Out-of-school time use in Pakistan: A qualitative study featuring youth's voices.

The current study addresses the lack of out-of-school time (OST) research in low- and middle-income countries by exploring OST use in the context of Pakistan and incorporating youth's voices. Using a qualitative descriptive design with focus-group discussions, we conducted a study in three middle schools set in low- to middle-income neighborhoods in urban and rural areas of Karachi, Pakistan. We engaged 86 youth (50% girls; aged 10-15 years) that were purposefully selected from grade six (31.4%), seven (44.2%) and eight (24.4%) classrooms, balancing gender and locality. In each focus group, we asked participants to describe their afterschool activity routine on a typical weekday afternoon until bedtime. Digital recordings of discussions were transcribed verbatim and analyzed using content analysis. Based on sixteen focus groups with five to six participants in each group, we identified eight distinct categories: religious activities, schoolwork, screentime, helping adult family members, family time, outdoor play, indoor leisure activities, and hanging out with friends. We found that structured activities (e.g., religious activities and schoolwork supervised by an adult) were reported more frequently than unstructured activities (e.g., outdoor play and family time). Participation in activities varied by gender and location (i.e., urban vs. rural), highlighting disparities associated with the sociocultural context that marginalized youth face. Our findings provide a glimpse into the everyday lives of Pakistani youth outside of school. Additionally, they elucidate how economic resources, sociocultural norms regarding gender, and community safety shape youth's time use and socialization patterns. Findings from this study can inform the development of OST activities and initiatives aimed at promoting the positive development of Pakistani youth.

The reporting of observational studies of drug effectiveness and safety: recommendations to extend existing guidelines.

INTRODUCTION: The use of observational data to assess drug effectiveness and safety can provide relevant information, much of which may not be feasible to obtain through randomized clinical trials. Because observational studies provide critical drug safety and effectiveness information that influences drug policy and prescribing practices, transparent, consistent, and accurate reporting of these studies is critical. AREAS COVERED: We provide recommendations to extend existing reporting guidelines, covering the main components of primary research studies (methods, results, discussion). EXPERT OPINION: Our recommendations include extending drug safety and effectiveness guidelines to include explicit checklist items on: study registration, causal diagrams, rationale for measures of effect, comprehensive assessment of bias, comprehensive data cleaning steps, drug equivalents, subject-level drug data visualization, sex and gender-based analyses and results, patient-oriented outcomes, and patient involvement in research.

Challenges with accessing health care for young children presumed to have malaria in the rural district of Butaleja, Uganda: a qualitative study

OBJECTIVE: A qualitative study was conducted to gain insight into challenges reported by Butaleja households during a previous household survey. Specifically, this paper discusses heads of households' and caregivers' perceptions of challenges they face when seeking care for their very young children with fever presumed to be malaria. METHODS: Eleven focus groups (FGs) were carried out with household members (five with heads of households and six with household caregivers) residing in five sub-counties located across the district. Purposive sampling was used to ensure the sample represented the religious diversity and geographical distance from the peri-urban center of the district. Each FG consisted of five to six participants. The FGs were conducted at a community centre by two pairs of researchers residing in the district and who were fluent in both English and the local dialect of Lunyole. The discussions were recorded, translated, and transcribed. Transcripts were reviewed and coded with the assistance of QDA Miner (version 4.0) qualitative data management software, and analyzed using thematic content analysis. RESULTS: The FG discussions identified four major areas of challenges when managing acute febrile illness in their child under the age of five with presumed malaria: (1) difficulties with getting to public health facilities due to long geographical distances and lack of affordable transportation; (2) poor service once at a public health facility, including denial of care, delay in treatment, and negative experiences with the staff; (3) difficulties with managing the child's illness at home, including challenges with keeping home-stock medicines and administering medicines as prescribed; and (4) constrained to use private outlets despite their shortcomings. CONCLUSIONS: Future interventions may need to look beyond the public health system to improve case management of childhood malaria at the community level in rural districts such as Butaleja. Given the difficulties with accessing quality private health outlets, there is a need to partner with the private sector to explore feasible models of community-based health insurance programs and expand the role of informal private providers

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Challenges with accessing health care for young children presumed to have malaria in the rural district of Butaleja, Uganda: a qualitative study.

