David Rhys Axon

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• Axon, D. R., Augustine, J. M., Warholak, T., & Lee, J. K. (2019). Improving rating scales: Applying Rasch analysis to student pharmacists' attitudes towards herbal medications. Currents in pharmacy teaching & learning, 11(7), 658-663.
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  This study analyzed the psychometric properties of a cross-sectional survey of student pharmacists' attitudes regarding herbal medications using a polytomous Rasch model. Seven items assessed students' attitudes towards herbal medications using a 6-point agreement scale (0 to 5). Student responses were reviewed to identify outliers and aberrant response patterns, assess scale fit, and perform item analysis. Scale performance was assessed to determine if response categories were independent and equally represented. Items were reviewed for model fit and construct validity with significant item gaps identified using a z-test.
• Axon, D. R., Campbell, P., & Warholak, T. (2019). Student pharmacists' experiences of teamwork in a quality improvement course. Currents in pharmacy teaching & learning, 11(2), 139-144.
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  Student pharmacists need to work in teams in the educational and practice settings, but there is limited information on their teamwork experiences in the published literature. The study objective was to assess second-year (P2) student pharmacists' teamwork experiences in an experiential quality improvement (QI) course.
• Axon, D. R., Patel, M. J., Martin, J. R., & Slack, M. K. (2019). Use of multidomain management strategies by community dwelling adults with chronic pain: evidence from a systematic review. Scandinavian journal of pain, 19(1), 9-23.
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  Background and aims Multidomain strategies (i.e. two or more strategies) for managing chronic pain are recommended to avoid excessive use of opioids while producing the best outcomes possible. The aims of this systematic review were to: 1) determine if patient-reported pain management is consistent with the use of multidomain strategies; and 2) identify the role of opioids and non-steroidal anti-inflammatory drugs (NSAIDs) in patient-reported pain management. Methods Bibliographic databases, websites, and reference lists of included studies were searched to identify published articles reporting community-based surveys of pain self-management from January 1989 to June 2017 using controlled vocabulary (and synonyms): pain; self-care; self-management; self-treatment; and adult. Two independent reviewers screened studies and extracted data on subject demographics, pain characteristics, pain self-management strategies, and pain outcomes. Pain self-management strategies were organized according to our conceptual model. Included studies were assessed for risk of bias. Differences between the researchers were resolved by consensus. Results From the 3,235 unique records identified, 18 studies published between 2002 and 2017 from 10 countries were included. Twenty-two types of pharmacological strategies were identified (16 prescription, six non-prescription). NSAIDs (15 studies, range of use 10-72%) and opioids (12 studies, range of use 5-72%) were the most commonly reported prescription pharmacological strategies. Other prescription pharmacological strategies included analgesics, acetaminophen, anticonvulsants, antidepressants, anxiolytics, salicylates, β-blockers and calcium channel blockers, disease-modifying anti-rheumatic drugs and steroids, muscle relaxants, topical products, triptans, and others. Twenty-two types of non-pharmacological strategies were identified: four medical strategies (10 studies), 10 physical strategies (15 studies), four psychological strategies (12 studies), and four self-initiated strategies (15 studies). Medical strategies included consulting a medical practitioner, chiropractic, and surgery. Physical strategies included exercise, massage, hot and cold modalities, acupuncture, physical therapy, transcutaneous electrical nerve stimulation, activity modification or restriction, assistive devices, and altering body position/posture. Psychological strategies included relaxation, prayer or meditation, therapy, and rest/sleep. Self-initiated strategies included dietary or herbal supplements, dietary modifications, and complementary and alternative medicine. Overall, the number of strategies reported among the studies ranged from five to 28 (out of 44 identified strategies). Limited data on pain outcomes was reported in 15 studies, and included satisfaction with pain management strategies, pain interference on daily activities, adverse events, lost work or restricted activity days, emergency department visits, and disabilities. Conclusions A wide variety and large number of pharmacological and non-pharmacological strategies to manage chronic pain were reported, consistent with the use of multidomain strategies. High levels of use of both NSAIDs and opioids also were reported. Implications Comprehensive review and consultation with patients about their pain management strategies is likely needed for optimal outcomes. Additional research is needed to determine: how many, when, and why multidomain strategies are used; the relationship between opioid use, multidomain management strategies, and level of pain; how multidomain strategies relate to outcomes; and if adding strategies to a pain management plan increases the risk of adverse events or interactions, and increases an individuals pain management burden.
