INNOVATIONS in pharmacy (Iip - E-Journal)
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Pharmacist Behavior Changes Following a Medication Counseling Training Program Targeting Teach-Back and Plain Language
Get PDFPurpose: To evaluate whether active learning-based training in teach-back and plain language (TBPL) techniques can lead to observable changes to patient-centered practices in pharmacist-patient counseling.
Methods: All pharmacists in direct patient care roles, inpatient and outpatient, were required to complete a didactic module and a workshop / webinar or small group training. The workshop / webinar and small group modalities incorporated elements of adult education theory. Following completion, pharmacists were surveyed to assess their ability, confidence and commitment to incorporating TBPL techniques into practice. Evaluation of pharmacist-patient counseling was completed pre- and post- training through direct observation. Student pharmacists were trained to evaluate pharmacists’ consultations on patients with ≥2 new medications. Students recorded completeness rates for 39 communication techniques.
Results: One-hundred and eighteen pharmacists completed the TBPL training program and 59 pharmacists completed an evaluation. A total of 84 direct observations were completed (40 pre-training and 44 post-training). Skills improved included: using plain language (p
Conclusion: Implementing a TBPL training program improved observable pharmacist-patient consultation skills. This approach is replicable and could be utilized as a model for other competencies.
Type: Original Researc
Development and Evaluation of Students’ Skills Critiquing Clinical Documentation
Get PDFObjectives: The main objective is to evaluate students’ ability to critique simulated clinical documentation containing intentional errors. Exploratory objectives include comparing student performance on two note critique activities and comparing performance of two consecutive student cohorts.
Methods: Students are introduced to the skills of clinical documentation in the second professional year. To uniquely develop students’ ability to identify challenges that may be present with notes in their future practice, students were taught specific skills in critiquing documentation, with an emphasis on the errors and omissions commonly seen in different sections of the note based on the previous literature. Students were assessed on their ability to correctly critique two notes containing intentional errors in two teaching laboratory courses.
Results: A total of 159 students completed two note critique activities, identifying 87.0% of intentional errors built into both activities. On the individual note components, students identified 97.9%, 73.0%, 78.8%, and 95.5% of the intentional errors in the subjective, objective, assessment, and plan (SOAP) sections, respectively.
Conclusion: Students perform fairly well when identifying errors in poorly written SOAP notes. They seem to struggle most with identifying intentional errors in the objective and assessment sections. Future instructional efforts will target improving students’ abilities critiquing these sections.
Type: Original Researc
The Impact of a Short-Term Pharmacology Enrichment Program on Knowledge and Science Attitudes in Precollege Students
Get PDFAs our nation and the global economy place an increased demand for science, technology, engineering, and mathematics (STEM) jobs, science educators must implement innovative approaches to pique precollege student’s interests in these careers. Pharmacology remains a relevant and engaging platform to teach biology and chemistry concepts, and this strategy applied over several months in the formal classroom increases science literacy in high school students. In order to improve the affordability and accessibility of this educational approach, we developed and assessed the impact of a short-term pharmacology day camp, ‘Pills, Potions, and Poisons’ (PPP), on high school students’ science knowledge and attitudes toward science careers. The PPP program was offered annually from 2009 through 2012, and participants spent 6 days learning about pharmacology and careers in the biomedical sciences. All PPP student participants (n=134) completed surveys assessing their basic science knowledge and science attitudes before and after the program. Students achieved significant gains in their science knowledge by the end (Day 6) of the PPP program (from 41% mean test score to 65%; p<0.001). In addition, the majority of participants agreed or strongly agreed that the PPP program positively impacted their attitudes toward science (p<0.001). This study provides evidence that a short-term pharmacology-centered science enrichment program can achieve significant gains in participant’s science knowledge as well as motivation and confidence towards science careers. Moreover, we report benefits experienced by the undergraduate, graduate, and professional pharmacy student teaching assistants (TAs, n=10) who reported improved communication skills and an increased interest in future educational work.