OBJECTIVE: A qualitative study was conducted to gain insight into challenges reported by Butaleja households during a previous household survey. Specifically, this paper discusses heads of households' and caregivers' perceptions of challenges they face when seeking care for their very young children with fever presumed to be malaria. METHODS: Eleven focus groups (FGs) were carried out with household members (five with heads of households and six with household caregivers) residing in five sub-counties located across the district. Purposive sampling was used to ensure the sample represented the religious diversity and geographical distance from the peri-urban center of the district. Each FG consisted of five to six participants. The FGs were conducted at a community centre by two pairs of researchers residing in the district and who were fluent in both English and the local dialect of Lunyole. The discussions were recorded, translated, and transcribed. Transcripts were reviewed and coded with the assistance of QDA Miner (version 4.0) qualitative data management software, and analyzed using thematic content analysis. RESULTS: The FG discussions identified four major areas of challenges when managing acute febrile illness in their child under the age of five with presumed malaria (1) difficulties with getting to public health facilities due to long geographical distances and lack of affordable transportation; (2) poor service once at a public health facility, including denial of care, delay in treatment, and negative experiences with the staff; (3) difficulties with managing the child's illness at home, including challenges with keeping home-stock medicines and administering medicines as prescribed; and (4) constrained to use private outlets despite their shortcomings. CONCLUSIONS: Future interventions may need to look beyond the public health system to improve case management of childhood malaria at the community level in rural districts such as Butaleja. Given the difficulties with accessing quality private health outlets, there is a need to partner with the private sector to explore feasible models of community-based health insurance programs and expand the role of informal private providers.

Understanding Unlicensed Drug Vendor Practices Related to Childhood Malaria in One Rural District of Uganda: An Exploratory Study.

This study investigated unlicensed drug outlets' practices for the management of malaria in the rural district of Butaleja, Uganda. A qualitative design using semistructured interviews was used. Interviews were recorded, translated, transcribed, and analyzed using thematic analysis. A total of 75 vendors, representing 85% of the outlets in the study area, were interviewed. Most of the vendors were associated with a drug shop type of outfit. About three-quarters reported having completed some level of postsecondary education, but just one-tenth of the vendors had qualifications that made them eligible to apply for a license to operate a drug shop. While most outlets stocked at least one type of antimalarial, only about one-quarter stocked an artemisinin-based combination therapy (ACT), one-quarter expressed a preference for ACTs, and less than one-tenth attested to firmly adhering to the national malaria treatment guidelines on dispensing ACTs as the first-line option. In contrast, nine out of 10 vendors stocked quinine and well over a third stocked antimalarials no longer recommended, such as chloroquine and sulphadoxine-pyrimethamine. Given the ongoing gap between the national malaria policy and unlicensed drug outlet practices, this study calls for greater engagement of unlicensed vendors to improve the management of childhood malaria.

Investigating unlicensed retail drug vendors' preparedness and knowledge about malaria: An exploratory study in rural Uganda.

