Report of the 2020-2021 Strategic Engagement Standing Committee.

EXECUTIVE SUMMARY For the American Association of Colleges of Pharmacy (AACP), strategic engagement is critical to the success of colleges and schools of pharmacy in expanding pharmacy and public health practice, meeting programmatic needs, and fulfilling institutional missions. The 2020-2021 Strategic Engagement Standing Committee was charged with identifying effective strategies to leverage the temporary expansion of pharmacist practice capabilities granted during the COVID-19 pandemic for sustained practice. The group was also tasked with looking at ways to partner with the Association of American Medical Colleges (AAMC), our medicine counterparts to develop a plan for collaborating with them to advance interprofessional practice. In this unique year, all standing committees were charged with reading all the reports last year to put President Lin's charges into perspective with the hopes of carrying over the overall theme and work of the previous years committee. Overall, throughout the COVID-19 pandemic, there have been several expansions on the scope of practice for pharmacists and vary by state. We hope to draw out some of those expansions to see how we can build upon efforts to make those permanent.

Report of the 2019-2020 Strategic Engagement Standing Committee.

For the American Association of Colleges of Pharmacy (AACP) strategic engagement is critical to the success of colleges and schools of pharmacy in expanding pharmacy and public health practice, meeting programmatic needs, and fulfilling institutional missions. The 2019-2020 Strategic Engagement Committee was charged with exploring the collaborative relationships colleges and schools have within their state to advance pharmacy practice. More specifically, this committee was tasked to examine those relationships with current state pharmacy and medical associations. This report seeks to provide insights from this work and share recommendations to assist AACP in facilitating practice transformation. To uncover current schools' relationships with state and medical associations, the committee utilized AACP's ability in convening members to conduct focus groups at INsight 2020 and one-on-one interviews with key faculty members. Overall, partnerships with state pharmacy associations are successful or growing, whereas there is still work to be done in developing relationships and collaborating with medical and health care societies. We found that there are several schools with "best practices" related to state association collaborations and look to highlight exemplar practices in this report as they are critical towards practice transformations.

The Mississippi Delta Health Collaborative Medication Therapy Management Model: Public Health and Pharmacy Working Together to Improve Population Health in the Mississippi Delta.

INTRODUCTION: The Mississippi Delta has high rates of chronic disease and is known for its poor health outcomes and health disparities. The University of Mississippi School of Pharmacy (UMSOP) and the Mississippi State Department of Health partnered in 2009 through the Mississippi Delta Health Collaborative to reduce health disparities and improve clinical outcomes by expanding the UMSOP's evidence-based medication therapy management (MTM) initiative, focused in Mississippi's 18-county Delta region, to federally qualified health centers (FQHCs) in 4 of those counties. METHODS: Between January 2009 and August 2018, the MTM initiative targeted FQHC patients aged 18 years or older with a diagnosis of diabetes, hypertension, and/or dyslipidemia. Pharmacists initially met face-to-face with patients to review all medications, provide education about chronic diseases, identify and resolve drug therapy problems, and take appropriate actions to help improve the effectiveness of medication therapies. Clinical parameters evaluated were systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol, low-density lipoprotein (LDL) cholesterol, triglycerides, and hemoglobin A1c (HbA1c). RESULTS: The analysis included 335 patients with hypertension (n = 287), dyslipidemia (n = 131), and/or diabetes (n = 331). Significant mean reductions occurred in the following metrics: SBP (7.1 mm Hg), DBP (6.3 mm Hg), LDL cholesterol (24.9 mg/dL), triglycerides (45.5 mg/dL), total cholesterol (37.7 mg/dL), and HbA1c (1.6% [baseline ≥6%] and 1.9% [baseline ≥9%]). CONCLUSION: Despite the cultural and environmental disadvantages present in the Mississippi Delta, the integrated MTM treatment program demonstrated significant health improvements across 3 chronic diseases: hypertension, dyslipidemia, and diabetes. This model demonstrates that a partnership between public health and pharmacy is a successful and innovative approach to care.

Use of a Modified Delphi Process to Define the Leadership Characteristics Expected of Pharmacy Faculty Members.

