INNOVATIONS in pharmacy (Iip - E-Journal)
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Facilitating Community Engagement in Academic Pharmacy Careers
Get PDFDespite the recognized value of community engagement in academic pharmacy, the implementation of sustainable and fruitful community partnerships can be challenging. This manuscript will highlight a junior faculty member’s journey with community engagement, sharing the ways that community engagement can guide an academic career and the benefits of community engagement in teaching, research and service. Also highlighted is the role – and argued responsibility - of the academic institution in community engagement, as well as an identification of the barriers that might be interfering with pharmacy faculty community engagement. Considerations for the development of faculty members striving to more fully incorporate engagement into their teaching, research, and service are provided.
Conflict of Interest
I 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.
Type: Commentar
Potentially Actionable Targets: Evidence Standards for Credible Next Generation Sequencing Technology Assessment Claims
Get PDFDespite considerable resources devoted to developing databases to support competitive credible claims for next generation sequencing (NGS) claims, we have yet to meet the standards required in health technology assessment to support such claims. The purpose of this commentary is to consider options open in establishing claims for NGS recommendations. Although NGS platforms offer potential promise in improving clinical outcomes, supporting cost-effectiveness and reducing the overall cost of care in target populations, this has yet to be demonstrated on a scale that is likely to satisfy reimbursers and health care decision makers. Issues addressed include (i) the importance of credible, evaluable and replicable claims from individual NGS platforms; (ii) the difficulties in moving beyond broad-brush claims for improved survival; (iii) the standards required for an NGS evidence base; (iv) protocol designs in establishing the independent contribution of NGS actionable therapy recommendations to outcomes claims; (v) the role of NGS registries; and (vi) protocols to support ongoing credible, evaluable and replicable claims in target patient populations. The critical issue is not analytical and clinical validity but clinical utility. This has yet to be demonstrated.
Type: Commentar
Should Pharmacy Technicians Administer Immunizations?
Get PDFPurpose. To describe the potential role for pharmacy technicians in administering immunizations – limited for this discussion to specifically inserting the needle into the patient’s arm and pressing down on the plunger – at the discretion of a supervising pharmacist as a way to enhance patient care and workflow efficiency.
Summary. Pharmacy technicians currently play an important role in facilitating pharmacy-based immunization programs. Technicians routinely perform non-clinical tasks related to pharmacy-based immunizations, though nearly all states prohibit technicians from administering vaccines. Several studies demonstrate that untrained laypersons can safely administer intranasal or intradermal vaccines, and laypersons routinely administer medications through intramuscular or subcutaneous routes (e.g., patients with diabetes or rheumatic conditions). It stands to reason that a trained pharmacy technician could perform comparably on these techniques that laypersons have mastered. One state has adopted rules to allow pharmacy technicians to administer immunizations if the technician has completed specific training on administration techniques and on basic life support. This task is performed at the discretion of the supervising pharmacist, and the pharmacist would still be responsible for clinical aspects of immunizing such as prescribing the right vaccine to the right patient. Additional considerations factoring into the decision as to whether or not to involve pharmacy technicians in immunization administration are also summarized.
Conclusion. If safety can be reasonably assured through training and supervision, it may be appropriate to delegate vaccine administration to appropriately trained pharmacy technicians. Such delegation may enhance workflow efficiency, which may confer added value for patient care and potentially improve access to community pharmacy-based immunizations.
Type: Commentar
Barriers to Enrollment in a Pharmacist-Led Fitness, Nutrition, and Weight Management Coaching Program
Get PDFObjectives: To investigate barriers to utilization of a pharmacist-led fitness, nutrition, and weight management coaching program, as well as describe patient reported expectations and explore the patient characteristics potentially associated with a higher willingness to participate in the future.
Design: Cross-sectional, descriptive study using an anonymous, electronic survey.
Setting: A large, national, grocery store chain.
Participants: Employee benefit plan members, eligible for a pharmacist-led fitness, nutrition, and weight management (FNWM) coaching program, who were not currently or previously enrolled in the program, and met coaching program qualifications.
Intervention: Peer-reviewed, electronic survey administered and collected using an Internet survey analysis software.
Main Outcome Measures: Barriers to enrollment in the pharmacist-led fitness, nutrition, and weight management coaching program.
Results: Of 1,130 emailed employees, 352 responded and 133 met study inclusion criteria and completed the whole survey. Of those who fit inclusion criteria, the majority (53.4%) of the respondents were aware of the coaching program (75.2%) and expressed interest in future participation (53.4%). “I am already taking steps to improve my health” and “I do not have time to participate in the program” were the highest rated barriers for both those interested and not interested in participating in the coaching program. The majority of participants believed pharmacists were qualified to provide the coaching service (78.2%) and preferred one-on-one coaching with the pharmacist (67.7%). Key topics respondents wanted the pharmacist to cover included general diet and nutrition, weight management strategies, and vitamins and supplements.