BACKGROUND: Despite major efforts to increase the uptake of preventive measures and timely use of the first line antimalarial treatment artemisinin-based combination therapies (ACT), Uganda continues to fall short of meeting its national malaria control targets. One of the challenges has been scaling up effective measures in rural and remote areas where the unlicensed private retail sector remains the first point of contact and a common source of treatment. The current paper discusses unlicensed vendors' (1) training related to malaria case management for children aged five and under, and (2) knowledge related to the cause of malaria, preventive measures, common signs, and symptoms, diagnostic procedures, and best treatment options. METHODS: A qualitative study using semi-structured interviews was conducted in the rural district of Butaleja, Uganda in 2011. All 88 unlicensed drug outlets enumerated in the study area were visited by six locally recruited research assistants, with one vendor from each outlet invited to participate. The transcripts were analyzed using acceptable qualitative research protocols. RESULTS: About half of the 75 vendors interviewed had received some sort of formal training on malaria at a post-secondary institution, although only 6.7% had qualifications which met licensure requirements. The study found widespread misconceptions relating to the cause, as well as prevention and treatment of malaria. A large majority of the vendors relied primarily on non-specific symptoms and limited physical exams for diagnoses, with less than one-tenth of the vendors recognizing that rapid or microscopic blood testing was necessary to confirm a clinical diagnosis of malaria. While most recognized mosquitoes as the primary vector for malaria, over two-fifths of the vendors held misconceptions about the factors that could increase the risk of malaria, and nearly a third believed that malaria could not be prevented. With respect to acute case management, three-quarters viewed as the best option a medicine other than the government's first-line antimalarial, artemisinin-based combination therapies (ACT). Almost three-fifths specified quinine as their preferred option, with about one-fifth recommending quinine injection. CONCLUSION: Findings from this study confirm significant gaps in unlicensed vendors' knowledge related to malaria. With increased utilization of unlicensed drug outlets in rural and remote settings such as Butaleja, findings from this study strongly supports the need to implement strategies to improve the quality of care delivered at these outlet.

Interrupting pathways to sepsis: Effectiveness of an intervention to reduce delays in timely care for sick children in rural Bangladesh.

RATIONALE: The time it takes for a child with suspected sepsis to receive care is critical. OBJECTIVE: We evaluated care-seeking practices for sick children under 5 years in rural Bangladesh, following interpersonal communication to inform households of newly introduced supports for quality care. Based on the Delays Framework, we assessed length and source of care-seeking delays, use of formal providers, and autonomous decision-making among mothers. METHOD: Using two cross-sectional rounds before and after the 3-year intervention (August 2012 and August 2015), we surveyed 400 mothers of recently sick children in 26 randomly sampled villages from 2 intervention and 2 control subdistricts, using structured questions about delays. Six to ten times during the 18-month intervention period, local workers communicated four key messages to most intervention households in 292 villages: serious symptoms of suspected sepsis in children, a call-in center number for referral advice, a reliable transport hub, and upgrades to the local hospital. RESULTS: Compared to baseline, endline results demonstrated a significant difference in the total delay between the onset of child's illness and seeking external care, with intervention families having shorter delays. Over 90% of mothers informed someone in the family, mainly the husband, about the sick child before acting to seek care. Delays due to transportation and receiving provider care were short and not different. Using a benchmark of seeking external care within 24 h of onset, only 14.14% of intervention households and 13.40% of control households were "timely" in seeking care. Approximately 78% of parents, similar for the two groups, sought care from a non-formal practitioner (the village doctor). CONCLUSION: The results demonstrate that the delay in deciding to seek external care is most serious, and that communication strategies at the community level are necessary to increase the uptake of improved health services.

How unlicensed drug vendors in rural Uganda perceive their role in the management of childhood malaria.

BACKGROUND: A large number of caregivers in Uganda rely on the private drug delivery sector to manage childhood illnesses such as malaria. In rural settings where the formal private sector is scarce, unlicensed retail drug outlets are an important initial source of care for households. Despite their abundance, little is known about them. This study explores unlicensed retail drug outlet vendors' perceptions of their practice and social environment in one rural district of Uganda. MATERIALS AND METHODS: A qualitative design using semi-structured interviews was conducted with vendors from unlicensed retail drug outlets across all 10 sub-counties of Butaleja District. The study was conducted over a six-week period in 2011. Open-ended questions were used to gain insight into participants' perspectives, and data were analyzed using acceptable qualitative research protocols. RESULTS: Interviews were carried out with 75 vendors by trained local research assistants. Most vendors operated out of drug shops, just over half were both owners and shop attendants, and only 14% had qualifications to apply for operating a licensed drug shop. Vendors' experiences with managing malaria in children aged five and under in their community revealed five major themes, their perceptions of: 1) their role in the community, 2) their ability to manage uncomplicated malaria in young children, 3) the challenges of day-to-day operations, 4) the effect of regulatory policies on their ability to serve their communities, and 5) the prospect of future training programs. While the literature has raised concerns regarding the quality of care provided at such unlicensed outlets, most vendors in this study had a limited awareness of their deficiencies. CONCLUSIONS: There was a general sentiment among vendors that the public health system within Butaleja was failing the community and their presence was filling an important vacuum. Given the dominance of unlicensed retail drug outlets over their formal (licensed) counterparts in many rural settings, further deliberations and research is critical to determine how best to fit in and create value from the unlicensed sector within the formal health system.

