Watson, Alexandra Publications
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Item Exploring the Impact of a Vicarious Learning Approach on Student Pharmacists' Professional Identity Formation Using a Simulated Pharmacist-Patient Encounter.(Pharmacy : a journal of pharmacy education and practice, 11/16/2023) Briceland, Laurie L; Dudla, Courtney ++; Watson, Alexandra; Denvir, PaulPurposefully developed professional identity formation (PIF) learning activities within the didactic curriculum provide crucial groundwork to complement PIF within authentic settings. The aim of this didactic exercise was to explore the impact upon student pharmacists' PIF after viewing, analyzing, and reflecting upon a simulated pharmacist-patient encounter (PPE). A 12 min role-play video was created, featuring a pharmacist counseling a standardized patient on a new medication regimen; foundational principles of medication safety, health literacy, social determinants of health, empathic communication, and motivational interviewing were included in the counseling, with some aspects intentionally performed well, others in need of improvement. Also included were the patient's varied reactions to the counseling. Students assumed the observer role and learned vicariously through viewing the PPE. Postactivity debriefs included justifying a foundational principle performed well by the pharmacist, and another in need of improvement, and a self-reflection essay expressing the impact of viewing the PPE on their PIF, from which extracts were thematically analyzed for impact. The main themes of the impact included increased awareness of counseling techniques, patient-friendly medical jargon, patient perspectives/empathy, positive and negative pharmacist role-modeling, and the value of the observer role. This PPE exercise enhanced PIF in terms of students thinking, acting, and feeling like a pharmacist, based on students' self-reflections, which most often referenced effective pharmacist-patient communication and enacting optimal patient care.Item Evaluation of a pharmacist's impact on the use of glucagon-like peptide-1 receptor agonists for weight management in a family medicine setting.(Family Practice, 10/6/2022) Crocetta, Nicholas ++; Guay, Kyle; Watson, AlexandraBackground: Glucagon-like peptide-1 receptor (GLP-1) agonists carry benefits and risks that must be evaluated prior to use and monitored throughout weight management therapy. Pharmacists possess the accessibility and extensive medication knowledge to evaluate and monitor the use of GLP-1 therapy in weight management patients. Objective: Evaluate the clinical and financial impact of a pharmacist-directed weight management service utilizing GLP-1 receptor agonists in a family practice setting. Methods: A retrospective cohort study including patients at 2 family practices, aged 18 and older, prescribed a weight management GLP-1 between October 1, 2021 and March 1, 2022 was performed. Patients who met inclusion and were prescribed a weight loss GLP-1 but were not managed by the clinical pharmacist were compared with the pharmacist cohort. Descriptive statistics and inferential statistics including an independent t-test were used in the data analysis. Results: There were 46 and 39 patients identified in the clinical pharmacist and primary care physician cohorts respectively. Patients in the clinical pharmacist cohort achieved a mean body weight reduction of 9.32% compared to 5.11% body weight reduction for patients in the primary care physician cohort (P = 0.01). There were 63 months identified of inappropriate GLP-1 therapy deprescribed in the clinical pharmacist cohort resulting in an estimated cost savings of $101,985.66. Conclusions: The implementation of a pharmacist-led weight management clinic in 2 family medicine offices resulted in a significant reduction in body weight and reduction in total costs to the healthcare system compared to patients receiving weight management services from their primary care physician alone.Item Reimbursement for clinical services provided by ambulatory care pharmacists via telehealth(Journal of the American College of Clinical Pharmacy, 2021) Murray, Brianna P ++; Watson, AlexandraIntroduction: Data specific to pharmacists' value in patient-provided clinical services in New York are limited due to their scope of practice restrictions. However, due to the coronavirus disease 2019 (COVID-19) pandemic, there has been an expansion of telehealth and allowance for billable services for pharmacists. Objectives: The objective of this study was to complete a retrospective review to assess reimbursement of clinical services provided by pharmacists via telehealth during the pandemic in a primary care setting. Methods: A report was generated which identified patients 18 years and older, who were provided services by pharmacists within a primary care group via telehealth during March to July 2020 in New York. It identified patients with an appointment type code of “PharmD Telemed 30” or “PharmD TM Follow UP 15,” including Medicare Annual Wellness Visits or AWVs (G0438-G0439) with procedural codes, and incident-to CPT codes (99211-99214). Information received included medical record number, name, date of birth, carrier plan name, billed procedure code and description, carrier