Providers' Perceptions of Student Pharmacists on Inpatient General Medicine Practice Experiences

Objective. To assess health care providers’ perceptions of student pharmacists involved as members of a general medicine team.Methods. A brief, anonymous, online survey instrument was distributed to 134 health care providers at 4 major medical centers in Massachusetts who interacted with Northeastern University student pharmacists during inpatient general medicine advanced pharmacy practice experiences beginning in March 2011. The survey instrument assessed health care provider perception of student pharmacists’ involvement, preparedness, clinical skills, and therapeutic recommendations.Results. Of the 79 providers who responded, 96.2% reported that student pharmacists were prepared for medical rounds and 87.3% reported that student pharmacists were active participants in patient care. Also, 94.9% and 98.7% of providers indicated that student pharmacist recommendations were appropriate and accurate, respectively. The majority (61.8%) of providers believed that student pharmacist involvement on internal medicine teams was beneficial.Conclusions. Provider perceptions regarding student pharmacist participation on general medicine practice experiences were mostly positive.     

An elective course to engage student pharmacists in elementary school science education

Objective. To develop and assess the impact of an elective course (HealthWISE) on student pharmacists’ skills in communication and health promotion and elementary school students’ knowledge of and attitudes toward science.Design. Three colleges and schools of pharmacy collaborated to develop a 1-credit elective course that used online and classroom teaching and learning techniques to prepare student pharmacists to teach science in elementary school classrooms. Student pharmacists delivered 6 science lessons to elementary students over the course of 2 months.Assessment. In weekly journal reflections and a final paper, student pharmacists reported improved communication and health promotion skills. Elementary teachers reported they were satisfied with student pharmacists’ performance in the classroom. On pretest and posttest evaluations, elementary students demonstrated increased science knowledge and enhanced enthusiasm for science following the lessons taught by student pharmacists.Conclusions. The HealthWISE elective course provided positive benefit for student pharmacists, elementary school teachers, and elementary students.     

An Evidence-Based Course in Complementary Medicines

Objective. To evaluate the impact of an evidence-based course in complementary medicines on the attitudes, knowledge, and professional practice behavior of undergraduate pharmacy students.Design. A required 12-week evidence-based complementary medicine course was designed and introduced into the third-year undergraduate pharmacy curriculum. The course included a combination of traditional lectures, interactive tutorial sessions, and a range of formal assessments.Assessment. Pre- and post-course survey instruments were administered to assess changes in students’ attitudes, perceptions, knowledge, and the likelihood they would recommend the use of complementary medicines in a pharmacy practice environment.Conclusion. Completion of a required evidence-based complementary medicines course resulted in a positive change in pharmacy students’ perceptions of the value of various complementary medicines as well as in their willingness to recommend them, and provided students with the required knowledge to make patient-centered recommendations for use of complementary medicines in a professional pharmacy practice setting. These findings support the need for greater evidence-based complementary medicine education within pharmacy curricula to meet consumer demand and to align with pharmacists’ professional responsibilities.     

Factors associated with abnormal glucose readings in a pharmacy-led community health fair using the ADA risk assessment tool

ObjectivesThe objective of this study was to evaluate whether the American Diabetes Association (ADA) risk tool correctly identified high-risk patients with abnormal glucose readings requiring referral to a health care provider in an underserved population at a large student pharmacist–led health fair. In addition, the association of abnormal glucose readings compared with alternative ADA risk score cut point values and other collected variables was evaluated.MethodsThis was a retrospective, cross-sectional study using deidentified data from a large student pharmacist–led health fair.ResultsA total of 35 of 188 (19%) patients were considered high risk per the ADA risk tool, and 11 of those 35 (31%) had abnormal glucose results. After controlling for ADA risk score, no additional collected clinical variables were independently associated with abnormal glucose results. Although the ADA cut point associated with an abnormal glucose screening with the highest area under the curve was greater than or equal to 4, a cut point of 3 or greater resulted in a sensitivity of 91.2%.ConclusionThe optimal method to identify patients who are at risk for an abnormal glucose screening is the ADA risk tool compared with the individual components of the tool or other evaluated risk factors. We suggest using an ADA risk cut point of greater than or equal to 3 instead of greater than or equal to 5 to identify patients likely to have abnormal glucose results in the health fair setting as this would greatly increase the chance of identifying patients who would need to be referred to their primary care provider for diagnostic testing.     

