INNOVATIONS in pharmacy (Iip - E-Journal)
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Primary Care Clinicians Attitudes and Knowledge of Pharmacogenetics in a Large, Multi-state, Healthcare System
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Background: Considerable progress has been made in the way of pharmacogenetic research and the development of clinical recommendations; however, its implementation into clinical practice has been slower than anticipated. We sought to better understand its lack of clinical uptake within primary care.
Aim: The primary objective of this survey was to ascertain primary care clinicians’ perceptions of pharmacogenetic use and implementation in an integrated health system of metropolitan and rural settings across several states.
Methods: Primary care clinicians (including MDs, DOs, NPs, and PAs) were invited to participate in a survey via email. Questions about pharmacogenetics knowledge and perceptions were presented to assess current understanding and usage of pharmacogenetics in practice.
Results: The rate of response for the survey was 17%. Of the 90 respondents, 58% were female, 69% were MDs/DOs, 20% were NPs, and 11% were PAs. Fifty-eight percent of respondents received their clinical degree in or after 2000. Ninety percent of respondents noted that they were uncomfortable ordering a pharmacogenetics test, with 76% stating they were uncomfortable applying the results of a pharmacogenetic test. Notably, 78% of respondents were interested in having pharmacogenetic testing available through Medication Therapy Management (MTM) services, although PAs were significantly less interested as compared to NPs and MD/DOs. Ninety-five percent of respondents were interested in a clinical decision support tool relevant to pharmacogenetic results.
Conclusions: As a whole, prescribing clinicians in primary care clinics are uncomfortable in the ordering, interpreting, and applying pharmacogenetic results to individual patients. However, favorable attitudes towards providing pharmacogenetic testing through existing MTM clinics provides the opportunity for pharmacists to advance existing practices.
Conflict of Interest: We declare no conflicts of interest or financial interests that the authors or members of their immediate families have in any product or service discussed in the manuscript, including grants (pending or received), employment, gifts, stock holdings or options, honoraria, consultancies, expert testimony, patents and royalties
Treatment of Human Subjects: IRB determined project was non-HSR
Type: Student Projec
Adolescents’ Misuse of Over-The-Counter Medications: The Need for Pharmacist-led Intervention
Get PDFAdolescents’ misuse of over-the-counter (OTC) medications is a growing patient safety concern, resulting in an alarming number of poisonings and emergency department visits. OTC medications are easily accessible and adolescents often have the misconception that these medications are safe, even at higher than recommended doses. Dextromethorphan and acetaminophen are the most common and frequently misused OTC medications among adolescents, with significantly dangerous health risks if used improperly. Pharmacists are critical to the provision of education on safe OTC medication use for adolescents and their family caregivers by leading and implementing relevant community-based interventions. Ideal channels in which to do this in the community are pharmacies and schools. It is challenging to gain the attention of adolescents and to engage them; methods that include innovative measures and initiatives may be the solution. Research is needed to determine how pharmacists can improve adolescents’ knowledge and safe use of OTC medications. Pharmacists must be supported through training and acquisition of expertise specific to adolescent engagement and education. The development of pharmacist-led educational interventions that are tailored for adolescents that address their limited OTC medication knowledge and raise awareness of safety risks associated with misuse is crucial to preventing and reducing this patient safety problem in the community.
Conflict of Interest: None
Article Type: Commentar
Assessing a Longitudinal Reflection Curriculum: A Case Study Of Student Self-Awareness Expressed Through Rotation Goal Achievement
Get PDFThe Center for the Advancement of Pharmacy Education 2013 Affective Domain mandates students develop self-awareness of personal attributes affecting professional growth. Students should self-identify needs, create and implement goals, and evaluate success. This case study describes the qualitative and quantitative findings of an intentional reflection assignment prompting students to engage in a cycle of goal writing – monitoring – reflection – new goal writing, during an immersive clinical practice experience. A blinded review of 144 student assignments is presented in the context of a curricular review of the Reflective Practitioner Program (RPP), a longitudinal reflective thread spanning four years of professional pharmacy training. Evidence gathered in the assignment review indicates that students are sufficiently capable of establishing meaningful goals and describing why the goal is important to their professional development. In contrast, students struggle with articulating strategies for goal achievement and emotions experienced during goal monitoring. In consideration of these findings, RPP faculty identified three major themes when discussing key aspects of the RPP curricular design: 1) students need to articulate strategies for goal achievement in addition to stated aims, 2) students hesitate to identify emotions when reflecting, and 3) reflection needs to be both retrospective and prospective in nature. This case study has resulted in meaningful changes to RPP curricular design and illustrates how programs may approach assessment of the Affective Domain via common curricular elements.
