Papers by Haley Phillippe
BMC Public Health, May 4, 2022
Background: Deep South states, particularly Alabama, experience disproportionately higher opioid ... more Background: Deep South states, particularly Alabama, experience disproportionately higher opioid prescribing rates versus national rates. Considering limited opioid use disorder (OUD) providers in this region, collaborative efforts between non-healthcare professionals is critical in mitigating overdose mortality. The Alabama Opioid Training Institute (OTI) was created in 2019 to empower community members to take action in combatting OUD in local regions. The OTI included: 1) eight full-day in-person conferences; and 2) an interactive mobile-enabled website (https:// alaba maoti. org). This study assessed the impact of the OTI on influential community members' knowledge, abilities, concerns, readiness, and intended actions regarding OUD and opioid overdose mitigation. Methods: A one-group prospective cohort design was utilized. Alabama community leaders were purposively recruited via email, billboards, television, and social media advertisements. Outcome measures were assessed via online survey at baseline and post-conference, including: OUD knowledge (percent correct); abilities, concerns, and readiness regarding overdose management (7-point Likert-type scale, 1 = strongly disagree to 7 = strongly agree); and actions/intended actions over the past/next 6 months (8-item index from 0 to 100% of the time). Conference satisfaction was also assessed. Changes were analyzed using McNemar or Marginal Homogeneity tests for categorical variables and two-sided paired t-tests for continuous variables (alpha = 0.05). Results: Overall, 413 influential community members participated, most of whom were social workers (25.7%), female (86.4%), and White (65.7%). Community members' OUD knowledge increased from mean [SD] 71.00% [13.32] pre-conference to 83.75% [9.91] post-conference (p < 0.001). Compared to pre-conference, mean [SD] ability scale scores increased (3.72 [1.55] to 5.15 [1.11], p < 0.001) and concerns decreased (3.19 [1.30] to 2.64 [1.17], p < 0.001) post-conference. Readiness was unchanged post-conference. Attendees' intended OUD-mitigating actions in the next 6 months exceeded their self-reported actions in the past 6 months, and 92% recommended the OTI to others.
The combination of 2 antiplatelet agents and warfarin may be beneficial to a select group of pati... more The combination of 2 antiplatelet agents and warfarin may be beneficial to a select group of patients, but its use remains controversial. Here&amp;amp;amp;amp;amp;amp;#39;s why.
PRiMER, 2021
Introduction: Current evidence supports the notion of debates as a pedagogical method to teach li... more Introduction: Current evidence supports the notion of debates as a pedagogical method to teach literature evaluation skills in health care education; however, there are no reports of this method as an interprofessional approach and its potential benefits. The aim of this study was to assess the impact of interprofessional clinical debates on attitudes toward interprofessional teamwork and perceived literature evaluation skills. Methods: We invited third-year family medicine residents and fourth-year pharmacy students to complete a survey before and after participating in an interprofessional clinical debate. The anonymous survey was composed of the Students' Perceptions of Interprofessional Clinical Education—Revised (SPICE-R2) instrument to evaluate perceptions of interprofessional teamwork, literature evaluation, and other skills gained through the process. We evaluated matched responses for change in attitudes toward interprofessional teams. Results: We evaluated 41 matched r...
The American journal of managed care, 2017
Venous thromboembolism (VTE) describes the diagnoses of deep vein thrombosis (DVT) or pulmonary e... more Venous thromboembolism (VTE) describes the diagnoses of deep vein thrombosis (DVT) or pulmonary embolism (PE). DVT is the formation of thrombi in the deep veins, most commonly the large veins of the legs or pelvis. PE develops when thrombi dislodge from clots in vein walls and travel through the heart to pulmonary arteries. In many patients, the presenting manifestation of PE is sudden death. VTE may be categorized as provoked or unprovoked. This categorization influences the risk of recurrent VTE and duration of anticoagulation therapy. It is important for primary care providers to clearly understand the pathogenesis and causes of thrombosis in order to create evidence-based therapeutic and prophylactic patient care plans that adequately prevent recurrent VTE.
