INNOVATIONS in pharmacy (Iip - E-Journal)
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A Precepting-Focused Advanced Pharmacy Practice Experience in Academia
Full text linkDescription of the Opportunity: Traditional advanced pharmacy practice experiences (APPEs) in academia provide students exposure to job responsibilities and expectations of pharmacy faculty members. The purpose of this manuscript is to describe the development and structure of a precepting-focused academic APPE, APPE student perceptions of the experience, and introductory pharmacy practice experience (IPPE) student perceptions of being precepted by APPE students.
Innovation: An academic pharmacy APPE was developed to emphasize preceptor development in addition to traditional academic pharmacy topics and responsibilities. Pre- and post-experience surveys were completed by APPE students to collect perceptions of academic pharmacy and precepting. During the experience, APPE students, under the supervision of faculty, precepted IPPE students, who were given the opportunity to assess the APPE student’s precepting ability by completing a survey following the experience. Descriptive statistics were used to analyze the results.
Findings: Nine students completed the academic APPE and the corresponding pre- and post-surveys. All students indicated the rotation increased their understanding of academia, and the majority (7/9) indicated an increased confidence in their precepting ability. Eighty-five IPPE students evaluated the APPE students, and the majority (78%) rated the quality of instruction from APPE students as “similar” to faculty instruction.
Conclusion: The structure of this experience allowed APPE students to gain exposure to academia and increase confidence in precepting, while facilitating the delivery of the IPPE program. Results indicate offering an academic APPE with an emphasis on experiential teaching is a potential strategy to prepare future pharmacy preceptors
Intentional Application of the Taba Curriculum Model to Develop a Rural Pharmacy Practice Course
Full text linkThe changing profession of pharmacy demands student preparation in dynamic courses that address the evolving healthcare landscape. Identifying an evidence-based approach to develop such coursework and content, however, can be a considerable challenge for curriculum innovators. This manuscript explores how curriculum design models can be applied as a guide to promote purposeful development of new curriculum, with the goal of promoting students as APPE, practice, and career-ready practitioners. Authors specifically describe a case study example for the process of creating a novel rural health course using the Taba curriculum design model as a guide for selecting course content, objectives, teaching strategies, learning experiences, and evaluative measures. Through the incorporation of the Taba model, this manuscript presents an evidence-based approach to curriculum development which can be replicated across schools and colleges of pharmacy. The described approach to curriculum design, which integrates models to guide the creative process, is a systematic approach to developing curriculum with purpose. Additional opportunities exist for curriculum innovators across the academy to explore incorporation of curriculum design models to guide course development, as well as to drive curricular assessment strategies and further curriculum refinement.
Article Type: Idea Pape
Illinois Pharmacists and Over the Counter Cannabidiol Products: A Survey on Knowledge and Educational Needs
Full text linkObjective: To assess Illinois pharmacists’ (1) baseline knowledge of CBD and self-rated competency of OTC-CBD product pharmacotherapy, (2) concerns about OTC-CBD product safety and level of preparedness with answering questions about the product, and (3) current and future interest in learning more about these types of products to target an area of need for continuing education in the pharmacy field.
Design: This observational cross-sectional study used a quantitative survey to obtain information about Illinois pharmacists’ knowledge, concerns and educational needs about OTC-CBD products. Survey questions were based on prior research and pilot tested for clarity and completeness. Descriptive statistics were utilized to assess all data.
Setting and Participants: The study researchers collaborated with two state-based pharmacy organizations to distribute the survey online with up to two reminders.
Results: A total of 181 participants completed the survey. Majority of the respondents were 31-60 years of age, had worked in pharmacy for less than 5 years, in a geographic location with a population of 50,000 or more. About 41% worked in hospital-based practice setting and 39.2% work in a community-based setting. Most pharmacists (64.1%) reported ever being asked about the safety or efficacy of cannabidiol containing products, and only 20.7% responded that they felt moderately/highly prepared to provide medication counseling to patients who use OTC-CBD products. Majority of respondents reported being concerned about safety, quality, and regulations related to OTC-CBD products. Almost all respondents indicated that information about state (90.5%) and federal (89.4%) laws related to CBD, and safety (99.5%) were preferred topics for future education.
