TRA). The survey was administered via the web-based platform Qualtrics. From a list obtained from the Ohio State Board of Pharmacy, 12,140 registered pharmacists were emailed the electronic survey. Descriptive statistics will be used and composite scores will be calculated for the constructs in the TRA. Pearson's correlations and binary logistic regression analyses will be done to address the third objective. Lastly, a qualitative analysis was conducted for three open-ended survey questions. Results: A total of 487 responses were retained for analysis. The majority of participants had positive attitudes (71.4%), subjective norm (60.3%), and self-efficacy (75.2%) toward the provision of MTMS. Of MTMS providers, most intended to continue providing MTMS (91.3%). A lesser percentage (40.6%), intended to provide additional MTMS to their current selection of services. Of non-MTMS, only 30.0% intended to begin providing such services. All TRA constructs were found to relate to each other among MTMS providers and a supporting supervisor (p=0.010), easy billing (p=0.032), and high confidence (p=0.21) were predictive of intention. Qualitative analyses identified that many participan (open full item for complete abstract)

Committee: Sharrel Pinto PhD (Committee Chair); Cindy Puffer RPh (Committee Member); Sadik Khuder PhD (Committee Member) Subjects: Pharmacy Sciences

Master of Science (MS), University of Toledo, 2015, Pharmaceutical Sciences (Health Outcomes and Socioeconomic Sciences)

Background: Individual pharmacy-based interventions have improved outcomes, but have not solved the $290 billion problem of medication non-adherence. Combinations of interventions have a potential to more heavily impact medication adherence, and associated healthcare costs. Objectives: To 1) Describe the implementation, and initial experiences, of a hybrid model of pharmacy care for patients with metabolic syndrome, 2) Study the impact of a hybrid model of pharmacy care on economic outcomes when compared to other community pharmacy models of care in patients with metabolic syndrome. 3) To study the impact of a hybrid model of pharmacy care on adherence to medications targeted by the CMS Five-Star Quality Rating System in patients with metabolic syndrome. Methods: This is an exploratory pilot of a large, prospective, randomized control study. The hybrid model utilizes an appointment based model to provide adherence blister packaging, Medication Therapy Management (MTM) and refill synchronization. A second group receives adherence packaging and refill synchronization, a third group MTM alone, and a control group receives none of the aforementioned services. Contact between the researcher and participant occurs every three months, alternating between face-to-face and telephonic. All four groups are compared for healthcare cost and utilization, as well as adherence to medications identified by the Centers for Medicare and Medicaid Services (CMS) STAR measures. Participants were recruited from a local endocrinology practice within an Integrated Delivery Network (IDN), and included adults within a certain health plan selected from a Diabetes Center. Patients were required to have; diabetes, hypertension and hyperlipidemia, and at least one medication for each disease state. Cost data was obtained via medical and prescription claims. Medication adherence was calculated from the claims data as the proportion of days covered (PDC). Baseline consists of data for (open full item for complete abstract)

Committee: Sharrel Pinto PhD (Advisor); Robert Bechtol (Committee Member); Aliaksandr Amialchuk PhD (Committee Member) Subjects: Economics; Health Care; Health Care Management; Health Sciences; Pharmacy Sciences

Master of Science in Pharmaceutical Science (MSP), University of Toledo, 2013, College of Pharmacy

In the past, pharmacists' roles were centered around dispensing and compounding medications. With the changing roles and responsibilities of pharmacists in managing patients' medication therapy, an emphasis is being made on providing team based care to patients. Recent changes in legislation, improvements in regulatory standards, and developmental changes in reimbursement strategies have driven this change in the healthcare environment. Several interprofessional models of care have been implemented in various settings to effectively allocate resources and improve the access and continuity of care. The counseling services provided by pharmacists provide opportunities for patients, physicians, and pharmacists to work closely with each other. Physicians benefit from these services through improving patient safety and utilizing their time and expertise to see more patients. Pharmacists benefit by building relationships with physicians with the goal of making medication related recommendations to improve patients' drug therapy. Therefore, for the collaboration between pharmacists and physicians to be successful, interaction between them is important and begins at the educational level. With the focus being made on patient centered care, incorporating some educational sessions on the services that other healthcare providers provide or workshops on collaboration could be an important part in the curriculum of both medical and pharmacy schools. It could allow them to better understand each other's role and responsibilities, skills, and expertise. It could also improve their communication skills, trust, and confidence with each other. Therefore, the aim of our study was to understand the perceptions of medical students on pharmacist-provided counseling services and towards collaboration. A modified Theory of Planned Behavior was used to assess awareness, attitude, perceived behavioral control, subjective norm, and intention of the fir (open full item for complete abstract)