Assets and challenges facing caregivers when managing malaria in young children in rural Uganda.

BACKGROUND: Despite efforts to improve malaria management for children, a substantial gap remains between policy and practice in Uganda. The aim of this study was to create quantitative profiles of assets and challenges facing caregivers in Butaleja District when managing malaria in children aged 5 years and under. The objectives were: (1) to estimate caregivers' assets and challenges during an acute episode; and, (2) to ascertain which caregiver attributes influenced receipt of an appropriate anti-malarial the most. METHODS: Data from a 2011 cross-sectional, household survey and ten psychometrically justified scales were used to estimate caregivers' assets and challenges. The scales scores were simple counts across a series of items, for example, the number of times a caregiver answered a knowledge item correctly or the number of times a caregiver relied on a credible source for information. Since high scores on six of the scales reflected attributes that eased the burden of caregiving, these were labelled 'caregiver assets'. Similarly, high scores on four of the measures signalled that a caregiver was having trouble managing the malaria episode, thereby reflecting deficits, and these were labelled 'caregiver challenges'. ANOVAs were used to compare scale scores between caregivers of children who received an appropriate anti-malarial versus those who did not. RESULTS: On the six asset scales, caregivers averaged highest on knowledge (65 %), followed by correct episode management (48 %), use of trustworthy information sources (40 %), ability to initiate or redirect their child's treatment (37 %), and lowest on possible encounters with health professionals to assist in treatment decisions (33 %). Similarly, the average caregiver reported problems with 74 % of the issues they might encounter in accessing advice, and 56 % of the problems in obtaining the best anti-malarial. Caregivers whose children received an appropriate anti-malarial demonstrated greater assets and fewer challenges than those whose child did not, with important regional differences existing. Overall, no one region performed particularly well across all ten scales. CONCLUSIONS: Findings from this study suggest that the low use of artemisinin-based combination therapy (ACT) in Butaleja for children 5 years and under may result from caregivers' high perceived barrier to accessing ACT and low perceived benefits from ACT.

Caregivers' treatment-seeking behaviors and predictors of whether a child received an appropriate antimalarial treatment: a household survey in rural Uganda.

BACKGROUND: This study responds to a rural community's concern that, despite national initiatives, malaria management in young children falls short of national guidelines in their district. This study aimed to: (1) describe caregivers' treatment-seeking behaviors in the rural district of Butaleja, (2) estimate the percentage of children who received an appropriate antimalarial, and (3) determine factors that maximized the likelihood of receiving an appropriate antimalarial. Appropriate antimalarial in this study is defined as having received only the Uganda's age-specific first-line malaria treatment for uncomplicated and severe malaria during the course of the febrile illness. METHODS: A household survey design was used in 2011 to interview 424 caregivers with a child aged five and under who had fever within the two weeks preceding the survey. The survey evaluated factors that included: knowledge about malaria and its treatment, management practices, decision-making, and access to artemisinin combination therapy (ACT) and information sources. Bivariate analysis, followed by logistic regression, was used to determine predictors of the likelihood of receiving an appropriate antimalarial. RESULTS: Home management was the most common first action, with most children requiring a subsequent action to manage their fever. Overall, 20.9 % of children received a blood test, 68.4 % received an antimalarial, and 41.0 % received an ACT. But closer inspection showed that only 31.6 % received an appropriate antimalarial. These results confirm that ACT usage and receipt of an appropriate antimalarial in Butaleja remain well below the 2010/2015 target of 85 %. While nine survey items differentiated significantly whether a child had or had not received an appropriate antimalarial, our logistic regression model identified four items as independent predictors of likelihood that a child would receive an appropriate antimalarial: obtaining antimalarials from regulated outlets (OR = 14.99); keeping ACT in the home for future use (OR = 6.36); reporting they would select ACT given the choice (OR = 2.31); and child's age older than four months (OR = 5.67). CONCLUSIONS: Few children in Butaleja received malaria treatment in accordance with national guidelines. This study highlighted the importance of engaging the full spectrum of stakeholders in the management of malaria in young children - including licensed and unlicensed providers, caregivers, and family members.

