Objectives. To assess the breadth, depth, and perceived importance of pharmacogenomics instruction and level of faculty development in this area in schools and colleges of pharmacy in the United States. Methods. A questionnaire used and published previously was further developed and sent to individuals at all US schools and colleges of pharmacy. Multiple approaches were used to enhance response. Results. Seventy-five (83.3%) questionnaires were returned. Sixty-nine colleges (89.3%) included pharmacogenomics in their PharmD curriculum compared to 16 (39.0%) as reported in a 2005 study. Topic coverage was ,10 hours for 28 (40.6%), 10-30 hours for 29 (42.0%), and 31-60 hours for 10 (14.5%) colleges and schools of pharmacy. Fewer than half (46.7%) were planning to increase course work over the next 3 years and 54.7% had no plans for faculty development related to pharmacogenomics. Conclusions. Most US colleges of pharmacy include pharmacogenomics content in their curriculum, however, the depth may be limited. The majority did not have plans for faculty development in the area of pharmacogenomic content expertise.

Most medication errors reported from US family physician offices were related to prescribing errors and more than half of the errors reached patients. The errors were prevented by pharmacists, patients and physicians. More than half of the errors could be prevented by electronic tools.

Purpose A collaborative pharmacist-physician (PharmD-MD) team approach to medication therapy management (MTM), with pharmacists initiating and changing medications at separate office visits, holds promise for cost-effective management of blood pressure (BP), but has not been evaluated in many systematic trials. The primary objective of this study was to examine BP control for hypertensive patients managed by a newly formed PharmD-MD MTM team vs. versus usual care (UC) in a university primary care clinic. Methods This was a randomized, pragmatic, clinical trial of hypertensive patients randomly selected for the PharmD-MD MTM team or UC. In the PharmD-MD MTM group pharmacists managed drug therapy initiation, monitoring, medication adjustments, biometric assessments, laboratory tests, and patient education. In the UC group, patients continued to see their primary care provider (PCP). Participants were age 18 years or over, diagnosed with hypertension, most recent BP ≥140/90 mmHg or ≥130/80 mmHg if co-diagnosed with diabetes mellitus, on at least one anti-hypertensive medication, and English speaking. Primary outcome was the difference in mean change in systolic BP (SBP) at 6 months. Secondary outcomes included percent achieving therapeutic BP goal, mean change in diastolic BP, LDL and HDL cholesterol. Findings A total of 75 patients were in the PharmD-PCP MTM group and 91 in the UC group. Mean reduction in SBP was significantly greater in the PharmD-PCP MTM group at 6 months [−7.1 (SD=19.4) vs. +1.6 (SD=21.0) mm Hg, (p=0.008)] but the difference was no longer statistically significant at 9 months [−5.2 (SD=16.9) vs. −1.7 (SD=17.7) mmHg, (p=0.22)] based on intent to treat analysis. In the intervention group, a greater percentage of patients who continued to see the MTM pharmacist vs. those who returned to their PCP were at goal at 6 months (88.5% vs. 63.6%) and 9 months (78.9% vs. 47.4%). No significant difference in change of LDL or HDL was detected at 6 or 9 months between groups, however mean initial visit values were near recommended levels. The PharmD-PCP MTM group had significantly fewer mean number of PCP visits than the UC group [1.8 (SD=1.5) vs 4.2 (SD=1.0), p<0.001) Implications A PharmD-PCP collaborative MTM service was more effective in lowering blood pressure than UC at 6 months for all patients and at 9 months for patients who continued to see the pharmacist. Incorporating pharmacists in the primary care team can be a successful strategy for managing medication therapy, improving patient outcomes and possibly extending primary care capacity.

BackgroundThe use of herbal supplements in the United States has become increasingly popular. The prevalence of herbal use among primary care patients varies in previous studies; the pattern of herbal use among urban racially/ethnically diverse primary care patients has not been widely studied. The primary objectives of this study were to describe the use of herbs by ethnically diverse primary care patients in a large metropolitan area and to examine factors associated with such use. The secondary objective was to investigate perceptions about and patterns of herbal use.MethodsData for a cross-sectional survey were collected at primary care practices affiliated with the Southern Primary-care Urban Research Network (SPUR-Net) in Houston, Texas, from September 2002 to March 2003. To participate in the study, patients had to be at least 18 years of age and visiting one of the SPUR-Net clinics for routine, nonacute care. Survey questions were available in both English and Spanish.ResultsA total of 322 patients who had complete information on race/ethnicity were included in the analysis. Overall, 36% of the surveyed patients (n = 322) indicated use of herbs, with wide variability among ethnic groups: 50% of Hispanics, 50% of Asians, 41% of Whites, and 22% of African-Americans. Significant factors associated with an individual's herbal use were ethnicity other than African-American, having an immigrant family history, and reporting herbal use by other family members. About 40% of survey respondents believed that taking prescription medications and herbal medicines together was more effective than taking either alone. One-third of herbal users reported using herbs on a daily basis. More Whites (67%) disclosed their herbal use to their health-care providers than did African-Americans (45%), Hispanics (31%), or Asians (31%).ConclusionsRacial/ethnic differences in herbal use were apparent among this sample of urban multiethnic adult primary care patients. Associated factors of herbal use were non-African-American ethnicity, immigrant family history, and herbal use among family members. Whereas Hispanics and Asians reported the highest rates of herbal use, they were the least likely to disclose their use to health-care professionals. These findings are important for ensuring medication safety in primary care practices.