Objective. To reach a consensus on a working definition for leadership and identify expectations for leadership among all pharmacy faculty members. Methods. A modified Delphi process was employed to establish consensus among experienced department and division chairs regarding the definition and expectations of faculty leadership to guide faculty evaluation and development. From the AACP faculty roster, 280 department and division chairs were surveyed to identify participants with at least five years of experience in their roles and willingness to participate. Twenty-three chairs were identified from a variety of colleges and schools to comprise the expert panel and asked to participate in three rounds of questions over a two-month period. One Likert-type question and six open-ended questions were included in round 1. A thematic analysis of round 1 responses provided items for participants to rate their agreement with and provide comments on in rounds 2 and 3. Consensus for items was set prospectively at 80% of participants selecting agree or strongly agree for each item. Items could be modified by the panel in subsequent rounds of surveys if participants suggested edits to items. Results. Consensus was achieved among 23 chairs regarding a definition, 10 guiding principles, four learning competencies, six skills, six expected leadership activities (ELAs), and 20 personal characteristics related to faculty leadership. Conclusion. The results of this study provide guidance to pharmacy faculty members and administrators regarding leadership characteristics including knowledge, skills, and activities expected for faculty members to develop into effective leaders for the academy and the pharmacy profession.

Pharmacist linkage in care transitions: From academic medical center to community.

OBJECTIVES: To improve the care of patients discharged from the University of Mississippi Medical Center (UMMC) after treatment for acute myocardial infarction, heart failure, pneumonia, and chronic obstructive pulmonary disease; reduce preventable hospital readmissions; and inform future care transition collaborations between hospital teams and community pharmacies. SETTING: Study was conducted at UMMC, UMMC outpatient pharmacies, and targeted community pharmacies. PRACTICE DESCRIPTION: UMMC is the state's only academic health science center, providing all levels of care. Participants were at UMMC's 722-bed hospital in Jackson, MS. Participating pharmacies included 2 UMMC outpatient pharmacies and community pharmacy research partner sites within 60 miles of UMMC. PRACTICE INNOVATION: A pharmacist transitions coordinator (PTC) worked with inpatient and community-based pharmacists to provide predischarge medication reconciliation and 30 days of medications on discharge. The PTC with access to inpatient and outpatient records facilitated communication among settings/providers. Community pharmacists provided telephonic and face-to-face medication therapy management (MTM). EVALUATION: The project was structured as a prospective, randomized controlled trial of pharmacist-led care coordination during transition from inpatient to community setting, with follow-up MTM by community pharmacists. In this intention-to-treat analysis, readmission rates were assessed with propensity adjustment. Drug therapy problems (DTPs) identified/resolved were assessed and reported through descriptive statistics. RESULTS: Ninety-six patients were enrolled. Positive outcomes in overall reduced readmission rates were observed in the intervention group at 30, 60, 90, and 180 days, although statistical significance was not achieved because of limited enrollment. Approximately 60% participated in MTM postdischarge, with 453 interventions and 169 DTPs identified and addressed (98% > 1 DTP; 20% > 5 DTPs). Implementation experience includes PTC successes, new partnerships, and connectivity among all providers, as well as enrollment challenges, follow-up, and service delivery timeframe. CONCLUSION: With access to patient records, pharmacists have the potential to positively affect patient outcomes through medication management during care transitions.

Evaluation of the impact of a residency in an independent pharmacy in rural Mississippi.

OBJECTIVES: To evaluate the impact of a postgraduate year 1 (PGY1) community pharmacy residency program on clinical pharmacy service implementation and enhancement in a rural Mississippi community. SETTING: An independent rural community pharmacy in Canton, MS. PRACTICE DESCRIPTION AND INNOVATION: Delivery of clinical pharmacy services provided by PGY1 community residents 1 day a week to an underserved population during an 18-month period. EVALUATION: Economic impact of a community pharmacy residency on the pharmacy's revenue stream determined by calculating an estimated dollar amount generated by clinical pharmacy services. RESULTS: By providing services 1 day a week, the residents were able to directly contribute an estimated $8000 of revenue from vaccinations and medication therapy management services. In addition, residents provided point-of-care testing, facilitated group education, developed a medication synchronization program, and assisted with physician outreach. CONCLUSION: Overall, community pharmacy residencies can contribute to the generation of revenue in rural independent settings and may also offer an opportunity to generate revenue in different areas that were not present before residency implementation, thereby improving access to care for patients.