Patterns of treatment-seeking behaviors among caregivers of febrile young children: a Ugandan multiple case study.

BACKGROUND: The vast majority of malaria deaths in Uganda occur in children five and under and in rural areas. This study's exploratory case study approach captured unique situations to illustrate special attributes and aspects of treatment-seeking during a malaria episode. METHODS: During August 2010, a qualitative exploratory study was conducted in seven of Butaleja District's 12 sub-counties. Multiple case study methodology consisting of loosely-structured interviews were carried out with eight caregivers of children five and under in the local dialect. Caregivers were geographically distant and not known to each other. Interviews were translated into English and transcribed the same day. Data were analyzed using content analysis. RESULTS: Of the eight cases, children recovered fully in three instances, survived but with deficits in three, and died in two. Common to all outcomes were (1) triggers to illness recognition, (2) similar treatment sequences and practices, (3) factors which influenced caregivers' treatment-seeking decisions, (4) challenges encountered while seeking care at public health facilities, (5) cost burdens associated with managing malaria, (6) life burdens resulting from negative outcomes from malaria, (7) variations in caregiver knowledge about artemisinin combination therapy, and (8) varying perspectives how malaria management could be improved. CONCLUSIONS: Despite the reality that caregivers in Butaleja District generally share similar practices, experiences and challenges, very few children ever receive treatment in accordance with the Uganda's national guidelines. To bring national practice into conformance with policy, three advances must occur: (1) All key stakeholders (those affiliated with the formal health system--public facilities and licensed private outlets, unlicensed drug vendors, and caregivers of young children) must concur on the need and the means to improve malaria management, (2) all health providers (formal and unlicensed) need to be engaged in training and certification to improve timely access to affordable treatment irrespective of a region's remoteness or low population density, and (3) future public health interventions need to improve caregivers' capacity to take the necessary actions to best manage malaria in young children.

Caregivers' treatment-seeking behaviors and practices in Uganda-A systematic review (Part II).

Prompt treatment with artemisinin combination therapies (ACTs) remains the cornerstone for managing uncomplicated malaria caused by Plasmodium falciparum. In accordance with global initiatives to curb malaria, the Ugandan government pledged to increase the proportion of children under five to receive the first-line antimalarial treatment to 85% by 2010. To achieve this, Uganda has implemented several initiatives to improve prompt access to ACTs. While several studies have evaluated various aspects of caregivers' treatment-seeking and its impact on malaria management in children since the advent of ACT, this is the first systematic review to synthesize the Uganda literature since 2004. A comprehensive search employed key web search engines databases. A total of 19 studies met the inclusion criteria. This review found that although most Ugandans associate mosquitoes with malaria, misconceptions about the cause of malaria is common. Home management continues to be a common first response, with most caregivers seeking subsequent treatment if the child does not improve. A major concern arising from this review was that an increase in ACT knowledge does not always translate into a child receiving an ACT. While 84% of caregivers in a recent national study spontaneously named ACT as the antimalarial of choice, only half of the children were reported to have received an antimalarial and only 44% received an ACT. As with ACT usage, prompt use of ACT fell significantly short of the 2010 target. Given the on-going popularity of home management, future research is needed to examine the diversity and adequacy of home management for malaria and the sequence of care provided from the moment of recognition of initial symptoms. Considering the pervasive use of polypharmacy to manage malaria, further research is needed to quantify the proportion of children who receive an appropriate antimalarial - defined as receiving only the first-line treatment. Finally, given children's reliance on caregivers to seek out appropriate care on their behalf, future studies need to examine specific assets and challenges influencing caregivers' treatment-seeking behaviors in order to positively influence decision-making at the household level.