Conflict of Interst: None
Type: Case Stud
Using the Plan-Do-Study-Act (PDSA) Model for Continuous Quality Improvement of an Established Simulated Patient Program
Get PDFObjective: To describe the use of a continuous quality improvement process for strengthening our simulated patient (SP) program and the initial steps that have been implemented.
Innovation: A workgroup that included five clinical faculty with significant experience working with SPs and a strong interest in improving the SP program was developed. The Plan-Do-Study-Act model was used as it allowed for incremental quality improvement changes, in order to ensure a high-quality SP program designed to optimize student learning. Data were gathered from students, SPs, and faculty. Opportunities for improvement were prioritized based on anticipated benefits and available resources. Changes related to planning, implementation, and evaluation and feedback have been executed.
Critical Analysis: Changes related to planning that were implemented included developing handbooks for SPs, faculty, and graduate student instructors, as well as material for students in order to better describe the program. SPs are now referred to as “simulated” as opposed to “standardized” as part of a broader effort to clarify the purpose of SP interactions to students. Streamlined rubrics have been piloted, including electronic rubrics for first year students. SPs are being trained on fewer cases, in order to improve the training program. When possible, activities now take place in one large classroom instead of many small classrooms to improve oversight. Finally, additional feedback has been obtained from SPs via a retreat. These changes have been well received by students, SPs, and faculty.
Next Steps: The collection of this data and initial quality improvement changes provided a basis for hiring a full-time employee who will: dedicate 50% of their time to programmatic assessment of the SP program, support faculty with logistics and training, and be the face of our program to the students and SPs. Further, formal quantitative and qualitative assessment of the SP program has begun.
Type: Not
Teaching the Philosophy of Practice as a Key Component of Pharmaceutical Care Practice: Response to Questions on the Teaching of the Patient Care Process
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Assessing Pharmacists' Knowledge of Halal Medications to Support the Health Beliefs of Patients
Get PDFObjectives: The purpose of this study was to explore the knowledge of pharmacists’ on Halal medications. In addition, it was a review of Halal medications in order to understand which resources need to be implemented to make this information readily available to support the health beliefs of patients and improve medication adherence.
Methods: Self-administered, anonymous questionnaires were distributed to pharmacists via Qualtrics by email, text message, and social media. Questionnaires assessed pharmacists’ knowledge on Halal medications and resources. Inclusion criteria included registered pharmacists working in any healthcare setting.
Results: A total of 121 voluntary pharmacists participated in the study. Over half (57.85%) of participants reported working in a retail setting. Only 14.05% had ever served a patient requesting Halal medications. When asked about awareness of Halal medications, only 4.13% were very aware. While 56.2% were familiar with dietary restrictions, only 1.65% were very aware of which medications to substitute if a patient cannot take a prescribed medication due to its ingredients and only 1.65% were aware of where to look to find alternative Halal medications. Over half of the participants were unaware of Halal pharmaceuticals, Haram ingredients, resources to utilize, or medications to use as an alternative.
Conclusion: Pharmacists are familiar with dietary restrictions due to medications derived from animal products but the majority are unaware of where to search for Halal medication alternatives, ingredients, or products. Resources are needed to make this information readily available. The more informed pharmacists are, the more likely they are to ask the right questions to ensure that patients’ religious beliefs are taken into consideration.
Type: Student Pape
Up for Debate: Re-Envisioning the Journal Club with an Article-Centric Student Debate
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Effective utilization of evidence-based medicine requires skillful development of a critical literature evaluation process. Although traditional journal club activities are a common modality to teach and refine these skills, they may limit a learner’s motivation to perform a well-rounded critique of primary literature.
Innovation: In response to the challenges with these traditional formats, we describe a novel approach to refining critical literature evaluation skills in an Advanced Pharmacy Practice Experience (APPE) setting utilizing a focused, article-centric journal club debate. Students, in pairs, are assigned a single article and are tasked with building critical arguments for both pro and con sides of the article, which culminates in a one-on-one debate.
