Impact of an online pharmacy precepting-focused continuing professional development program.

INTRODUCTION: This study aimed to determine the preceptor-reported impact of an online continuing professional development (CPD) program on pharmacy preceptors' abilities and techniques for teaching students in clinical settings. METHODS: In 2017, an online program to educate and support pharmacy preceptors' use of CPD to create individualized clinical teaching development plans was launched. After allowing time for preceptors to implement their CPD plan, a follow-up program was launched in 2019 where preceptors completed a seven-question survey to assess their impact on clinical teaching from the initial program. Two questions described completion of the CPD plan with response options including "Yes," "No," or "Partially". Five open-ended questions allowed for descriptions of changes implemented and overall teaching impact. Impact of implemented changes were categorized as positive, negative, or no change. Changes implemented by preceptors were categorized as goal setting, feedback, communication/education skills, student-teacher connection, or educational resources development. RESULTS: Of the 119 preceptors who responded to at least one question, 52% fully implemented and 39% partially implemented their pre-identified CPD plan. A total of 75 preceptors provided responses regarding impact of implemented activities; 69 (92%) were coded as a positive impact on their clinical teaching. Preceptor skill development was most commonly in communication/educational skills (45%), student/teacher connection (33%), and educational resources development (33%). CONCLUSIONS: This online precepting CPD program had a positive preceptor-reported impact on clinical teaching delivered by preceptors to students. Further investigation is warranted to disseminate this program.

Accommodating Pharmacy Students With Physical Disabilities During the Experiential Learning Curricula.

Accommodating pharmacy students with physical disabilities during the experiential learning portion of the Doctor of Pharmacy (PharmD) curriculum can present unique challenges for pharmacy schools. The available literature regarding accommodations for pharmacy students in the experiential learning environment is sparse, leaving programs with little guidance. This commentary from the Big Ten Academic Alliance calls on the Academy to create a community of shared resources and best practice examples and offers practical suggestions for accommodating pharmacy students with mobility, vision, and auditory disabilities during introductory pharmacy practice experiences (IPPEs) and advanced pharmacy practice experiences (APPEs).

Implementation of the Individual Teamwork Observation and Feedback Tool to Evaluate Pharmacy Student Performance.

Objective. To determine the appropriateness and feasibility of implementing the Individual Teamwork Observation and Feedback Tool (iTOFT) in advanced pharmacy practice experiences (APPEs) to allow direct observation and rating of students' interprofessional teamwork skills.Methods. In the academic year 2018-2019, preceptors administered iTOFT at least once during required acute care and ambulatory care APPEs. After administration, which involved direct observation of students' behavior on an interprofessional team, preceptors evaluated iTOFT results and offered feedback to students. To determine implementation success of the iTOFT activity, an implementation satisfaction survey was administered to preceptors and students, which included questions on appropriateness and feasibility.Results. The iTOFT activity was completed 149 times each during required acute care and ambulatory care APPEs. Results demonstrated positive teamwork behaviors, eg, no students received an "inappropriate" rating on any iTOFT item. The implementation survey response rate was 33% (34/102) for preceptors and 40% (50/125) for students. Both groups reported that the iTOFT activity was feasible. Respondents also reported that completing the iTOFT activity did not interfere with workflow and that it was not difficult to find opportunities to complete it. Per preceptor report, mean time to complete the iTOFT activity was 37.7 minutes, but there were concerns identified regarding fidelity with all iTOFT steps.Conclusion. Incorporation of the iTOFT activity into the required acute and ambulatory care APPEs at a school of pharmacy was feasible. Future directions include determining ways to increase iTOFT fidelity.

Incorporation of Student Pharmacists into a Proton Pump Inhibitor Deprescribing Telehealth Program for Rural Veterans.

