David Rhys Axon

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• Anderson, E. J., Axon, D. R., Taylor, A. M., Towers, V., Warholak, T., Johnson, M., Forbes, S., & Manygoats, T. (2020). Impact evaluation of a four-year academic-community partnership in provision of medication management and tertiary prevention services for rural patients with diabetes and/or hypertension. Preventive medicine reports, 17, 101038.
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  Medication therapy management (MTM) services, including targeted, pharmacist-delivered, tertiary prevention interventions, were provided to rural patients with chronic diseases via an academic-community partnership. The purpose of this investigation was to evaluate the overall program and pre/post patient outcomes from this four-year, multi-site collaboration. Five community health sites collaborated with a university-based MTM provider to deliver services in Arizona (2012-16). Eligible patients: were 18 or older (median 65 years); had a diagnosis of diabetes and/or hypertension; and resided in a rural community. Participants received an initial telephone consultation with the MTM pharmacist; follow-up consultations were conducted after 30 or 90 days for high- and low-risk patients, respectively. Community partner staff collected clinical data and addressed pharmacists' recommendations. Descriptive analysis and bivariate analyses of pre- and post-intervention results were conducted. Most (n = 410, 70%) of the 577 participants receiving an initial and follow-up consultation with the MTM pharmacist had both diabetes and hypertension. These individuals showed statistically significant improvements in fasting blood glucose (p 
• Axon, D. R., Aljadeed, R., Potisarach, P., Forbes, S., DiLeo, J., & Warholak, T. (2020). Pilot study of focus groups exploring student pharmacists' perceptions of a medication management center internship. Currents in pharmacy teaching & learning, 12(9), 1123-1128.
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  Student pharmacists are expected to participate in real-life, patient-centered experiences to help develop clinical knowledge and professional skills. This study explored student pharmacist intern perceptions of work experience at a medication management center (MMC). We also examined how working at the MMC helped fulfill curricular requirements, helped develop leadership skills, and provided professional development opportunities.
• Axon, D. R., Chinthammit, C., Tate, J., Taylor, A. M., Leal, S., Pickering, M., Black, H., Warholak, T., & Campbell, P. J. (2020). Current Procedural Terminology Codes for Medication Therapy Management in Administrative Data. Journal of managed care & specialty pharmacy, 26(10), 1297-1300.
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  Three pharmacist-specific Current Procedural Terminology (CPT) codes exist to facilitate medication therapy management (MTM) reimbursement (codes 99605, 99606, and 99607). However, no studies have used CPT codes in administrative claims databases to identify subjects who have received MTM services.
• Axon, D. R., Vaffis, S., & Marupuru, S. (2020). Identifying Predictive Characteristics of Opioid Medication Use among a Nationally Representative Sample of United States Older Adults with Pain and Comorbid Hypertension or Hypercholesterolemia. Healthcare (Basel, Switzerland), 8(3).
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  The prevalence of older adults with pain and comorbid cardiovascular conditions is increasing in the United States (U.S.). This retrospective, cross-sectional database study used 2017 Medical Expenditure Panel Survey data and hierarchical logistic regression models to identify predictive characteristics of opioid use among a nationally representative sample of older U.S. adults (aged ≥50 years) with pain in the past four weeks and comorbid hypertension (pain-hypertension group) or hypercholesterolemia (pain-hypercholesterolemia group). The pain-hypertension group included 2733 subjects ( = 803 opioid users) and the pain-hypercholesterolemia group included 2796 subjects ( = 795 opioid users). In both groups, predictors of opioid use included: White race versus others, Hispanic versus non-Hispanic ethnicity, 1 versus ≥5 chronic conditions, little/moderate versus quite a bit/extreme pain, good versus fair/poor perceived mental health, functional limitation versus no functional limitation, smoker versus non-smoker, and Northeast versus West census region. In addition, Midwest versus West census region was a predictor in the pain-hypertension group, and 4 versus ≥5 chronic conditions was a predictor in the pain-hypercholesterolemia group. In conclusion, several characteristics of older U.S. adults with pain and comorbid hypertension or hypercholesterolemia were predictive of opioid use. These characteristics could be addressed to optimize individuals' pain management and help address the opioid overdose epidemic.
