INNOVATIONS in pharmacy (Iip - E-Journal)
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Lessons Learned from an Academic, Interdisciplinary, Multi-Campus, Research Collaboration
Full text linkBackground: The formation of productive academic research groups can be difficult, especially in environments without a robust and existing research infrastructure. Idaho and Alaska, are Institutional Development Award (IDeA)-eligible states, historically receiving low levels of funding from the National Institutes of Health (NIH).
Purpose/Methods: We present a case study highlighting an academic research collaboration established across two-disciplines, three-career stages, and three-campuses utilizing distance technology.
Results: One lesson learned from our experiences is that regardless of position (junior or senior faculty) or time at the institution/department (new or established), it is important to reach out to others. Collaborations require conscientious effort to establish and maintain. Second, a psychologically safe space must be created, establishing trust. Lastly, in order to eliminate distractions, optimize team performance, and improve deliverables, the team must have a shared mission. Team members must recognize, appreciate, and fully utilize each other and available resources.
Conclusion: Our experiences and lessons learned can be utilized by others to strengthen opportunities to form and grow interdisciplinary research collaborations and develop a stronger research infrastructure.
Article Type: Not
Attitudes and Perceptions of Tobacco-Related Products in College Students
Full text linkBackground – Despite the highly publicized health consequences, some college students do not perceive tobacco consumption as harmful. Historically-Black College and Universities (HBCUs) have the lowest rates of tobacco-free policies compared to other colleges, universities, and minority-serving institutions, making their students at higher risk for tobacco abuse. A campus Alcohol, Tobacco, and Other Drug Prevention Committee (ATDP) was formed and led by a pharmacist to develop all tobacco cessation policies at the HBCU.
Objectives – (1) To determine the knowledge and attitudes of cigarettes, cigars, smokeless tobacco, electronic cigarettes, and hookah among college students in a rural area with high tobacco usage; (2) To assess perceptions on the effectiveness of smoking cessation resources on the college campus led by the ATDP committee.
Methods – A cross-sectional study was conducted on 99 students between 18 – 26 years attending a HBCU in Maryland. The online survey was disseminated to assess student’s health behaviors and attitudes towards tobacco products and their successfulness in abstinence using campus resources with the Health Belief Model.
Results – Participants had more perceived harms with smoking tobacco (cigarettes and cigars) and smokeless tobacco, and greater perceived benefits with using electronic cigarettes and hookah (P < 0.001). Most students had limited knowledge of the four tobacco categories (5.8 ± 2.6 on a 10-point Likert scale). Self-efficacy to quit was 4.2 ± 1.7 on a 10-point Likert scale despite the current resources at the HBCU.
Conclusion – Students had a perceived benefits sequential rank order with hookah, e-cigarettes, smokeless tobacco, followed by smoking tobacco. Campuses should investigate barriers for abstinence, raise awareness about the dangers of tobacco, and create programs that enhance self-efficacy when quitting.
Innovation and Practice Implication - This is the first study of its kind that compares all major tobacco products head-to-head in a rural and underrepresented population. Additionally, the development of a campus-wide tobacco policy was novel as it was pharmacist-led. The results show this population has limited knowledge of tobacco products with more perceived benefits among newer nicotine delivery systems. Targeted education and public health programs should be implemented to prevent this susceptible group from initiating and continuing tobacco products.
Article Type: Original Researc
GPAs, PCATs, and Coupons: Wilting Quality in Pharmacy School Admissions and the Impact on Pharmacy Faculty
Full text linkIntroduction: The number of available seats in US pharmacy schools has reached unprecedented numbers as applications are on the decline. A combination of forces signals that admissions to pharmacy school are becoming less selective.
Commentary: The conflict of balancing a need to fill the incoming class while maintaining selectivity is a growing problem in pharmacy education. Faculty may notice changes in the student quality and ultimately, program and graduate quality. Pressure from administration hinders faculty governance with negative consequences that impact faculty morale and the profession as a whole. Maintaining a firm position in the face of reduced applications is challenging but necessary if we are to protect the students we seek to support as faculty and stewards of the pharmacy profession.
