A need for a holistic residency application review process.
Soric Mate M; Robinson Jennifer D; Ulbrich Timothy R
JACCP: Journal of the American College of Clinical Pharmacy
2019
2019-06
<a href="http://doi.org/10.1002/jac5.1119" target="_blank" rel="noreferrer noopener">10.1002/jac5.1119</a>
National Trends in Statin Medication Prescribing in Patients With a History of Stroke or Transient Ischemic Attack
statin; stroke; transient ischemic attack
BACKGROUND: Guidelines support statin therapy post-stroke or transient ischemic attack (TIA); however, previously reported utilization rates are suboptimal. OBJECTIVE: This study investigates the incidence of statin usage in patients with a documented stroke or TIA while identifying predictors of statin use. METHODS: A retrospective, cross-sectional study utilizing data from the National Ambulatory Medical Care Survey. RESULTS: A total of 2963 unweighted visits were included in the analysis, representing a total of 52 645 000 office visits when weighted. Statin therapy was initiated or continued in 35.7% (95% confidence interval [CI]: 32.4-39.0%) of office visits. Upon multivariate analysis, positive predictors of statin therapy included a diagnosis of hyperlipidemia (odds ratio [OR]: 3.60; 95% CI: 2.40-5.41), angiotensin-converting enzyme inhibitor (ACE-I) therapy (OR: 2.52; 95% CI: 1.69-3.76), aspirin therapy (OR: 2.02; 95% CI: 1.40-2.93), and clopidogrel therapy (OR: 2.60; 95% CI: 1.69-4.02). Negative predictors of statin therapy included office visits with neurologists when compared to visits with primary care practitioners (OR: 0.55; 95% CI: 0.33-0.90) and office visits in rural areas when compared to office visits in urban areas (OR: 0.64; 95% CI: 0.41-0.99). CONCLUSION: Various factors impact statin therapy use with overall utilization being suboptimal, highlighting an opportunity for medication optimization.
Snyder Brittany M; Soric Mate M
Journal of Pharmacy Practice
2019
2019-07
<a href="http://doi.org/10.1177/0897190019865147" target="_blank" rel="noreferrer noopener">10.1177/0897190019865147</a>
Grade point average is an inappropriate measure of a residency candidate's knowledge and skills.
Education; screening; students
Accreditation standards set forth by the American Society of Health‐System Pharmacists note that postgraduate year one programs should have a formal process in place to screen candidates based upon predetermined criteria to ensure applicants have the appropriate qualifications to complete residency training. This standard encourages programs to have a set of consistent criteria and an objective approach to evaluate each applicant. As a result, many programs rely heavily on accessible metrics, such as grade point average (GPA), to quickly compare candidates. The GPA has many flaws that, if utilized by residency programs, could result in screening out highly qualified candidates early in the application review process who possess the skills that residency program directors covet, such as work ethic, passion, adaptability, leadership, research experience, communication skills, professionalism, cultural competency, and personality fit. To identify qualified candidates for postgraduate residency training, the application review process must be reexamined to promote a more holistic approach, going beyond the student's ability in the classroom. Further discussion is needed regarding the pros and cons of utilization of standardized and consistent assessments of residency applicants' knowledge, skills, behaviors, and attitudes to complete a holistic review of candidates as discussed in this article. Further research is needed to identify the factors defining a successful resident and tools to predict those factors. [ABSTRACT FROM AUTHOR]
Soric Mate M; Robinson Jennifer D; Ulbrich Timothy R
JACCP: Journal of the American College of Clinical Pharmacy
2019
2019-04
<a href="http://doi.org/10.1002/jac5.1076" target="_blank" rel="noreferrer noopener">10.1002/jac5.1076</a>
Prevalence and Predictors of Benzodiazepine Monotherapy in Patients With Depression: A National Cross-Sectional Study
OBJECTIVE: Depression guidelines discourage benzodiazepine monotherapy and limit use to short-term adjunctive therapy with antidepressants; however, patients with depression continue to receive benzodiazepine monotherapy. The prevalence and predictors of this prescribing pattern have not been described previously and are warranted to assist clinicians in identifying patients at highest risk of receiving benzodiazepine monotherapy. METHODS: A national, cross-sectional analysis of the National Ambulatory Medical Care Survey from 2012 to 2015 was performed for adults treated for depression. Depression was identified using a survey item specifically assessing the presence of depression. Office visits involving patients with bipolar disorder, schizoaffective disorder, or pregnancy were identified by ICD-9 code or specific survey item and were excluded. The primary endpoint was benzodiazepine monotherapy prescribing rate defined as initiation or continuation of a benzodiazepine in the absence of any antidepressant agent. A multivariate logistic regression model was created to identify variables associated with benzodiazepine monotherapy. RESULTS: In total, 9,426 unweighted visits were eligible for inclusion. Benzodiazepine monotherapy was identified in 9.3% of patients treated for depression (95% CI, 8.2%-10.6%). Predictors of benzodiazepine monotherapy included age of 45-64 years (OR = 1.39; 95% CI, 1.01-1.91), epilepsy-related office visit (OR = 5.34; 95% CI, 1.39-20.44), anxiety-related office visit (OR = 1.67; 95% CI, 1.23-2.27), underlying pulmonary disease (OR = 1.43; 95% CI, 1.09-1.87), and concomitant opiate prescribing (OR = 2.86; 95% CI, 2.01-4.06). Psychiatrists were less likely to prescribe benzodiazepine monotherapy than were other providers (OR = 0.42; 95% CI, 0.29-0.61). CONCLUSIONS: Benzodiazepine monotherapy is utilized in nearly 1 in 10 patients treated for depression. Adults aged 45 to 65 years, patients prescribed opioids, patients seen by primary care providers, and those with underlying anxiety, epilepsy, or pulmonary disorders are at highest risk.