• Axon, D. R., Taylor, A. M., Vo, D., & Bingham, J. (2019). Initial assessment of an interprofessional team-delivered telehealth program for patients with epilepsy. Epilepsy research, 158, 106235.
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  Epilepsy affects 3.5 million people in the United States (US). Rural-dwelling individuals have less access to healthcare and consequently poorer health outcomes. This study describes the outcomes of an interprofessional telehealth program for rural-dwelling individuals with epilepsy in one US state.
• Campbell, A. M., Axon, D. R., Martin, J. R., Slack, M. K., Mollon, L., & Lee, J. K. (2019). Melatonin for the prevention of postoperative delirium in older adults: a systematic review and meta-analysis. BMC geriatrics, 19(1), 272.
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  Older surgical patients are at high risk of developing postoperative delirium. Non-pharmacological strategies are recommended for delirium prevention, but no pharmacological agents have compelling evidence to decrease the incidence of delirium. The purpose of this study was to assess whether perioperative melatonin decreases the incidence of delirium in older adults undergoing surgical procedures.
• Marupuru, S., Axon, D. R., & Slack, M. K. (2019). How do pharmacists use and recommend vitamins, minerals, herbals and other dietary supplements?. BMC complementary and alternative medicine, 19(1), 229.
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  Use of complementary and alternative medicine (CAM), including vitamins, minerals, herbals, and other dietary supplements, is widespread in the United States (ranging from 24% in Hispanics to 50% in American Indians). Pharmacists are an accessible source for healthcare information, but little is known about their use of CAM products and to whom they would recommend these products.
• Tetuan, C., Axon, D. R., Bingham, J., Boesen, K., Lipsy, R., Scovis, N., Taylor, A. M., Warholak, T., Lott, B. E., & Leal, S. (2019). Assessing the Effect of a Telepharmacist's Recommendations During an Integrated, Interprofessional Telehealth Appointment and Their Alignment with Quality Measures. Journal of managed care & specialty pharmacy, 25(12), 1334-1339.
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  A growing provider shortage contributes to the widening gap in significant disparities that rural communities face. To expand access to care for rural-dwelling patients with epilepsy, a national nonprofit organization initiated an integrated, interprofessional telehealth program.
• Almodovar, A. S., Axon, D. R., Coleman, A. M., Warholak, T., & Nahata, M. C. (2018). The Effect of Plan Type and Comprehensive Medication Reviews on High-Risk Medication Use. Journal of managed care & specialty pharmacy, 24(5), 416-422.
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  In 2007, the Centers for Medicare & Medicaid Services (CMS) instituted a star rating system using performance outcome measures to assess Medicare Advantage Prescription Drug (MAPD) and Prescription Drug Plan (PDP) providers.
• Axon, D. R., Bhattacharjee, S., Warholak, T. L., & Slack, M. K. (2018). Xm Scores for Estimating Total Exposure to Multimodal Strategies Identified by Pharmacists for Managing Pain: Validity Testing and Clinical Relevance. Pain research & management, 2018, 2530286.
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  To assess the validity of an exposure score obtained from the Xm tool for all pharmacological and nonpharmacological strategies used by individuals to manage chronic pain.
• Axon, D. R., Hernandez, C., Lee, J., & Slack, M. (2018). An Exploratory Study of Student Pharmacists' Self-Reported Pain, Management Strategies, Outcomes, and Implications for Pharmacy Education. Pharmacy (Basel, Switzerland), 6(1).