Conclusions: Consumers are seeking information about CBD containing products; however, many pharmacists do not feel prepared when it comes to being the drug expert for these products. Educational opportunities are necessary for pharmacists to become more comfortable and knowledgeable regarding safe and effective use of CBD-OTC containing products
Use of a CPD Plan Template with SMART Goals as Part of a Diabetes Pharmacotherapy Module
Full text linkObjective: To evaluate the effectiveness of a Continuing Professional Development (CPD) plan template used in Fall of 2017 on quality of SMART goal development and student quiz scores.
Innovation: The gap in time from when pharmacology is taught and when it is applied has contributed to poor student retention and performance in the diabetes pharmacotherapy course. To address this gap, the diabetes pharmacotherapy learning sequence was redesigned and included a self-assessment (pre-test), and the completion of a “CPD plan template”, which involved writing 1-3 SMART goals for each question missed on the pre-test. Following sequence completion, students took an identical post-quiz. Pre- and post- quiz scores were compared. Quality of CPD plan SMART goals was evaluated.
Key Findings: The CPD plan template was completed by 98% of students. The majority, 62.5% of students, wrote SMART goals at the intermediate or good level, while 37.5% were evaluated as needs improvement. The average pre-quiz score was 7.4 points and average post-quiz score was 17.1 points with an average improvement of 9.8 points (p<0.0001). There was a statistically significant improvement for top 25% post-quiz scoring students who wrote “good” SMART goals compared to those who wrote goals needing improvement (p= 0.002). For students scoring in the lowest 25%, students with goals needing improvement scored higher than those with intermediate quality goals (p< 0.04).
Next Steps: It may be beneficial to introduce CPD to students sooner, as well as teach students more intentionally how to create and use SMART goals to improve learning. Finally, instructor follow up with students regarding use of their plan during a learning sequence may have additional benefit.
Article Type: Not
Advancing Community Pharmacy Practice – A Technician Product Verification Pilot to Optimize Care
Full text linkElevating the technical role of pharmacy technicians to perform Technician Product Verification (TPV) is one strategy that has shown promise to optimize pharmacy practice models. This is done by better positioning pharmacists to provide clinical care, in line with their education and expertise. TPV permits a Validated Pharmacy Technician, as defined by the Wisconsin Pharmacy Examining Board, to verify the accuracy of a product filled by another technician. The pharmacist maintains responsibility for assessing the clinical appropriateness of the prescription, including drug utilization review, data entry, and patient counseling.
During the study period, 12,891 pharmacist-verified prescriptions (baseline) and 27,447 Validated Pharmacy Technician-verified prescriptions were audited for accuracy. The aggregate verification error rate for pharmacist-verified prescriptions was 0.16% and 0.01% for Validated Pharmacy Technician-verified prescriptions. The mean error rate was significantly less for Validated Pharmacy Technician-verified prescriptions than for pharmacist-verified prescriptions (0.19 ± 0.174 % vs 0.03 ± 0.089 %, p=0.020) (Figure 3).
This suggests TPV in the community pharmacy setting maintained patient safety. In this study, Validated Pharmacy Technicians were shown to be more accurate than pharmacists at performing product verification. The ability to delegate the product verification task holds the potential to free up pharmacist time for increased direct patient care. Increasing direct patient care by pharmacists in community pharmacies may have significant implications for improving patient outcomes and pharmacy quality.
Article Type: Original Researc
Considerations over a Case of Suspected Therapeutic Failure in Pediatric Patients after Switching Valproate Manufacturers
Full text linkIntroduction: Product switching followed by suspected adverse events are common and unsettling for antiepileptic drugs. The objective of this case study was to describe the investigation performed after report of suspected therapeutic failure in pediatric patients following a switch to a different valproate manufacturer and identify strategies concerning medication management for improving therapeutic outcomes.