• Axon, D. R., Vaffis, S., Chinthammit, C., Lott, B. E., Taylor, A. M., Pickering, M., Black, H., Warholak, T., & Campbell, P. J. (2020). Assessing the association between medication adherence, as defined in quality measures, and disease-state control, health care utilization, and costs in a retrospective database analysis of Medicare supplemental beneficiaries using statin medications. Journal of managed care & specialty pharmacy, 26(12), 1529-1537.
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  Adherence to medication, and related health and economic outcomes, is becoming increasingly important as populations age and as the number of Americans managing chronic conditions increases. The Pharmacy Quality Alliance (PQA) statin medication adherence measure is used in Medicare star ratings to evaluate health plan performance. Yet, limited evidence exists that investigates the association between statin medication adherence, as specified in the PQA adherence quality measure, and disease-state control, health care utilization, and costs. To determine the association between adherence (≥80% proportion of days covered) and disease-state control, health care utilization, and health care costs for Medicare supplemental beneficiaries using statin medications eligible for inclusion in the PQA statin adherence quality measure. This retrospective study used a cohort of eligible beneficiaries for inclusion in the PQA statin adherence measure with low-density lipoprotein (LDL) laboratory values from IBM MarketScan Medicare Supplemental Research Databases (2009-2015). A logistic regression model assessed the association between adherence and LDL control (controlled individuals had LDL levels ≤ 100 mg/dL). Health care utilization and costs during a 1-year period, from first statin medication claim, were compared between adherent and nonadherent groups using generalized linear models with log link and negative binomial distribution (utilization) or gamma distribution (costs), adjusting for covariates. Beta coefficients were used to compute cost ratios (CR) and rate ratios (RR). Cohort characteristics were assessed using t-tests, Wilcoxon rank sum tests, or chi-square tests. An a priori alpha level of 0.001 was used. The study cohort consisted of 77,174 beneficiaries, of whom 58,668 (76.0%) were classified as adherent to their statin medications. After controlling for other factors, odds of disease-state control were approximately 2 times higher among medication adherent beneficiaries compared with their nonadherent counterparts (OR = 2.192; 95% CI = 2.109-2.278). Multivariable analyses showed adherers experienced 4.7% fewer outpatient (RR = 0.953; 95% CI = 0.940-0.965) and 27.5% fewer inpatient (RR = 0.725; 95% CI = 0.687-0.766) visits; had 9.9% lower outpatient (CR = 0.901; 95% CI = 0.885-0.916) and 28.3% lower inpatient (CR = 0.717; 95% CI = 0.705-0.729) costs; 14.7% lower total costs (CR = 0.853; 95% CI =0.838-0.868); and 7.0% higher prescription drug costs (CR = 1.070; 95% CI = 1.052-1.089) than nonadherers. Adherence to statin medications was associated with a reduction in total costs of $157.32 per member per month. This retrospective database analysis demonstrated that statin adherence was associated with approximately twice the odds of having a controlled disease state compared with nonadherence in a large Medicare sample. Adherent beneficiaries had fewer outpatient and inpatient visits (lower utilization), lower outpatient and inpatient costs, and lower total costs, a calculated savings of $157.32 per member per month, despite having higher prescription drug costs. Finally, these results provide important new information by demonstrating that adherence (≥ 80%) is associated with lower health care costs in a short (1-year) time frame. Funding for this study was provided by Pharmacy Quality Alliance; Merck & Co. (Kenilworth, NJ); and SinfoniaRx. All authors except Pickering and Black were employed by the University of Arizona College of Pharmacy or the Mel & Enid Zuckerman College of Public Health at the time of this study. Pickering is employed by the Pharmacy Quality Alliance, and Black is employed by Merck & Co. Chinthammit also reports employment with Eli Lilly and Company, and Campbell reports employment with the Pharmacy Quality Alliance. Axon reports grants from Arizona Department of Health Services, unrelated to this work. Warholak reports grants from Novartis and the Arizona Department of Health Services, unrelated to this work. This research was presented as a poster at the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) Annual Meeting 2019, May 18-22, 2019, in New Orleans, LA.
