Interprofessional education in introductory pharmacy practice experiences at US colleges and schools of pharmacy

Objective. To assess the extent to which US colleges and schools of pharmacy are incorporating interprofessional education into their introductory pharmacy practice experiences (IPPEs), and to identify barriers to implementation; characterize the format, structure, and assessment; and identify factors associated with incorporating interprofessional education in IPPEs.Methods. An electronic survey of 116 US colleges and schools of pharmacy was conducted from March 2011 through May 2011.Results. Interprofessional education is a stated curricular goal in 78% of colleges and schools and consistently occurred in IPPEs in 55%. Most colleges and schools that included interprofessional education in IPPEs (70%) used subjective measures to assess competencies, while 17.5% used standardized outcomes assessment instruments. Barriers cited by respondents from colleges and schools that had not implemented interprofessional education in IPPEs included a lack of access to sufficient healthcare facilities with interprofessional education opportunities (57%) and a lack of required personnel resources (52%).Conclusions. Many US colleges and schools of pharmacy have incorporated interprofessional education into their IPPEs, but there is a need for further expansion of interprofessional education and better assessment related to achievement of interprofessional education competencies in IPPEs.     

Portfolio use and practices in US colleges and schools of pharmacy

Objectives. To identify the prevalence of portfolio use in US pharmacy programs, common components of portfolios, and advantages of and limitations to using portfolios.Methods. A cross-sectional electronic survey instrument was sent to experiential coordinators at US colleges and schools of pharmacy to collect data on portfolio content, methods, training and resource requirements, and benefits and challenges of portfolio use.Results. Most colleges and schools of pharmacy (61.8%) use portfolios in experiential courses and the majority (67.1%) formally assess them, but there is wide variation regarding content and assessment. The majority of respondents used student portfolios as a formative evaluation primarily in the experiential curriculum.Conclusions. Although most colleges and schools of pharmacy have a portfolio system in place, few are using them to fulfill accreditation requirements. Colleges and schools need to carefully examine the intended purpose of their portfolio system and follow-through with implementation and maintenance of a system that meets their goals.     

A recent history of opioid use in the US: Three decades of change

Background: The opioid epidemic in the United States is a problem that has developed over decades. While clinical, regulatory, and legislative changes have been implemented to combat this issue, changes will not be immediate. Moreover, the changes that have been carried out may have unintended negative consequences such as increased use of illicit opioids (e.g., heroin and synthetics) and challenges in effective and appropriate pain management.

Objectives: This review focuses on the last three decades and presents key changes the United States has seen in the use of opioids. Conclusions/Importance: There have been numerous policy changes and programs aimed at decreasing opioid use and abuse in the United States; however, it will take a major shift in the mindset of clinicians, the general public, and policy makers to alleviate this epidemic.     

Journalists and substance use: A systematic literature review

ABSTRACT

Background: Journalists' exposure to potentially traumatic events (PTEs), high levels of job stress, and anecdotal reports within the industry seem to suggest that journalists are at greater risk than the general population to experience substance use disorders. The present systematic literature review (SLR) aims to provide a concise, comprehensive, and systematic review of the quantitative literature relating to journalists' experience of substance use. Methods: The systematic review method adopted within the present study was based on that prescribed by Fink in the 2010 book, Conducting systematic literature reviews: From the internet to paper, 3rd ed., which contains three main elements: sampling the literature, screening the literature, and extracting data. Results: Alcohol consumption is the most widely studied substance in journalist samples and is discussed in relation to quantity, level of risk, and potential alcoholism. The review also considers journalists' use of substances, including cigarettes, cannabis, and other illicit substances. In particular, comparisons are made between journalistic roles and gender. Conclusions: The research is piecemeal in nature, in that more recent research does not build upon the research that has come before it. Much of what has been reported does not reflect the progress that has taken place in recent years within the alcohol consumption and substance use field in terms of theory, assessment, scale development, practice, and interventions with those who use or are addicted to various substances. This SLR raises a number of methodological and theoretical issues to be explored and addressed in future research.     

A statewide screening,brief intervention,and referral to treatment (SBIRT) curriculum for medical residents: Differential implementation strategies in heterogeneous medical residency programs