Narrative review of current context of malaria and management strategies in Uganda (Part I).

In accordance with international targets, the Uganda National Malaria Control Strategic Plan established specific targets to be achieved by 2010. For children under five, this included increasing the number of children sleeping under mosquito nets and those receiving a first-line antimalarial to 85%, and decreasing case fatality to 2%. This narrative review offers contextual information relevant to malaria management in Uganda since the advent of artemisinin combination therapy (ACT) as first-line antimalarial treatment in 2004. A comprehensive search using key words and phrases was conducted using the web search engines Google and Google Scholar, as well as the databases of PubMed, ERIC, EMBASE, CINAHL, OvidSP (MEDLINE), PSYC Info, Springer Link, Cochrane Central Register of Controlled Trials (CENTRAL), and Cochrane Database of Systematic Reviews were searched. A total of 147 relevant international and Ugandan literature sources meeting the inclusion criteria were included. This review provides an insightful understanding on six topic areas: global and local priorities, malarial pathology, disease burden, malaria control, treatment guidelines for uncomplicated malaria, and role of the health system in accessing antimalarial medicines. Plasmodium falciparum remains the most common cause of malaria in Uganda, with children under five being most vulnerable due to their underdeveloped immunity. While international efforts to scale up malaria control measures have resulted in considerable decline in malaria incidence and mortality in several regions of sub-Saharan Africa, this benefit has yet to be substantiated for Uganda. At the local level, key initiatives have included implementation of a new antimalarial drug policy in 2004 and strengthening of government health systems and programs. Examples of such programs include removal of user fees, training of frontline health workers, providing free ACT from government systems and subsidized ACT from licensed private outlets, and introduction of the integrated community case management program to bring diagnostics and treatment for malaria, pneumonia and diarrhea closer to the community. However despite notable efforts, Uganda is far from achieving its 2010 targets. Several challenges in the delivery of care and treatment remain, with those most vulnerable and living in rural settings remaining at greatest risk from malaria morbidity and mortality.

A demonstration study comparing "role-emergent" versus "role-established" pharmacy clinical placement experiences in long-term care facilities.

BACKGROUND: Increasing challenges to recruit hospital sites with full-time on-site pharmacy preceptors for institutional-based Advanced Pharmacy Practice Experiences (APPE) has made it necessary to consider alternate experiential models. Sites with on-site discipline specific preceptors to supervise students have typically been referred to in the literature as "role-established" sites. In British Columbia, long-term care (LTC) facilities offered a unique opportunity to address placement capacity issues. However, since the majority of these facilities are serviced by off-site community pharmacists, this study was undertaken to explore the viability of supervising pharmacy students remotely - a model referred to in the literature as "role-emergent" placements. This paper's objectives are to discuss pharmacy preceptors' and LTC non-pharmacist staff experiences with this model. METHODS: The study consisted of three phases: (1) the development phase which included delivery of a training program to create a pool of potential LTC preceptors, (2) an evaluation phase to test the viability of the LTC role-emergent model with seven pharmacists (two role-established and five role-emergent) together with their LTC staff, and (3) expansion of LTC role-emergent sites to build capacity. Both qualitative and quantitative methods were used to obtain feedback from pharmacists and staff and t-tests and Mann-Whitney U tests were used to examine equivalency of survey outcomes from staff representing both models. RESULTS: The 76 pharmacists who completed the training program survey rated the modules as "largely" meeting their learning needs. All five role-emergent pharmacists and 29 LTC participating staff reported positive experiences with the pharmacy preceptor-student-staff collaboration. Preceptors reported that having students work side-by-side with facility staff promoted inter-professional collaboration. The staff viewed students' presence as a mutually beneficial experience, suggesting that the students' presence had enabled them to deliver better care to the residents. As a direct result of the study findings, the annual role-emergent placement capacity was increased to over 45 by the end of the study. CONCLUSIONS: This study demonstrated that role-emergent LTC facilities were not only viable for quality institutional APPEs but also provided more available sites, greater student placement capacity, and more trained pharmacy preceptors than could be achieved in role-established facilities.