Soric Mate M; Paxos Chris; Dugan Sara E; Fosnight Susan M; Turosky Jodie Z; Sadana Prabodh; Emshoff Jessica B; Everly Lukas; Snyder Brittany M; Mistry Bhavin K; Bhat Shubha; Unruh Amy E; Safi Ismail M
The Journal of Clinical Psychiatry
2019
2019-05
<a href="http://doi.org/10.4088/JCP.18m12588" target="_blank" rel="noreferrer noopener">10.4088/JCP.18m12588</a>
Efficacy of Tramadol for Pain Management in Patients Receiving Strong Cytochrome P450 2D6 Inhibitors
CYP2D6; cytochrome P450; drug interaction; pain control; tramadol
STUDY OBJECTIVE: Tramadol is metabolized by cytochrome P450 (CYP) 2D6 to form an active metabolite that exhibits its analgesic effect. Medications that inhibit this enzyme are used often in practice, yet the clinical impact of this interaction on the analgesic effects of tramadol has yet to be fully described. The objective was to determine whether a clinically relevant decrease in pain control is observed in patients taking scheduled tramadol concomitantly with a strong CYP2D6 inhibitor. DESIGN: Retrospective cohort study. SETTING: Large health care system. PATIENTS: One hundred fifty-two adult inpatients who received scheduled tramadol for at least 24 hours with (76 patients) or without (76 patients) a strong CYP2D6 inhibitor between January 1, 2012, and February 28, 2017, were included in the analysis. Patients hospitalized for opioid use disorder or those receiving substandard dosing of tramadol were excluded. MEASUREMENTS AND MAIN RESULTS: The primary outcome was mean breakthrough opiate consumption in the presence and absence of CYP2D6 inhibitors. Secondary outcomes included mean pain scores, length of hospital stay, tramadol discontinuation rates, and prespecified subgroup analyses based on patient sex, race, and specific CYP2D6 inhibitor administered. Patients receiving concurrent CYP2D6 inhibitors required significantly more breakthrough morphine milligram equivalents per day compared with patients receiving scheduled tramadol without CYP2D6 inhibitors (geometric mean ± SD 18.2 ± 6.3 vs 5.7 ± 6.7 mg morphine milligram equivalents, p<0.001). No significant differences existed between cohorts for mean pain score, length of hospital stay, or tramadol discontinuation rate. CONCLUSION: This study demonstrated a clinically relevant decrease in the efficacy of tramadol when used for pain control in patients receiving a strong CYP2D6 inhibitor. These results should encourage clinicians to review medication lists for this interaction and adjust regimens accordingly to ensure adequate pain control.
Frost Derek A; Soric Mate M; Kaiser Ricky; Neugebauer Rachel E
Pharmacotherapy
2019
2019-06
<a href="http://doi.org/10.1002/phar.2269" target="_blank" rel="noreferrer noopener">10.1002/phar.2269</a>
Coaching for Success: A Residency Search Primer and Update for Preceptors and Faculty.
United States; Hospitals; Students; pharmacy student; postgraduate training; preceptor; residency; Education; Internship and Residency; Preceptorship; Faculty; Pharmacy; Online Services; Pharmacy and Pharmacology; Pharmacy – Evaluation
Pharmacy residency programs have become increasingly competitive in recent years, and changes to the residency search and application process have altered the process for matching with a residency. In this article, major residency topics, from the benefits of residency training to searching for and ranking programs, are summarized. A discussion of tips and tricks for applying for residencies and interviewing for positions is included along with specific suggestions developed with data following the implementation of the Pharmacy Online Residency Centralized Application Service (PhORCAS). The article is organized in a question and answer format to help facilitate understanding of key concepts and common questions that may arise from applicants. Many changes have taken place in the residency search and application process in recent years, and the process of obtaining a residency is complex. Residency applicants and those advising applicants may find value in the answers to commonly asked residency application questions to help ensure the greatest chance of a successful residency match.