The Impact of Clinical Pharmacist Integration on a Collaborative Interdisciplinary Diabetes Management Team.

OBJECTIVE: The national initiative, Project IMProving America's Communities Together (IMPACT): Diabetes, was intended to scale a proven American Pharmacists Association (APhA) Foundation process model, which integrates pharmacists on the collaborative health-care team, in communities greatly affected by diabetes to improve key indicators of diabetes. This article discusses the results from 1 community in Mississippi. METHODS: This national prospective study followed patients with a hemoglobin A1c (HbA1c) >7% from September 2011 to January 2013. Pharmacists collaborated with providers and other health-care professionals to provide medication therapy management services for a minimum of 3 visits. Outcome measures included HbA1c, systolic and diastolic blood pressure (SBP and DBP), fasting cholesterol panel, body mass index (BMI), influenza vaccine and smoking status, and foot and eye examination dates. RESULTS: At this site, there were statistically significant outcomes including mean HbA1c decrease of 1.2% in SBP and DBP of 8.3 mm Hg and 3.5 mm Hg, respectively, and reduction in low-density lipoprotein of 16.6 mg/dL, all of which were greater improvements compared to overall results from combined sites. CONCLUSION: Patients in this community who received care from the collaborative team, including a pharmacist, had improvement in most key indicators of diabetes, with a clinically significant reduction in HbA1c.

Pathways to Improve Student Pharmacists' Experience in Research.

OBJECTIVE: To describe the implementation of a student research program and to provide outcomes from the initial 4 years' experience. DESIGN: Students conducted individual research projects in a 4-year longitudinal program (known as Pathway), with faculty member advising and peer mentoring. A prospective assessment compared perceptions of those who completed the Pathway program with those of students who did not. Descriptive statistics, t tests, and analysis of variance (ANOVA) were used. ASSESSMENT: The class of 2013 was the first to complete the Pathway program. In the Pathway assessment project, 59% (n=47) of students who responded reached self-set goals. Pathway students agreed that this research experience improved their ability to work/think independently, evaluate literature, and distinguish themselves from other students. CONCLUSION: The Pathway program helped students understand the research process and reach other self-set goals.

Preparation of faculty members and students to be citizen leaders and pharmacy advocates.

To identify characteristics and quality indicators of best practices for leadership and advocacy development in pharmacy education, a national task force on leadership development in pharmacy invited colleges and schools to complete a phone survey to characterize the courses, processes, and noteworthy practices for leadership and advocacy development at their institution. The literature was consulted to corroborate survey findings and identify additional best practices. Recommendations were derived from the survey results and literature review, as well as from the experience and expertise of task force members. Fifty-four institutions provided information about lecture-based and experiential curricular and noncurricular components of leadership and advocacy development. Successful programs have a supportive institutional culture, faculty and alumni role models, administrative and/or financial support, and a cocurricular thread of activities. Leadership and advocacy development for student pharmacists is increasingly important. The recommendations and suggestions provided can facilitate leadership and advocacy development at other colleges and schools of pharmacy.

Quality improvement in health care: opportunities and responsibilities for pharmacists.

Quality in health care has never been more important than today. As health care providers, pharmacists have an obligation to serve as leaders and visionaries and actively demonstrate and document the advances that patient-centered pharmacy services can provide. Many agencies and organizations have developed initiatives to advance patient care through quality improvement measures and patient safety programs. Pharmacists, both individually and collectively, must actively engage in quality improvement and patient safety programs that elevate care and support the evidence base for clinical pharmacy services.

Health information technology use in a rural clinic: the pharmacist's perspective.

Poor communication of medical information during care transitions can lead to medication errors, adverse drug events, and increased health care costs. The crucial pharmacist's role sometimes requires efforts to improve documentation. Here, we describe our experience integrating a pharmacist into a medical team at a federally qualified health center.