Promoting direct patient care services at community pharmacies through advanced pharmacy practice experiences.

OBJECTIVES: To determine the relative benefits of three different models of advanced pharmacy practice experience (APPE) in successfully integrating the delivery of direct patient care into students' final year community pharmacy clerkships. METHODS: All fourth-year pharmacy students at the University of British Columbia were divided into one of three study arms for their community APPE: a 2 × 4-week rotation in a traditional format, a 1 × 8-week rotation where their preceptors had experienced a 2-day education course and a 1 × 8-week rotation with both preceptor education plus a 5-day pre-APPE in-store orientation and peer debriefing. KEY FINDINGS: All 123 students conducted patient consultations and documented their care. Students in the pre-APPE + preceptor education arm provided nearly double the number of direct patient consultations than did students in the preceptor-education-only arm or the traditional 2 × 4-week arm. Numbers of drug-related problems identified and interventions performed per patient consult did not differ across study arms. CONCLUSIONS: Pre-APPE orientation activities provided an enhanced learning environment, promoted greater student engagement, provided care to more patients, increased preceptor preparedness and enhanced in-store patient-centred care practice. Certain of these learning activities can also form part of third- and fourth-year introductory pharmacy practice experiences to prepare students for their final-year APPE.

An interprofessional Web-based resource for health professions preceptors.

OBJECTIVE: To develop a Web-based preceptor education resource for healthcare professionals and evaluate its usefulness. METHODS: Using an open source platform, 8 online modules called "E-tips for Practice Education" (E-tips) were developed that focused on topics identified relevant across healthcare disciplines. A cross-sectional survey design was used to evaluate the online resource. Ninety preceptors from 10 health disciplines affiliated with the University of British Columbia evaluated the E-tips. RESULTS: The modules were well received by preceptors, with all participants indicating that they would recommend these modules to their colleagues, over 80% indicating the modules were very to extremely applicable, and over 60% indicating that E-tips had increased their confidence in their ability to teach. CONCLUSION: Participants reported E-tips to be highly applicable to their teaching role as preceptors. Given their multidisciplinary focus, these modules address a shared language and ideas about clinical teaching among those working in multi-disciplinary settings.

Patient satisfaction with pharmaceutical care delivery in community pharmacies.

BACKGROUND: The purpose of this study was to validate previously published satisfaction scales in larger and more diversified patient populations; to expand the number of community pharmacies represented; to test the robustness of satisfaction measures across a broader demographic spectrum and a variety of health conditions; to confirm the three-factor scale structure; to test the relationships between satisfaction and consultation practices involving pharmacists and pharmacy students; and to examine service gaps and establish plausible norms. METHODS: Patients completed a 15-question survey about their expectations regarding pharmaceutical care-related activities while shopping in any pharmacy and a parallel 15 questions about their experiences while shopping in this particular pharmacy. The survey also collected information regarding pharmaceutical care consultation received by the patients and brief demographic data. RESULTS: A total of 628 patients from 55 pharmacies completed the survey. The pilot study's three-factor satisfaction structure was confirmed. Overall, satisfaction measures did not differ by demographics or medical condition, but there were strong and significant store-to-store differences and consultation practice advantages when pharmacists or pharmacists-plus-students participated, but not for consultations with students alone. CONCLUSION: Patient satisfaction can be reliably measured by surveys structured around pharmaceutical care activities. The introduction of pharmaceutical care in pharmacies improves patient satisfaction. Service gap details indicated that pharmacy managers need to pay closer attention to various consultative activities involving patients and doctors.