Committee: Sharrel Pinto (Advisor); Robert Bechtol (Committee Member); Gregory Stone (Committee Member) Subjects: Curriculum Development; Health Care; Health Care Management

Master of Science in Pharmaceutical Science (MSP), University of Toledo, 2012, College of Pharmacy

Background: The number of US citizens that are struggling to access care is steadily increasing. Medically underserved populations tend to suffer from increased health complications as a result. Pharmacist may increase health care access by providing non-dispensing services, which have shown to be effective improving patient health. Little information exists that describes pharmacists' involvement in providing care to underserved populations and their potential to grow in this role. Objectives: 1.) To measure the proportion of pharmacists that frequently provide non-dispensing services to underserved populations in the State of Ohio 2.) To identify which factors either environment or personal that pharmacists' feel most prevent the provision of non-dispensing services underserved populations 3.) To identify environmental or personal factors that predict pharmacists' provision of non-dispensing services to underserved populations 4.) To assess if pharmacists are willing to work with underserved patient populations with different characteristics, provide specific non-dispensing services, and provide disease state management for different diseases 5.) To assess if pharmacists perceive themselves capable to work with underserved "#! ! patient populations with different characteristics, provide specific non-dispensing services, and provide disease state management for different diseases. Methods: A cross-sectional survey was designed based on the Social Cognitive Theory to assess pharmacists' provision of non-dispensing services to underserved populations and mailed to 2,000 pharmacists between December 2011 and March 2012. Descriptive and logistic regression analyses were run to determine pharmacists' involvement with underserved populations, their willingness and capabilities to provide services to underserved populations, and barriers to providing care. Results: 363 pharmacists responded for a response rate of 19.7%. Currently, 43% of pharmacists provide some form of (open full item for complete abstract)

Committee: Varun Vaidya PhD (Committee Chair); Sharrel Pinto PhD (Committee Member); Caroline Gaither PhD (Committee Member) Subjects: Pharmacy Sciences

MS, University of Cincinnati, 2013, Pharmacy: Pharmaceutical Sciences

Objectives: To determine if a community pharmacy-based transition of care program 1.) decreases hospital readmissions, 2.) resolves medication-related problems, and 3.) increases patient satisfaction. Methods: This prospective, quasi-experimental study compared patients who received transition of care MTM services from a community pharmacist with patients who received usual post-discharge care. Nurse case managers from two hospitals recruited and consented patients prior to discharge. Patients greater than 18 years of age and discharged home with a diagnosis of heart failure, COPD, pneumonia, or acute myocardial infarction were eligible. Case managers faxed discharge paperwork for interested patients to the selected pharmacy. MTM services occurred at community pharmacies within one week of hospital discharge. Pharmacists reconciled the patients' medications, identified drug therapy problems, recommended changes to therapy, and provided self-management education. Medication recommendations were communicated with the primary care physician and interventions were documented on a data collection form. Patients' received a two-week follow-up telephone call from the pharmacist. Research personnel conducted a 30-day telephone survey to assess hospital readmissions and patient satisfaction using a previously validated survey instrument. Preliminary Results: Sixty-five patients completed the entire study period. Six patients in the usual care group were admitted to the hospital within 30 days and nine patients were seen in the emergency room. In the 19 patients who received MTM services from the pharmacist, 126 interventions were documented and one 30-day readmission and one emergency visit was observed. The overall mean patient satisfaction with the transition of care process was not significantly different between patients who were seen by the pharmacist and those who were not. However, patients in the pharmacist only group were more likely to agree that they understan (open full item for complete abstract)

Committee: Pamela Heaton Ph.D. (Committee Chair); James A Kirby Pharm.D. (Committee Member); Stacey M Frede Pharm.D. (Committee Member); Jill Boone Pharm.D. (Committee Member); Teresa Cavanaugh Pharm.D. (Committee Member); Wayne Conrad Pharm.D. (Committee Member); Kelly Epplen (Committee Member) Subjects: Pharmaceuticals