Patient-centered health care using pharmacist-delivered medication therapy management in rural Mississippi.

OBJECTIVE: To describe and provide preliminary clinical and economic outcomes from a pharmacist-delivered patient-centered health care (PCHC) model implemented in the Mississippi Delta. SETTING: Mississippi between July 2008 and June 2010. PRACTICE DESCRIPTION: 13 community pharmacies in nine Mississippi Delta counties. PRACTICE INNOVATION: This PCHC model implements a comprehensive medication therapy management (MTM) program with pharmacist training, individualized patient encounters and group education, provider outreach, integration of pharmacists into health information technology, and on-site support in community pharmacies in a medically underserved region with a large burden of chronic disease and health disparities. The program also expands on traditional MTM services through initiatives in health literacy/cultural competency and efforts to increase the provider network and improve access to care. MAIN OUTCOME MEASURES: Criteria-based clinical outcomes, quality indicator reports, cost avoidance. RESULTS: PCHC services have been implemented in 13 pharmacies in nine counties in this underserved region, and 78 pharmacists and 177 students have completed the American Pharmacists Association's MTM Certificate Training Program. Preliminary data from 468 patients showed 681 encounters in which 1,471 drug therapy problems were identified and resolved. Preliminary data for clinical indicators and economic outcome measures are trending in a positive direction. CONCLUSION: Preliminary data analyses suggest that pharmacist-provided PCHC is beneficial and has the potential to be replicated in similar rural communities that are plagued with chronic disease and traditional primary care provider shortages. This effort aligns with national priorities to reduce medication errors, improve health outcomes, and reduce health care costs in underserved communities.

Multi-institutional study of women and underrepresented minority faculty members in academic pharmacy.

OBJECTIVES: To examine trends in the numbers of women and underrepresented minority (URM) pharmacy faculty members over the last 20 years, and determine factors influencing women faculty members' pursuit and retention of an academic pharmacy career. METHODS: Twenty-year trends in women and URM pharmacy faculty representation were examined. Women faculty members from 9 public colleges and schools of pharmacy were surveyed regarding demographics, job satisfaction, and their academic pharmacy career, and relationships between demographics and satisfaction were analyzed. RESULTS: The number of women faculty members more than doubled between 1989 and 2009 (from 20.7% to 45.5%), while the number of URM pharmacy faculty members increased only slightly over the same time period. One hundred fifteen women faculty members completed the survey instrument and indicated they were generally satisfied with their jobs. The academic rank of professor, being a nonpharmacy practice faculty member, being tenured/tenure track, and having children were associated with significantly lower satisfaction with fringe benefits. Women faculty members who were tempted to leave academia for other pharmacy sectors had significantly lower salary satisfaction and overall job satisfaction, and were more likely to indicate their expectations of academia did not match their experiences (p<0.05). CONCLUSIONS: The significant increase in the number of women pharmacy faculty members over the last 20 years may be due to the increased number of female pharmacy graduates and to women faculty members' satisfaction with their careers. Lessons learned through this multi-institutional study and review may be applicable to initiatives to improve recruitment and retention of URM pharmacy faculty members.

Pharmacists as mid-level practitioners/providers.

With recent changes in health-care delivery, the profession of pharmacy is presented with opportunities for expanded involvement in direct patient care as mid-level practitioners/providers. Will pharmacists be proactive in realizing these opportunities? Expanding current roles to improve medication-related health outcomes for patients will require that pharmacists establish collaborative practice relationships, differentiate our unique services from those of other mid-level practitioners/providers, and share these results with the public and other health-care providers. This article encourages pharmacists to advocate for advancing pharmacy practice to meet the needs of society, to continue the dialogue regarding an expanded scope of practice for pharmacists as mid-level practitioners/providers, and to actively engage in developing these new roles.

Benchmarking in academic pharmacy departments.

