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Article: Building Demand for Deprescribing Expertise: Pharmacists as Deprescribing Care Coordinators.

Campbell, Noll L

The Senior care pharmacist

2023 Volume 38, Issue 1, Page(s) 3–4

Abstract: A number of barriers to deprescribing exist, with knowledge, skills, and self-efficacy often highlighted by prescribers within an interrupted, siloed nature of the existing health care system. Thus, deprescribing is not likely to occur without a change ... ...

Abstract	A number of barriers to deprescribing exist, with knowledge, skills, and self-efficacy often highlighted by prescribers within an interrupted, siloed nature of the existing health care system. Thus, deprescribing is not likely to occur without a change in the system. Pharmacists are extremely well positioned to positively impact the deprescribing process, and particularly senior care pharmacists given familiarity with population-specific pharmacodynamic and pharmacokinetic characteristics of medications. Similarly, our health care partners have endorsed pharmacists to not only collaborate but to drive the deprescribing trials. Therefore, no other profession is better positioned to advocate for the value of deprescribing as a core component of the pharmaceutical care process.
MeSH term(s)	Humans ; Deprescriptions ; Pharmacists ; Delivery of Health Care ; Pharmaceutical Services
Language	English
Publishing date	2023-02-08
Publishing country	United States
Document type	Journal Article
ISSN	2639-9636
ISSN	2639-9636
DOI	10.4140/TCP.n.2023.3
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Article ; Online: An Improved Statistical Modeling Approach to Individual Anticholinergic Drug Use Trend Analysis.

Lou, Zhouyang / Li, Mingyang / Kong, Nan / Campbell, Noll L / Tu, Wanzhu

IEEE journal of biomedical and health informatics

2024 Volume 28, Issue 2, Page(s) 1122–1133

Abstract: Anticholinergic (AC) drugs are commonly prescribed to older adults for treating diseases and chronic conditions, such as chronic obstructive pulmonary disease, urinary incontinence, gastrointestinal disorder, or simply pain and allergy. The high ... ...

Abstract	Anticholinergic (AC) drugs are commonly prescribed to older adults for treating diseases and chronic conditions, such as chronic obstructive pulmonary disease, urinary incontinence, gastrointestinal disorder, or simply pain and allergy. The high prevalence of AC drug use can have a detrimental effect on the mental health of older adults. We aim to improve the prediction of future trends of AC drug use at the individual level, with pharmacy refill data. The individual drug use data presents challenges in the modeling, such as data being discrete-valued with excess zeros and having significant unobserved heterogeneity in the trend pattern. To address these challenges, we propose a statistical model of hierarchical structure and an EM scheme for the model parameter estimation. We evaluate the proposed modeling approach through a numerical study with synthetic data and a case study with real-world pharmacy refill data. The simulation study show that our analysis method outperforms the existing ones (e.g., reducing MSE significantly), particularly in terms of accurately predicting the trend pattern. The real-world case study further verifies the out-performance and demonstrate the advantageous features of our method. We expect the prediction tool developed based on our study can assist pharmacists' decision on initiating or strengthening behavioral interventions with the hope of discontinuing AC drug misuse.
MeSH term(s)	Humans ; Aged ; Cholinergic Antagonists/therapeutic use ; Models, Statistical ; Pharmaceutical Services ; Urinary Incontinence ; Computer Simulation
Chemical Substances	Cholinergic Antagonists
Language	English
Publishing date	2024-02-05
Publishing country	United States
Document type	Journal Article
ZDB-ID	2695320-1
ISSN	2168-2208 ; 2168-2194
ISSN (online)	2168-2208
ISSN	2168-2194
DOI	10.1109/JBHI.2023.3332598
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Article ; Online: Home medication inventory method to assess over-the-counter (OTC) medication possession and use: A pilot study on the feasibility of in-person and remote modalities with older adults.