Background: Proton pump inhibitors (PPIs) are among the most widely prescribed class of medications in the United States. Although effective in the treatment of acid related disease, inappropriate PPI use is prevalent, and long-term PPI use has been associated with adverse effects. Objectives: This evaluation explores the novelty of a student-pharmacist directed PPI deprescribing telehealth program with the goals of (1) determining whether PPIs are appropriately prescribed in Veterans via remote student-led chart reviews, (2) identifying if a gap exists between urban and rural Veterans prescribed a PPI, and (3) assessing the feasibility of integrating student pharmacists into the PPI deprescribing process utilizing telehealth visits through a pilot study. Methods: Student pharmacists evaluated PPI appropriateness in Veterans at the William S. Middleton Veterans Hospital. Students collected data via remote chart reviews, compared appropriateness of PPI therapy in rural versus urban Veterans, and conducted a deprescribing pilot call study in rural Veterans with inappropriate PPI indications. Clinical decision-making was agreed upon in collaboration with pharmacist preceptors, however all means of communication with Veterans was performed by student pharmacists. Results: 51% of Veterans were found to have an inappropriate indication for their PPI, though comparison of inappropriate PPI use in rural versus urban Veterans was not statistically significant (n=170, p-value 0.34). 83% of Veterans agreed to proceed with PPI deprescribing and 71% of Veterans ended the pilot study with at least some degree of PPI dose reduction (n=33). Conclusion: Inappropriate PPI use among rural and urban Veterans is prevalent, however a significant difference was not observed between the two cohorts. Student pharmacists are capable of successful telehealth deprescribing interventions in collaboration with pharmacists.

Intentional Application of the Taba Curriculum Model to Develop a Rural Pharmacy Practice Course.

The changing profession of pharmacy demands student preparation in dynamic courses that address the evolving healthcare landscape. Identifying an evidence-based approach to develop such coursework and content, however, can be a considerable challenge for curriculum innovators. This manuscript explores how curriculum design models can be applied as a guide to promote purposeful development of new curriculum, with the goal of promoting students as APPE, practice, and career-ready practitioners. Authors specifically describe a case study example for the process of creating a novel rural health course using the Taba curriculum design model as a guide for selecting course content, objectives, teaching strategies, learning experiences, and evaluative measures. Through the incorporation of the Taba model, this manuscript presents an evidence-based approach to curriculum development which can be replicated across schools and colleges of pharmacy. The described approach to curriculum design, which integrates models to guide the creative process, is a systematic approach to developing curriculum with purpose. Additional opportunities exist for curriculum innovators across the academy to explore incorporation of curriculum design models to guide course development, as well as to drive curricular assessment strategies and further curriculum refinement.

Preceptor Fidelity to the Creation of Precepting-Focused Continuing Professional Development Learning Plans.

OBJECTIVES: To determine preceptor fidelity to the creation of continuing professional development (CPD) learning plans for improvements in clinical teaching. To determine topics of interest for preceptor development programming with a focus on clinical teaching skills. METHODS: An online CPD program focusing on the reflect and plan stages was launched. The online program introduced preceptors to CPD, encouraged preceptors to review student feedback, and required completion of a CPD precepting plan. Preceptors were provided four guided questions to develop their plans. Preceptor fidelity to the creation of a CPD plan to improve precepting skills was rated as: 1) having a plan for improving a precepting skill, 2) having a plan for improving precepting, but not skill-based, or 3) having a plan lacking a precepting focus. Topics of precepting improvement were identified. RESULTS: Of the 491 preceptors who completed CPD plans, 46.2% of the plans were skill-based. Of those, 59.5% of the CPD plans included specific learning items. Only 3.9% of preceptors submitted nonprecepting focused CPD plans and the remaining 49.9% of CPD plans were non skill-based, but precepting focused. Giving feedback was the most frequently listed topic with 45.8% of preceptors including it in their CPD plans. CONCLUSIONS: This online precepting CPD program successfully guided preceptors in developing CPD plans that have the potential to improve student learning experiences. Future precepting CPD programs will need to provide direction on the use of skill-based objectives. Further investigation is needed to determine the effectiveness of the program in changing precepting behavior.

Grading trends and evaluation of student performance across advanced pharmacy practice experiences (APPE) in the Big Ten Academic Alliance (The GRAPPES study).