Implications: Faculty governance is at risk as pressure exists to admit less-prepared students into programs. Faculty must advocate for responsible leadership by initiating dialogue on admissions and selectivity. Furthermore, faculty mentorship programs need a new level of discussion that includes analysis and understanding of this paradigm in pharmacy academia.
Article Type: Commentar
Impact of Adherence Education and Monitoring on Community Pharmacy Performance Scores and Patient Satisfaction
Full text linkBackground: Adherence, specifically to noninsulin diabetes medications, statins, and renin-angiotensin system antagonists (i.e. angiotensin-converting-enzyme inhibitors (ACEi), angiotensin II receptor blockers (ARBs), and aliskiren), is a measure tracked by the Centers for Medicare and Medicaid Services (CMS) to give Medicare Part D plans a star rating; pharmacies are impacted by these star ratings. The pharmacy is given a performance score based on the measure. Some pharmacies use a performance information management platform (PIMP) that allows pharmacies to better understand performance information to impact patient care.
Objectives: (1) To evaluate if a monthly adherence monitoring and education service impacts the percentage of patients adherent determined by pharmacy performance scores; (2) To determine patient satisfaction with the service in a large community pharmacy chain.
Methods: A six-month prospective interventional pilot study including patients with a proportion of days covered (PDC) of less than 80% for oral diabetes or renin-angiotensin system antagonists (RASA) medications was conducted in two pharmacies of a large community pharmacy chain in Southwest Virginia. Using pharmacy internal data analytics and PIMP data, the percentage of patients who are adherent to oral diabetes or RASA medications was determined including the baseline PDC for each patient. At the start of the study, the standard of care in this large community chain pharmacy was to address adherence, follow-up in one month and every three months thereafter. In this study, pharmacists provided monthly telephonic adherence monitoring and education for a six-month period. Each session was scripted for medication adherence history, education and data collection. The pharmacist provided guidance and counseling based on how the patient answered the questions. Pharmacists gathered information about adherence patterns and behaviors using a 14 item Likert-scale and multiple choice-based questionnaire during the first session. After completion of the final adherence monitoring and education session, pharmacists gathered patient satisfaction information using an eight item Likert-scale questionnaire. At the end of the six-month period, using PIMP data, the percentage of patients adherent to oral diabetes or RASA medications was determined based on pharmacy performance scores. The data was analyzed using uni-variate and bi-variate statistics to determine if there was a difference in pharmacy performance scores from the pre-study analysis. The adherence patterns and behaviors, as well as patient satisfaction with the program was evaluated to determine factors influencing nonadherence.
Results: A total of 55 patients were identified in two pharmacies, ten of which were excluded or declined involvement, leaving 45 enrolled in the adherence monitoring and education service. Of the 45 enrolled patients, ten completed the adherence patterns and behaviors questionnaire. About half of the patients were men (50.95%) with an average age of 71.17 years and taking an average of 6.55 prescription medications. All patients had Medicare Part D insurance and majority had a yearly income of less than $40,000. The average baseline PDC was 68.92. In pharmacy 1, the average performance score for oral diabetes medications trended down and the average performance score for hypertension medications trended up over the study period. In pharmacy 2, the average performance score for oral diabetes medications trended up and the average performance score in hypertension medications trended up over the study period. The adherence patterns and behaviors questionnaire revealed the majority of patients rarely forgot to take medications or run out of medications. Additionally, cost of medications did not seem to impact adherence and majority of patients knew the names and indications of their medications. Only one patient completed the patient satisfaction survey.
Conclusions: An adherence monitoring and education service had mixed results in improving patient adherence and pharmacy performance scores. Only one patient completed the satisfaction survey, thus no conclusions can be made regarding patient satisfaction of the program. More research needs to be done regarding telephonic adherence programs.