• Bingham, J. M., Michaud, V., Turgeon, J., & Axon, D. R. (2020). Effectiveness of an Advanced Clinical Decision Support System on Clinical Decision-Making Skills in a Call Center Medication Therapy Management Pharmacy Setting: A Pilot Study. Pharmacy (Basel, Switzerland), 8(4).
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  (1) Background: There is limited evidence related to the efficacy of advanced clinical decision support systems (CDSS) on the quantity of high-quality clinical recommendations in a pharmacy-related medication therapy management (MTM) setting. The study aimed to assess the effect of an advanced CDSS on the quantity of relevant clinical pharmacist recommendations in a call center MTM setting. (2) Methods: This pre-test/post-test with comparator group study compared clinical skills assessment scores between certified MTM pharmacists in March 2020. A Wilcoxon Signed Rank test assessed the difference between pre- and post-test scores in both groups. (3) Results: Of 20 participants, the majority were less than 40 years old (85%) with a Doctor of Pharmacy degree (90%). Nine were female. Intervention group participants had less than three years of experience as a pharmacist. The control group had less than three years (40%) or seven to ten years (40%) of experience. There was a significant increase in intervention group scores between pre- (median = 3.0, IQR = 3.0) and post-test segments (median = 6.5, IQR = 4.0, = 0.02). There was no significant change between control group pre- and post-test segments ( = 0.48). (4) Conclusion: Pharmacist exposure to an advanced CDSS was associated with significantly increased quantity of relevant clinical recommendations in an MTM pharmacy setting.
• Bingham, J. M., Silva Almodovar, A., Taylor, A. M., Axon, D. R., Nahata, M. C., Leal, S., Warholak, T., & Scovis, N. (2020). A Research Partnership to Enhance Postgraduate Pharmacy Residency Training Outcomes. Pharmacy (Basel, Switzerland), 8(3).
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  Pharmacy residents must complete research as part of their program; however, challenges exist in providing experiences that result in successful research dissemination outcomes. A university-based research team, integrated into an ambulatory care pharmacy residency program aimed to improve presentation and publication rates of pharmacy resident research projects. Data on the number of postgraduate year-2 (PGY2) residents and their productivity were collected and summarized to assess progress. A total of 13 residents completed their residency over seven years. Each resident produced one regional presentation, and one national presentation beginning in year four. To date, three peer-reviewed papers have been published, with another one in-press. Responses from residents found lack of guidance, lack of data availability for projects and feedback fatigue were barriers to a positive research experience. To address these problems, a university-based research team was integrated to provide research mentor guided support, ensure study feasibility, and provide structured feedback. This program evaluation highlighted the integration of a PGY2 ambulatory care pharmacy residency with a designated, interprofessional university-based research team. Future work is warranted to reduce research-related barriers and formally evaluate resident post-program knowledge, skills, and subsequent dissemination rates.
• Bingham, J. M., Taylor, A. M., Boesen, K. P., & Axon, D. R. (2020). Preliminary Investigation of Pharmacist-Delivered, Direct-to-Provider Interventions to Reduce Co-Prescribing of Opioids and Benzodiazepines among a Medicare Population. Pharmacy (Basel, Switzerland), 8(1).
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  Co-prescribing of opioids and benzodiazepines can lead to overdoses and mortality. This retrospective study analyzed prescription claims data collected in 2016. A national medication therapy management (MTM) program conducted prescriber-based outreach interventions for patients with concurrent opioid and benzodiazepine prescriptions. The pharmacist's direct-to-prescriber intervention was conducted following a targeted medication review. The pharmacist initiated interventions with the prescriber via facsimile to recommend discontinuation of concurrent use of these drugs. This study included 57,748 subjects who were predominantly female (67.83%) and aged ≥ 65 years (66.90%). Prescribers were most commonly located in the southern United States (46.88%). The top prescribed opioid medications were hydrocodone-acetaminophen (33.60%), tramadol (17.50%), and oxycodone-acetaminophen (15.66%). The top benzodiazepines prescribed concurrently with opioids were alprazolam (35.11%), clonazepam (21.16%), and lorazepam (20.09%). Based on the pharmacists' recommendations, 37,990 (65.79%) resulted in a medication discontinuation (benzodiazepines 40.23%; opioids 59.77%) by the provider. There were significant differences in the proportion of opioids discontinued by subject age ( < 0.001) and prescriber geographical region ( = 0.0148). The top medications discontinued by the prescriber were hydrocodone-acetaminophen (18.86%), alprazolam (14.19%), and tramadol HCl (13.51%). This study provides initial evidence for pharmacist-supported, direct-to-prescriber programs as an effective medication safety strategy.