ABSTRACT

Background: Many screening, brief intervention, and referral to treatment (SBIRT) training curricula have been implemented within graduate medical residency training programs, with varying degrees of success. The authors examined the implementation of a uniform, but adaptable, statewide SBIRT curriculum in 7 diverse residency training programs and whether it could improve resident knowledge, skills, and attitudes regarding SBIRT and unhealthy alcohol and other drug (AOD) use. Methods: The authors assessed the implementation of the Pennsylvania SBIRT Medical and Residency Training (SMaRT) curriculum at 7 residency sites training a variety of disciplines. Faculty could use a variety of training modalities, including (1) Web-based self-directed modules; (2) didactic lectures; (3) small-group sessions; and/or (4) skill-transfer interactions with standardized or real patients in preceptor-led encounters. Acquisition of knowledge, skills, and attitudes regarding SBIRT and unhealthy AOD use–associated patient care were assessed via a pre- and post-survey instrument with 4 domains: Resident Knowledge, Resident Competence, Resident Skills and Attitudes (Alcohol), and Resident Skills and Attitudes (Drug). Responses to the pre- and post-surveys (N = 365) were compared and analyzed with t tests and Wilcoxon signed-rank tests. Results: The diverse modalities allowed each of the residency programs to adapt and implement the SMaRT curriculum based on their needs and environments. Residents' knowledge, skills, and attitudes regarding SBIRT and working with unhealthy AOD use, as assessed by survey, generally improved after completing the SMaRT curriculum, despite the variety of models used. Specifically, Resident Knowledge and Resident Competence domains significantly improved (P < .000). Residents improved the least for survey items within the Resident Skills and Attitudes (Alcohol) domain. Conclusions: Adaptable curricula, such as SMaRT, may be a viable step towards developing a nationwide curriculum.     

Substance use initiation: The role of simultaneous polysubstance use

Introduction and Aims. Simultaneous polysubstance use (SPU) is a common phenomenon, yet little is known about its role in substance use initiation. Design and Methods. In the present study, 226 cannabis users completed structured interviews about their substance use history. For each substance ever used, participants provided details of their age of first use, their use in the preceding 30 days and whether they co‐administered any other licit or illicit substances the first time they used the substance. Results. For most illicit substances [powder cocaine, crack, amphetamine, methamphetamine, 3,4‐methylenedioxymethamphetamine (MDMA; ecstasy), heroin, opium, gamma‐hydroxybutyric acid (GHB), ketamine, psilocybin (magic mushrooms), mescaline, phencyclidine (PCP), peyote and inhalants], results showed that a clear majority of participants (≥75%) reported SPU during their first‐ever use of the substance. While SPU was less common on occasions of first use of alcohol, tobacco and cannabis, a high proportion of SPU on occasions of first use of ‘harder’ drugs could be accounted for by the co‐use of alcohol, tobacco and/or cannabis. Discussion and Conclusions. Such findings raise the possibility that specific alcohol, tobacco and/or cannabis use episodes might directly contribute to the initiation of new substance use. Understanding the role of SPU on occasions of first use might help better identify risk factors for substance use progression and improve intervention efforts.[Olthuis JV, Darredeau C, Barrett SP. Substance use initiation: The role of simultaneous polysubstance use. Drug Alcohol Rev 2013;32:67–71]     

A diabetes self-management education class taught by pharmacy students

Objective. To assess the impact of pharmacy students teaching a diabetes self-management education (DSME) class on their competence and confidence in providing diabetes education.Design. Pharmacy students enrolled in a service-learning elective first observed pharmacy faculty members teaching a DSME class and then 4 weeks later organized and taught a DSME class to a different group of patients at a student-run free medical clinic.Assessment. Student performance as assessed by faculty members using a rubric was above average, with a mean score of 3.3 on a 4.0 scale. Overall, student confidence after teaching the group DSME class was significantly higher than before teaching the class.Conclusion. Organizing and teaching a DSME class improved third-year pharmacy students’ confidence and diabetes knowledge and skills, as well as provided a valuable service to patients at a free medical clinic.     

Pharmacoeconomic education in US colleges and schools of pharmacy: an update

Objectives

To determine the extent of pharmacoeconomics education at US pharmacy colleges and schools in 2007.

Methods

An e-mail survey was developed and sent to pharmacoeconomics instructors at all US colleges of pharmacy.

Results

Of the 90 colleges and schools of pharmacy that completed the survey, 7 colleges and schools did not currently have someone teaching pharmacoeconomics (eg, new school or looking for instructor). For the 83 colleges and schools that had an instructor who taught pharmacoeconomics, 69 covered pharmacoeconomic-related topics in a required course only; 5, in an elective course only; and 9, in both a required and elective course. The number of hours of pharmacoeconomic-related topics presented in required courses ranged from 1 to 48 hours (mean = 21 ± 14; median = 19).

Conclusions

Pharmacoeconomics education courses are offered at the majority of US colleges and schools of pharmacy. There was a wide range of hours devoted to pharmacoeconomic-related topics and the topics covered in these colleges and schools varied. Although the majority of US colleges and schools of pharmacy offer pharmacoeconomics courses, official guidelines are needed for the specific aspects and topics that should be covered in the classroom.     