Bright David R; Adams Alex J; Ulbrich Timothy R; Soric Mate M
Hospital pharmacy
2015
2015-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1310/hpj5006-467" target="_blank" rel="noreferrer noopener">10.1310/hpj5006-467</a>
Impact of Tranexamic Acid in Total Knee and Total Hip Replacement.
Aged; Antifibrinolytic Agents/adverse effects/therapeutic use; Arthroplasty; Blood Transfusion; Blood Transfusion/statistics & numerical data; Case-Control Studies; Descriptive Statistics; Female; Hemoglobins – Analysis; Hemoglobins/metabolism; Hip; Hip/*methods; Human; Humans; Knee; Knee/*methods; Length of Stay – Evaluation; Length of Stay/statistics & numerical data; Male; Outcome Assessment; Replacement; Retrospective Design; Retrospective Studies; total hip replacement; total knee replacement; tranexamic acid; Tranexamic Acid – Administration and Dosage; Tranexamic Acid/adverse effects/*therapeutic use; Venous Thromboembolism – Risk Factors; Venous Thromboembolism/epidemiology
OBJECTIVE: To evaluate the net clinical benefit of tranexamic acid use in patients undergoing total knee or total hip replacement. METHODS: This is a retrospective study of patients undergoing total knee or total hip replacement. The primary outcome was the net clinical benefit of tranexamic acid use. Secondary outcomes included length of stay, incidence of venous thromboembolism, change in hemoglobin, and number of units of blood transfused. RESULTS: Four hundred and six patients were screened for inclusion and 327 patients met inclusion criteria; 174 patients received tranexamic acid versus 153 patients who received usual care. Tranexamic acid demonstrated a positive net clinical benefit versus usual care (40.8% vs 13.7%, P \textless .01) but did not affect length of stay (3.39 vs 3.37 days, respectively, P = .76). Venous thromboembolism was comparable between groups (2.3% vs 0.7%, P = .38). Average change in hemoglobin and need for transfusion were lower in the treatment group versus the usual care group, respectively (3.46 vs 4.26 mg/dL, P \textless .01). CONCLUSION: Tranexamic acid demonstrated a significant benefit in decreasing change in hemoglobin as well as the need for blood transfusion with no increase in the risk of venous thromboembolism in patients undergoing total knee or total hip replacement.
Boyle Jaclyn A; Soric Mate M
Journal of pharmacy practice
2017
2017-02
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1177/0897190015621813" target="_blank" rel="noreferrer noopener">10.1177/0897190015621813</a>
Prevalence and Predictors of Metformin Prescribing in Adults with Type 2 Diabetes Mellitus: A National Cross-Sectional Study.
*evidence-based medicine; *metformin; *predictors; *prescribing; Adolescent; Adult; Aged; Cross-Sectional Studies; Diabetes Mellitus; Female; Humans; Hypoglycemic Agents/*therapeutic use; Logistic Models; Male; Metformin/*therapeutic use; Middle Aged; Prevalence; Type 2/*drug therapy
OBJECTIVE: Metformin is the first-line oral type 2 diabetes treatment. Despite an abundance of evidence, metformin is routinely underused. This study evaluated the rates of metformin use in an appropriate outpatient type 2 diabetes population and identified predictors of metformin use. METHODS: A national cross-sectional study was conducted using data from the National Ambulatory Medical Care Survey. Office visits involving patients aged 18-79 years with a diagnosis of type 2 diabetes were included, and visits involving patients with a diagnosis of chronic renal failure or heart failure were excluded. The primary outcome was metformin-prescribing rate. Multivariate logistic regression identified variables associated with metformin prescribing. RESULTS: A total of 2348 patient visits were eligible for inclusion, representing 88,671,714 office visits nationally. Metformin was continued or initiated in 40.6% of these visits. The strongest independent predictors of metformin prescribing were insulin use (odds ratio [OR] 0.32; 95% confidence interval [CI] 0.21-0.47), presence of four or more chronic conditions (OR 0.58; 95% CI 0.34-0.98), patients with Medicare insurance (OR 0.57; 95% CI 0.39-0.83), visit with a surgical specialist (OR 0.39; 95% CI 0.25-0.61) or a medical specialist (OR 0.59; 95% CI 0.38-0.92), and Hispanic ethnicity (OR 2.03; 95% CI 1.28-3.22). CONCLUSION: Metformin-prescribing rates are low, particularly in patients receiving insulin, with Medicare insurance, seen by medical or surgical specialists, or with four or more chronic conditions. The observed low rates of metformin use represent an important opportunity to improve the quality of care for patients with type 2 diabetes.
Soric Mate M; Moorman John M; Boyle Jaclyn A; Dengler-Crish Christine M
Pharmacotherapy
2016
2016-07
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1002/phar.1772" target="_blank" rel="noreferrer noopener">10.1002/phar.1772</a>