Background: Studies demonstrate the effectiveness of anticoagulation management service (AMS) in providing antithrombotic therapy for eligible patients. We sought to extend this concept by determining whether an interim telephone model (IT) is comparable to our current AMS model at achieving optimal therapeutic outcomes. Methods:The 36-month trial (24-month study plus 12month extension) enrolled 192 eligible patients receiving long-term warfarin therapy at a Veterans Affairs hospital. Consenting participants were randomly assigned to either our current face-to-face clinic model (AMS), or our IT model. The primary outcome was the percentage of time individuals' international normalized ratios (INRs) were maintained within their target INR range (2.0-3.0 or 2.5-3.5). Secondary outcomes included the number of adverse events (eg, thromboembolism or hemorrhage) experienced during the study. Results:We found no statistically significant differ-ence between the 2 groups in the percentage of time maintained within INR target range overall (55.1% for AMS; 57.8% for IT; P=.28) nor over the course of the study. There were no statistically significant differences in the rate of thromboembolic or serious bleeding events between IT and AMS participants. Nevertheless, we did note differences related to intensity of anticoagulation. The IT group receiving treatment at a higher intensity (INR, 2.5-3.5) experienced greater anticoagulation control (P = .04) and fewer complications than the AMS group. The IT participants, however, reported a significantly higher rate of minor bleeding events, experienced mainly by those at an INR range of 2.0 to 3.0. Conclusion:Our IT model is a viable modification of our AMS model for the management of patients undergoing chronic anticoagulant therapy.

Objective. To assess Doctor of Pharmacy (PharmD) students' skills and confidence in using an evidence-based medicine (EBM) approach to answer practice-based, clinical questions. Methods. Pharmacy students' ability to provide evidence-based answers for real-world clinical questions was assessed at two time points in the PharmD curriculum using a standard tool and trained evaluators. Pharmacy students' confidence regarding their EBM skills was self-assessed at four points in the program, with the first survey administered before the EBM sequence and the final survey administered prior to graduation. The survey included five self-assessed skill questions and nine self-confidence questions. Results. Two hundred twenty-four students from two graduating classes were included in the analysis. Over 97% of students received passing scores on their clinical inquiries (mean score590.4%), confirming their competency in EBM skills. Students' survey responses on all self-assessed skill and confidence questions improved significantly from baseline to graduation. Conclusion. Longitudinal teaching of EBM concepts and opportunities for skills practice developed PharmD students' ability to successfully provide evidence-based answers to authentic clinical questions. This was consistent with students' confidence level and self-assessed skill levels reported on surveys. Future directions include confirming students' use and understanding of EBM concepts after graduation.

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Safe over the counter (OTC) medication use by older adults (OAs, aged 65+) is difficult to achieve because of age-related physiologic complexities, and millions of OAs in the US who are at risk of experiencing a major adverse drug event linked to an OTC medication. Our interdisciplinary team studies how we can improve OTC safety in OAs by developing human factors-based, community pharmacy interventions. Testing the effectiveness of our interventions on improving OTC safety necessitated the development of a framework that captures the ways OTC medication misuse can occur and designing and implementing a tool that can be used to evaluate for potential misuse, which can be used by researchers and healthcare professionals to understand misuse in OAs. This paper shares the results of our efforts and discusses the implications of our work for other HF practitioners that may be interested applying our approach to their research.