Type: Original Researc
Imaginary Worlds: Modeled claims for cost-effectiveness published in PharmacoEconomics January 2015 to December 2015
Get PDFThe purpose of this review is to assess whether or not economic evaluation studies published in PharmacoEconomics in 2015 meet the standards of normal science. Two questions are key to the assessment: (i) did the authors attempt to generate testable claims as to the impact of the pharmaceutical product in health care systems and (ii) did the authors suggest how the claims might be evaluated? A total of 31 studies were evaluated, including 14 research articles, 8 systematic reviews and 9 reviews. Although the majority of the studies met recommended standards for cost-effectiveness analysis, none met the standards of normal science. They were best categorized as imaginary worlds or thought experiments. The reader has no idea whether the claims for the products are right or even if they were wrong. Journal editors have two options: (i) require authors to submit cost-effectiveness claims that are evaluable with a protocol suggesting how the claim may be evaluated or (ii) continue to publish non-evaluable cost-effectiveness claims but insist authors indicate that the claims are non-evaluable.
Conflict of Interest
None
Type: Commentar
Assessment of Barriers to Providing Introductory Pharmacy Practice Experiences (IPPEs) in the Hospital Setting
Get PDFObjectives: The primary objective of the study is to identify the barriers to providing Introductory Pharmacy Practice Experiences (IPPEs) in the hospital setting.
Methods: Potential barriers to IPPEs were identified via literature review and interviews with current IPPE preceptors from various institutions. Based on this information, an electronic survey was developed and distributed to IPPE preceptors in order to assess student, preceptor, logistical and college or school of pharmacy related barriers that potentially exist for providing IPPE in the hospital setting.
Results: Sixty-eight of the 287 eligible survey respondents (24%) completed the electronic survey. Seventy-six percent of respondents agreed or strongly agreed that available time was a barrier to precepting IPPE students even though a majority of respondents reported spending a third or more of their day with an IPPE student when on rotation. Seventy-three percent of respondents disagreed or strongly disagreed that all preceptors have consistent performance expectations for students, while just 46% agreed or strongly agreed that they had adequate training to precept IPPEs. Sixty-five percent of respondents agreed that IPPE students have the ability to be a participant in patient care and 70% of preceptors believe that IPPE students should be involved in patient care.
Conclusions: Conducting IPPEs in the institutional setting comes with challenges. Based on the results of this study, experiential directors and colleges/schools of pharmacy could make a positive impact on the quality and consistency of IPPEs by setting student expectations and training preceptors on appropriate and consistent expectations for students.
Type: Original Researc
A Cross-Sectional Study Evaluating the Impact of One Year versus Two Years of Exposure to Interprofessional Education on Student Perceptions of Physician-Pharmacist Interprofessional Clinical Education (SPICE)
Get PDFBackground: Evaluating student perceptions of interprofessional education (IPE) is important to meet accreditation standards. The objective of this study was to evaluate the impact of one year versus two years of exposure to IPE on student perceptions, as well as evaluate differences between professions.
Methods: In this cross-sectional study, first and second year medical and pharmacy students enrolled in an interprofessional experiential course series at each of their respective institutions completed a perceptions instrument prior to a standardized objective behavioral assessment. Student demographics and perception scores were summarized using descriptive statistics. Chi-squared tests and Cochran-Mantel-Haenszel tests were used to assess differences in demographic variables. Between-group differences in perception scores were assessed using Wilcoxon Rank-Sum tests.
Results: 155 students completed the instrument out of the 163 students enrolled in the course series. Overall, the median scores were ≥4 (4=Agree, 5=Strongly Agree) for all SPICE items and factors. No significant differences were observed between first and second year students in response to any of the SPICE items or factors. When comparing professions, significant differences were observed between pharmacy students and medical students that IPE “enhances my education” (p=0.003), “improves patient satisfaction” (p=0.001), and “enhances my future ability to collaborate” (p=0.001). Significant differences were also observed between pharmacy students and medical students for 2 of the 3 factors: teamwork (p=0.001) and patient outcomes (p=0.005). For all of the differences in items and factors, pharmacy students reported higher levels of agreement.
Conclusions: Two years of exposure to IPE compared to one year (i.e. second year students vs. first year students) did not result in higher levels of agreement; however, agreement was high across all students which may have limited the ability to detect a difference. When perceptions are high early in the curriculum, maintaining the same level of agreement longitudinally may be a more appropriate educational outcome. Pharmacy students had higher levels of agreement compared to medical students for certain items. Further research is needed to determine if these differences have an impact on interprofessional collaboration.