Article type: Original Researc
Interprofessional Care of Emergency Department Doctors and Pharmacists: Crossing a Collaboration Chasm
Full text linkRole clarity of emergency department doctors and pharmacists is essential to provide collaborative care. Evidence is available that interprofessional care of doctor-pharmacist collaboration improves patient care in emergency settings. Pharmacists need to improve their knowledge and skill in emergency practice to be more productive and sought after. Team dynamics, training, and administrative support are critical. Interprofessional collaboration should not be programmed to fail for the short-term convenience of any profession. With more considerable effort from different stakeholders, once a collaborative system is established that will sustain improved patient care and the public trust of healthcare. Crossing a collaboration chasm takes time and effort. Interprofessional education should be built-in essential competencies to be collaborative with role clarity, teamwork, better communication, and ultimately patient-centeredness.
Article Type: Commentar
Regulating Pharmacy Practice: Analysis of Pharmacy Laws in Ten States
Full text linkBackground: The National Association of Boards of Pharmacy (NABP) recently established a task force to help states develop regulations based on “standards of care” rather than “prescriptive rule-based regulation.” This signals a shift in orthodoxy as pharmacy has traditionally been a highly regulated profession. A benchmark report on the pharmacy, nursing, and medical statutes and regulations in Idaho found that pharmacy had a higher overall word count, more overall restrictions, and had to be amended more frequently to keep pace with change.
Objective: To identify opportunities to make the transition to a “standard of care” regulatory model in pharmacy law, this manuscript attempts to quantify the regulatory burden for 10 Western U.S. states.
Method: The relevant statutes and regulations were gathered from each of the 10 states, and key measures were extracted, including word count, restrictions, exemptions, and the composition.
Results: States exhibited wide variation in overall regulatory burden as measured by word count (average of 65,882 words, SD=35,057). The top categories of pharmacy law are: 1) professional practice standards (25,249 ± 16,077 words); 2) facility standards (15,230 ± 10,240 words); and 3) licensing (11,412 ± 6,191 words). More than 65% of all pharmacy regulations are in rule adopted by board of pharmacy rather than in statutes passed by the legislature.
Conclusions: States exhibited major variation in total regulatory burden, with the largest contributors to cross-state variation being regulations related to professional practice standards and facility standards. This analysis suggests these two areas should be the primary targets of states looking to decrease regulatory burdens and that regulatory boards have a significant opportunity to remove regulatory burdens even in the absence of legislative action
Smoking Cessation Considerations for People with Multiple Sclerosis
Full text linkBackground: Comprehensive care of people with multiple sclerosis integrates disease modifying therapy, symptom management and minimization of risk factors for disease progression. Cigarette smoking is a modifiable risk factor associated with development and progression of disease and increased disability. However, little is known about specific factors that affect smoking cessation in patients with multiple sclerosis or how to integrate smoking cessation into specialized multiple sclerosis care.
Methods: Twenty-nine active smokers with multiple sclerosis were surveyed at the James Q. Miller Multiple Sclerosis clinic at the University of Virginia Health. Demographics, smoking history, multiple sclerosis history, interest in quitting, barriers to quitting and cessation modalities of interest were collected, specifically interest in working with a clinical pharmacist for cessation.
Results: Seventy-six percent of individuals believed that there was no relationship between smoking and MS diagnosis and 52% were unaware of any relationship between smoking and disease progression. Less than half of patients (41%) reported receiving counseling from a primary care physician or neurologist about the importance of smoking cessation. Common barriers to quitting included enjoyment of smoking (76%) and cravings (55%). Seventy-six percent of patients expressed interest in utilizing pharmacotherapy and 37% were interested in working closely with a clinical pharmacist.
Conclusions: It is critical that providers caring for patients with multiple sclerosis assess smoking status and educate smokers about the relationship between smoking and disease progression. Efforts should be made to better understand patient-specific barriers to quitting and preferred methods of treatment, including pharmacotherapy and behavioral therapy. A multidisciplinary approach to smoking cessation that includes a clinical pharmacist may aid in the development of individualized care plans with frequent monitoring to improve patient success.
