Clinical pharmacy spring seminar celebrates wide-ranging research

The 13th annual Spring Research Seminar highlighting work by students, residents, and faculty members in the UCSF School of Pharmacy Department of Clinical Pharmacy—and featuring 48 project posters—was held May 3, 2011 on UCSF’s Parnassus campus.

Rifkind Award winners

The winners of the 4th annual Gary Rifkind Spring Research Seminar Awards are:

• Student pharmacist category: Angela Anson for the poster: “Prices, Availability and Affordability of Medications in Guatemala: A Survey of the World Health Organization’s Essential Medicines for Children.”
• Resident category: Megan McCurdy, PharmD, for the poster: “Electronic Pharmacy Management Software for HIV Clinics in Resource-Limited Countries.”
• Professional researchers / assistant professor category: Donna Odierna, DrPH, for the poster: “Arguments For and Against the Use of Systematic Reviews in Healthcare Decision Making: Cui Bono?”

Anson also presented her findings at the awards ceremony marking the conclusion of the 2nd Annual UCSF Inter-School Research Festival. McCurdy and Odierna will be presented with their awards at the department’s June 9th faculty meeting.

The Rifkind Awards of $1,000 each were created to recognize and celebrate clinical pharmacy research. They are the gift of Gary Rifkind, PharmD, a UCSF School of Pharmacy alumnus, Class of 1960.

Anson’s study, a collaboration with the Department of Pharmacy at the Universidad del Valle in Guatemala, collected data on two dozen medicines from 54 hospitals, retail pharmacies and public access pharmacies in six regions throughout the country and concluded with key policy recommendations.

The survey found access to drugs vital to reducing mortality in children under 5 years old was low. Mean drug availability was less than half even in inpatient settings and private retail pharmacies; only one quarter in the more affordable public pharmacies. Indeed, in the lower-middle income nation, an injectable course of the antibiotic Ceftriaxone, if available, cost as much as 15 days’ minimum wages.

McCurdy’s poster evaluated six open-source pharmacy management software programs used in HIV clinics in developing countries for their ability to offer pharmacists basic and clinical tools aimed at improving adherence and outcomes for patients receiving antiretroviral therapy.

Her group found none of the programs met all the needs of pharmacists to practice higher-level medication management in resource-limited settings. In particular, the researchers found limited clinical screening and adherence tracking in all six—which may stymie the ability of pharmacists in those countries to play more active roles in HIV management.

Odierna’s poster looked at published papers that took pro or con positions regarding the use of systematic reviews—studies that synthesize the results of an assembly of primary investigations, including meta-analyses—for the development of health policy and clinical practice guidelines.

Although the study's data is preliminary, collecting and analyzing 31 articles, its key finding was that beyond the main, mostly academic affiliations of the papers’ primary authors there is very little disclosure of financial or other conflicts of interest. This lack of transparency makes it difficult for policy makers to take into account potential biases (i.e. cui bono? means “to whose benefit?”) even as preliminary data suggests affiliations did affect pro and con arguments concerning systematic reviews’ validity.

Wide-ranging poster session

The posters presented in the 13th annual 3-hour seminar were generated by a total of 171 researchers. They ranged widely in subject from health services and policy research to clinical and epidemiological evaluations of drug regimens. For example:

• Faculty member Brett Heintz, PharmD, analyzed the use of aminoglycoside (AG) antibiotics and outcomes in the treatment of nearly 100 dialysis-dependent patients in the UC Davis Health System over a 2-year period.

  Heintz found that among a subset of patients with severe gram-negative rod infections (GNR)—for which aminoglycosides exhibit concentration-dependent efficacy—a pre-dialysis ratio of the antibiotic’s blood plasma concentration to its maximum inhibitory concentration of less than six was a risk factor for mortality, along with retention of catheters, inadequate empiric therapy and other factors. The findings provide the basis for future control studies evaluating the potential benefits of more aggressive pre-dialysis AG dosing.

• Carly Paoli, PharmD, MPH, a postdoctoral fellow in pharmacoeconomics, outcomes, and policy presented research findings on racial disparities in the diagnosis and treatment of breast cancer in women under the same Southeastern U.S. commercial health plan.

  The retrospective analysis of nearly 1,500 patients found African-American women had their breast cancer diagnosed at later stages and had a longer time to treatment. In particular, among women with estrogen/progesterone-positive breast cancer, which is treated with hormone therapy after primary treatment, white women were more than twice as likely as African-American women to receive that therapy. A follow-up study is being launched to determine why those differences are occurring.

• Postdoctoral scholar Grace Wang, PhD, MPH, of the department’s Center for Translational and Policy Research on Personalized Medicine examined associations between the use of gene expression profiling (GEP), which estimates the risk of cancer recurrence and the likelihood of chemotherapy benefit, and the number of different chemotherapies that were then administered. The study examined data from a commercial health plan for nearly 700 women (30 to 64 years old) within a year of a non-metastatic breast cancer diagnosis.

  The analysis found that GEP may inform patient and provider decisions about whether to use chemotherapy as well as how many different types of chemotherapeutic agents to try. Indeed, GEP results indicating both low and high recurrence risk were significantly associated with chemotherapy use when compared to women without GEP results. But the average number of different types of chemotherapies employed was lowest among women with low risk GEP results—as well as being low risk on other factors.

• While GEP has seen uneven adoption due to cost and uncertain benefit, clinical pharmacy researcher Su-Ying Liang, PhD, looked at a key factor in its use—physician characteristics. Controlling for patient characteristics and focusing on nearly 400 women 35 to 65 years old who were diagnosed with estrogen-receptor-positive, lymph node-negative breast cancer, they found that while the rate of GEP use was 24.9% overall, women whose oncologists were in group practice or medical school physicians—or were younger—were more likely to receive GEP.

• Student pharmacist Hilary Campbell examined a missing link in the move to electronic prescriptions. While federal incentive programs now encourage e-prescribing by physicians and other providers, her research revealed a dearth of state-level programs to aid the pharmacy end—either by reimbursing for the new transaction fees or helping to pay for new software.

• Faculty member Betty Dong, PharmD, and the department’s Drug Research Unit director Francesca Aweeka, PharmD, led researchers evaluating the association between the pharmacokinetics of the antiretroviral drug nevirapine (NVP) and the reported development of rash and liver toxicity in more than 350 HIV-infected women in seven countries in sub-Saharan Africa.

  The study presented in their poster, completed through the AIDS Clinical Trials Group, reported lower NVP clearance among the women compared to what had been reported previously, resulting in higher blood NVP levels. But while grade 3+ rashes were associated with the higher NVP blood levels in a small number of participants, liver toxicity was not. The study also concluded that a baseline CD4 count of 250 cells per cubic millimeter or more was a significant predictor of NVP toxicity and drug discontinuation.

• A year after UCSF’s 2009 implementation of an emergency department pharmacist program to provide clinical and distributive services during the busiest hours, pharmacy resident Sijy Mathew, PharmD, and UCSF Medical Center staff pharmacist Zlatan Coralic, PharmD, surveyed more than 100 UCSF emergency staffers—including physicians, medical residents, and nurse practitioners. They found that staff favor the pharmacists’ presence and consider them an integral component of emergency patient care.

  Among the findings: 99% of emergency department staffers reported the department pharmacist improves quality of care, fully 100% had consulted with the pharmacist at least a few times in their previous five shifts. As for the pharmacists’ most important role: 51% felt it was maximizing medication safety by being available for consult while 30% said it was pharmacist attendance at codes/resuscitations.