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  The objective of this study was to describe the prevalence, management strategies, and outcomes of pain experienced by student pharmacists, and to discuss implications for pharmacy education. A questionnaire administered to student pharmacists collected data about their experience, management strategies, and outcomes of pain. Data were analyzed using -tests, chi-square or Fisher's tests, and logistic regression. Of the 218 student pharmacists who completed the survey, 79% experienced pain in the past five years. Chronic pain impacted students' ability to work (15%) and attend school (9%). Respondents most commonly used prescription (38%) and over-the-counter (OTC, 78%) non-steroidal anti-inflammatory drugs (NSAIDs), and rest (69%) to manage pain. Men used more opioids, whereas women used more OTC NSAIDs ( < 0.05). Emergency department visits were associated with increased prescription drug use to manage pain. This study found that 15% of student pharmacists had chronic pain in the past five years, which was managed with medical and non-medical strategies.
• Axon, D. R., Lim, R. H., Lewis, P. J., Sandher, S., Thondee, J., Edwards, K., & Howard, R. L. (2018). Junior doctors' communication with hospital pharmacists about prescribing: findings from a qualitative interview study. European journal of hospital pharmacy : science and practice, 25(5), 257-261.
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  To explore factors affecting communication between Foundation Year (FY) 1 doctors and hospital pharmacists about prescribing from the junior doctors' perspective.
• Bhattacharjee, S., Al Yami, M., Kurdi, S., & Axon, D. R. (2018). Prevalence, patterns and predictors of depression treatment among community-dwelling older adults with stroke in the United States: a cross sectional study. BMC psychiatry, 18(1), 130.
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  Depression is one of the most common psychiatric conditions among stroke survivors and is associated with several negative health outcomes. However, little is known about the depression treatment patterns among stroke survivors. The objective of this study was to examine national-level prevalence, patterns and predictors of depression treatment among community-dwelling stroke survivors.
• Bhattacharjee, S., Axon, D. R., Goldstone, L., & Lee, J. K. (2018). Patterns and Predictors of Depression Treatment among Stroke Survivors with Depression in Ambulatory Settings in the United States. Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association, 27(3), 563-567.
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  Despite the importance of treating depression, little is known regarding the current practice pattern of depression treatment among older adults with stroke and depression. We used national survey data from ambulatory settings to examine the depression treatment patterns and predictors among stroke survivors in the United States (US).
• Bingham, J., Axon, D. R., Scovis, N., & Taylor, A. M. (2018). Evaluating the Effectiveness of Clinical Pharmacy Consultations on Nutrition, Physical Activity, and Sleep in Improving Patient-Reported Psychiatric Outcomes for Individuals with Mental Illnesses. Pharmacy (Basel, Switzerland), 7(1).
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  One fifth of U.S. adults have a current mental illness. Nutrition, physical activity, and sleep are critical to physical health; any related deficiencies may worsen existing mental health conditions. Little is known about the impact of clinical pharmacist assessment and consultation in improving physical and mental health outcomes. The study objective was to determine whether patients' mental health status improved following clinical pharmacist consultation. This pilot study involved clinical pharmacist-delivered services at an integrated medical behavioral health clinic in June 2018. Inclusion criteria required adults aged 18 years older, an established mental health diagnosis, and taking ≥2 prescribed psychotropic medications. One pharmacist conducted telephonic, medical, and psychiatric health risk assessment and counseling to improve nutrition, physical activity, and sleep status, both initially and at two-week follow-up. The Duke Health Profile (Duke) physical, anxiety, depression, and anxiety-depression scores measured patients' pre/post changes. Participants ( = 20) experienced higher Duke physical scores ( = 0.007) and significantly lower anxiety ( = 0.025), depression ( = 0.001) and anxiety-depression scores ( = 0.005) at follow-up. This pilot study provides preliminary evidence for pharmacist-led, targeted, telephonic counseling in improving short-term physical and mental Duke health scores. Further research evaluating the impact of clinical pharmacists' role in improving physical and behavioral health outcomes is warranted.
