One click away: Pilot study of the perceived academic impact of screen time among pharmacy students.

INTRODUCTION: We examined the perceived impact (direct and indirect) of screen time on pharmacy students' academics and how pharmacy students attempt to overcome perceived negative impacts. METHODS: Focus group interviews with first-year and third-year pharmacy students at a single school of pharmacy were conducted, digitally audio-recorded, transcribed, and analyzed. Screen time was defined as time on any device with internet access, and academic impact was referred to as studying and academic performance. Three major questions were asked: (1) At this time in your life, what do you use screen time for?, (2) How does screen time affect you academically, directly or indirectly?, and (3) What suggestions do you have for trying to overcome the negative impacts of screen time? RESULTS: Participants reported using screen time for educational purposes, communication, entertainment, and creative outlets. Two identified themes were the ease of access to screens and the need for self-control to limit access. Positive (and more direct) academic impacts included having useful online resources and electronically organizing educational materials. Primarily negative impacts were distraction, which included the habitual nature of screen time and time management struggles, and poor sleep hygiene. Students reported addressing self-control needs by being more self-aware, attempting to set boundaries, using screen time as a reward, and limiting one's academic need for using internet-enabled devices by doing things "by hand". CONCLUSIONS: Helping students to maximize positive and minimize negative impacts of screen time may provide opportunities for collaboration among student leaders, instructors, and student affairs administrators.

Teaching interprofessional teamwork skills to health professional students: A scoping review.

An expanding body of literature is examining interprofessional teamwork and its effect in healthcare. To produce capable healthcare professionals prepared to participate in interprofessional roles, teamwork training must begin early in health professional students' training. The focus of this scoping review was to explore interprofessional education (IPE) studies designed to teach and/or assess interprofessional teamwork skills to students from two or more different health professions, to find and describe effective pedagogy and assessment strategies. Using a scoping review methodology, 1,106 abstracts were reviewed by three teams of investigators. Eligibility criteria were inclusion of students in interprofessional teams, an intervention to improve interprofessional teamwork skills and assessment of outcomes related to teamwork. Thirty-three studies met the criteria for inclusion. The literature was varied in terms of study design, teaching methods and assessment measures for interprofessional teamwork. The lack of rigorous, comparable studies in this area makes recommending one teaching method or assessment measure over another difficult. Regardless of teaching method, it appears that most learning activities where interprofessional teams interact result in positive changes in student perceptions and attitudes towards IPE and practice. As health education programs seek to incorporate more interprofessional activities into their respective programs, it is important to review methods and measures that would best fit their individual program. This review highlights the importance of standardising the reporting of methods and outcomes for those who wish to incorporate the studied methods into their curricula.

Optimizing the Benefits of Self-Monitoring Among Patients With Cancer.

PURPOSE/OBJECTIVES: To investigate oncology professionals' perspectives about, experience with, and envisioned feasibility of incorporating patient self-monitoring as a patient-centered practice. 
. RESEARCH APPROACH: An interpretive, descriptive study.
. SETTING: Four health systems and five cancer centers in three states. 
. PARTICIPANTS: 38 nurses, nurse practitioners, oncologists, physician assistants, and radiation therapists.
. METHODOLOGIC APPROACH: Individual and focus group interviews.
. FINDINGS: Three themes were revealed. CONCLUSIONS: This study uncovers the potential contribution of patient self-monitoring as a means of providing patient-generated data that informs clinical decision making, going beyond self-monitoring for self-management only. Because the term self-monitoring is not used by clinicians, adoption of an agreed-upon term is recommended as the first step toward developing and implementing a self-monitoring strategy. Findings support the need to reenvision patient education to ensure self-monitoring is clinically useful while preventing an excessive focus on the negative, which may contribute to patient anxiety.
. INTERPRETATION: The full potential for self-monitoring by patients is not entirely reached. Because nurses are charged with providing patient education, they are strategically positioned to adopt the term self-monitoring and integrate a self-monitoring strategy into patient-centered practice.

Tracking and journaling the cancer journey.

Clinicians sometimes suggest to patients that they keep track of illness-related issues. Self-monitoring is a helpful term to describe these at-home activities that yield essential information for self-management. The purpose of this article is to create greater awareness of the opportunities (and potential shortcomings) of patient self-monitoring for oncology nursing practice.

"How I kept track of it of course was my business": cancer patient self-monitoring as self-stylized work.