Alamer, Khalid A / Holden, Richard J / Chui, Michelle A / Stone, Jamie A / Campbell, Noll L

Research in social & administrative pharmacy : RSAP

2024 Volume 20, Issue 4, Page(s) 443–450

Abstract: Background: There is a need for reproducible methods to measure over-the-counter (OTC) medication possession and use. This is because OTC medications are self-managed, variably monitored by healthcare professionals, and in certain populations such as ... ...

Abstract	Background: There is a need for reproducible methods to measure over-the-counter (OTC) medication possession and use. This is because OTC medications are self-managed, variably monitored by healthcare professionals, and in certain populations such as older adults some OTC medications may introduce risk and cause more harm than benefit. Objective: (s): To develop and assess the feasibility of the Home Medication Inventory Method (HMIM), a novel method to measure possession and use of OTC medications. Methods: We benchmarked, adapted, and standardized prior approaches to medication inventory to develop a method capable of addressing the limitations of existing methods. We then conducted a pilot study of the HMIM among older adults. Eligible participants were aged ≥60 years, reported purchasing or considering purchasing OTC medication, and screened for normal cognition. Interviews were conducted both in person and remotely. When possible, photographs of all OTC medications were obtained with participant consent and completion times were recorded for both in-person and remote modalities. Results: In total 51 participants completed the pilot study. Home medication inventories were conducted in-person (n = 15) and remotely (n = 36). Inventories were completed in a mean (SD) of 20.2 min (12.7), and 96 % of inventories completed within 45 min. A total of 390 OTC medications were possessed by participants, for a mean (SD) of 7.6 (6.3) per participant. No differences in duration of interviews or number of medications reported were identified between in-person and remote modalities. Anticholinergic medications, a class targeted in the pilot as potentially harmful to older adults, were possessed by 31 % of participants, and 14 % of all participants reported use of such a medication within the previous 2 weeks. Conclusions: Implementing the HMIM using in-person and remote modalities is a feasible and ostensibly reproducible method for collecting OTC medication possession and use information. Larger studies are necessary to further generalize HMIM feasibility and reliability in diverse populations.
MeSH term(s)	Humans ; Aged ; Pilot Projects ; Feasibility Studies ; Reproducibility of Results ; Nonprescription Drugs/therapeutic use
Chemical Substances	Nonprescription Drugs
Language	English
Publishing date	2024-01-21
Publishing country	United States
Document type	Journal Article
ZDB-ID	2192059-X
ISSN	1934-8150 ; 1551-7411
ISSN (online)	1934-8150
ISSN	1551-7411
DOI	10.1016/j.sapharm.2024.01.005
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Article: Editorial: Deprescribing and Minimizing Use of Anticholinergic Medications.

Soiza, Roy L / Boustani, Malaz A / Campbell, Noll L / Mangoni, Arduino A

Frontiers in pharmacology

2021 Volume 12, Page(s) 820051

Language	English
Publishing date	2021-12-15
Publishing country	Switzerland
Document type	Editorial
ZDB-ID	2587355-6
ISSN	1663-9812
ISSN	1663-9812
DOI	10.3389/fphar.2021.820051
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Article ; Online: Lessons Learned from a Shared Curriculum on Tobacco Cessation Using a Mixed-Methods Approach.

Elkhadragy, Nervana / Corelli, Robin L / Campbell, Noll L / Zillich, Alan J / Hudmon, Karen Suchanek

Pharmacy (Basel, Switzerland)

2023 Volume 11, Issue 4

Abstract: Although the sharing of curricular content between health professional schools can reduce faculty burden, the literature provides little guidance to support these efforts. The objective of this investigation was to synthesize data from two prior studies ... ...