Key Findings: The debate has been well received by students and faculty for increasing engagement in the critical literature evaluation process. The article-centric nature of the debate pushes students to a deeper understanding of an article’s merits and pitfalls. Ongoing limitations include significant faculty assessment burden and lack of a standardized, debate-specific evaluation rubric.
Next Steps: Future efforts should focus on evaluating student performance and perceptions of the debate compared to traditional journal club formats utilizing pre- and post- surveys. The creation of a debate-specific grading rubric may streamline the evaluation process and reduce faculty assessment burden.
Article Type: Not
Methods & Measures
Get PDFArticle 1: QUALITY Makes No Sense without “U” and “I”: Building Consensus around Quality via a Modified Delphi Process Robert A. Bechtol, MS; Kristin K. Janke, PhDArticle 2: Theoretical and Empirical Analysis of Alternative Scoring Functions for the EQ-5D-5L Ruixuan Jiang, PharmD; You-Shan Feng, PhD; Thomas Kohlmann, PhD; A. Simon Pickard, PhDArticle 3: Is Self-Rated Health of Americans Different in 2017 Compared to 2002? Ashley S. Cha, BA; Ernest H. Law, PharmD; James W. Shaw, PharmD, PhD; A. Simon Pickard, PhDArticle 4: Development of an Instrument to Assess Academic Detailer’s Experience with Academic Detailing Visits Christopher D. Saffore, PharmD; Andrea Monteiro, MSc; Mary Smart, PharmD; Aleksandrina Ruseva, PharmD Candidate; A. Simon Pickard, PhD; Todd A. Lee, PharmD, PhDArticle 5: Development of an Instrument to Assess Prescriber’s Satisfaction with an Academic Detailing Intervention Andrea L. Monteiro, MSc; Christopher D. Saffore, PharmD; Mary Smart, PharmD; Sarette Tilton, PharmD Candidate; Todd A. Lee, PharmD, PhD; A. Simon Pickard, PhDArticle 6: Medication Hoarding Behaviors Scale (MHBS) SuHak Lee, PharmD; Donald L. Uden, Pharm
Use of a Comic Book to Assist Pharmacy Student Learning of the Affordable Care Act (ACA)
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Purpose: To assess the pedagogical effectiveness of a comic book in pharmacy student learning of the Affordable Care Act (ACA).
Methods: Comparative-group, matched pre-posttest survey design was used to measure pharmacy students’ comprehension of ACA. PharmD students (P-1year) from two sections of a Pharmacy and US Healthcare course participated in this study. Treatment group students received a comic book on ACA. The comparison group received the textual information, without pictures, from the book in a typed document. A posttest survey was administered later in the semester, before the instructor discussed ACA in class. Fourteen questions, developed from the information in the book and document, assessed pharmacy students’ comprehension of ACA. Response options included a visual analogue scale. Independent sample t-test was used to assess the differences in the mean pre-posttest scores between the two groups.
Results: A total of 103 (n = 49 comparison vs. n = 54 treatment group) students completed the survey. No statistically significant differences were found in the pre-test mean scores between the groups. Differences in the pre-post test mean scores of treatment group were significantly higher than the differences in the mean scores of the comparison group. Students agreed that the comic book format gave them a better understanding of ACA and increased their interest in learning more about the Act.
Conclusion: Comic books were found to be effective in student learning of the ACA. The positive response from students highlight the point that pharmacy faculty could use comic books as supplemental reading in pharmacy courses.
Conflict of Interest This research was made possible through the faculty start-up funds awarded by the College of Pharmacy and Health Sciences, St. John’s University.
Treatment of Human Subjects: IRB review/approval required and obtained
Type: Original Researc
Factors Influencing Students’ Preferences to Pursue International Advanced Pharmacy Practice Experiences
Get PDFThe Problem: To improve the quality of the international APPE program and facilitate growth, a questionnaire was developed to identify perceived barriers for selection of and ways to increase interest in international APPEs. Survey Design: A questionnaire was administered to two consecutive third-year classes to gauge interest, perceived barriers and possible facilitators for engagement in international APPEs. Key Findings: Cost and need to travel independently were most frequently identified as barriers to participating in international APPEs. Suggestions to increase participation in international APPEs include: schools of pharmacy actively developing funding support, pairing students for international APPEs, and earlier targeted marketing.
Disclosures: None
Type: Note