Patient experiences in managing non-communicable diseases in Namibia

IntroductionThe prevalence of non-communicable diseases (NCDs) is rising in Namibia, and with it, the need for pharmacists to empower patients. This research aims to 1) identify patient-reported barriers and facilitators to managing chronic NCDs for Namibians, and 2) characterize common patient-reported medication and health-related needs of Namibians with chronic NCDs.MethodsThis qualitative study used semi-structured interviews to elicit participant perspectives regarding NCDs. The study used the conceptual frameworks of the Health Belief Model, the Theory of Planned Behavior, and the Explanatory Models of Illness to identify and understand key factors necessary to develop relevant patient-centered interventions. Participants were recruited from pharmacies throughout Namibia. Data were analyzed using thematic analysis from the transcribed interviews.ResultsA total of 23 interviews were conducted, with 20 being included in the final analysis. Themes identified included: 1) participants were motivated to seek care when they were symptomatic; 2) participants felt motivated to care for their condition to improve their own lives and their families for their family's sake; 3) participants integrated information from a variety of sources into their disease knowledge; 4) participants describe wanting to be more engaged in managing their health and wanting support to help manage their condition; 5) participants describe awareness of lifestyle changes necessary to improve health, but face many barriers to achieving them.ConclusionThis study identified key factors that are essential for pharmacists and other health care professionals to be aware of in order to support patients who are diagnosed with an NCD. Health care providers should consider strategies to engage patients to harness their motivations, enhance health education, and create systems to reduce barriers to addressing lifestyle.     

Geriatric care as an introductory pharmacy practice experience

Objective. To describe the design, delivery, and impact of a geriatric introductory pharmacy practice experience (IPPE) to develop students’ skills related to consultant pharmacists’ roles and patient care responsibilities.Design. A required 2-unit geriatric IPPE, involving 40 hours in a geriatric-care facility, 5 reflection hours, and 12 classroom-discussion hours, was developed for first- and second-year pharmacy students. Students interviewed patients and caregivers, reviewed patient charts, triaged patient needs, prepared care plans, and performed quality-assurance functions.Assessment. After completing the IPPE, students’ geriatric- and patient-care abilities were enhanced, based on review of their interactions, care plans, reflections, and examinations, and they demonstrated cognitive, affective, and psychomotor-domain learning skills. Students’ care plans and quality assurance activities revealed positive patient outcomes, opportunities for measurable patient health improvement, and a positive impact on quality assurance activities. Student evaluations and feedback from health workers at the facilities also were positive.Conclusions. This geriatric IPPE in which students cared for a specific patient and interacted with other health care providers is an innovative approach to enhancing students’ abilities to serve the growing geriatric population.     

A Global Health Elective Course in a PharmD Curriculum

Objective. To describe the design, development, and the first 4 implementations of a Global Health elective course intended to prepare pharmacy students pursue global health careers and to evaluate student perceptions of the instructional techniques used and of skills developed during the course.Design. Following the blended curriculum model used at Touro College of Pharmacy, the Global Health course combined team-based learning (TBL) sessions in class, out-of-class team projects, and online self-directed learning with classroom teaching and discussion sessions.Assessment. Student performance was assessed with TBL sessions, team projects, and class presentations, online quizzes, and final examinations. A precourse and postcourse survey showed improvement in global health knowledge and attitudes, and in the perception of pharmacists’ role and career opportunities in global health. Significant improvement in skills applicable to global health work was reported and students rated highly the instructional techniques, value, and relevance of the course.Conclusion. The Global Health elective course is on track to achieve its intended goal of equipping pharmacy students with the requisite knowledge and applicable skills to pursue global health careers and opportunities. After taking this course, students have gone on to pursue global field experiences.     

The Assessment, Development, Assurance Pharmacist's Tool (ADAPT) for ensuring quality implementation of health promotion programs

Objective. To develop and validate the Assessment, Development, Assurance Pharmacist''s Tool (ADAPT), an instrument for pharmacists and student pharmacists to use in developing and implementing health promotion programs.Methods. The 36-item ADAPT instrument was developed using the framework of public health''s 3 core functions (assessment, policy development, and assurance) and 10 essential services. The tool''s content and usage was assessed and conducted through peer-review and initial validity testing processes.Results. Over 20 faculty members, preceptors, and student pharmacists at 5 institutions involved in planning and implementing health promotion initiatives reviewed the instrument and conducted validity testing. The instrument took approximately 15 minutes to complete and the findings resulted in changes and improvements to elements of the programs evaluated.Conclusion. The ADAPT instrument fills a need to more effectively plan, develop, implement, and evaluate pharmacist-directed public health programs that are evidence-based, high-quality, and compliant with laws and regulations and facilitates documentation of pharmacists’ contributions to public health.     

