Online versus Live Delivery of Education to Pharmacists in a Large Multicentre Health Region: A Non-inferiority Assessment of Learning Outcomes.

BACKGROUND: The prevalence of online modules for continuing education in the health professions has been increasing in recent years. However, the effectiveness of online modules for pharmacist learning has not been thoroughly studied. OBJECTIVES: The primary aim of this study was to determine if providing education to pharmacists through a self-paced enhanced online module was non-inferior to a face-to-face learning module with respect to knowledge application on the topic of postoperative insulin dosing. Secondary aims were to determine pharmacists' knowledge gain and retention, as well as their satisfaction with the modules. METHODS: The participants in this prospective, randomized, parallel-group non-inferiority trial were pharmacists in a large multicentre health region. Outcomes were measured by comparing scores obtained on pre- and post-module knowledge-assessment questionnaires. A between-group difference in change on knowledge application scores of less than 25 percentage points was the predetermined non-inferiority margin. RESULTS: A total of 74 pharmacists consented to participate, 38 randomly assigned to use the enhanced online module and 36 to attend the face-to-face learning session. For questions examining knowledge application, the mean improvement achieved by the online learning group was 26 percentage points greater than that achieved by the face-to-face learning group (95% confidence interval [CI] 25 to 27; p < 0.001). For questions testing knowledge gain, the improvement achieved by the online learning group was 7 percentage points less than that achieved by the face-to-face learning group (95% CI 2 to 12; p = 0.008). Therefore, the enhanced online module was deemed to be non-inferior to the face-to-face learning session in terms of knowledge application and knowledge gain. Insufficient data were available to analyze the secondary outcome of knowledge retention over time. Participant satisfaction was similar for the 2 groups (p = 0.62). CONCLUSION: The self-paced enhanced online module was non-inferior to facilitated face-to-face learning in terms of improving application and knowledge of insulin dosing. Pharmacists had similar levels of satisfaction with the 2 modes of learning.

CONTEXTE: La prévalence des modules d'apprentissage en ligne pour la formation continue des professionnels de la santé a augmenté ces dernières années. Cependant, l'efficacité de ces modules pour l'apprentissage des pharmaciens n'a pas fait l'objet d'études rigoureuses. OBJECTIFS: Le principal objectif de cette étude était de déterminer si la formation offerte aux pharmaciens au moyen d'un module d'autoapprentissage en ligne amélioré était non inférieure à un module d'apprentissage en personne pour ce qui est de l'application des connaissances sur le sujet de la détermination des doses d'insuline postopératoires. Les objectifs secondaires étaient de mesurer l'acquisition et la rétention des connaissances par les pharmaciens et leur satisfaction par rapport à l'apprentissage. MÉTHODES: Les participants à cette étude prospective de non-infériorité à répartition aléatoire et groupes parallèles étaient des pharmaciens d'une importante régie régionale de la santé multicentre. Les résultats ont été mesurés en comparant les scores obtenus aux questionnaires d'évaluation des connaissances pré- et post-formation. Une différence intergroupe du changement des scores de l'application des connaissances de moins de 25 points de pourcentage constituait la marge de non-infériorité prédéterminée. RÉSULTATS: En tout, 74 pharmaciens ont consenti à participer à l'étude, dont 38 ont été répartis de façon aléatoire dans le groupe module d'apprentissage en ligne amélioré et les 36 autres, dans le groupe séance d'apprentissage en personne. Pour les questions examinant l'application des connaissances, l'amélioration moyenne obtenue dans le groupe apprentissage en ligne était supérieure de 26 points de pourcentage à celle obtenue dans le groupe apprentissage en personne (intervalle de confiance [IC] à 95 %, 25 à 27; p < 0,001). Pour les questions testant l'acquisition de connaissances, l'amélioration obtenue dans le groupe apprentissage en ligne était inférieure de 7 points de pourcentage à celle obtenue dans le groupe apprentissage en personne (IC à 95 %, 2 à 12; p = 0,008). Par conséquent, le module d'apprentissage en ligne amélioré a été jugé non inférieur à la séance d'apprentissage en personne pour ce qui est de l'application des connaissances et de l'acquisition des connaissances. L'insuffisance des données n'a pas permis d'analyser le résultat secondaire relatif à la rétention des connaissances au fil du temps. La satisfaction des participants était similaire entre les deux groupes (p = 0,62). CONCLUSION: Le module d'autoapprentissage en ligne amélioré était non inférieur à une séance d'apprentissage en personne au chapitre des connaissances et de leur application pour déterminer les doses d'insuline postopératoires. Les niveaux de satisfaction des pharmaciens étaient similaires entre les deux méthodes d'apprentissage. [Traduction par l'éditeur].