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
Pharmacists’ Provision of Contraception: Established and Emerging Roles
Get PDFPharmacists’ roles in provision of family planning products is expanding in the United States (U.S.). This article details established as well as emerging roles for U.S. pharmacists in the provision of contraception. These include helping patients develop reproductive life plans; dispensing prescription contraceptive products and counseling patients; assisting and educating patients with non-prescription contraceptive products, including emergency contraception; participating in collaborative practice agreements; administering contraception products; and making referrals and developing partnerships. The provision of contraception in the U.S. is dynamic, and pharmacists should continue to be aware of changes that will impact them professionally. As approximately 45% of pregnancies in the U.S. are unintended, through these roles pharmacists can impact an important public health priority.
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: Idea Pape
A Pharmacist’s Reflection: Living a week, when death’s four seconds away
Get PDFConflict of Interest
I declare no conflicts of interest or financial interests that the author or members of his immediate family 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
Cost-Effectiveness and Formulary Evaluation: Imaginary Worlds and Entresto Claims in Heart Failure
Get PDFThe Program in Social and Administrative Pharmacy at the University of Minnesota recently released its proposed guidelines for formulary evaluation. The guidelines were focused on ensuring that comparative claims made for pharmaceutical products and devices rested on a credible evidence base. The argument was put forward that if value claims for clinical and cost-effectiveness outcomes were to be accepted then they had to be empirically evaluable. The purpose of this commentary is to explore alternative modeled claims for Entresto, an angiotensin receptor neprilysin inhibitor, versus the standard of care with an ACE inhibitor in patients with chronic heart failure. Two models are compared: a lifetime cost-per-QALY model and a 3-year cost and budget impact model. The primary reason for this comparison is the puzzling feature that for a product which is over 120 time as expensive compared to the standard of care (Entresto 3 per month) the modeled claim can be made that the product is, in willingness to pay terms, cost-effective. The analysis illustrates that, perhaps not surprisingly, different models can generate quite different perspectives on the presumption of ‘cost-effectiveness’. In the present case the simple decision model yields a breakeven monthly cost for Entresto of only $23.74. If modeled claims are to be useful for formulary decision making, then we need to eschew ‘black box’ models with non-evaluable claims in favor of those models that yield credible, evaluable and replicable claims that can support defensible product placement and pricing decisions.
Conflict of Interest
None
Type: Commentar
Imaginary Worlds: The Status of Modeled Quality Adjusted Life Year Claims for New Oral Anticoagulants in Atrial Fibrillation Published Between January 2012 and February 2016
Get PDFThe purpose of this commentary is to evaluate modeled quality adjusted life year claims (QALYs) for new oral anticoagulants (NOACs) published in the period from January 2012 to February 2016. The focus of this commentary is to assess whether or not the modeled claims meet the standards of normal science in supporting falsification and replication. A systematic and consensus review by the authors identified a total of 23 cost-utility NOACs evaluations along with four single technology appraisals undertaken by the National Institute for Health and Care Excellence (NICE) in the UK. Each study was evaluated in terms of four criteria: (i) did the study generate evaluable claims (ii) id the authors attempt to generate evaluable claims (iii) did the authors suggest how the claims might be evaluated and (iv) did the authors caution readers as to the implications of generating non-evaluable projections or claims for credibility in health system decision making? None of the 23 studies assessed or the four NICE single technology appraisals met any of the four assessment criteria. None of the studies presented projections or claims in a form suitable for empirical evaluation. None could support falsification or replication. They failed the standards associated with the scientific method. Failure to meet the standards of normal science meant that the studies, from a formulary assessment perspective, are not credible. The claims made were either impossible to verify, or if potentially verifiable, were not presented in a testable form. There was no basis for assessing whether the claims were right or even if they were wrong. This lack of scientific credibility is a major concern. In particular, the choice of a lifetime cost-utility framework for assessing the NOACs against warfarin and against each other effectively precludes any experimental assessment. If medical economics is to advance through the formulation and testing of hypotheses, then editors of journals should consider whether or not to set standards for the acceptance of publications to include the requirement for testable claims and the results of claims assessment. If this is not acceptable, then it should be made clear that published modeled claims and simulations are simply imaginary worlds or thought experiments. Editors cannot sit back and assume that at some time in the future non-testable projections will possibly be evaluated.
Conflict of Interest
None
Type: Commentar