Conclusion: The two major barriers reported in the study were lack of time and the use of other health improvement methods; however, a large number of respondents indicated future interest in participating. Future programs may be able to increase utilization by focusing on programming that is more accommodating to participants’ schedules and integrating along with other weight loss programs. This study also provides some support regarding patient acceptance of pharmacists in innovative roles, such as fitness, nutrition, weight management coaching.
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
Type: Original Researc
Performance on Interdisciplinary Topics in an Integrated Pharmacy Course
Get PDFObjectives: Many colleges and schools of Pharmacy combine interdisciplinary topics such as pathophysiology, pharmacology, medicinal chemistry and therapeutics into one integrated course. Our main aim for this study is to determine if students pass integrated courses and yet fail to pass interdisciplinary sections of those courses.
Methods: Two representative integrated sequence courses were evaluated without any study-imposed intervention. Individual student examination scores (~140 students) were evaluated for overall performance as well as for performance on the interdisciplinary topics of pathophysiology/pharmacology, medicinal chemistry, and therapeutics. The degree of difficulty of the examination questions, as well as the test item discrimination, were also measured.
Results: There were students that passed the course but failed one, or more, of the interdisciplinary topics. Combining data from both courses, medicinal chemistry was the most frequently failed discipline (29 students), followed closely by pharmacology (22 students), and distantly by therapeutics (1 student). The examination questions for medicinal chemistry were not more difficult nor more discriminatory than the questions for the other disciplines.
Conclusions: These data indicate that students pass integrated courses, but fail to pass interdisciplinary sections of those courses, especially the pharmaceutical sciences. It is not known if these results are consistent, nor what long-term adverse consequences may result. These results inform curricular and assessment aspects of the pharmacy academy as pertains to establishing the scientific foundation required by the CAPE 2013 Educational Outcomes.
Type: Original Researc
Introducing an Undergraduate Degree of Cosmetic Science and Formulation Design within a College of Pharmacy
Get PDFAs a unique and versatile undergraduate degree program, a Bachelor of Science in Pharmaceutical Sciences (BSPS) is offered by a number of colleges/schools of pharmacy. These provide a bachelor's degree concentrated in pharmaceutical sciences, and can be a non-Doctor of Pharmacy option, possibly before progressing to graduate degree studies. Recently implemented at the University of Toledo College of Pharmacy and Pharmaceutical Sciences (UTCPPS), one such BSPS major is Cosmetic Science and Formulation Design. This new undergraduate major was created to serve the needs of the cosmetic and personal care industry, with a great need identified for well-trained new professionals with basic knowledge in the sciences and business. This Cosmetic Science and Formulation Design major was added to four other BSPS majors at UTCPPS. Introduced in 2013, this major is the only functioning undergraduate degree in Cosmetic Science and Formulation Design in the United States. Preliminary job placement data provides promising evidence that this undergraduate major has helped graduates launch a career in the cosmetic and personal care, or pharmaceutical industries. Based on our experience from the past three years, we believe that this cosmetic science major has been worth its resource investment. We hope others designing new undergraduate pharmaceutical sciences programs might integrate advice from this experience into their impending programs.
Type: Idea Pape
Evaluating Patient Interest in an Adherence-Focused Smartphone App to Improve HIV Care
Get PDFObjective: Evaluate patient interest in a smartphone mobile application (app) to assist in medication adherence.
Methods: In January 2014, a 19-question, anonymous, paper survey was distributed to a convenience sample of patients in the reception area of a nonprofit HIV primary care clinic and pharmacy.
Results: Of the 101 patients surveyed, 72.3% had a smartphone and 70.3% were interested in downloading and using an adherence app if one was available. If an app was customizable, patients desired appointment reminders (87%), notifications to schedule appointments (85%), refill notifications (83%), medication reminders (79%), and adherence tracked by pharmacy (59%).
Conclusions: Results share insights on the potential use of technology to assist an HIV patient population with medication adherence.
Conflict of Interest
Dr. Jennifer Rodis is the creator and director of the Partner For Promotion (PFP) program otherwise she has no additional 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.
All other authors 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
Type: Student Projec
An Objective Structured Clinical Examination to Assess Pharmacy Resident Performance
Get PDFObjective: The objective was to utilize an Objective Structured Clinical Examination (OSCE) for assessment of pharmacy residents.
Innovation: Post-graduate year 1 (PGY1) and post-graduate year 2 (PGY2) pharmacy residents completing multiple, local residency programs were invited to participate in an OSCE. A total of eight PGY1 residents and one PGY2 resident completed the OSCE. American Society of Health-System Pharmacists (ASHP) residency program goals were aligned for each case, which were originally developed for a fourth-year pharmacy student OSCE. Station design included outpatient and inpatient settings with patient and physician interactions. Median communication and clinical skills scores were evaluated.
