Readiness of Pharmacists as Providers of Social Determinants of Health and Call to Action.

Social determinants of health (SDOH) are defined as the conditions in the environments where people are born, live, learn, work, play, worship, and age. SDOH has an enormous impact on achieving the goals set by Healthy People 2030. With their education and training, pharmacists are in an ideal position to provide SDOH services. Community pharmacists should take innovative approaches in collaboration with the Community Pharmacy Enhanced Services Network to develop standard protocols for SDOH and reimbursements for these services. Pharmacists not being recognized nationally as healthcare providers is the major barrier to the implementation and expansion of pharmacist-provided SDOH programs. Thus, approval of the Pharmacy and Medically Underserved Areas Enhancement Act (H.R. 2759) is crucial to overcoming this barrier. This legislation is designed to increase access to pharmacists who are primary care providers for rural and underserved populations. These practice changes align well with the American Association of Colleges of Pharmacy strategic priorities 1, 3, and 4. Moreover, one of the most important recommendations in the Pharmacy Forecast 2022 is to develop standardized SDOH protocols and integrate them into the daily workflow of pharmacists and pharmacy technicians. However, are pharmacists adequately prepared and motivated to engage in practices designed to mitigate SDOH challenges that impact patients' health, functioning, and quality-of-life outcomes and risk? This commentary urges pharmacy education programs to implement curricular modifications and pharmacy practice professionals to advocate, develop and implement best practice models for providing SDOH services.

Association Between Accreditation Era, North American Pharmacist Licensure Examination Testing Changes, and First-Time Pass Rates.

Objective. To estimate whether first-time pass rates on the North American Pharmacist Licensure Examination (NAPLEX) have been influenced by the number of pharmacy programs founded since 2000, the programs' accreditation era, and the changes to the blueprint as well as changes to the testing conditions and passing standards implemented by the National Association of Boards of Pharmacy (NABP) beginning in 2015.Methods. This was a retrospective, observational cohort study using publicly published data. The number of programs and pass rates were collected from 2008 to 2020. Programs reporting pass rates from 2016 to 2020 were eligible. Accreditation era was defined as programs accredited before or after 2000. Pass rates were categorized into NAPLEX tests administered before or after 2015. Statistical analyses were conducted for comparisons.Results. Pass rates were initially found to decline as the number of programs rose. First-time pass rates of programs accredited before 2000 were higher than pass rates of programs accredited after 2000 every year after 2011. Only 40% of the programs accredited after 2000 exceeded the national average between 2016-2020. Blueprint changes implemented in 2015 and the changes to testing conditions plus passing standards implemented in 2016 had a greater effect on pass rates than the number of programs or applicants.Conclusion. Programs accredited after 2000 generally had lower first-time NAPLEX pass rates. Even so, blueprint changes and changes to the testing conditions plus passing standards instituted by the NABP were more important predictors of the decline of first-time NAPLEX pass rates. Stakeholders should collaborate and embrace best practices for assessing practice-ready competency for licensure.

Predicting the 2016 US News & World Report rankings using a reputation and prestige model.

INTRODUCTION: The objective was to determine institutional, faculty, and student attributes predictive of the 2016 US News & World Report (USNWR) pharmacy rankings and to explore if student attributes modify program rankings. METHODS: Institutional attributes and student and faculty resources and outcomes were obtained from various sources. Regression analyses predicted rankings. RESULTS: USNWR rankings were higher for older programs, those located at an academic health center or classified as a research-intensive institution, and members of a Power Five athletic conference. Number of fulltime equivalent faculty, Pharmacy College Admissions Test composite percentile, pharmacy practice h-index score, funding rank, and first time North American Pharmacist Licensure Examination (NAPLEX) pass rate predicted higher rankings. Nearly 45% of programs in the empiric models left or entered the top 25 rankings compared with the existing USNWR method (range 31 place increase to 22 place decrease). Among USNWR top 25 ranked programs, 16 remained in the top 25 in all four empiric models and three were not included in any of the models. Six USNWF unranked programs moved into the top 25 by one or more of the empiric models. CONCLUSIONS: Faculty and student attributes significantly impact program rankings, while impact of institutional attributes is negligible if independent of student and faculty attributes. Faculty numbers and productivity influence USNWR rankings more than student academic preparation and success on NAPLEX. These findings will inform efforts to improve the validity of the USNWR rankings and identify programs that are both prestigious and of high quality.