Diagnostic reasoning by hospital pharmacists: assessment of attitudes, knowledge, and skills.

BACKGROUND: Hospital pharmacists participate in activities that may be considered diagnostic. Two reasoning approaches to diagnosis have been described: non-analytic and analytic. Of the 6 analytic traditions, the probabilistic tradition has been shown to improve diagnostic accuracy and reduce unnecessary testing. To the authors' knowledge, pharmacists' attitudes toward having a diagnostic role and their diagnostic knowledge and skills have never been studied. OBJECTIVES: To describe pharmacists' attitudes toward the role of diagnosis in pharmacotherapeutic problem-solving and to characterize the extent of pharmacists' knowledge and skills related to diagnostic literacy. METHODS: Pharmacists working within Lower Mainland Pharmacy Services (British Columbia) who spent at least 33% of their time in direct patient care were invited to participate in a prospective observational survey. The survey sought information about demographic characteristics and attitudes toward diagnosis. Diagnostic knowledge and skills were tested by means of 3 case scenarios. The analysis included simple descriptive statistics and inferential statistics to evaluate relationships between responses and experience and training. RESULTS: Of 266 pharmacists invited to participate, 94 responded. The attitudes section of the survey was completed by 90 pharmacists; of these, 80 (89%) agreed with the definition of "diagnosis" proposed in the survey, and 83 (92%) agreed that it is important for pharmacists to have diagnosis-related skills. Respondents preferred an analytic to a non-analytic approach to diagnostic decision-making. The probabilistic tradition was not the preferred method in any of the 3 cases. In evaluating 5 clinical scenarios that might require diagnostic skills, on average 84% of respondents agreed that they should be involved in assessing such problems. Respondents' knowledge of and ability to apply probabilistic diagnostic tools were highest for test sensitivity (average of 61% of respondents with the correct answers) and lower for test specificity (average of 48% with correct answers) and likelihood ratios (average of 39% with correct answers). CONCLUSIONS: Respondents to this survey strongly believed that diagnostic skills were important for solving drug-related problems, but they demonstrated low levels of knowledge and ability to apply concepts of probabilistic diagnostic reasoning. Opportunities to expand pharmacists' knowledge of diagnostic reasoning exist, and the findings reported here indicate that pharmacists would consider such professional development valuable.

Best possible medication history for hemodialysis patients obtained by a pharmacy technician.

BACKGROUND: Outpatients undergoing hemodialysis are at high risk for adverse drug events. Limited resources make it challenging for pharmacists to routinely obtain a best possible medication history (BPMH). OBJECTIVES: The primary objective was to determine whether, for patients undergoing hemodialysis, a pharmacy technician has the skills to obtain a BPMH that would allow a pharmacist to identify drug-related problems. The secondary objectives were to determine the number and types of medication discrepancies and drug-related problems identified and the time required by the technician to complete the BPMH. METHODS: All patients treated in the hemodialysis unit during the study period were included, except for those who required an interpreter or were unable to participate in an in-person interview. A single technician was taught how to interview patients according to a structured format. For each patient, the technician's BMPH was verified by a pharmacist. The agreement rate between technician and pharmacists was determined, along with the number and types of discrepancies and drug-related problems identified. RESULTS: The technician interviewed 99 patients. Of the 1334 medication orders reviewed, the technician and pharmacists agreed on all but 15 (agreement rate 98.9%). A total of 358 medication discrepancies were noted for 93 patients (3.8 discrepancies per patient). Of these, 210 (59%) were undocumented intentional discrepancies, and 148 (41%) were unintentional discrepancies (most commonly errors of commission). Of the 135 drug-related problems identified, the majority involved dosing problems or nonadherence. The technician required an average of 17 min for each interview. CONCLUSION: An adequately trained technician was capable of interviewing patients to create a BPMH. A variety of medication discrepancies and drug-related problems were identified. Generation of a BPMH by a technician is a useful approach allowing pharmacists to identify drug-related problems.