INTRODUCTION: With over a third of the doctor of pharmacy curriculum relying on experiential education (EE), it is critical that students are assessed and graded in accordance with their actual performance. The objective of this paper is to review advanced pharmacy practice experience (APPE) grading across the Big Ten Academic Alliance to describe how APPE grading occurs at these institutions and highlight differences in approach and outcomes. METHODS: Experiential directors/deans were asked to import de-identified data (e.g., APPE curriculum, midpoint and final evaluation score and grade, number of preceptors, number of students, number of years of pharmacy school, total hours of APPEs offered, number and duration of APPEs per year, grading scale information). A chi-square test including pairwise comparisons with a Bonferroni p-value adjustment for multiple comparisons was performed. RESULTS: Seven college/schools submitted data from over 3600 students between 2012-2015. The distribution of letter grades differed significantly across all colleges/schools in 2012-2013, 2013-2014 and 2014-2015 (p < 0.0001). Similarly, the distribution of letter grades by rotation type varied significantly for all colleges/schools (p < 0.0001). Students in acute care, ambulatory care, and other patient care rotation types were less likely to obtain an "A" and more likely to obtain a "B" compared to students in other rotation types. CONCLUSIONS: When letter grades are used for APPEs, the trend suggests over 95% of students receive an "A" or "B" grade. Final grades varied by rotation type with more "B" grades observed in patient care rotations than "A" grades over the three-year period.

Evaluation of a pharmacist-led pilot service based on the anticholinergic risk scale.

OBJECTIVES: To determine primary care physician (PCP) acceptance rates of electronic medication therapy recommendations based on anticholinergic burden for high-risk elderly patients, and to evaluate potential associations between recommendation acceptance and patient-provider characteristics. SETTING: Two medical clinics within Dean Health System, an integrated health care organization comprising ambulatory surgery centers, medical clinics, community pharmacies, specialty pharmacies, a health plan, and a pharmacy benefits management company. PRACTICE INNOVATION: In this pilot service, the medical records of patients at least 60 years old who met the following criteria were evaluated bimonthly: 1) PCP visit within 2 weeks; (2) three or more inpatient hospitalizations or emergency department visits in the past year; and (3) ten or more active medications. Anticholinergic Risk Scale (ARS) scores of eligible patients were calculated, and medication therapy recommendations were sent electronically to PCPs for patients with an ARS score greater than 3. Post-visit recommendation outcomes were recorded. EVALUATION: Descriptive statistics were utilized to characterize patients, physicians, and recommendations. A generalized linear mixed effects model with physician specific random effects was employed to evaluate recommendation acceptance rates, and odds ratios were calculated to quantify associations between baseline patient/provider characteristics and the likelihood of recommendation acceptance. Changes in aggregate ARS scores were evaluated with the use of a paired t test. RESULTS: Fifty-nine patients were included in this pilot, with 89 medication therapy recommendations made to 21 PCPs. An overall recommendation acceptance rate of 50% (95% confidence interval [CI] 37%-63%) was observed. There were no significant associations identified between baseline patient/provider characteristics and medication recommendation acceptance. CONCLUSION: High recommendation acceptance rates were achieved with the combination of objective anticholinergic risk assessment and algorithm-driven medication therapy recommendations. The lack of identified associations between patient/provider characteristics and recommendation acceptance supports the future scalability of this novel service.

An online virtual-patient program to teach pharmacists and pharmacy students how to provide diabetes-specific medication therapy management.

OBJECTIVE: To develop, implement, and assess the effectiveness of an online medication therapy management (MTM) program to train pharmacists and pharmacy students in providing MTM services for patients with diabetes and to increase their intent to perform these services. DESIGN: An online program was created using an Internet-based learning platform to simulate 4 MTM meetings between a pharmacist and a virtual patient diagnosed with diabetes. ASSESSMENT: Eighty students and 42 pharmacists completed the program. After completing the program, scores on post-intervention assessments showed significant improvement in 2 areas: control over performing MTM, and knowledge of how to perform MTM. Students had a significantly less-positive attitude about MTM and a decline in their perception of the social expectation that MTM is part of the practice of pharmacy, while pharmacists' attitudes did not change significantly in these areas. CONCLUSION: This online program using a virtual patient improved both participants' belief that they have control over performing MTM, and their knowledge of how to perform MTM for diabetic patients, which may increase the likelihood that pharmacists and pharmacy students will perform MTM in the future.

Exploring the impact of an automated prescription-filling device on community pharmacy technician workflow.