An online module series to prepare pharmacists to facilitate student engagement in patient-centered care delivery: development and evaluation.

INTRODUCTION: Accreditation bodies across North America have adopted revised standards that place increased emphasis on experiential education and preceptors to promote and demonstrate patient-centered, pharmaceutical care practices to students. Since such practices are still evolving, challenges exist in recruiting skilled preceptors who are prepared to provide such opportunities. An online educational module series titled "A Guide to Pharmaceutical Care" (The Guide) was developed and evaluated to facilitate this transition. The objectives of this paper are: (1) to describe the development of the modules; and (2) to present the evaluation results from its pilot testing. METHODS: The Guide was developed as an online, self-directed training program. It begins by providing an overview of patient care (PC) philosophy and practice, and then discusses the tools that facilitate PC. It also provides a range of tips to support students as they provide PC during their experiential learning. Pharmacists participating in the pilot study were recruited using purposive and snowball sampling techniques. A pre-post quantitative survey with additional open-ended questions was used to evaluate the modules. RESULTS: THE MODULES INCORPORATED A VARIETY OF TEACHING STRATEGIES: self-reflection exercises, quizzes to review important concepts, quick tips, flash cards, and video clips to illustrate more in-depth learning. Thirty-two pharmacists completed the pre-post assessment and reported significant increases in their confidence because of this training. The most influenced outcome was "Application of techniques to facilitate learning opportunities that enable pharmacy students to practice pharmaceutical care competencies." They also indicated that the training clarified necessary changes in their teaching techniques as well as increased their own practice skills. CONCLUSION: The study results indicated that a series of self-paced online modules with appropriate content improved the pharmacists' confidence to nurture students' experiential learning for PC practice as well as enhanced their PC knowledge and skills within their own practices.

Comparison of patients' expectations and experiences at traditional pharmacies and pharmacies offering enhanced advanced pharmacy practice experiences.

OBJECTIVES: To compare patients' expectations and experiences at pharmacies offering traditional APPE learning opportunities with those offering enhanced APPEs that incorporate pharmaceutical care activities. METHODS: A survey of anchored measures of patient satisfaction was conducted in 2 groups of APPE- affiliated community pharmacies: those participating in an enhanced APPE model versus those participating in the traditional model. The enhanced intervention included preceptor training, a comprehensive student orientation, and an extended experience at a single pharmacy rather than the traditional 2 x 4-week experience at different pharmacies. RESULTS: While patient expectations were similar in both traditional and enhanced APPE pharmacies, patients in enhanced pharmacies reported significantly higher in-store satisfaction and fewer service gaps. Additionally, satisfaction was significantly higher for patients who had received any form of consultation, from either pharmacist or students, than those reporting no consultations. CONCLUSION: Including provision of pharmaceutical care services as part of APPEs resulted in direct and measurable improvements in patient satisfaction.

Metformin induces reductions in plasma cobalamin and haptocorrin bound cobalamin levels in elderly diabetic patients.

OBJECTIVE: To study the effect of short term metformin therapy on plasma levels of cobalamin, cobalamin related metabolites and cobalamin binding proteins in elderly patients. DESIGN AND METHODS: Twenty patients with type 2 diabetes were assigned to receive metformin or not for 3 months. Cobalamin and its metabolites were measured before and after metformin therapy. RESULTS: As compared to baseline measures, there was a metformin therapy specific significant decrease in plasma levels of total cobalamin, total haptocorrin and haptocorrin bound cobalamin. CONCLUSIONS: Plasma total cobalamin and haptocorrin bound cobalamin levels are reduced by short term metformin therapy in an elderly diabetic population. Larger scale, longer term studies are necessary to determine if there is an unequivocal decrease in functional measures of cobalamin status.