Reasons for Non-use of Proven Interventions for Hospital Inpatients: Pharmacists' Perspectives

Background:

Recently, health care institutions have been using performance indicators to measure and improve quality of care. One such indicator, the Ideal Medication Intervention Index, reflects the rate of implementation of proven pharmacologic interventions, which studies have shown are underutilized. Identifying the reasons why proven interventions are underused is essential to determining how their rate of use can be improved.

Objective:

To characterize the reasons for non-use of proven interventions from the perspective of clinical pharmacists within the authors’ health care organization.

Methods:

A survey of all clinical pharmacists within the organization was conducted. The survey used standardized, case-based scenarios involving pharmacologic interventions known to improve health outcomes. Respondents were asked to rank potential reasons why a patient might not receive a proven intervention.

Results:

Of the 115 pharmacists invited, 53 (46%) participated in the survey. Most of the respondents practised on medical wards. The 2 most common reasons for non-use of proven interventions were a team preference to defer management of such issues to the outpatient care provider and issues related to workload.

Conclusions:

Clinical pharmacists revealed that their perceptions of priorities, communication with their interdisciplinary teams, and workload issues contributed to non-use of proven pharmacologic interventions among patients in their care. Efforts to increase the utilization of the proven clinical interventions studied here should focus on changing pharmacists’ perceptions of priorities.     

Development and Evaluation of a Pharmacogenomics Educational Program for Pharmacists

Objectives. To evaluate hospital and outpatient pharmacists’ pharmacogenomics knowledge before and 2 months after participating in a targeted, case-based pharmacogenomics continuing education program.Design. As part of a continuing education program accredited by the Accreditation Council for Pharmacy Education (ACPE), pharmacists were provided with a fundamental pharmacogenomics education program.Evaluation. An 11-question, multiple-choice, electronic survey instrument was distributed to 272 eligible pharmacists at a single campus of a large, academic healthcare system. Pharmacists improved their pharmacogenomics test scores by 0.7 questions (pretest average 46%; posttest average 53%, p=0.0003).Conclusions. Although pharmacists demonstrated improvement, overall retention of educational goals and objectives was marginal. These results suggest that the complex topic of pharmacogenomics requires a large educational effort in order to increase pharmacists’ knowledge and comfort level with this emerging therapeutic opportunity.     

An Elective Course on Pharmacy-Based Health Screenings

Objective. To provide an elective course for pharmacy students focused on the knowledge and skills necessary to implement health screenings in a pharmacy environment.Design. Course lectures focused on expert recommendations for health screenings as well as regulatory requirements and procedures integral to the implementation of screening services. Workshops provided hands-on experience with blood glucose, body composition, bone density, and cholesterol testing devices.Assessment. Attainment of knowledge and skills was assessed by patient case assignments, screening device demonstrations, group projects, and a final quiz. Annual course evaluations revealed consistently favorable student feedback regarding the course design and content. Students reported a high level of preparedness and interest in participating in health screening services in future practice.Conclusion. An elective course focused on the delivery of health screenings in pharmacy settings was well received by student participants and exposed students to a unique opportunity in patient care.     

Teaching and Learning Health Literacy in a Doctor of Pharmacy Program

Objective. To evaluate the impact of health literacy (HL) activities incorporated into a required, first professional year (P1), patient-centered communication course on pharmacy students’ knowledge, abilities, confidence, and attitudes related to HL.Design. Integrated, active-learning HL activities were incorporated into the course. Students’ knowledge and abilities were assessed with course evaluations. Students’ knowledge, confidence levels, and attitudes were evaluated by a precourse and postcourse survey. Third professional year (P3) students who did not complete HL activities were also surveyed.Assessment. Almost all students “met” or “exceeded” expectations (the top 2 levels of achievement on the objective structured clinical examination (OSCE) grading rubrics) on HL course evaluations. Survey results showed significant improvement in P1 students’ knowledge, confidence, and attitudes related to HL after completing the course. First year students (postcourse) rated their confidence levels and attitudes higher than P3 students.Conclusion. The use of integrated, active-learning activities is effective at improving P1 pharmacy students’ knowledge, abilities, confidence levels, and attitudes related to HL.     