payment amount, and patient responsible amount. Results: A total of 485 patients were provided services during the timeframe. There were 223 encounters billed for the 99 211 CPT code, 156 of which received payment from insurers with an average of $20.14. For initial and subsequent AWVs there were a total of 48 and 150 encounters, respectively, billed by the pharmacists. Forty-one of the encounters billed as a G0438 received payment from insurers with an average of $175.75. One hundred thirty-three of the encounters billed as a G0439 received payment from insurers with an average payment of $114.09. Conclusion: The results of this study provided insight into whether specific services or insurances should be targeted for payment of services. Expansion of these services could show improvement in patient care and can assist in gathering outcomes to better support pharmacists gaining provider status on the state and national level.Item Assessing the impact of clinical pharmacists on naloxone coprescribing in the primary care setting.(American Journal of Health-System Pharmacy : AJHP, 3/24/2020) Watson, Alexandra; Guay, Kyle; Ribis, DaraPurpose: Opioid use and overdose are epidemic in the United States. While there is concern regarding the abuse of illegal opioids, overdose is also strongly associated with prescription opioids. The Centers for Disease Control and Prevention supports coprescribing of naloxone with opioids; however, a review of naloxone prescriptions recorded within a primary care group indicated limited use of the reversal agent. Methods: Through the collaboration of pharmacy and information services personnel, a report was created to identify all patients receiving chronic opioid therapy. To assess the risk of overdose, a validated risk scoring method was used. If patients were determined to be at high risk for overdose, outreach by a clinical pharmacist was conducted to educate them on the benefits of naloxone. For patients agreeable to receiving naloxone, prescriptions were entered into the electronic health record for primary care provider (PCP) verification. Contact was made following order verification to ensure patient understanding of proper naloxone use and naloxone accessibility. Results: Prior to the project (ie, in calendar year 2016), only 5 prescriptions for naloxone had been prescribed within the medical group. During the naloxone coprescribing initiative, 230 patients were identified by clinical pharmacists as being at elevated risk for opioid overdose. Of these, 86 (37%) were deemed ineligible for naloxone. Out of the 144 patients determined to be eligible, 63 (44%) were agreeable to receiving naloxone. Further review determined that 7 additional patients were agreeable after a follow-up conversation with their PCP. Of the patients that agreed to receive naloxone, 48 (76%) confirmed that they had picked up naloxone from their pharmacy. Conclusion: The naloxone coprescribing initiative was an innovative project that focused on an epidemic that affects communities across the United States. This program embraced the strengths of multiple departments for the good of the patient, in keeping with the idea of team-based care. The pharmacy-driven approach highlighted the importance of having pharmacists within an ambulatory care setting and allowed high-level pharmacist practice without adding to the workload of other members of the healthcare team.Item The effects of interprofessional collaboration on nurse managed warfarin program(Journal of Interprofessional Education & Practice, 2018-12) Braungart, Carol; Watson, Alexandra; Rubin, RochelBackground: Warfarin is an effective, inexpensive therapy for thromboembolic prevention and treatment which requires oversight of the International Ratio (INR) to prevent injury due to clotting or bleeding. Guidelines suggest a Time in Therapeutic Range (TTR) of the INR should be above 65% in order to reduce risk of adverse event. Research was initiated to determine if nurses utilizing a standardized protocol within an Internal Medical practice could provide the same standard of care as the medical providers at the site. Program design: Nurses (Licensed Practical and Registered Nurses) in an Internal Medicine Practice received competency based education regarding management of warfarin from an embedded clinical pharmacist. A retrospective analysis was performed on patients comparing TTR before and after the training protocol and conversion to nurse managed management was implemented. Observations: Using the Rosendaal method, the mean baseline TTR from July 1, 2015–June 30, 2016 was 69.6%. Following 12 months of the pharmacist-nurse collaboration for warfarin monitoring, the mean TTR from July 1, 2016–June 30, 2017 was 68.4%. Findings: There was no significant difference in TTR in the provider managed or nurse managed cohort suggesting the quality of patient management and maintenance of TTR is maintained. While the study did not show improvement of TTR by the nursing staff, quality of care was maintained and interprofessional collaboration was created. Future implications of the study include identifying the patients who are candidates to switch to a novel agent and build on established interprofessional relationships to further patient safety and efficacy