Case description: It was reported that different pediatric patients’ condition changed (agitation/ seizures) after refilling the same drug prescription (sodium valproate syrup) from a different manufacturer. Medical staff reported a suspected therapeutic failure and some units of the product batch associated with the problem were seized by the local Post-marketing Surveillance Service for investigation of potential quality deviations. The seized units were evaluated by the State’s Surveillance Laboratory, nevertheless, drug potency was found to be 98.7%.
Conclusion: We consider that the reported event could be associated with aspects of medication use, i.e. potential dose measurement deviations resulting from remaining of residual liquid in the cup or eventual delay at prescription refilling process and consequential - even though brief - pharmacotherapy discontinuity. Patient education and counseling by pharmacists are essential for preventing drug-related problems and enhancing positive outcomes of pharmacotherapy.
Article Type: Case Stud
More Unnecessary Imaginary Worlds – Part 3: Cystic Fibrosis and the Institute for Clinical and Economic Review’s Draft Evidence Report
Full text linkOn 20 February 2020, the Institute for Clinical and Economic Review (ICER) released its draft evidence report to establish the value of innovative therapies in the treatment of cystic fibrosis. Following its usual practice, ICER contracted with an outside group to construct a value assessment framework, in this case a microsimulation model, to generate value claims. The primary outcomes for value claims were incremental cost-per-QALY simulations for four target cystic fibrosis populations. The value assessment, in common with the same model applied earlier by ICER in cystic fibrosis, recommended substantial price discounts based on arbitrary threshold cost-per-QALY values. Unfortunately, the entire exercise, as detailed in previous commentaries in INNOVATIONS in Pharmacy is essentially a waste of time. Not only is the reference case model presented by ICER only one of a multiverse of other models, all driven by a selective application of model structure and assumptions, but the fact that the utilities that are applied to hypothetical time spent in different disease stages to modeled QALYs and lifetime cost-per-QALY claims fail to meet fundamental measurement axioms: they are ordinal manifest scores. Applied to target cystic fibrosis target patient groups, the modeled claims are meaningless. From the manufacturer’s perspective, in this case Vertex Pharmaceuticals who have developed all the cystic fibrosis therapies ‘modeled’ by the ICER contractor, their response to ICER claims should be to reject them out of hand; the constructs are imaginary and the outcome claims nonsense.
Article Type: Commentar
A Global Comparison of Initial Pharmacy Education Curricula: An Exploratory Study
Full text linkBackground: Time-tabled curricular contents and syllabi reflect the actual delivery of the academic programme and one of key quality components in healthcare professional education. There is a need of global evidence base of Initial Pharmacy Education and Training (IPET) curricula for assisting the advancement of IPET globally.
Objectives: To seek the differences and similarities among IPET curricula and to explore relative trends and weighting of IPET curricula globally.
Methods: Sample curricular documents were collected purposively either through a parallel survey study investigating the structures and processes of IPET globally in collaboration with the International Pharmaceutical Federation Education (FIPEd), or through research team network. Collected textual documents containing IPET curricular contents were analysed by a mixed approach of the comparative content and framework analyses, using curriculum clusters in a guideline from the PHARMINE project.
Results: IPET curricular documents were collected from 16 countries and territories. The study showed study years spent in the IPET years range from four to six years, and a sample mean of average syllabus time spent per year is 728 hours/year (excluding outlier). There was a biggest variance in the pharmacy practice cluster (PRAC) among samples, ranging from 49.3 to 12.8%, showing a significant negative correlation with the chemical science cluster (CHEM) g = -0.77 (p<.0001). Categorised further into three curricular content groups, the study identified that there was variances in a tendency of the curricular orientation of science or practice-focus between countries.