Mental health training programs for community pharmacists,pharmacy staff and students: A systematic review

BackgroundPrimary care is often the first point of contact for people living with mental disorders. Community pharmacists, pharmacy staff and students are increasingly being trained to deliver mental health care. However, there is still a gap in the literature exploring the characteristics of all available mental health training programs and their components and their influence on pharmacists, pharmacy staff and students’ outcomes.ObjectivesTo summarize the evidence evaluating mental health training programs completed by community pharmacists, pharmacy staff and students. More specifically, to explore the components of mental health training programs and identify those that facilitate significant improvements in outcomes.MethodsA systematic review was conducted following the Cochrane handbook and reported according to PRISMA guidelines. A search for published literature was conducted in three databases (PubMed, Scopus, and Web of Science) in July 2021. Eligible studies were included if they described and evaluated the impact of mental health training programs delivered to community pharmacists, pharmacy staff and pharmacy students regardless of design or comparator. The methodological quality of included studies was appraised using both the NIH quality assessment, to evaluate studies with an uncontrolled pre-post design, and the Cochrane EPOC risk of bias assessment, to evaluate studies with a controlled (randomized and non-randomized) study design.ResultsThirty-three studies were included. Most of the identified mental health training programs contained knowledge-based components and active learning activities. Changes in participants' attitudes, stigma, knowledge, confidence and skills were frequently assessed. An extensive range of self-assessment and observational instruments used to evaluate the impact of the training programs were identified. Positive improvements in participants’ attitudes, knowledge and stigma were frequently identified following participation in training programs.ConclusionsThis systematic review highlights the importance of mental health training programs in increasing pharmacists', pharmacy staff and pharmacy students’ skills and confidence to deliver mental health care in community pharmacy. Future research should build upon this basis and further focus on finding the most efficient measures to evaluate these training programs and assess their long-term effectiveness, allowing comparison between programs.     

Impact and feasibility of a community pharmacy bone mineral density screening and education program.

OBJECTIVE: To assess the impact of a community pharmacy-based bone mineral density (BMD) screening and education program and determine the feasibility of providing such a service in community pharmacies. DESIGN: Uncontrolled study using convenience sample combined with economic feasibility analysis. SETTING: Two independent and four chain community pharmacies. PARTICIPANTS: Women age 18 years and older. INTERVENTION: Pharmacy patrons were invited to a free BMD screening. Demographic information was collected, and patients were screened using an ultrasound BMD analyzer. BMD results were reviewed with the participant during an education session and forwarded to primary care providers. Questionnaires were completed at baseline and after 3 months. MAIN OUTCOME MEASURES: Time spent with each participant, project costs, and willingness to pay for screenings were used to estimate feasibility; questionnaire responses assessed impact of the intervention on participants' health care decisions, lifestyle modifications, and communications with their prescribers about osteoporosis. RESULTS: Of the 140 women screened at baseline, 82% indicated the screening was "very useful" for making health care decisions, and 91% believed it encouraged them to talk with their physicians about osteoporosis. At 3 months, 11% of patients reported having improved exercise habits, and 30% had increased their calcium and vitamin D intake. A total of 41% of respondents indicated a willingness to pay dollar 20 or more for the BMD screening service. The average screening time was 23 minutes. Based on fixed costs of the screening device and materials and variable costs associated with personnel time, a community pharmacy could generate a positive net income with a BMD screening program. Cost of the BMD analyzer could be recovered through revenue generated in 24-35 screening days, depending on the fees charged. CONCLUSION: A community pharmacy osteoporosis program had a positive impact on patient health care by influencing lifestyle modifications, increasing use of medications, and encouraging participants to discuss osteoporosis with their physician. Patients are willing to pay for this service; feasibility varies depending on available resources and patient population served.     