• Campbell, P. J., Axon, D. R., Taylor, A. M., Pickering, M., Black, H., Warholak, T., & Chinthammit, C. (2020). Associations of Renin-Angiotensin System Antagonist Medication Adherence and Economic Outcomes Among Commercially Insured US Adults: A Retrospective Cohort Study. Journal of the American Heart Association, 9(17), e016094.
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  Background Medication non-adherence can result in considerable morbidity, mortality, and costs. The Pharmacy Quality Alliance hypertension medication adherence measure is used by US healthcare payers and providers to assess renin-angiotensin system antagonist medication adherence. However, associations between renin-angiotensin system antagonist adherence as calculated in quality measures, and healthcare service use and expenditure in commercial populations over a 1-year timeframe has not been assessed. Methods and Results This retrospective cohort study used eligible commercially insured individuals from the Truven Health MarketScan Commercial Claims and Encounters Research Databases (2009-2015). Generalized linear models with log link and gamma distribution (expenditure) or negative binomial distribution (usage) assessed relationships between hypertension adherence (≥80% proportion of days covered) and healthcare use and expenditures (in 2015 US dollars) while adjusting for covariates (age, sex, geographic region; health plan; Deyo-Charlson Comorbidity Index, number of chronic medications, and treatment naivety). Beta coefficients were used to compute cost ratios and rate ratios. A total of 4 842 058 subjects were eligible; of those, 3 310 360 (68%) were adherent (adherent mean age 53.3±8.0 years, 55.9% men; non-adherent mean age 50.3±9.1 years, 53.1% men). Adherence was associated with fewer inpatient (rate ratios, 0.612; 95% CI, 0.607-0.617) and outpatient visits (rate ratios, 0.995; 95% CI, 0.994-0.997); and lower total costs (cost ratios, 0.876; 95% CI, 0.874-0.878) compared with non-adherence. Adherence was associated with lower average per member per month total costs ($97.98) compared with non-adherence. Conclusions Adherence to renin-angiotensin system antagonists was associated with fewer outpatient and inpatient visits, and lower total costs compared with non-adherence in a 1-year time frame.
• Chinthammit, C., Axon, D. R., Anderson, S., Lott, B., Taylor, A. M., Pickering, M., Black, H., Warholak, T., & Campbell, P. J. (2020). A retrospective cohort study evaluating the relationship between statin medication adherence and economic outcomes in commercial health plans. Journal of clinical lipidology.
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  Adherence to statin medications is suboptimal; however, the association of statin adherence, as defined in medication adherence quality measures, with healthcare service use and expenditure within one year has not been assessed in a commercially insured United States (US) population.
• Chinthammit, C., Bhattacharjee, S., Axon, D. R., Slack, M., Bentley, J. P., Warholak, T. L., Wilson, D. L., & Lo-Ciganic, W. H. (2020). Geographic Variation in the Prevalence of High-Risk Medication Use Among Medicare Part D Beneficiaries by Hospital Referral Region. Journal of managed care & specialty pharmacy, 26(10), 1309-1316.
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  Understanding geographic patterns of high-risk medication (HRM) prescribed and dispensed among older adults may help the Centers for Medicare & Medicaid Services and their partners develop and tailor prevention strategies.
• Guerra, B., Vaffis, S., Axon, D. R., Leal, S., Warholak, T., Taylor, A. M., & Scovis, N. (2020). Perceptions and experiences of promotoras and pharmacists in an academic-community partnership providing telephonic MTM services to a Spanish-speaking, rural population: a focus group study. Journal of managed care & specialty pharmacy, 26(11), 1390-1397.