This study provides insight into the role clinical pharmacists play with regard to drug error interventions using a national practice-based research network. Most drug errors reported by clinical pharmacists in the United States did not result in patient harm; however, severe harm and death due to drug errors were reported. Drug error types, therapeutic categories, and clinical pharmacist interventions varied between the inpatient and outpatient settings. Nearly half of reported errors were prevented by clinical pharmacists before the drugs reached the patients. The majority of clinical pharmacist recommendations were accepted by prescribers.

PURPOSE In this study, we developed and fi eld tested the Medication Error and Adverse Drug Event Reporting System (MEADERS)-an easy-to-use, Web-based reporting system designed for busy offi ce practices. METHODSWe conducted a 10-week fi eld test of MEADERS in which 220 physicians and offi ce staff from 24 practices reported medication errors and adverse drug events they observed during usual clinical care. The main outcomes were (1) use and acceptability of MEADERS measured with a postreporting survey and interviews with offi ce managers and lead physicians, and (2) distributions of characteristics of the medication event reports.RESULTS A total of 507 anonymous event reports were submitted. The mean reporting time was 4.3 minutes. Of these reports, 357 (70%) included medication errors only, 138 (27%) involved adverse drug events only, and 12 (2.4%) included both. Medication errors were roughly equally divided among ordering medications, implementing prescription orders, errors by patients receiving the medications, and documentation errors. The most frequent contributors to the medication err ors and adverse drug events were communication problems (41%) and knowledge defi cits (22%). Eight (1.6%) of the reported events led to hospitalization. Reporting raised staff and physician awareness of the kinds of errors that occur in offi ce medication management; however, 36% agreed or strongly agreed that the event reporting "has increased the fear of repercussion in the practice." Time pressure was the main barrier to reporting. CONCLUSIONS It is feasible for primary care clinicians and offi ce staff to report medication errors and adverse drug events to a Web-based reporting system. Time pressures and a punitive culture are barriers to event reporting that must be overcome. Further testing of MEADERS as a quality improvement tool is warranted.

BackgroundIn recent years waterpipe smoking has become a popular practice amongst young adults in eastern Mediterranean countries, including Iran. The aim of this study was to assess waterpipe smoking perceptions and practices among first-year health sciences university students in Iran and to identify factors associated with the initiation and maintenance of waterpipe use in this population.ResultsOut of 371 first-year health sciences students surveyed, 358 eight students completed a self-administered questionnaire in the classrooms describing their use and perceptions towards waterpipe smoking. Two hundred and ninety six responders met study inclusion criteria. Waterpipe smoking was common among first-year health sciences university students, with 51% of students indicating they were current waterpipe smokers. Women were smoking waterpipes almost as frequently as men (48% versus 52%, respectively). The majority of waterpipe smokers (75.5%) indicated that the fun and social aspect of waterpipe use was the main motivating factor for them to continue smoking. Of waterpipe smokers, 55.3% were occasional smokers, using waterpipes once a month or less, while 44.7% were frequent smokers, using waterpipes more than once a month. A large number of frequent waterpipe smokers perceived that waterpipe smoking was a healthier way to use tobacco (40.6%) while only 20.6% thought it was addictive. Compared to occasional smokers, significantly more frequent smokers reported waterpipe smoking was relaxing (62.5% vs. 26.2%, p = 0.002), energizing (48.5% vs. 11.4%, p = 0.001), a part of their culture (58.8% vs. 34.1%, p = 0.04), and the healthiest way to use tobacco (40.6% vs. 11.1%, p = 0.005).ConclusionsSocial and recreational use of waterpipes is widespread among first-year health sciences university students in Iran. Women and men were almost equally likely to be current waterpipe users. Public health initiatives to combat the increasing use of waterpipes among university students in Iran must consider the equal gender distribution and its perception by many waterpipe smokers as being a healthier and non-addictive way to use tobacco.

Eighty-one pharmacists from 48 primary care practice sites in 11 states were recruited to join a PBRN. These pharmacists provided descriptive data regarding their practice site, characteristics of patients served, and clinical services provided as a first step in collaborative research efforts.