Using a longitudinal case-based approach to teach population health and disease prevention.

BACKGROUND AND PURPOSE: Both colleges of pharmacy in one state separately required a two-credit public and population health course. These courses had been exclusively conducted in a traditional lecture-based format, with little active learning components. Our goal was to redesign and align these required courses across the two colleges of pharmacy using a longitudinal, case-based, active-learning curriculum. EDUCATIONAL ACTIVITY AND SETTING: Two interprofessional faculty from each university met bi-weekly via videoconference or telephone to: (1) develop an integrated, longitudinal, case-based curriculum with lecture/didactic/case-based materials; and (2) identify and implement an evaluation plan. This course curriculum applied problem-based learning and team-based learning approaches to the Clinical Prevention & Population Health Curricular Framework developed by the Healthy People Curriculum Task Force. FINDINGS: Course evaluations were used to analyze curricular outcomes. Improvement in course evaluation scores and student survey results remained consistent over three years. Students' written comments have also remained overwhelmingly positive over the three-year implementation period. SUMMARY: An interprofessionally developed, longitudinal, case-based curriculum for teaching disease prevention and population health using a social determinants of health approach was determined to be an improved teaching methodology over previous iterations. Although there were challenges in implementing the curriculum across two separate institutions, the overwhelming result was perceived to be positive for both schools, faculty members, and students.

Systematic review of professional liability when prescribing ß-lactams for patients with a known penicillin allergy.

OBJECTIVE: To describe medical negligence and malpractice cases in which a patient with a known penicillin allergy received a ß-lactam and experienced an adverse reaction related to the ß-lactam. DATA SOURCES: Lexis-Nexus, Westlaw, and Google Scholar were searched. STUDY SELECTIONS: Medical negligence and malpractice cases were eligible for inclusion if they met the following criteria: the plaintiff had a known penicillin allergy, received a ß-lactam, and experienced an adverse event. All United States federal and state cases were eligible. RESULTS: Twenty-seven unique cases met the inclusion criteria. Eighteen cases involved the receipt of a penicillin-based antibiotic; of these cases with a known legal outcome, the plaintiff (patient or representative) prevailed or settled in 3 cases and defendants (providers) prevailed in 7 cases. Seven cases involved the receipt of a cephalosporin; of these cases with a known legal outcome, the plaintiff settled with physicians before trial in 1 case and defendants prevailed in 3 cases. Two cases involved the receipt of a carbapenem. Defendants prevailed in one case and the legal outcome of the other case is unknown. In cases in which the defense successfully moved for summary judgment, judges cited a lack of scientific evidence demonstrating a cephalosporin or carbapenem was contraindicated for a patient with a penicillin allergy. CONCLUSION: The cases with published legal outcomes found limited professional liability for clinicians who prescribed cephalosporins or carbapenems to a patient with a known penicillin allergy. These results may decrease the litigation fears of practitioners and risk managers within health care systems.

Pharmacotherapeutic disparities: racial, ethnic, and sex variations in medication treatment.

PURPOSE: Variations in the medication treatment received by racial and ethnic minorities and women and the negative health outcomes associated with these differences were examined. METHODS: Studies published between January 1990 and June 2008 were identified via electronic searches of MEDLINE, PsychINFO, International Pharmaceutical Abstracts, PubMed, and CINAHL using search terms related to race, ethnicity, sex, drug treatment, and disparity or variation. Articles were excluded if they addressed only medical or surgical care or did not include a statistical analysis of differences in drug treatment based on race, ethnicity, or sex. Data regarding the frequency of reported race, ethnic, and sex differences in medication treatment, the types of treatment differences observed, and associated health outcomes were extracted. RESULTS: A total of 311 research articles were identified that investigated whether race, ethnicity, or sex was associated with disparities in medication treatment. Seventy- seven percent (n = 240) of included articles revealed significant disparities in drug treatment across race, ethnicity, and sex (p < 0.05). The most frequent disparity, found in 73% of the articles studied, was differences in the receipt of prescription drugs; however, documented disparities occurred related to differences in the drugs prescribed, drug dosing or administration, and wait time to receipt of a drug. Documented outcomes associated with pharmacotherapeutic disparities included increased rates of hospitalization, decreased rates of therapeutic goal attainment (e.g., low- density-lipoprotein cholesterol, blood pressure goals), and decreased rates of survival. CONCLUSION: A literature review revealed significant disparities in the medication treatment received by racial and ethnic minorities and women.