Elucidation of a resource reputation model to explain US News & World Report ranking using path analysis.

INTRODUCTION: The US News & World Report (USNWR) ranking is based on a reputation and prestige survey mailed to academic peers. This study's goal was to determine direct and indirect institutional, faculty, and student attributes predictive of the 2016 USNWR pharmacy rankings. METHODS: The Resource and Reputation Model (RRM) explains the development of perceptions of reputation and prestige. Institutional characteristics as well as student and faculty resources and outcomes were obtained from various sources. Path analysis determined the total, direct, and indirect effects. RESULTS: USNWR rankings were higher if programs were older, affiliated with an academic health center, classified as a research-intensive institution, and members of a Power 5 football conference. Program rank was predicted by the number of full-time faculty equivalents and pharmacy practice h-index score and funding. Pharmacy College Admissions Test comprehensive percentile and first-time North American Pharmacy Licensure Examination (NAPLEX) pass rate were also predictive of higher rank. All but affiliation with an academic health center or research-intensive institution directly predicted rank, but they had indirect impact through programmatic quality attributes. CONCLUSIONS: The RRM helps to explain pharmacy programs' USNWR rankings. Elucidation of its components provide insight into explaining the rankings and improving the methodology. Academic pharmacy could work with USNWR to develop criteria-based objective methodology to validate and improve rankings. Faculty, faculty productivity, and student academic preparation and success on NAPLEX influence USNWR rankings more than immutable factors such as program age and affiliations.

Length of advanced pharmacy practice experience and first-time NAPLEX pass rate of US pharmacy programs.

INTRODUCTION: The objectives of this study were to (1) report the length in weeks of advanced pharmacy practice experiences (APPEs) of US pharmacy programs in 2016 and (2) compare first-time North American Pharmacy Licensure Examination (NAPLEX) pass rates according to the length in weeks of the programs' APPEs. METHODS: First-time NAPLEX pass rate was obtained from the National Association of Boards of Pharmacy public web page. The length in weeks of programs' individual APPEs (iAPPEs) and program characteristics were obtained from the individual pharmacy programs' web pages. Analysis of variance was used to compare iAPPE length and first-time NAPLEX pass rate and multiple regression was used to quantify the independent influence of iAPPE length on first-time NAPLEX pass rate. RESULTS: The length in weeks was evenly distributed among four-, five- and six-week iAPPEs for NAPLEX testing years 2013 to 2015, although six-week iAPPEs have been preferred recently. The first-time NAPLEX pass rate was not associated with the total APPE length or whether the program used four-, five- or six-week iAPPEs for all three years and for the three-year aggregate pass rate. CONCLUSION: Six-week iAPPEs were the most common, but not the majority among pharmacy programs. Longer total or individual APPEs did not translate into higher first-time NAPLEX pass rates. Length of iAPPE rotations can be chosen without concern that student pharmacists' performances on first-time NAPLEX pass rates will be significantly impacted.

Impact of Completion of a Pre-Pharmacy Biochemistry Course and Competency Levels in Pre-Pharmacy Courses on Pharmacy Student Performance.