Benchmarking in academic pharmacy, and recommendations for the potential uses of benchmarking in academic pharmacy departments are discussed in this paper. Benchmarking is the process by which practices, procedures, and performance metrics are compared to an established standard or best practice. Many businesses and industries use benchmarking to compare processes and outcomes, and ultimately plan for improvement. Institutions of higher learning have embraced benchmarking practices to facilitate measuring the quality of their educational and research programs. Benchmarking is used internally as well to justify the allocation of institutional resources or to mediate among competing demands for additional program staff or space. Surveying all chairs of academic pharmacy departments to explore benchmarking issues such as department size and composition, as well as faculty teaching, scholarly, and service productivity, could provide valuable information. To date, attempts to gather this data have had limited success. We believe this information is potentially important, urge that efforts to gather it should be continued, and offer suggestions to achieve full participation.

Health-care reform 2010: how will it impact you and your practice?

There are several transformative features of the 2 landmark health-care reform laws passed by the Congress and signed into law by the President in March. The most critical elements that will impact pharmacists and patients are categorized into 6 key areas in this commentary: health insurance reform; improvements in Medicare and Medicaid; pharmacy practice expansion; health professions education and workforce initiatives; prevention and wellness; and enhanced access to affordable medications. The relevant features of these new opportunities are presented and the implications for pharmacists and their patients are discussed.

Identifying perceptions of professionalism in pharmacy using a four-frame leadership model.

OBJECTIVES: To determine whether professionalism in pharmacy education is addressed from Bolman and Deal's four-frame leadership model. METHODS: Students (N=624), faculty (N=57), preceptors (N=56), and academic administrators (N=8) at 6 colleges and schools of pharmacy were surveyed to assess professionalism. Using grounded theory methodology and a constant comparative process, common themes were identified for each question in each group. Themes were assigned to the four-frame model and the data were compared. RESULTS: Mechanisms of addressing professionalism consistent with all 4 frames of the Bolman and Deal's model were identified. Faculty assessment of student professionalism was significantly lower (P<0.05) than the student group, preceptors, and administrators. CONCLUSIONS: Mechanisms of addressing professionalism in pharmacy education span all four frames of Bolman and Deal's leadership model. The values students bring into a pharmacy program may play an important role in the process of professional socialization. Faculty members have a tremendous opportunity to enhance student professionalism with their daily verbal and nonverbal interactions with students.

Implementation and refinement of a problem-based learning model: a ten-year experience.

OBJECTIVES: To evaluate the effectiveness of a problem-based learning (PBL) model implemented in 1995 at the University of Mississippi School of Pharmacy. DESIGN: The third-professional (P3) year curriculum was reoriented from a faculty-centered model of teaching to a student-centered model of learning. Didactic lectures and structured classroom time were diminished. Small student groups were organized and a faculty facilitator monitored each group's discussions and provided individual student assessments. At the end of each 8-week block, students were assessed on group participation, disease and drug content knowledge, and problem-solving abilities. Faculty and student input was solicited at the end of each year to aid programmatic improvement. In 2000, a formal 5-year review of the PBL program was conducted. ASSESSMENT: Recommendations for improvement included clarifying course objectives, adopting a peer-review process for examination materials, refining the group assessment instruments, and providing an opportunity for student remediation after a course was failed. A weekly case conference presided over by a faculty content expert was also recommended. Ongoing critical evaluation during the following 5-year period was provided by graduates of the program, faculty participants, and accreditation reviews. CONCLUSION: Over our 10-year experience with a PBL model of P3 education, we found that although the initial challenges of increased demands on personnel and teaching space were easily overcome, student acceptance of the program depended on their acknowledgment of the practical benefits of active learning and on the value afforded their input on curricular development.

The effect of obesity surgery on obesity comorbidity.

Obesity is epidemic in the modern world. It is becoming increasingly clear that obesity is a major cause of cardiovascular disease, diabetes, and renal disease, as well as a host of other comorbidities. There are at present no generally effective long-term medical therapies for obesity. Surgical therapy for morbid obesity is not only effective in producing long-term weight loss but is also effective in ameliorating or resolving several of the most significant complications of obesity, including diabetes, hypertension, dyslipidemia, sleep apnea, gastroesophageal reflux disease, degenerative joint disease, venous stasis, pseudotumor cerebri, nonalcoholic steatohepatitis, urinary incontinence, fertility problems, and others. The degree of benefit and the rates of morbidity and mortality of the various surgical procedures vary according to the procedure.