Critical Analysis: The OSCE allows for assessment of all residents on common scenarios. Pharmacy residents met competency requirements and demonstrated excellent communication skills. The OSCE was able to evaluate both physician-pharmacist communication and patient-pharmacist communication. Baseline performance related to the ASHP goals and objectives was not completed; however, the OSCE could highlight resident strengths and weaknesses in communication and clinical skills. The OSCE could simulate independent practice, may reduce bias, and could provide an evaluation of the resident by a patient. However, the OSCE incurs higher resource utilization, specifically monetary and time, than other assessment methods.
Next Steps: The pilot study results provide a beginning for further study of OSCEs for pharmacy residents. Further study should include surveying the residency directors about use of the OSCE, a comparison of performance between the OSCE and preceptor evaluations of residents on ASHP goals and objectives, and an evaluation of OSCE implementation at different time points within the residency.
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
Type: Not
Interprofessional Approach to Increase Billable Care-Events in a Rural Community
Get PDFObjectives: The study was designed to build a financially stable, replicable, and interprofessional program around a Center of Excellence (COE) model exclusively in a community pharmacy setting. This involved creating a separate pharmacy-based clinic within the community pharmacy with recognized rendering providers by payers allowing pharmacists to bill incident to for services and increase the quality of patient clinical outcomes.
Setting: Apple Discount drugs in Salisbury, MD is a multi-site independent community pharmacy setting offering traditional pharmacy services along with several pharmacist run clinical programs.
Practice Innovation: The pharmacy developed an interprofessional team around a Center of Excellence (COE) model as a separate medical clinic within the community pharmacy as a subsidiary of the parent company that was staffed with healthcare providers that are recognized by payers to bill for services.
Main Outcome Measures: Outcomes of the study included analysis of the number of patients seen, the ability to obtain reimbursement for the clinical services offered, and changes in A1C and BMI to support the clinical value of pharmacist intervention.
Results: A total of 309 patients with diabetes were seen over a 16 month period, including 120 patients who completed the 10 hour diabetes training program. Clinical outcomes showed an improvement in A1C from 9.1 pre enrollment to 7.5 post intervention, and a drop in BMI from 35.7 pre enrollment to 32.4 post intervention. The pharmacy was also able to increase the amount of reimbursement for services provided.
Conclusions: The development of a pharmacy based clinic business model inside of a community pharmacy has increased the amount of clinically billed services for the pharmacy. Improvements in clinical outcomes led to an acceptance of the pharmacist as a member of the patient’s care team by patients, local physician’s offices, and third party payers.
Funding: This work was supported by the Community Pharmacy Foundation [grant #143 , 2015]
Type: Commentar
Characteristics of Patients Accepting and Declining Participation in a Transition of Care Service Provided by a Community Pharmacy
Get PDFObjectives: To identify characteristics of patients who accepted or declined an appointment for a transition of care service provided by an independent community pharmacist and identify the most common reasons patients declined the service.
Methods: A transition of care service was offered by a community pharmacy to patients discharged to home from the cardiac unit of a local hospital. The community pharmacist approached patients prior to discharge for recruitment into the service. Outcomes included service acceptance rate, LACE score at discharge, readmission risk category, age, gender, geographic home location, and reason for refusing the service. Descriptive statistics and logistic regression were used to compare characteristics between those who accepted or declined the service. Reasons for decline were assessed using content analysis.
Results: Of the 87 patients that were included in the analysis, 21 patients received the transitions of care service (24.1%). None of the characteristics were found to be statistically significant between patients who received or declined the service. Patients at a moderate risk for readmission seemed more likely to accept the pharmacist-run appointment than those at high risk (27.9% vs 15.3%; P = 0.29). Of the 66 patients who declined, 51 gave a reason (77.3%). Thirty-nine patients saw no benefit (76.5%), five patients had perceived barriers (10%), and seven patients gave reasons that fell into both categories (13.5%).
Conclusions: This evaluation did not find a statistically significant difference in characteristics between those patients who accepted or declined participation in a pharmacist-run transition of care service. Patients may be less likely to accept pharmacist-run transition of care appointments primarily due to no perceived benefits. To increase participation, we need to understand the patient’s health beliefs, educate patients on pharmacy services, and implement changes to recruit potential patients.
Conflict of Interest
Disclosures: The authors have no actual or potential conflict of interest in relation to this evaluation.
This evaluation was presented as a poster presentation at American Pharmacists Association Annual Meeting and Exposition, March 4-7, 2016 and at the Pharmacy Society of Wisconsin Education Conference, April 5-6, 2016. This evaluation was presented as a podium presentation at Great Lakes Residency Conference, April 27-29, 2016.
Type: Original Researc