Poor performance in foundational science courses, which are usually taken during the first or second year of pharmacy school, can have several negative consequences including increases in student drop-out rates and increases in the number of dismissals and remediating students. The primary goal of the current study was to determine whether completion of a pre-pharmacy biochemistry course and/or performance on a biochemistry competency test (administered at the beginning of the pharmacy program) are associated with pharmacy student performance in foundational science courses and overall academic performance. A secondary goal was to determine whether performance in pre-pharmacy courses and/or student demographics are associated with pharmacy student performance. Prospective univariate analyses (n = 75) determined that completion of a pre-pharmacy biochemistry course is not associated with pharmacy student performance. However, performance on a biochemistry competency test was associated with performance in Biochemistry and Cell&Molecular Biology (p = 0.002). Furthermore, post-hoc analyses determined that pre-pharmacy cumulative chemistry GPA correlates with performance in both the Biochemistry and Cell&Molecular Biology and Medicinal Chemistry foundational science courses (p = 0.002 and p = 0.04, respectively) and can predict first year GPA (p = 0.002). The combined data indicate that further assessment of the impact of pre-pharmacy competency in biochemistry and chemistry on pharmacy student success is warranted.

Where we are now: A 2015 snapshot of assessment personnel and practices in US Schools and Colleges of pharmacy.

PURPOSE: To describe infrastructures and personnel of US schools and colleges of pharmacy (S/COPs) assigned to coordinate and administer programmatic and curricular assessment. METHODS: A web-based survey instrument consisting of 23 standardized questions was administered using QualtricsTM, Provo, Utah. An invitation to participate was sent to 128 deans via e-mail with an embedded link to the survey instrument. A follow-up e-mail reminder was sent to non-responders after two weeks, then weekly for another month. The survey was closed after two months. CONCLUSIONS: The final response rate was 47% (N = 60), with respondents comprising a representative cross-section of US S/COPs. Most US S/COPs have a written plan of programmatic assessment, stand-alone assessment committees with representative membership, and either a dean-level or faculty administrator responsible for leading assessment activities. On a sliding scale from 0% to100%, most respondents report their programs have achieved a culture of assessment in the 70-99% range. Considerable progress has been made in 15 years since assessment personnel in the US S/COPs were last formally documented.

Towards an Operational Definition of Clinical Competency in Pharmacy.

OBJECTIVE: To estimate the inter-rater reliability and accuracy of ratings of competence in student pharmacist/patient clinical interactions as depicted in videotaped simulations and to compare expert panelist and typical preceptor ratings of those interactions. METHODS: This study used a multifactorial experimental design to estimate inter-rater reliability and accuracy of preceptors' assessment of student performance in clinical simulations. The study protocol used nine 5-10 minute video vignettes portraying different levels of competency in student performance in simulated clinical interactions. Intra-Class Correlation (ICC) was used to calculate inter-rater reliability and Fisher exact test was used to compare differences in distribution of scores between expert and nonexpert assessments. RESULTS: Preceptors (n=42) across 5 states assessed the simulated performances. Intra-Class Correlation estimates were higher for 3 nonrandomized video simulations compared to the 6 randomized simulations. Preceptors more readily identified high and low student performances compared to satisfactory performances. In nearly two-thirds of the rating opportunities, a higher proportion of expert panelists than preceptors rated the student performance correctly (18 of 27 scenarios). CONCLUSION: Valid and reliable assessments are critically important because they affect student grades and formative student feedback. Study results indicate the need for pharmacy preceptor training in performance assessment. The process demonstrated in this study can be used to establish minimum preceptor benchmarks for future national training programs.

Using Likert-type and ipsative/forced choice items in sequence to generate a preference.