OBJECTIVE: To explore community pharmacy technician workflow change after implementation of an automated robotic prescription-filling device. METHODS: At an independent community pharmacy in rural Mayville, WI, pharmacy technicians were observed before and 3 months after installation of an automated robotic prescription-filling device. The main outcome measures were sequences and timing of technician workflow steps, workflow interruptions, automation surprises, and workarounds. RESULTS: Of the 77 and 80 observations made before and 3 months after robot installation, respectively, 17 different workflow sequences were observed before installation and 38 after installation. Average prescription filling time was reduced by 40 seconds per prescription with use of the robot. Workflow interruptions per observation increased from 1.49 to 1.79 (P = 0.11), and workarounds increased from 10% to 36% after robot use. CONCLUSION: Although automated prescription-filling devices can increase efficiency, workflow interruptions and workarounds may negate that efficiency. Assessing changes in workflow and sequencing of tasks that may result from the use of automation can help uncover opportunities for workflow policy and procedure redesign.

Predictors of pharmacy students' intentions to monitor diabetes.

PURPOSE: This research explores predictors of pharmacy students' adoption of one specific behavior, monitoring diabetes ABCs (A1c, blood pressure, and cholesterol) in the community pharmacy. Specifically, this research assessed which student situation and attitudinal factors are predictors of students' intentions and behavior in asking patients about the diabetes targets and goals as per a conceptual model. METHODS: Data was drawn from a randomized controlled trial to assess the impact of the diabetes check in pharmacy students during their community pharmacy clerkships. A survey measured students' self-efficacy, outcome expectancies, role beliefs, mattering as well as students' experiences with the Diabetes Check and intentions to routinely monitor diabetes. Stepwise hierarchical multiple linear regression reflected the conceptual model and was used to assess the research questions. RESULTS: Survey response rate was 94% and analysis was performed on a sample of 118 students. In summary, pharmacy students' intentions and monitoring behaviors were predicted by the students' situation and attitudes. Specifically, students' intentions to ask patients about the diabetes ABCs were predicted by pharmacy site counseling, monitoring role beliefs, self-efficacy, and positive outcome expectancies. Mattering predicted intentions, but differently in each study group. Behavior in asking about patients with diabetes about blood pressure and cholesterol was predicted by pharmacy site counseling, self efficacy, and monitoring role beliefs. Students' behavior in asking about A1c was pharmacy site counseling, self efficacy, and monitoring role beliefs in additional to completing the Diabetes Check assignment. CONCLUSIONS: Monitoring intentions and behaviors were consistently predicted by pharmacy site counseling, monitoring role beliefs, and self-efficacy and future research investigating the pharmacists' behavior should include these variables. The role of mattering and outcome expectancies in predicting monitoring intentions requires further study.

A randomized controlled trial to evaluate the impact of structured patient interactions on pharmacy students' counselling behaviours and attitudes.

OBJECTIVES: To determine whether pharmacy students who performed Diabetes Checks with patients have greater improvements in attitudes and behaviour regarding monitoring than students who performed a control activity. The Diabetes Check is a brief structured interaction that was designed to facilitate patient-pharmacist conversations about monitoring A1c, blood pressure and cholesterol (diabetes ABCs). METHODS: A randomized controlled trial was conducted where students in the intervention group performed five to ten Diabetes Checks. In the control group, students performed two drug-profile reviews for patients with diabetes. Students completed a pre- and post-assessment of the frequency of monitoring behaviour and attitudes, including self-efficacy, outcome expectancies, role beliefs (counselling role orientation and monitoring role orientation) and mattering. Improvements in behaviours and attitudes were assessed with bivariate and multiple linear regression. The study setting was University of Wisconsin-Madison School of Pharmacy and its affiliated Ambulatory Pharmaceutical Care Clerkship community pharmacies. KEY FINDINGS: Of 130 students, 119 (92%) completed surveys at both time points. Students who completed the Diabetes Check intervention had greater improvements in the frequency of monitoring patients' A1c values and in their counselling role orientation than control group students. CONCLUSIONS: The Diabetes Check improved pharmacy students' monitoring behaviour and general counselling beliefs. The Diabetes Check is a practical intervention to get patients and pharmacy students working together to monitor diabetes and potentially improve patient health.

Recall of A1C, blood pressure, and cholesterol levels among community pharmacy patients with diabetes.

