Initiative to improve student perceptions of relevance and value in a top 200 drugs course through improved curricular alignment and course modification.

Problem description: When course evaluations and student feedback demonstrated a decline in student perceptions of a Top 200 Drugs course, proposed modification focused on curricular alignment to impact those perceptions in a positive manner. Quality improvement methods: Student course evaluations and feedback from student leaders were reviewed to determine elements of course structure and design for modification. The following areas were identified: quantity of assessment content, frequency of class meetings, in-person vs. online, and self-paced vs. instructor-guided learning. Changes in student perceptions were determined through comparison of subsequent course evaluations to those of the previous four years. Course evaluations focused on coordinator availability, course organization, exam management, and achievement of course objectives. Results of CQI inquiry: The review of course evaluations showed improvement in all focus areas following modifications to course structure and design. Student free-text comments provided further insight for descriptive analysis. Interpretation and discussion: The evaluation score improvement was consistent with student comments. Contributing factors included curricular alignment, frequency of examinations, examination content, and faculty-guided learning through lecture and active learning. Alignment to pharmacology courses highlighted the relevance and value through the union of pharmaceutical sciences, clinical sciences, and pharmacy practice instruction. Conclusions: The alignment versatility of Top Drugs makes it ideal for bridging pharmaceutical and clinical sciences to bring relevance and value to students. The instructors will continue to offer the Top Drugs course in this format. Further plans for research include additional layers of curricular alignment and innovative active learning.

Effectiveness of non-pharmacological interventions to treat orthostatic hypotension in elderly people and people with a neurological condition: a systematic review.

OBJECTIVE: The objective of this review was to summarize the best available evidence regarding the effectiveness of non-pharmacological interventions to treat orthostatic hypotension (OH) in elderly people and people with a neurological condition. INTRODUCTION: Orthostatic hypotension is common in elderly people and people with a neurological condition and can interfere with or limit rehabilitation. Non-pharmacological interventions to treat OH could allow for longer and earlier mobilization, which is recommended in national clinical guidelines for rehabilitation in the acute or sub-acute phase following stroke or other neurological conditions. INCLUSION CRITERIA: The review considered people aged 50 years and older, and people aged 18 years and elderly people with a neurological condition. Non-pharmacological interventions to treat OH included compression garments, neuromuscular stimulation, physical counter-maneuvers, aerobic or resistance exercises, sleeping with head tilted up, increasing fluid and salt intake, and timing and size of meals. The comparator was usual care, no intervention, pharmacological interventions, or other non-pharmacological interventions. Outcome measures included systolic blood pressure, diastolic blood pressure, heart rate, cerebral blood flow, observed/perceived symptoms, duration of standing or sitting in minutes, tolerance of therapy, functional ability, and adverse events/effects. METHODS: Databases for published and unpublished studies available in English up to April 2018 with no lower date limit were searched. Critical appraisal was conducted using standardized instruments from JBI. Data were extracted using standardized tools designed for quantitative studies. Where appropriate, studies were included in a meta-analysis; otherwise, data were presented in a narrative form due to heterogeneity. RESULTS: Forty-three studies - a combination of randomized controlled trials (n = 13), quasi-experimental studies (n = 28), a case control study (n = 1), and a case report (n = 1) - with 1069 participants were included. Meta-analyses of three interventions (resistance exercise, electrical stimulation, and lower limb compression bandaging) showed no significant effect of these interventions. Results from individual studies indicated physical maneuvers such as leg crossing, leg muscle pumping/contractions, and bending forward improved orthostatic hypotension. Abdominal compression improved OH. Sleeping with head up in combination with pharmacological treatment was more effective than sleeping with head up alone. Eating smaller, more frequent meals was effective. Drinking 480 mL of water increased blood pressure. CONCLUSIONS: The review found mixed results for the effectiveness of non-pharmacological interventions to treat OH in people aged 50 years and older, and people with a neurological condition. There are several non-pharmacological interventions that may be effective in treating OH, but not all have resulted in clinically meaningful changes in outcome. Some may not be suitable for people with moderate to severe disability; therefore, it is important for clinicians to consider the patient's abilities and impairments when considering which non-pharmacological interventions to implement.

Implementation of a medication therapy management program in a primary care clinic.

OBJECTIVE: This study examined the use of a medication therapy management (MTM) program by clinic-embedded pharmacists within a primary care clinic primarily by evaluating the impact on patient identification for pharmacy services. Secondary outcomes included characterizing intervention type, targeted drugs and disease states, and barriers to successful interventions, SETTING: Primary care clinic. PRACTICE DESCRIPTION: CoxHealth Center Steeplechase is a primary care clinic of 13 providers with a clinic-embedded pharmacist, pharmacy residents, and student pharmacists providing chronic disease state management under collaborative practice agreements. PRACTICE INNOVATION: Community pharmacists have an established history of providing services through MTM programs. Clinic-embedded pharmacists have the potential to participate in these programs as well, and many barriers to providing patient care services reported by community pharmacists can be overcome by clinic-embedded pharmacists, potentially allowing for greater success of MTM interventions. EVALUATION: A 4-week pilot, in which clinic-embedded pharmacists dedicated 4 hours per week of effort to MTM services, examined the effectiveness of the program at identifying patients not otherwise receiving clinical pharmacy services, types of identified interventions, intervention success rates, barriers to intervention success, and revenue generation. RESULTS: The clinical pharmacy team attempted 46 interventions in 34 unique patients in this 4-week pilot. Of the identified patients, 67.7% (n = 23) had no contact with the clinical pharmacy team in the previous year. Targeted interventions were more frequently attempted (targeted interventions n = 42; comprehensive reviews n = 4) and more successful than comprehensive medication reviews (88% vs. 25% success rate). Barriers to success included patient refusal of services, inability to contact the patient, and inapplicability of targeted interventions. CONCLUSION: Implementation of an MTM program in one clinic required coordinated interdepartmental efforts to implement, but it effectively expanded pharmacy services by identifying patients not otherwise referred to the clinical pharmacy team for chronic disease management.