• Campbell, P. J., Patel, M., Martin, J. R., Hincapie, A. L., Axon, D. R., Warholak, T. L., & Slack, M. (2018). Systematic review and meta-analysis of community pharmacy error rates in the USA: 1993-2015. BMJ open quality, 7(4), e000193.
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  While much is known about hospital pharmacy error rates in the USA, comparatively little is known about community pharmacy dispensing error rates.
• Silva Almodovar, A., Surve, S., Axon, D. R., Cooper, D., & Nahata, M. C. (2018). Self-Directed Engagement with a Mobile App (Sinasprite) and Its Effects on Confidence in Coping Skills, Depression, and Anxiety: Retrospective Longitudinal Study. JMIR mHealth and uHealth, 6(3), e64.
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  Inadequacies in mental health care coverage remain an enormous problem in the United States. Barriers include scarcity of accessible mental health care professionals. Use of a mental health mobile app incorporating social cognitive theory may help improve confidence in coping skills and improve anxiety and depression. Sinasprite is a mobile app that recruited users via self-referral and clinician referral. Users completed questionnaires to obtain demographic and medical histories. At baseline and 6-week follow-up, users completed the Patient Health Questionnaire 8 (PHQ-8), General Anxiety Disorder 7-Item (GAD-7), and the Coping Self-Efficacy Scale (CSE). It is unknown how self-directed use of a mobile app improves confidence in coping skills and its effects on self-reported depression and anxiety.
• Taylor, A. M., Axon, D. R., Campbell, P., Fair, M. K., Nelson, M., Boesen, K., Martin, R., & Warholak, T. L. (2018). What Patients Know About Services to Help Manage Chronic Diseases and Medications: Findings from Focus Groups on Medication Therapy Management. Journal of managed care & specialty pharmacy, 24(9), 904-910.
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  Managing and treating patients with multiple chronic conditions presents challenges on many levels. Pharmacist-delivered medication therapy management (MTM) services, mandated as part of the Medicare Part D drug benefit, are designed to help patients manage their chronic conditions and medications.
• Taylor, A. M., Bingham, J., Schussel, K., Axon, D. R., Dickman, D. J., Boesen, K., Martin, R., & Warholak, T. L. (2018). Integrating Innovative Telehealth Solutions into an Interprofessional Team-Delivered Chronic Care Management Pilot Program. Journal of managed care & specialty pharmacy, 24(8), 813-818.
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  Pharmacist-delivered medication therapy management (MTM) services can improve patient outcomes, yet little is known about outpatient, interprofessional telepharmacy programs.
• Axon, D. R., & Slack, M. (2017). Response to Dietary Supplement Use, Knowledge, and Perceptions Among Student Pharmacists. American journal of pharmaceutical education, 81(10), 6854.
• Axon, D. R., Vanova, J., Edel, C., & Slack, M. (2017). Dietary Supplement Use, Knowledge, and Perceptions Among Student Pharmacists. American journal of pharmaceutical education, 81(5), 92.
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  To compare dietary supplement use between student pharmacists and the general population, and assess knowledge, attitudes toward use, and dietary supplement effectiveness; and to explore how student pharmacists view their education on dietary supplements. Paper questionnaires administered to student pharmacists collected data about their use, knowledge, and attitudes of dietary supplements. Use was compared to the 2007 National Health Interview survey findings. Of 179 students who responded, 52% had used at least one dietary supplement in their lifetime versus 25% in the general population. Students perceived supplement label information as unhelpful, research into supplements inadequate, and supplements non-essential to health. Students thought supplement knowledge was important but their education was inadequate. Dietary supplement use was higher in this sample of student pharmacists than the general population. Student pharmacists had limited knowledge and need more education on dietary supplements.