Conclusion: The study allowed a first global comparison of IPET curricula from all WHO regions, which provided a better understanding of current IPET practice and delivery across nations and established evidence base to address challenges and gaps for further improvement of IPET curriculum in any country.
Article Type: Original Researc
Nonsense on Stilts – Part 1: The ICER 2020-2023 Value Assessment Framework for Constructing Imaginary Worlds
Full text linkPrevious commentaries in the Formulary Evaluation section of INNOVATIONS in Pharmacy have pointed to the lack of credibility in modeled claims for cost-effectiveness and associated recommendations for pricing and access by the Institute for Clinical and Economic Review (ICER). The principal objection to ICER reports has been that their modeled claims fail the standards of normal science: they are best seen as pseudoscience. The purpose of this latest commentary is to provide a critique of the recently released ICER 2020 Value Assessment Framework (VAF). Although ICER has taken upon itself the pole position in health technology assessments and recommendations for product pricing in the US health care system, the incremental, lifetime cost-per-QALY modeling methodology should not be taken seriously. The creation of imaginary modeled worlds, built entirely from assumption, fails the demarcation test between science and pseudoscience. The ICER evidence reports are best seen as the health technology assessment equivalent of ‘intelligent design’ in counterpoint to ‘natural selection’. It is surprising, therefore, that health care decision makers should take ICER’s recommendations seriously as providing ‘approximate information’ for formulary decision making. What is not appreciated is that the claims made by ICER lack credibility, are impossible to evaluate and lack the ability to be replicated across treatment settings. Indeed, the models presented under the guise of a ‘state of the art’ value assessment were never intended to support evaluable claims. We have no idea and will never know if they are right or if they are wrong. ICER’s position becomes even more untenable once the models presented are assessed in detail. Without in any way supporting the ICER methodology, it is worth noting that all too often ICER’s claims for incremental QALYs in specific models are based upon what appears to be, from the limited evidence presented, a casual and ad hoc assemblage of utility scores from diverse constructs. This is a critical weakness given the role attributed by ICER to the modeled cost-per-QALY claims as central to ICERs imaginary value assessment. ICER also overlooks the fact that the utility scores it captures from the literature to populate its imaginary reference case world lack objectivity. They are ordinal rather than interval measures. To apply these manifest scores to time spent in a disease stage and then aggregate these over different disease stages is nonsensical. The critical issue is one of instrument development. The case made here is for the application of Rasch Measurement Theory (RMT) to construct a unidimensional instrument with interval properties, in this case from the needs fulfillment construct of quality of life (QoL). Unless an instrument meets RMT standards in its development, the logic of Rasch modeling to achieve fundamental measurement standards means that other scales are, by definition, ordinal. It is absurd to ‘assume’ they are interval. RMT is designed to create instruments to evaluate change and test hypotheses. In the absence of instruments that have RMT properties, the cost-per-QALY reference case modelling meme collapses. It is an analytical dead end. If we are to support a meaningful scientific program to discover new facts to support health care delivery and improve the lives of patients, caregivers and their families, then ICER should be put to one side.
Article Type: Commentar
Implementing a Graphic Organizer Active Learning Exercise with an Interactive Lesson Template
Full text linkObjective: To describe a systematic approach to active learning using a lesson template with a graphic organizer activity.
Innovation: The authors describe a tool that can be used to incorporate a graphic organizer activity into a traditional lecture class to promote active learning. This interactive template offers a step-by-step process to plan and implement a graphic organizer activity. The graphic organizer was used in a contact dermatitis lecture as part of a Nonprescription Medicines course for first year pharmacy students.
Critical Analysis: A survey of students immediately after the activity identified that students agreed they were interested in the activity, were engaged with the activity, and perceived an understanding of the course material. An instructor reflection revealed that students were excited and identified some instructor challenges to executing the activity.
Next Steps: Instructors interested in using graphic organizers in lectures can refer to this approach for guidance. In addition to a graphic organizer, the structure of this template can be applied to different active learning activities, thus creating consistency in delivering active learning.
Article Type: Not