Abstract	Although the sharing of curricular content between health professional schools can reduce faculty burden, the literature provides little guidance to support these efforts. The objective of this investigation was to synthesize data from two prior studies to delineate recommendations guiding the future development of shared curricula in health professional education. Applying Rogers' Diffusion of Innovations Theory as a guiding framework, relevant data were extracted from a two-phase mixed-methods study evaluating the long-term impact of the shared Rx for Change: Clinician-Assisted Tobacco Cessation program. Phase 1, a qualitative study, involved telephone interviews with faculty participants of train-the-trainer workshops conducted between 2003 and 2005. These results informed the development of a phase 2 national survey, administered electronically as a long-term follow-up (13 to 15 years later) with train-the-trainer workshop participants. Results from the two studies were synthesized and summarized, producing seven key recommendations to guide development of shared curricula: (1) appeal to attendees, (2) relate content to clinical practice, (3) deliver live, in-person training, (4) develop high-quality materials, delivered by experts, (5) provide support, (6) meet accreditation standards, and (7) demonstrate effectiveness. Future program developers should consider these recommendations to enhance dissemination, adoption, and long-term sustainability of shared curricular content.
Language	English
Publishing date	2023-08-02
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2737194-3
ISSN	2226-4787 ; 2226-4787
ISSN (online)	2226-4787
ISSN	2226-4787
DOI	10.3390/pharmacy11040123
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Article ; Online: Preventing Alzheimer Disease by Deprescribing Anticholinergic Medications.

Campbell, Noll L / Holden, Richard / Boustani, Malaz A

JAMA internal medicine

2019 Volume 179, Issue 8, Page(s) 1093–1094

Language	English
Publishing date	2019-06-23
Publishing country	United States
Document type	Journal Article
ZDB-ID	2699338-7
ISSN	2168-6114 ; 2168-6106
ISSN (online)	2168-6114
ISSN	2168-6106
DOI	10.1001/jamainternmed.2019.0676
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Article ; Online: Racial disparities in the pharmacological treatment of insomnia: A time-to-event analysis using real-world data.

Holler, Emma / Campbell, Noll L / Boustani, Malaz / Dexter, Paul / Ben Miled, Zina / Owora, Arthur

Sleep health

2023 Volume 9, Issue 2, Page(s) 128–135

Abstract: Objective: Examine the association between race and time to pharmacologic treatment of insomnia in a large multi-institutional cohort.: Methods: Retrospective analysis of electronic medical records from a regional health information exchange. ... ...

Abstract	Objective: Examine the association between race and time to pharmacologic treatment of insomnia in a large multi-institutional cohort. Methods: Retrospective analysis of electronic medical records from a regional health information exchange. Eligible patients included adults with at least one healthcare visit per year from 2010 to 2019, a new insomnia diagnosis code during the study period, and no prior insomnia diagnosis codes or medications. A Cox frailty model was used to examine the association between race and time to an insomnia medication after diagnosis. Results: In total, 9557 patients were analyzed, 7773 (81.3%) of whom where White, 1294 (13.5%) Black, 238 (2.5%) Other, and 252 (2.6%) unknown race. About 6.2% of Black and 8% of Other race patients received an order for a Food and Drug Administration-approved insomnia medication after diagnosis compared with 13.5% of White patients. Black patients were significantly less likely to have an order for a Food and Drug Administration-approved insomnia medication at all time points (adjusted hazard ratio [aHR] range: 0.37-0.73), and patients reporting Other race were less likely to have received an order at 2 (aHR 0.51, 95% confidence interval [CI] 0.28-0.94), 3 (aHR 0.33, 95% CI 0.13-0.79), and 4 years (aHR 0.21, 95% CI 0.06-0.71) of follow-up. Similar results were observed in a sensitivity analysis including off-label medications. Conclusions: Patients belonging to racial minority groups are less likely to be prescribed an insomnia medication than White patients after accounting for sociodemographic and clinical factors. Further research is needed to determine the extent to which patient preferences and physician perceptions affect these prescribing patterns and investigate potential disparities in nonpharmacologic treatment.
MeSH term(s)	Adult ; Humans ; Black People/statistics & numerical data ; Minority Groups/statistics & numerical data ; Racial Groups/statistics & numerical data ; Retrospective Studies ; Sleep Initiation and Maintenance Disorders/drug therapy ; Sleep Initiation and Maintenance Disorders/epidemiology ; Healthcare Disparities/ethnology ; Healthcare Disparities/statistics & numerical data ; Hypnotics and Sedatives/administration & dosage ; Hypnotics and Sedatives/therapeutic use ; Practice Patterns, Physicians'/statistics & numerical data ; Time-to-Treatment/statistics & numerical data ; White/statistics & numerical data ; United States/epidemiology
Chemical Substances	Hypnotics and Sedatives
Language	English
Publishing date	2023-02-27
Publishing country	United States
Document type	Journal Article ; Multicenter Study ; Research Support, Non-U.S. Gov't
ZDB-ID	2813299-3
ISSN	2352-7226 ; 2352-7218
ISSN (online)	2352-7226
ISSN	2352-7218
DOI	10.1016/j.sleh.2023.02.002
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Article ; Online: Helping the Helpers - A research protocol for user-centered technology to aid caregiver management of medications for people with Alzheimer's disease and related dementias.