The Journal of family practice, 2010
Each year, venous thrombosis develops in approximately 1 in 1000 people. Th e cause: An alteratio... more Each year, venous thrombosis develops in approximately 1 in 1000 people. Th e cause: An alteration in blood composition, venous stasis, or vascular damage—commonly known as Virchow’s triad. Changes in blood composition are associated with hereditary thrombophilias, such as factor V Leiden mutation or a defi ciency in protein C or S or antithrombin III (AT). Changes in blood fl ow (stasis) and vessel damage stem from acquired conditions that commonly lead to hypercoagulability—pregnancy, malignancy, and estrogen use among them. Regardless of the reason a patient is at elevated risk, however, the goal is the same: to prevent the development of thrombi, thereby reducing the increased morbidity and mortality associated with thromboembolism. Achieving that goal requires an understanding of both inherited and acquired risk factors, familiarity with diagnostic tools, and knowledge of appropriate treatment. Th is review, which begins with hereditary hypercoagulable states before turning to acquired conditions associated with hypercoagulability, will help toward that end.
Hospital Pharmacy, 2010
Hospitals everywhere are faced with the same dilemma as other companies, struggling to manage ris... more Hospitals everywhere are faced with the same dilemma as other companies, struggling to manage rising health care expenses while providing optimal care for their employees. One of the often overlooked drug expense is the drugs consumed by the facility's employees. Although the average pharmacy department manager has a considerable amount of experience and expertise in dealing with drug expense issues for inpatients or even classic outpatients, the path to optimizing the drug expense investment strategies for their fellow employees can be difficult and elusive to discern. This article should provide a pharmacy manager with a few examples of how to contain costs for employee outpatient pharmacies.
The Senior Care Pharmacist
Diabetes mellitus is a common disease state among older people, with type 2 diabetes making up mo... more Diabetes mellitus is a common disease state among older people, with type 2 diabetes making up most cases. As the disease progresses, many patients will need to transition to insulin therapy. Pharmacists can play a pivotal role in the care of older people with diabetes by providing recommendations related to insulin therapy. Senior care pharmacists need to be knowledgeable about the pharmacokinetics, dosing, adverse effects, and cost concerns related to insulin therapy.
The Journal of family practice
The combination of 2 antiplatelet agents and warfarin may be beneficial to a select group of pati... more The combination of 2 antiplatelet agents and warfarin may be beneficial to a select group of patients, but its use remains controversial. Here's why.
Journal of pharmacy practice, Jan 17, 2014
Pregnancy is associated with an increased risk of venous thromboembolism (VTE), with a reported i... more Pregnancy is associated with an increased risk of venous thromboembolism (VTE), with a reported incidence ranging from 0.49 to 2 events per 1000 deliveries. Risk factors include advanced maternal age, obesity, smoking, and cesarian section. Women with a history of previous VTE are at a 4-fold higher risk of recurrent thromboembolic events during subsequent pregnancies. Additionally, the presence of concomitant thrombophilia, particularly factor V Leiden (homozygosity), prothrombin gene mutation (homozygosity), or antiphospholipid syndrome (APS), increases the risk of pregnancy-related VTE. Low-molecular-weight heparin (LMWH) and unfractionated heparin (UFH) are the drugs of choice for anticoagulation during pregnancy. LMWH is preferred due to ease of use and lower rates of adverse events. Women with high thromboembolic risk particularly those with a family history of VTE should receive antepartum thromboprophylaxis. Women with low thromboembolic risk or previous VTE caused by a tran...
Journal of pharmacy practice, Jan 17, 2014
Acquired thrombophilia is associated with an increased risk of venous thromboembolism (VTE). Anti... more Acquired thrombophilia is associated with an increased risk of venous thromboembolism (VTE). Antiphospholipid syndrome (APS) is the most prevalent acquired thrombophilia and is associated with both venous and arterial thromboses. Human immunodeficiency virus (HIV) is another form of acquired thrombophilia. Risk factors associated with VTE in this population include those related to the disease itself, host factors, and the pharmacotherapy for HIV. A significant proportion of VTE events occur in patients with malignancies. There is an increase in mortality associated with patients having cancer who experience VTE when compared to patients having cancer without VTE. Combination oral contraceptive (COC) use infers risk of thromboembolic events. The risk is dependent upon the presence of an underlying inherited thrombophilia, the estrogen dose, and generation of progestin. Patients at highest risk of VTE include those receiving high-dose estrogen and fourth-generation, progesterone-cont...
Journal of pharmacy practice, Jan 16, 2014
Although controversial, screening for thrombophilia has become common. Testing for antiphospholip... more Although controversial, screening for thrombophilia has become common. Testing for antiphospholipid antibodies is indicated in order to guide treatment decisions if there is clinical suspicion for antiphospholipid syndrome. The utility of identifying other thrombophilias in symptomatic venous thromboembolism (VTE) is questionable, as the risk of recurrence does not appear to be increased by an appreciable degree with the most common disorders (heterozygosity for factor V Leiden or prothrombin mutation). Although recurrence appears to be increased in those with homozygous or multiple abnormalities and potentially deficiencies in natural anticoagulants, screening to detect these conditions is difficult to justify based on their rarity. The American College of Chest Physicians' current guidelines note the increased risk of recurrence with idiopathic, proximal events regardless of thrombophilia status. They suggest duration of anticoagulation therapy be based on location and provoki...