OBJECTIVES: Self-monitoring behaviors of cancer patients benefit patients, caregivers, and providers, and yet the phenomenon of self-monitoring from the cancer-patient perspective has not been studied. We examined cancer patients' self-monitoring preferences and practices, focusing on the meaning of self-monitoring within the cancer experience. METHODS: Semi-structured interviews were conducted among adult cancer patients who had been seen at least once at a rural United States cancer center. Questions sought out the meaning of self-monitoring and its practical aspects. Qualitative data were analyzed by adapting the four-stepped method by Giorgi for empirical phenomenological analysis. RESULTS: Twenty participants were interviewed (11 women and 9 men). Transcribed interviews revealed that cancer patient self-monitoring is self-stylized work that ranges from simple to complex, while being both idiosyncratic and routine. Participants reported using tools with systems for use that fit their distinctive lives for the purpose of understanding and using information they deemed to be important in their cancer care. Three conceptual categories were discerned from the data that help to elucidate this self-stylized work as fitting their individual priorities and preferences, reflecting their identities, and being born of their work lives. SIGNIFICANCE OF RESULTS: Findings highlight patients' unique self-monitoring preferences and practices, calling into question the assumption that the sole use of standardized tools are the most effective approach to engaging patients in this practice. Self-monitoring efforts can be validated when providers welcome or adapt to patients' self-stylized tools and systems. Doing so may present opportunity for improved communications and patient-centered care.

'Being a Part of Treatment': the meaning of self-monitoring for rural cancer patients.

BACKGROUND: The diagnosis and treatment of cancer entail managing vast amounts of information in order for patients to participate effectively in disease self-management. Information management includes patients' responses to acquire, manage, and use external and internal information, such as through self-monitoring practices. OBJECTIVE: The study objective was to examine the meaning of self-monitoring practices within the context of rural patients' responses to internal and external information. METHODS: An empirical phenomenological approach was used. Participants were adults 18 years or older, who were once diagnosed with cancer, who agreed to discuss health monitoring behavior in relation to their cancer experience, and who used services at a small, rural cancer center. Data were collected using semistructured interviews. RESULTS: Findings revealed a self-directed pursuit of self-monitoring that was shaped by 4 factors, that is, cognitive, affective, interpersonal, and symptomatic. Quotations from participants illustrate these factors. "I'd ask the questions …" represents the cognitive factor. "Are the horse stories about cancer treatments true?" represents the affective factor. The interpersonal factor is represented as "My nurse was there for me!" The symptomatic factor is represented as "Chemotherapy blocks out your memory." Informed by these factors, participants' self-monitoring practices fostered participants' sense of control and self-advocacy efforts. CONCLUSION: Nurses are in a strategic position to engage in supportive care practices through the facilitation of self-monitoring. IMPLICATIONS FOR PRACTICE: Assessment questions grounded in study findings are suggested for use by nurses to develop patient-centered education that facilitates self-monitoring practices.

Pharmacy participation and claim characteristics in the Wisconsin Medicaid Pharmaceutical Care Program from 1996 to 2007.