Werner, Nicole E / Campbell, Noll L / Boustani, Malaz / Ganci, Aaron / Holden, Richard J

Research in social & administrative pharmacy : RSAP

2022 Volume 18, Issue 9, Page(s) 3680–3686

Abstract: Background and objective: Systematically supporting caregiver-assisted medication management through IT interventions is a critical area of need toward improving outcomes for people living with ADRD and their caregivers, but a significant gap exists in ... ...

Abstract	Background and objective: Systematically supporting caregiver-assisted medication management through IT interventions is a critical area of need toward improving outcomes for people living with ADRD and their caregivers, but a significant gap exists in the evidence base from which IT interventions to support caregivers' medication tasks can be built. User-centered design can address the user needs evidence gap and provide a scientific mechanism for developing IT interventions that meet caregivers' needs. The present study employs the three phases of user-centered design to address the first two stages of the NIH Stage Model for Behavioral Intervention Development. Methods: We will conduct a three-phase study employing user-centered design techniques across three aims: Aim 1) assess the needs of ADRD caregivers who manage medications for people with ADRD (Stage 0); Aim 2) co-design a prototype IT intervention to support caregiver-assisted medication management collaboratively with ADRD caregivers (Stage IA); and Aim 3) feasibility test the prototype IT intervention with ADRD caregivers (Stage IB). Discussion: Our user-centered design protocol provides a template for integrating the three phases of user-centered design to address the first two stages of the NIH Stage Model that can be used broadly by researchers who are developing IT interventions for ADRD caregivers.
MeSH term(s)	Alzheimer Disease/drug therapy ; Caregivers ; Humans ; Technology
Language	English
Publishing date	2022-04-01
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	2192059-X
ISSN	1934-8150 ; 1551-7411
ISSN (online)	1934-8150
ISSN	1551-7411
DOI	10.1016/j.sapharm.2022.03.014
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Article ; Online: Usability-In-Place-Remote Usability Testing Methods for Homebound Older Adults: Rapid Literature Review.

Hill, Jordan R / Brown, Janetta C / Campbell, Noll L / Holden, Richard J

JMIR formative research

2021 Volume 5, Issue 11, Page(s) e26181

Abstract: Background: Technology can benefit older adults in many ways, including by facilitating remote access to services, communication, and socialization for convenience or out of necessity when individuals are homebound. As people, especially older adults, ... ...