Substance Use Prevalence and Screening Instrument Comparisons in Urban Primary Care

ABSTRACT

Substance use screening in a primary care setting compared the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST version 3.0), Two-Item Conjoint Screen (TICS), National Institute on Alcohol Abuse and Alcoholism (NIAAA) daily limit single item, and electronic medical record (EMR). Among 236 consecutive adults, ASSIST moderate- to high-risk substance use prevalence was tobacco, 15.3%; alcohol, 8.5%; cannabis, 5.1%; cocaine, 2.5%; and opioids, 2.5%. Compared to ASSIST, a positive TICS was 45% (95% confidence interval [CI], 27–64%) sensitive, 99% (95–100%) specific; the NIAAA single-item screen was 80% (56–94%) sensitive, 87% (82–91%) specific. The NIAAA single item correlated closely with alcohol ASSIST. TICS and EMR were less sensitive for any nontobacco substance use.     

The science of safety curriculum in US colleges and schools of pharmacy

Objective. To describe the integration of science of safety (SoS) topics in doctor of pharmacy (PharmD) curricula of US colleges and schools of pharmacy.Methods. A questionnaire that contained items pertaining to what and how SoS topics are taught in PharmD curricula was e-mailed to representatives at 107 US colleges and schools of pharmacy.Results. The majority of the colleges and schools responding indicated that they had integrated SoS topics into their curriculum, however, some gaps (eg, teaching students about communicating risk, Food and Drug Administration [FDA] Sentinel Initiative, utilizing patient databases) were identified that need to be addressed.Conclusions. The FDA and the American Association of Colleges of Pharmacy (AACP) should continue to collaborate to develop resources needed to ensure that topics proposed by the FDA in their SoS framework are taught at all colleges and schools of pharmacy.     

Evaluation of a Substance Use Disorder Curriculum for Internal Medicine Residents

ABSTRACT

Teaching about diagnosis, treatment, and sequelae of substance use disorders (SUDs) is insufficient in most Internal Medicine residency programs. To address this, the authors developed, implemented, and evaluated a novel and comprehensive SUD curriculum for first year residents (interns) in Internal Medicine, which anchors the ensuing 3-year longitudinal SUD curriculum. This intern curriculum includes didactic and experiential elements and allows skills practice. Topics include local epidemiology of substance abuse, neurobiology of SUDs, and screening, treatment, and referral. The entire curriculum is delivered over 7 hours during a month-long ambulatory rotation. Among 58 interns who have completed a pre-post evaluation of the curriculum, the majority reported an increased sense of responsibility for and confidence in treating patients with SUDs.     

Barriers to Buprenorphine Expansion in Ohio: A Time-Elapsed Qualitative Study

ABSTRACT

Buprenorphine partial opioid agonist pharmacotherapy, a key treatment for opioid use disorders (OUDs), is underutilized in the United States. Qualitative interviews, conducted in 2012/2013 and repeated in 2015, identified systemic barriers to providing buprenorphine treatment in Ohio. A representative sample of Ohio’s Alcohol, Drug Abuse and Mental Health Services (ADAMHS) county boards (n = 18) was selected based on percentage of OUD admissions, density of buprenorphine prescribers, and county board area population. Boards reported that the barriers to the use of buprenorphine in 2012/2013 included (1) negative attitudes toward the use of buprenorphine among substance use disorder treatment providers; (2) a lack of prescribers; and (3) lack of funding. The 2015 interviews suggested that the lack of prescribers surpassed lack of funding as the main impediment to buprenorphine expansion. Negative provider attitudes were no longer problematic. Concerns about buprenorphine diversion, however, had emerged as a new barrier. This article offers recommendations for future policy efforts to overcome these barriers and expand the use of evidence-based opioid treatments. It highlights the need for payers and policymakers to increase the number of buprenorphine prescribers to make best use of funding available to fight the opioid epidemic.     

Substance misuse trends in South Africa

This paper, the first in a series related to the Joint European South African Research Network in Anxiety Disorders programme, examines substance use trends in South Africa. Alcohol remains the substance with the greatest burden of harm. Yet, trends vary by region, with for example methamphetamine being a major driver of psychiatric and substance abuse treatment demand in the Western Cape province. Heroin use is increasing in several provinces, where rapid intervention is required to avoid an epidemic. In particular, the state (the main funder of drug services) urgently needs to provide opioid substitution treatment. Apart from an inadequate number of treatment services, barriers to treatment are high. Barriers are predominantly cost, transport and resource related. Services are also impacted by a small and inadequately trained workforce and poor integration with mental health services. To adequately intervene with substance use disorders, South Africa needs an evidence-based policy and service planning framework that forges linkages with the mental health service system.     

Goals for medical education on drugs and alcohol for the year 2000

The issues involved in teaching about drug and alcohol issues in medical schools incorporate a wide range of concerns. Any attempt to raise the proficiency of doctors in dealing with drug and alcohol problems must begin during their basic training, and impart the skills to continue learning after graduation. The principles of community medicine are especially relevant to education in drug and alcohol problems, and basic teaching techniques must be examined as well as course content when reviewing current ideas about drug and alcohol education in medical schools.