BACKGROUND: Under the 1995 Wisconsin Act 27, the biennial budget, Wisconsin Medicaid was required to develop an incentive-based pharmacy payment system for pharmaceutical care (PC) services. Started on July 1, 1996, the Wisconsin Medicaid Pharmaceutical Care Program (WMPCP) is the longest currently ongoing Medicaid program to compensate pharmacists for nondispensing services. The program reimburses pharmacies for providing PC services that increase patient compliance or prevent potential adverse drug problems by paying an enhanced PC dispensing fee. Pharmacists can bill for PC services provided to Wisconsin Medicaid fee-for-service and SeniorCare (i.e., state prescription drug assistance program for low-income seniors) beneficiaries. OBJECTIVES: To examine trends in (a) the number of pharmacies participating in the WMPCP and the intensity of participation among participating pharmacies; and (b) frequencies of reason, action, result, and level-of-service (time) codes associated with PC service claims from July 1, 1996, through June 30, 2007, which represents Wisconsin state fiscal years (SFYs) 1997 through 2007. METHODS: A retrospective, longitudinal, and descriptive research design was used to analyze all paid claims for PC services provided to Wisconsin Medicaid fee-for-service and SeniorCare recipients during SFYs 1997 through 2007. The total number of paid PC claims and the average number of claims paid per pharmacy were examined to determine trends in pharmacy participation. Mean annual reimbursement amounts for PC per claim and per pharmacy were calculated. Reason, action, result, and level-of-service (time) codes that appeared in the claims were grouped into categories and analyzed to characterize the total number of claims paid overall and per SFY. RESULTS: During the study period, one-half (n = 601) of the approximately 1,200 licensed pharmacies in the state of Wisconsin were paid for a claim through the WMPCP. However, intensity of participation in the WMPCP was low, with 57% of all participating pharmacies being paid for 10 or fewer PC claims and 19% paid for only 1 PC claim over the 11-year study period. The growth in claims per year coupled with smaller growth in the number of participating pharmacies resulted in a trend of growth in the mean number of claims per participating pharmacy in the program. The proportion of total WMPCP claims accounted for by the top 10 pharmacies with the highest volume of PC claims varied from 46.6% to 80.2% per year. Patient behaviors (e.g., early or late refills) and drug use issues/problems (e.g., patient complaints or symptoms) were the most common reasons for pharmacists to provide PC services (62% of all PC claims), although drug choice reasons (e.g., product selection opportunity) were more common after 2004. The majority (55.1%) of PC services took 15 minutes or less of pharmacists' time. The total dollar amount paid to pharmacies for PC services was $876,822 between SFYs 1997 and 2007, with an overall mean of $1,459 paid per participating pharmacy. CONCLUSIONS: Trends in pharmacy participation and claims volume showed growth, albeit limited, in PC program participation with a majority of paid claims dealing with patient behaviors and drug use issues or problems that consumed a small amount of pharmacists' time (15 minutes or less). The intensity of participation (claims per pharmacy) increased over time, suggesting that some pharmacies may have developed effective systems for participating and successfully submitting claims to WMPCP for enhanced dispensing fees. Further evaluation of the impact and implications of this program for patients, pharmacists, and the state is needed to gauge overall program success and provide evidence or guidance for continued or expanded PC initiatives.

Patient perspective of medication information desired and barriers to asking pharmacists questions.

OBJECTIVES: To identify information patients want from a community pharmacist with new and refill prescription dispensing, examine how this varies across certain patient characteristics, and identify perceived barriers to asking pharmacists' questions. DESIGN: Cross-sectional study. SETTING: Six states (Wyoming, Colorado, Nebraska, Utah, Montana, and Arizona), from January 2006 to August 2008. PARTICIPANTS: Convenience sample of 600 patients or caregivers at community pharmacies. INTERVENTION: Brief, face-to-face, structured interviews. MAIN OUTCOME MEASURES: Information desired by patients when receiving new and refill prescriptions and reasons why patients would not ask pharmacists medication-related questions. RESULTS: Information most often desired at first medication dispensing was adverse effects (58.2%), basic instructions (32.6%), and drug interactions (31%). Less than 9% of patients stated no need for pharmacist-provided information or that written information sufficed. Younger (t = 4.81, P < 0.001) and more educated (X2 = 4.385, P = 0.036) patients were more likely to indicate a desire for adverse effect information than older or less educated patients. When asked about refills, nearly one-half reported wanting information beyond how many refills remain. Of patients, 15% wanted a review of information given when originally dispensed. A review of information was more often desired by patients with less than or equal to a high school education (X2 = 7.830, P < 0.01). Overall, information during refill dispensing was desired more often by those with less education (X2 = 4.786, P = 0.029). CONCLUSION: These results support revisiting current pharmacy practice and practice laws about refill counseling and risk information provision, with greater potential implications for less educated individuals.

Symptom-monitoring behaviors of rural cancer patients and survivors.

GOALS OF WORK: Symptom monitoring is described among rural cancer patients and survivors with comparison across study variables. MATERIALS AND METHODS: An anonymous survey was mailed to adult cancer patients and survivors. Sampling was via a cancer center serving a region of a US rural-frontier state. Symptom monitoring was measured as keeping written track of symptoms, side effects, trends in how one is feeling, and/or limits to what one can do. MAIN RESULTS: Useable response rate was 60.4% (134/222). Respondents were on average 62.3 years old, 53.0% were female, and 52.3% had earned less than a college degree. Breast (30.6%) and prostate (28.4%) cancers were most common. Symptom monitoring was reported and confirmed via tracking means, by 32.1% of respondents. Symptom monitoring was associated with "shared" or "passive" symptom management decisions, keeping written track of questions to ask providers and answers received, report of fatigue, and having received the suggestion or advice on how to monitor. Symptom monitoring was not associated with age, education, sex, number of symptoms, or being given something with which to monitor. CONCLUSIONS: Symptom monitoring apart from intervention appears common among rural cancer patients and survivors. Findings support using multi-dimensional ways to inquire of, and refer to, such behavior. Data show symptom monitoring is more common among those suffering cancer-related fatigue, indicating opportunities for intervention to optimize monitoring for improved outcomes. Findings also suggest symptom-monitoring patients may rely on, or interact more with, providers regarding symptom management.