Abstract	Background: Technology can benefit older adults in many ways, including by facilitating remote access to services, communication, and socialization for convenience or out of necessity when individuals are homebound. As people, especially older adults, self-quarantined and sheltered in place during the COVID-19 pandemic, the importance of usability-in-place became clear. To understand the remote use of technology in an ecologically valid manner, researchers and others must be able to test usability remotely. Objective: Our objective was to review practical approaches for and findings about remote usability testing, particularly remote usability testing with older adults. Methods: We performed a rapid review of the literature and reported on available methods, their advantages and disadvantages, and practical recommendations. This review also reported recommendations for usability testing with older adults from the literature. Results: Critically, we identified a gap in the literature-a lack of remote usability testing methods, tools, and strategies for older adults, despite this population's increased remote technology use and needs (eg, due to disability or technology experience). We summarized existing remote usability methods that were found in the literature as well as guidelines that are available for conducting in-person usability testing with older adults. Conclusions: We call on the human factors research and practice community to address this gap to better support older adults and other homebound or mobility-restricted individuals.
Language	English
Publishing date	2021-11-02
Publishing country	Canada
Document type	Journal Article ; Review
ISSN	2561-326X
ISSN (online)	2561-326X
DOI	10.2196/26181
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Article ; Online: Relationship between angiotensin-converting enzyme inhibitors and angiotensin receptor blockers prescribing and delirium in the ICU-A secondary analysis.

Mulkey, Malissa A / Khan, Sikandar / Perkins, Anthony / Gao, Sujuan / Wang, Sophia / Campbell, Noll / Khan, Babar

Journal of the American Geriatrics Society

2023 Volume 71, Issue 6, Page(s) 1873–1880

Abstract: Background: Studies suggest Angiotensin-Converting Enzyme inhibitors (ACEI) and Angiotensin Receptor Blockers (ARB) may slow the decline of memory function in individuals with mild to moderate Alzheimer's disease by regulating migroglial activation and ... ...

Abstract	Background: Studies suggest Angiotensin-Converting Enzyme inhibitors (ACEI) and Angiotensin Receptor Blockers (ARB) may slow the decline of memory function in individuals with mild to moderate Alzheimer's disease by regulating migroglial activation and oxidative stress within the brain's reticular activating system. Therefore, we evaluated the relationship between delirium prevalence and being prescribed ACEI and ARB in participants admitted to the intensive care units (ICU). Methods: A secondary analysis of data from two parallel pragmatic randomized controlled trials was performed. ACEI and ARB exposure was defined as being prescribed an ACEI or an ARB within six months prior to the ICU admission. The primary endpoint was the first positive delirium assessment based on Confusion Assessment Method for the ICU (CAM-ICU) for up to thirty days. Results: A total of 4791 patients admitted to the medical, surgical, and progressive ICU and screened for eligibility for the parent studies between February 2009 and January 2015 from two level 1 trauma and one safety net hospital in a large urban academic health system were included. Delirium rates in the ICU were not significantly different among participants with no exposure to ACEI/ARB (12.6%), or exposure to ACEI (14.4%), ARB (11.8%), or ACEI and ARB in combination (15.4%) in six months prior to the ICU admission. Exposure to ACEI (OR = 0.97[0.77, 1.22]), ARB (OR = 0.70 [0.47, 1.05]), or both (OR = 0.97 [0.33, 2.89]) in six months prior to ICU admission was not significantly associated with odds of delirium during the ICU admission after adjusting for age, gender, race, co-morbidities, and insurance status. Conclusions: While the impact of ACEI and ARB exposure prior to the ICU admission was not associated with the prevalence of delirium in this study, further research is needed to fully understand the impact of antihypertensive medications on delirium.
MeSH term(s)	Humans ; Angiotensin-Converting Enzyme Inhibitors/therapeutic use ; Angiotensin Receptor Antagonists/therapeutic use ; Retrospective Studies ; Antihypertensive Agents/therapeutic use ; Delirium/drug therapy ; Delirium/epidemiology
Chemical Substances	Angiotensin-Converting Enzyme Inhibitors ; Angiotensin Receptor Antagonists ; Antihypertensive Agents
Language	English
Publishing date	2023-03-11
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	80363-7
ISSN	1532-5415 ; 0002-8614
ISSN (online)	1532-5415
ISSN	0002-8614
DOI	10.1111/jgs.18285
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