OBJECTIVES: To determine the proportion of patients with diabetes mellitus who knew their personal and target glycosylated hemoglobin (AIC), blood pressure, and low density lipoprotein cholesterol (LDL-C) (ABC) levels and the proportion of patients whose recalled ABC levels were below targets set by the American Diabetes Association (ADA). DESIGN: Cross-sectional survey. SETTING: 35 community and clinic pharmacies in May 2003 through May 2004. PARTICIPANTS: 132 student pharmacists in Ambulatory Pharmaceutical Care Clerkship who recruited a convenience sample of 816 evaluable patients with diabetes. INTERVENTION: Student-administered questionnaires. MAIN OUTCOME MEASURES: Patients' self-reported and target ABC values and comparison of these with recommended ADA guidelines. RESULTS: The greatest number of patients were able to recall their personal blood pressure level (68%), followed by A1C (53%) and LDL-C (23%). Of those who knew their levels, one-half or fewer were within ADA targets for one or more ABCs. Only 1% of patients who were able to provide ABC levels were below all three ADA target values. Patients were most likely to provide an A1C target (43%), followed by blood pressure (35%) and LDL-C (21%). CONCLUSIONS: While almost three-quarters of the patients identified in community pharmacies knew their blood pressure levels, one-half or fewer knew their A1C or LDL-C levels. Fewer than 50% of patients reported even one ABC target number. Pharmacists should take advantage of this educational opportunity by working with patients with diabetes to increase their knowledge of these ABCs.

Evaluation of structured patient interactions: the Diabetes Check.

OBJECTIVES: To evaluate a structured patient intervention, the Diabetes Check, in which pharmacy students ask patients with diabetes about 3 clinical targets: A1c, blood pressure, and low-density lipoprotein (LDL) cholesterol (ABC) levels. Specific objectives were to: (1) describe the effect of patients' reactions on pharmacy students; (2) describe pharmacy students' confidence and role beliefs; and (3) determine predictors of pharmacy students' intention to use the Diabetes Check in the future. METHODS: After training, pharmacy students were asked to perform 10 diabetes checks and complete an evaluation. Data from the evaluations described pharmacy students' reactions, role beliefs, and confidence. Linear regression was performed to predict intention of using the Diabetes Check in future. RESULTS: One-hundred twenty-eight pharmacy students used the Diabetes Check tool with over 1000 patients. Most pharmacy students were encouraged by patients' reactions (56%). Pharmacy students' perceptions of patients' reaction and pharmacy students' role beliefs about monitoring ABCs significantly predicted pharmacy students' reported intention to use a Diabetes Check (r-squared = 0.52). CONCLUSIONS: Pharmacy students' perceptions of patient reactions and role beliefs about the importance of monitoring predicted their reported intention of performing a Diabetes Check in the future.

Fracture risks for women in long-term care: high prevalence of calcaneal osteoporosis and hypovitaminosis D.

STUDY OBJECTIVES: To determine the prevalence of osteoporosis as assessed by peripheral bone mineral density (BMD) in women living in a nursing home, to determine how many women with low BMD had received a diagnosis of osteoporosis, to assess the prevalence of vitamin D deficiency, and to seek reasons for vitamin D deficiency. DESIGN: Measurement of calcaneal BMD and serum 25-hydroxyvitamin D. SETTING: Skilled nursing facility. PATIENTS: Forty-nine women aged 68-100 years. MEASUREMENTS AND MAIN RESULTS: Bilateral calcaneal BMD was measured by dual-energy x-ray absorptiometry and serum 25-hydroxyvitamin D by radioimmunoassay. Medical records were reviewed to assess osteoporosis risk factors, previous documentation of osteoporosis or malabsorption, and supplemental vitamin D intake. Fifty-nine percent of the 39 women with calcaneal BMD measurements (95% confidence interval [CI] 44-74%) exhibited calcaneal osteoporosis (T score < -2.5). Sixty percent (95% CI 46-74%) had 25-hydroxyvitamin D levels of 20 ng/ml or less, which is associated with secondary hyperparathyroidism; only 4% of women had levels above 30 ng/ml, recently recommended as optimal. Vitamin D status was suboptimal even in most women taking multivitamins. Osteoporosis was documented in the records of 17% of 23 women with calcaneal osteoporosis. CONCLUSION: Osteoporosis was prevalent but poorly documented in women living in the nursing home. Peripheral BMD measurements have the potential to improve the recognition and management of osteoporosis in women in long-term care facilities. The high prevalence of vitamin D deficiency, even in those taking multivitamins, indicates that practical new approaches for vitamin D repletion in this population are urgently needed.