Outcome and self-efficacy expectations for medication management of patients with diabetes: influence of the pharmacist-patient relationship.

OBJECTIVE: To examine how outcome and self-efficacy expectations for medication management and self-monitoring of patients with diabetes vary by different indicators of a pharmacist-patient relationship. DESIGN: Cross-sectional descriptive study. SETTING: United States during late 2004. PARTICIPANTS: 568 noninstitutionalized adults (age > or = 18 years) with type 1 or type 2 diabetes who use at least one antidiabetic medication. INTERVENTION: Self-administered mail survey. MAIN OUTCOME MEASURES: Outcome and self-efficacy expectations for medication management and self-monitoring and pharmacist-patient relationship indicators. RESULTS: The adjusted response rate was 60.6% (568 of 937). Respondents had differing mean self-efficacy expectation scores (F = 7.82, P < 0.001) across knowing the pharmacist to varying degrees, and mean self-efficacy expectation scores were slightly higher for those who consult with a pharmacist to learn about antidiabetic medications (t = -2.41, P = 0.02) compared with those who do not. Relationship quality was correlated with both self-efficacy (r = 0.17, P < 0.000) and outcome expectation (r= 0.11, P = 0.02) scales. Self-efficacy expectations were higher for those scoring in the upper third of the pharmacist-patient relationship index compared with those in the lower third (t = -2.79, P = 0.006). CONCLUSION: Descriptive results support some association between the pharmacist-patient relationship and self-efficacy expectations, although whether this association lies in pharmacists providing education, social support, or both is not clear. Further research is needed to investigate this association to better elucidate the potential contribution of a pharmacist-patient relationship to patients' diabetes self-management. The pharmacist-patient relationship index developed for this study appears to provide a more comprehensive and sensitive measure compared with other indices, suggesting potential utility in future studies.

Measurement of self-advocacy in cancer patients and survivors.

BACKGROUND: The Patient Self-Advocacy Scale, originally developed for use in HIV/AIDS patients, was adapted for use in cancer patients and survivors. The scale contains three dimensions: increased illness education, increased assertiveness with a doctor, and potential for mindful non-adherence. DISCUSSION AND CONCLUSION: Evidence for modest reliability and construct validity was found; however, ceiling effects exist for the Illness Education subscale, which supports the need to move beyond items regarding information seeking to perhaps include use and management of information.

Adverse effect monitoring: opportunity for patient care and pharmacy practice.

OBJECTIVES: To present an adverse effect monitoring tool with theoretical, practical, and data-supported explanation and justification for use in pharmacy practice for the purpose of building patient-pharmacist partnerships and improving medication-management outcomes. DESIGN: Randomized pretest-posttest experimental design. SETTING: Ambulatory patients in three multidisciplinary cancer clinics. PATIENTS: 74 patients who were beginning chemotherapy. INTERVENTIONS: A calendar for daily adverse drug event tracking by ambulatory patients was adapted from The WriteTrack: Personal Health Tracker and provided to those assigned to the intervention group, who were asked to record symptoms and possible adverse drug events during their first two chemotherapy cycles. Patient reports of self-monitoring activities were gathered through posttests (n = 74) and semistructured interviews (n = 7). MAIN OUTCOME MEASURES: Self-reported use and perceived usefulness of the tool. RESULTS: A total of 88.4% of the experimental group (38 of 43 individuals) reported using the monitoring tool to keep written track of adverse effects, while 38.7% of the control group (12 of 31 individuals) reported keeping some form of written record of their experiences. A total of 65.8% of those in the intervention group found patterns in their adverse effects, 47.4% indicated they took the calendar to the clinic to help them recall events, and 26.3% reported using the calendar at the clinic to show their health care team what was happening. Experimental group subjects most often shared the adverse effect monitoring information with nurses alone (23.7%). Patients using the diary indicated that it had a high degree of utility and value and that they would use it again and recommend it to other patients with cancer. CONCLUSION: A system for adverse effect monitoring by patients in the context of cancer drug management was acceptable and useful, and pharmacists could incorporate this tool into their daily practice with minimal effort, time, and expense. Patients' self-documented symptoms and adverse effects can be valuable data when used to help tailor medication regimens to improve clinical status while satisfying patients' personal priorities.