Healthcare contact and treatment uptake following hepatitis C virus screening and counseling among rural Appalachian people who use drugs

BackgroundHepatitis C virus (HCV) remains a major contributor to morbidity and mortality worldwide. Since 2009, Kentucky has led the United States in cases of acute HCV, driven largely by injection drug use in rural areas. Improved treatment regimens hold promise of mitigating the impact and transmission of HCV, but numerous barriers obstruct people who inject drugs (PWID) from receiving care, particularly in medically underserved settings.Methods503 rural people who use drugs were recruited using respondent-driven sampling and received HCV screening and post-test counseling. Presence of HCV antibodies was assessed using enzyme immunoassay of dried blood samples. Sociodemographic and behavioral data were collected using computer-based questionnaires. Predictors of contacting a healthcare provider for follow-up following HCV-positive serotest and counseling were determined using discrete-time survival analysis.Results150 (59%) of 254 participants reported contacting a healthcare provider within 18 months of positive serotest and counseling; the highest probability occurred within six months of serotesting. 35 participants (14%) reported they were seeking treatment, and 21 (8%) reported receiving treatment. In multivariate time-dependent modeling, health insurance, internet access, prior substance use treatment, meeting DSM-IV criteria for generalized anxiety disorder, and recent marijuana use increased the odds of making contact for follow-up. Participants meeting criteria for major depressive disorder and reporting prior methadone use, whether legal or illegal, were less likely to contact a provider.ConclusionWhile only 8% received treatment after HCV-positive screening, contacting a healthcare provider was frequent in this sample of rural PWID, suggesting that the major barriers to care are likely further downstream. These findings offer insight into the determinants of engaging the cascade of medical treatment for HCV and ultimately, treatment-as-prevention. Further study and increased resources to support integrated interventions with effectiveness in other settings are recommended to mitigate the impact of HCV in this resource-deprived setting.     

A non-invasive direct nose to brain drug delivery platform vs. invasive brain delivery approach: patient-centered care impact analysis

Current literature lacks structured methodologies for analyzing medical technologies’ impact from the patient-centered care perspective. This study introduces, applies and validates ‘Patient-Centered Care Impact Analysis’ (PCIA) as a method for identifying patient-centered care associated demands and expectations for a particular technology and assessing its compliance with these demands. PCIA involves five stages: (1) demand identification, (2) ranking demands’ impact magnitude, (3) scoring demand compliance (DC), (4) demand priority (DP) assignment based on impact magnitude and compliance, (5) generating a summative impact priority number (IPN). PCIA was performed as a comparative assessment of two central nervous system (CNS) drug-delivery platforms; SipNose, a novel noninvasive Direct-Nose-to-Brain (DNTB), vs. the standard-of-care invasive intrathecal/intracerebroventricular injection (Invasive I/I). Study participants included a ranking team (RT) without experience with the SipNose technology that based their scoring on experimental data; and a validation team (VT) experienced with the SipNose platform. All had experience with, or knowledge of, InvasiveI/I. Demand identification and impact magnitude were performed by one content and one assessment expert. Each participant assessed each technology’s DC. DP scores, IPN’s and IPN DNTB:InvasiveI/I ratios were generated for each technology, for each team, based on DC and summative DP scores, respectively. Both teams assigned DNTB higher DC scores, resulting in higher DNTB DP, IPN scores and DNTB:InvasiveI/I IPN ratios. Lack of difference between team assessments of DP and IPN ratio validate PCIA as an assessment tool capable of predicting patient-centered clinical care quality for a new technology. The significant differences between the platforms highlight SipNose’s patient-care centered advantages as an effective CNS drug-delivery platform.     

An Online Virtual-Patient Program to Teach Pharmacists and Pharmacy Students How to Provide Diabetes-Specific Medication Therapy Management

Objective. To develop, implement, and assess the effectiveness of an online medication therapy management (MTM) program to train pharmacists and pharmacy students in providing MTM services for patients with diabetes and to increase their intent to perform these services. Design. An online program was created using an Internet-based learning platform to simulate 4 MTM meetings between a pharmacist and a virtual patient diagnosed with diabetes.Assessment. Eighty students and 42 pharmacists completed the program. After completing the program, scores on post-intervention assessments showed significant improvement in 2 areas: control over performing MTM, and knowledge of how to perform MTM. Students had a significantly less-positive attitude about MTM and a decline in their perception of the social expectation that MTM is part of the practice of pharmacy, while pharmacists’ attitudes did not change significantly in these areas.Conclusion. This online program using a virtual patient improved both participants’ belief that they have control over performing MTM, and their knowledge of how to perform MTM for diabetic patients, which may increase the likelihood that pharmacists and pharmacy students will perform MTM in the future.