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  The literature is limited concerning the collaboration between pharmacists and promotoras in the delivery of medication therapy management (MTM) services. Yet, this information could help address a practice gap while improving MTM collaborative care approaches. To identify the knowledge, attitudes, and barriers of clinical call center health professionals (pharmacists, nurses, pharmacy interns) and promotoras towards MTM collaborative care in implementing the Rural Arizona Medication Therapy Management (RAzMTM) program. A descriptive, qualitative study using semistructured focus groups was conducted with call center health professionals and promotoras who participated in the RAzMTM program to improve pharmaceutical care for patients with diabetes and/or hypertension in rural Arizona. Recruitment and consent letters, a demographic questionnaire, and a focus group guide were designed specifically for this project. Three facilitators participated in each focus group-one guided the discussion while the others took notes. Focus groups were audio recorded to verify all responses and transcribed verbatim with omission of participant identifiers. Thematic analysis was conducted by 2 independent researchers who reviewed the transcripts to identify codes, seek consensus, and agree on themes, with negotiation from a third independent researcher. Nine participants took part in 2 focus groups. Participants were predominantly female (89%), college graduates and/or had postgraduate/professional degrees (78%), and were Hispanic or Latino (89%). Five themes were identified: (1) roles and responsibilities of RAzMTM participants; (2) benefits unique to the RAzMTM program; (3) interprofessional experience of RAzMTM participants; (4) professional growth for RAzMTM participants; and (5) opportunities for future improvement. Perceptions of the participants in the RAzMTM program were consistent-experiences of health professionals and promotoras were positive; they recognized the benefit of each other's involvement in the program; and they learned how to work together to improve patient care. Future recommended program improvements include improving ease of scheduling (e.g., extending pharmacist availability to provide MTM services). These focus group results suggest that provision of telephonic MTM services, using an academic-community partnership, was positively received by participating pharmacists and promotoras. However, future work is needed for continued improvement of strategies to enhance interprofessional relationships in patient chronic disease management. This project was supported by the Grant or Cooperative Agreement Number DP004793, funded by the Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention or the Department of Health and Human Services. This work also was supported, in part, by SinfoniaRx. Axon, Taylor, and Warholak received funding from SinfoniaRx. Axon reports grants from Tabula Rasa Op-Co, Merck & Co, Pharmacy Quality Alliance, Arizona Department of Health, and American Association of Colleges of Pharmacy, outside the submitted work. Warholak and Taylor received funding from Arizona Department of Health Services as part of a contract, outside the submitted work. Vaffis reports funding from Merck and Pharmacy Quality Alliance. This study was presented as a poster at the American Society of Health-System Pharmacists Summer Meetings & Exhibition (June 10-12, 2019, Boston, MA) and as a podium presentation at the Arizona Pharmacy Association Southwestern States Residency Conference (June 14, 2019, Phoenix, AZ).
• Hall-Lipsy, E., Anderson, E. J., Taylor, A. M., Warholak, T., Axon, D. R., Faqeeri, Z., & Jastrzab, R. (2020). Community health worker perspectives of an academic community medication therapy management collaboration. Journal of the American Pharmacists Association : JAPhA, 60(3), 475-480.e1.
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  To qualitatively assess community health workers' (CHWs') perceptions of the challenges and benefits associated with participating in a collaborative, interprofessional medication therapy management (MTM) program for rural, underserved, predominantly Latinx, patients with diabetes and hypertension.
• Marupuru, S., Axon, D. R., Campbell, P., Chinthammit, C., Forbes, S., Martin, R., Taylor, A. M., & Warholak, T. L. (2020). Exploring performance predictors among employees in a pharmacist-led medication management center. Journal of the American Pharmacists Association : JAPhA, 60(6), 809-817.
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  Health care companies are increasingly interested in developing and maintaining employee motivation. However, this can be challenging with different professions working together in delivering telephonic medication therapy management services. The purpose of the study is to assess employees' perceptions of performance metrics, strategies to achieve those metrics, motivational work factors, and barriers to achievement at a medication management center (MMC).
• 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.