BACKGROUND: Collaboration and implementation of a minimum, standardized set of core global educational and professional competencies seems appropriate given the expanding international evolution of pharmacy practice. However, winnowing down hundreds of competencies from a plethora of local, national and international competency frameworks to select the most highly preferred to be included in the core set is a daunting task. OBJECTIVE: The objective of this paper is to describe a combination of strategies used to ascertain the most highly preferred items among a large number of disparate items. In this case, the items were >100 educational and professional competencies that might be incorporated as the core components of new and existing competency frameworks. METHODS: Panelists (n = 30) from the European Union (EU) and United States (USA) were chosen to reflect a variety of practice settings. Each panelist completed two electronic surveys. The first survey presented competencies in a Likert-type format and the second survey presented many of the same competencies in an ipsative/forced choice format. Item mean scores were calculated for each competency, the competencies were ranked, and non-parametric statistical tests were used to ascertain the consistency in the rankings achieved by the two strategies. RESULTS: This exploratory study presented over 100 competencies to the panelists in the beginning. The two methods provided similar results, as indicated by the significant correlation between the rankings (Spearman's rho = 0.30, P < 0.09). CONCLUSIONS: A two-step strategy using Likert-type and ipsative/forced choice formats in sequence, appears to be useful in a situation where a clear preference is required from among a large number of choices. The ipsative/forced choice format resulted in some differences in the competency preferences because the panelists could not rate them equally by design. While this strategy was used for the selection of professional educational competencies in this exploratory study, it is applicable in other situations where a smaller set of highly preferred items might be selected from a large list of choices in other areas of inquiry (e.g., patient reported outcomes).

Influence of explanatory and confounding variables on HRQoL after controlling for measurement bias and response shift in measurement.

The purpose of this study was to examine the influence of explanatory and confounding variables on health-related quality of life after accounting for response shift, measurement bias and response shift in measurement using structural equation modeling. Hypertensive patients with coronary artery disease randomized to anti-hypertensive treatment, completed the ShortForm-36 questionnaire at both baseline and 1 year (n = 788). Three measurement biases were found and all three were considered as response shift in measurement. Older patients reported worse scores for both physical functioning (PF) and role-physical at baseline and 1 year later compared to younger patients; and males reported better PF than females after conditioning on the latent trait of general physical health. Before controlling for response shift, patients' PF scores were not statistically different over time; however, PF scores significantly improved (p < 0.01) after controlling for recalibration response shift. Assessment of how patients perceive their change in health-related quality of life over time is warranted.

Assessment of response shift using two structural equation modeling techniques.

OBJECTIVE: To identify response shift using two structural equation modeling (SEM) techniques. STUDY DESIGN AND SETTING: Hypertensive patients (n = 909) with coronary artery disease (CAD) completed SF-36 surveys at both baseline and 1-year follow-up. Response shift was identified using Oort and Schmitt SEM techniques. The type of response shift linked to changes in various parameters of the SEM measurement model is defined differently for both SEM approaches. Effect sizes were calculated for the impact of response shift on the change of SF-36 domain scores when using the Oort approach. RESULTS: Both Oort and Schmitt SEM approaches identified response shift only in the SF-36 physical functioning (PF) scale. The effect size of recalibration on the change of PF domain scores when using the Oort approach was -0.12. CONCLUSION: This study showed that hypertensive patients with CAD experienced a response shift over a 1-year period. Both the SEM approaches identified response shift (uniform recalibration using the Oort approach and recalibration using the Schmitt approach); however, both approaches use different parameters to define and test response shift. We found that either the variation in analytic methods or the sample used may influence the identification and type of response shift.

Expanding Consumer Medication Access: The Time Is Now.

The US FDA is proposing an expanded over-the-counter (OTC) medication policy to improve patient access to medications under the supervision of a pharmacist. Higher levels of medication access via multiple medication categories are common in other industrialized nations. Pharmacists are well trained and widely available. Expanding medication access can help alleviate the physician shortage by directing patients with appropriate health conditions that can be managed with medication to community pharmacists. Examples include migraine headaches and seasonal allergies, which have a significant impact on patients' quality of life and work productivity. Clinically relevant medications and dosages should be selected. Medication use guidelines should not be so restrictive as to defeat the policy intent. The proposed FDA policy is a long-overdue change that will help optimize available health personnel resources for patient care.