Cleary, Jacqueline Publications
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Item Why I Use Pharmacogenetic Testing in Primary Care(MedCentral, 2023-10-13) Cleary, Jacqueline H.Clinical Pharmacy Specialist Jacqueline Cleary on how pharmacogenetic results can be used to make decisions about common medications, from NSAIDs to statins to warfarin.Item Interprofessional opioid and addiction teaching day for third year medical and pharmacy students(Journal of Interprofessional Education & Practice, 2023-03) Engle, Amanda; Cleary, Jacqueline H.; Cabral, C. LynnThe national opioid crisis has prompted concerns on how best to prepare health professions students with skills needed to care for these complex problems. A multi-modal program was designed to deliver opioid management, pain, and addiction content along with an authentic interprofessional education experience to all third-year pharmacy and medical students. The first objective called for students to demonstrate interprofessional education competencies in communication, teamwork, values, and roles/responsibilities, while the second objective called for students to demonstrate application of acquired knowledge in the clinical therapeutics of pain and addiction medicine. The program, Opioid and Addiction Teaching Day (OATD), included pre-recorded lectures provided asynchronously, followed by synchronous interprofessional small groups facilitated by interprofessional faculty hosted on Microsoft Teams (MS Teams). This varied format supported asynchronous independent content learning for adult learners, while the synchronous, remote interprofessional small group workshop offered on three separate occasions allowed for 327 students from two different health professions schools to collaborate. The ability to offer OATD remotely addressed a need for social distancing, and created more scheduling flexibility, which resulted in an increase in student and faculty participation when compared to similar programs held in person. Students identified gains in all IPE abilities, assessed using the validated Interprofessional Collaborative Competency Attainment Scale (ICCAS), with the most gains noted in effective communication and use of an interprofessional team approach with the patient to assess the health situation and to provide whole person care. There was a thirty-four percent increase in average score on the quiz pharmacy students took before and after completing the didactic pre-work component of OATD. Resources developed to support OATD included content creation for lectures, quizzes, and telescopic cases, “How To” guides for use of Microsoft Teams (MS Teams), and interprofessional education faculty development. All resources developed for OATD are included in the appendix of this publication.Item Pain management-related assessment and communication across the care continuum: Consensus of the opioid task force of the Island Peer Review Organization pain management coalition(Journal of the American College of Clinical Pharmacy, 2/5/2022) Juba, Katherine M; Triller, Darren; Myrka, Anne; Cleary, Jacqueline H; Winans, Amanda; Wahler Jr, Robert G; Argoff, Charles; Meek, Patrick DPrescription opioid analgesics contribute to serious, preventable adverse drug events (ADEs) and despite efforts ranging from regulatory changes to quality improvement initiatives, national studies indicate that opioid-related emergency department visits and hospitalizations are increasing amid the coronavirus disease 2019 (COVID-19) pandemic. Effective pain management is challenging during care transitions, and system imperfections make patients vulnerable to ADEs as they leave one care setting and move to another. Therefore, the Island Peer Review Organization (IPRO) pain management coalition convened a task force to develop resources to guide improvements in opioid-related communication during patient care transitions. Create a consensus list of requisite communication elements (RCEs) that should accompany all patients prescribed opioids as they undergo care transitions. An interprofessional task force of pain management experts was convened and completed a blinded, iterative Delphi process. After four Delphi rounds, the panel reached consensus on a pain management discharge communication (PMDC) List of 24 RCEs across the domains of opioid dosing and pain management (nine elements), factors associated with adverse drug events (nine elements), and patient education and caregiver support (six elements). During transitions of care providers need detailed information on opioid dosing, pain characteristics, risk factors for adverse events, and patient/caregiver capacity to adequately manage symptoms while avoiding potentially fatal ADEs. The PMDC list may guide the development of new clinical tools, quality measures, accreditation standards, and checklists for pharmacists involved in the delivery of opioid stewardship during a care transition. Additional work is needed to design comprehensive, interprofessional opioid stewardship programs to ensure that the requisite communication elements are consistently available at the time of a care transition.Item Pharmacists' role in buprenorphine management for opioid use disorder: A narrative review(Journal of the American College of Clinical Pharmacy, 2022-02) Cleary, Jacqueline H.; Engle, Amanda; Winans, AmandaThe continued rise in patients treated for opioid use disorder (OUD) has called for an increase in access to OUD therapies. Pharmacists, who have previously demonstrated their value in various disease states, have begun to address gaps in OUD care by facilitating buprenorphine treatment. The objective was to review current literature and characterize the pharmacists' role in buprenorphine collaborative care models for patients with OUD. PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, and Google Scholar were queried through May 2021. Studies were included if a pharmacist was part of a care model in which buprenorphine was prescribed for OUD and excluded if there was a pain management indication, a limited pharmacist role, or a survey methodology was used. Eight care models were included in this review. Key characteristics identified were (1) pharmacist role, (2) collaborating prescriber type, (3) clinic setting, (4) pharmacist practice type, and (5) outcomes. All models were located within a variety of outpatient settings. No collaborative practice model involved autonomous buprenorphine prescriptive authority by pharmacists. The majority utilized a psychiatrist as a collaborating prescriber, alongside a psychiatry-trained pharmacist. Less than half utilized pharmacists to make dosing recommendations. Outcomes evaluating treatment retention and relapse rates were most reported. Most outcomes identified across each model were either improved or unchanged by pharmacist involvement. Pharmacists are valued members of buprenorphine care teams across a variety of settings, collaborate with various clinicians, and have a positive impact on patient outcomes such as treatment retention and relapse. Few published collaborative care models exist, suggesting pharmacists may be underutilized in caring for this growing patient population. The role of the pharmacist in buprenorphine management is not currently well-defined; however, pharmacists are well prepared to take a more active role to help address the opioid crisis.Item Analgesics of the Future: Inside the Potential of Glial Cell Modulators(Practical Pain Management, 2021-09-08) Cleary, Jacqueline H.; Gerken, Megan*; Pratt, Allison*Inside the potential of glial cell modulators for disease modification and pain management including OUD, opioid tolerance, and hyperalgesia.