Journal of pharmacy practice, Jan 16, 2014
Thrombophilia alters normal hemostasis, shifting the balance in favor of thrombus formation. Inhe... more Thrombophilia alters normal hemostasis, shifting the balance in favor of thrombus formation. Inherited conditions include factor V Leiden (FVL), prothrombin G20210A mutation, deficiencies in natural anticoagulants (antithrombin [AT], protein C, and protein S), hyperhomocysteinemia, and elevations in clotting factors (factors VIII and XI). Although FVL and prothrombin mutation are common disorders, deficiencies in the natural anticoagulants are rare. The risk of initial thrombosis conferred by inherited thrombophilia varies with the highest risk in those homozygous for either FVL or prothrombin mutation, or with AT deficiency. In the nonpregnant patient, the presence of a thrombophilia does not affect treatment of an acute event. Although vitamin B supplementation has been shown to decrease the levels of homocysteine, the treatment has failed to show a benefit in thrombus prevention and is therefore not recommended.
The Journal of family practice, 2011
The combination of 2 antiplatelet agents and warfarin may be beneficial to a select group of pati... more The combination of 2 antiplatelet agents and warfarin may be beneficial to a select group of patients, but its use remains controversial. Here's why.
The Consultant Pharmacist, 2011
To create an antibiogram-a profile of an organism&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39... more To create an antibiogram-a profile of an organism&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s susceptibility/resistance to a panel of antibiotics- for a long-term care facility to assess the prevalence of resistance of bacteria present at the facility. Retrospective analysis of culture and sensitivity data from July 1, 2009, through June 30, 2010. A long-term care facility in Huntsville, Alabama. Residents of the long-term care facility that had one or more culture and sensitivity test performed. Susceptibility of bacteria to each antimicrobial tested. Results were compiled and reported according to the Clinical and Laboratory Standards Institute Analysis and Presentation of Cumulative Antimicrobial Susceptibility Test Data. The most commonly seen bacteria in our long-term care facility were Escherichia coli, Staphylococcus aureus, Enterococcus faecalis, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Proteus mirabilis. Resistance rates for these bacteria were high and included the presence of methicillinresistant S. aureus and extended-spectrum beta-lactamase-producing bacteria. Resistance rates were high among all organisms reported. This poses a serious threat to the health care team&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s ability to effectively treat residents of this facility. Development of an antibiogram to assist physicians in antimicrobial selection will be beneficial in helping evaluate trends in drug resistance to current available treatments. Implementing clinical pathways for empiric treatment of infections could improve the ability to provide consistent treatment for all residents in the facility.
Expert Opinion on Pharmacotherapy, 2013
Mitiglinide , a rapid-acting insulin secretion-stimulating agent, is approved in Japan for the tr... more Mitiglinide , a rapid-acting insulin secretion-stimulating agent, is approved in Japan for the treatment of type 2 diabetes (T2DM). Rapid-acting insulin secretion-stimulating agents, also known as meglitinides, are not recommended as monotherapy, however, may be added to metformin therapy for those patients with continued postprandial hyperglycemia. Currently, repaglinide (Prandin®) and nateglinide (Starlix®) are the only US Food and Drug Administration-approved agents in this class of drugs. This review describes the pharmacology, pharmacokinetics, efficacy, safety, and potential role in therapy of mitiglinide therapy. Phase II and III clinical studies have demonstrated that A1C levels should be expected to decrease by 0.17 - 1.1% with mitiglinide therapy. The most common adverse effects in these studies were hypoglycemia related. Meglitinides are limited by their cost, frequency of administration, and minimal available data assessing clinical impact; however, mitiglinide shows selective action on the pancreatic β-cells, has greater affinity for β-cells, and limited metabolism when compared to other meglitinides. These properties may allow more utility in patients with chronic kidney disease or at high risk of hypoglycemia. The primary role in therapy for mitiglinide is the treatment of elevated postprandial glucose in patients with T2DM.
Annals of Pharmacotherapy, 2010
Annals of Pharmacotherapy, 2013
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Papers by Haley Phillippe