Article Type: Case Stud
Pharmacy Faculty Burnout: Cause for Concern that Requires Our Support and Use of Best Evidence
Full text linkRecent attention has been afforded to the concept of burnout and other quality of worklife issues among pharmacy faculty, underscoring the importance of organizational culture, citizenship, collegiality, and support. Support comes from the larger academic institution, the college/school, and individual colleagues. Evidence points to reassurance of worth, guidance, and positive affirmation as being among the most salient factors in mitigating burnout of faculty, who are caught in the midst of increasing demands and higher administrative burdens. A supportive culture that reassures worth of individual faculty is not a unidimensional typology, but rather, is one that permeates through all components of a multifaceted and strong culture that encourages citizenship. There is a growing body of research and evidence on faculty burnout and related factors. This commentary calls for the use of such evidence in guiding policies, creating mentoring programs, and carrying out daily activities in much the same manner that scholars use the best available evidence in their own specific lines of inquiry in teaching and research.
Article Type: Commentar
Examining Student Motivation to Use a Gamified System in an Immunology and Immunization Training Course
Full text linkBackground: Gamification is the process of adding game elements into classroom activities to encourage student participation and motivation. Classcraft® is a gamified learning system designed to integrate easily with normal classroom activities and to enhance collaboration and teamwork.
Educational activity and setting: This study explored the use of the Classcraft® system in an Immunology and Immunization Training course, specifically examining students’ motivation to use the system and potential impacts on their motivation.
Findings: Results showed that value and enjoyment motivated students to use Classcraft®. Furthermore, the ease of use of the system positively impacted students’ enjoyment of the system. Students’ choice regarding how much they were required to engage with the system positively impacted the value and enjoyment that they experienced with the system.
Summary: Students’ demonstrated motivation to use Classcraft® provides a foundation for further research into the use of gamified learning systems within pharmacy classrooms. Research is needed to understand if use of a gamified learning system positively impacts learning outcomes
Hospital and Community Pharmacists’ Views of and Perspectives on the Establishment of an Intraprofessional Collaboration in the Transition of Care for Newly Discharged Patients
Full text linkBackground Hospital and community pharmacists are increasingly involved in patients’ medication interventions related to the transition of care from the hospital to a patient’s home. These interventions may enable pharmacists to collaborate across healthcare sector boundaries. However, little is known about pharmacists’ views on intraprofessional collaboration across healthcare sectors and what affects the establishment of such collaboration.
Objectives The aim of this study was to understand the views and perspectives of hospital pharmacists (HPs) and community pharmacists (CPs) on establishing an intraprofessional collaboration in relation to newly discharging patients.
Methods Joint focus group interviews with HPs and CPs in the Zealand region of Denmark were conducted. The HPs were employed at the only hospital pharmacy in the region (Region Zealand Hospital Pharmacy). Five HPs and six CPs participated in two focus groups. The focus groups were analyzed using theoretical thematic analysis.
Results Three themes and seven subthemes were identified. The first theme, “Context”, was divided into two subthemes: “Prioritization of new tasks in the intraprofessional collaboration” and “The lack of insight into the patient’s hospital stay”. The second theme, “The hospital physicians and GPs as the focal points for the HPs’ and CPs’ work”, was divided into three subthemes: “The limitation of the CPs and HPs based on current roles and organizations”, “Lack of regular access to the physician gives the patients more responsibility” and “Lack of support from the GPs for the work conducted by HPs and CPs”. The last theme, “Individuals”, had two subthemes: “The motivation for working intraprofessionally” and “CPs’ hesitancy towards the new tasks in the intraprofessional collaboration”.
Conclusion Both HPs and CPs are highly influenced by their work context in regard to establishing a new intraprofessional collaboration. Limited resources for intraprofessional collaboration should be taken into account. Likewise, the collaboration should fit into daily routines, which may eliminate hesitancy towards new forms of collaboration and tasks shared between HPs and CPs. The physician was identified as an important key professional, since the work tasks of both HPs and CPs depend on the physician, which in turn limits the capability and success of solely intraprofessional collaboration.
Original Researc