Perceptions and Utility of Course Evaluations in US Pharmacy Schools.

OBJECTIVE: This study aimed to describe the purpose, implementation, and perceived utility of course evaluations in pharmacy programs. METHODS: After a literature review, a 34-item survey was developed, pretested, and sent to assessment administrators at accredited pharmacy programs (N = 139) with at least 3 follow-ups. Descriptive and inferential statistics were performed in IBM SPSS Statistics software. RESULTS: A total of 90 programs responded (64.7% response rate). Most students (94%) were offered the opportunity to complete course evaluations. Some students completed evaluations during the course (47%), while others did so within 1 week of completion of the course (49%). Whether or not class time was given for students to complete the survey was often dependent on faculty choice (52.2%). Results were typically released after final grades were posted (92%), in time to use for the next semester of teaching (77%). Faculty were chosen to be evaluated by the number of teaching hours (50%) followed by all instructors (45.6%). Programs used the results for performance reviews by chairs (91%), course coordinator reviews (84%), and committee continuous quality improvement efforts (72%). Most programs did not provide faculty guidance on using evaluations (78%) nor development/mentoring (57%); only 22% of programs offered student development in completing evaluations. CONCLUSION: While most programs invite feedback from all students via evaluations, most did not provide guidance to faculty on how to use this feedback for faculty or course development purposes. A more robust process to optimize the use of course evaluations should be developed.

Evaluation of Early Versus Late Postdischarge Medication Reconciliation on Readmission Rates and Emergency Department Visits.

BACKGROUND: The current literature speculates ideal postdischarge follow-up focusing on transitions from hospital to home can range anywhere between 48 hours and 2 weeks. However, there is a lack of evidence regarding the optimal timing of follow-up visit to prevent readmissions. OBJECTIVE: The purpose of this study is to evaluate the impact of early (<48 hours) versus late (48 hours-14 days) postdischarge medication reconciliation on readmissions and emergency department (ED) use. METHODS: In this retrospective study, data for patients who had a clinic visit with a primary care provider (PCP), clinical pharmacist, or both for postdischarge medication reconciliation were reviewed. Primary outcome included hospital use rate at 30 days. Secondary outcomes included hospital use rate at 90 days and hospital use rate with a postdischarge PCP follow-up visit, clinical pharmacist, or both at 30 days. RESULTS: One hundred sixty patients were included in the analysis: 31 early group patients and 129 late group patients. There was no significant difference on hospital use at 30 days in patients who received early or late groups (32.3% vs 21.8%, P = .947). There was also no significant difference on hospital use at 90 days in patients in early versus late group (51.6% vs 50.3%, P = .842). The type of provider (PCP vs pharmacists) conducting postdischarge medication reconciliation did not show significance on hospital use at 30 days (19.9% vs 21.4%, P = .731). CONCLUSION: Results from this study suggest patients can be seen up to 14 days postdischarge for medication reconciliation with no significant difference on hospital use.

The Use of Ketamine for Acute Treatment of Pain: A Randomized, Double-Blind, Placebo-Controlled Trial.

BACKGROUND: Pain is one of the most common reasons for emergency department (ED) visits in the United States. Ketamine is a sedative with N-methyl-D-aspartate (NMDA) receptor antagonism. Recent literature has suggested that the use of subdissociative dose ketamine (SDDK) may be safe and effective for acute pain. OBJECTIVE: The objective of our study was to evaluate ketamine in subdissociative doses as an adjunct for acute pain in the ED. METHODS: This was a single-center, prospective, randomized, double-blind, placebo-controlled trial that evaluated the use of SDDK in adult patients who presented to the ED with acute pain. Patients received ketamine 0.3 mg/kg via intravenous piggyback over 15 min or placebo. Morphine 0.1 mg/kg intravenous push was administered with the study interventions. The primary outcome was the patient's pain score 15 min after initiation of the intervention. Secondary outcomes included adverse events, consumption of rescue analgesia, patient's length of stay, and patient satisfaction with treatment. RESULTS: Thirty patients were enrolled in each group. Median pain scores in patients who received ketamine were lower than in controls at 15 min (3.5 [interquartile range {IQR} 1.0-7.3 vs. 6.0 [IQR 4.0-9.0], respectively; p = 0.018). No serious adverse events occurred. No difference was detected in the amount of rescue analgesia used or in length of stay. Patients who received ketamine reported a higher mean satisfaction score with their pain management (8.57 [standard deviation {SD} 2.1]) than patients who received placebo (6.05 [SD 2.6]; p = 0.01). CONCLUSION: When used as an adjunct, SDDK administered at 0.3 mg/kg over 15 min resulted in safe and effective analgesia for ≤30 min in patients who presented with acute pain in the ED.

Reversibility of renal dysfunction after discontinuation of tenofovir.

OBJECTIVES: The association of tenofovir (TDF) with nephrotoxicity has been a controversial issue. Few studies are published regarding the reversibility of renal dysfunction once TDF is discontinued. Studies have yet to be conducted in an urban, non-white patient population, making this one of the largest studies observing a non-white cohort. The objective of this study was to determine whether the decline in creatinine clearance (CrCL) associated with TDF use is reversible once TDF is discontinued in a non-white patient population. METHODS: This single-center, retrospective, chart review was performed at an urban outpatient HIV clinic. Patients who had been switched from tenofovir to zidovudine or abacavir because of a decline in renal function were included. The primary endpoint was the percentage of patients who regained full, moderate, mild, or no recovery of CrCl. RESULTS: Sixty-two patients were included. The mean age was 50 years old, 82% were black, and 66% were males with a mean baseline CrCL of 76 ml/min. Mean difference in CrCL from baseline to 12 months post-TDF was shown to be -11.34 ml/min. After a 1-year follow up period, 37.5% of patients had a full recovery of their baseline CrCL. An additional 41% of patients achieved a moderate recovery (80%-99% of baseline CrCL) and 17.9% patients had a mild recovery (50%-79% of baseline CrCL). Two patients required dialysis. The percent of patients with an undetectable HIV RNA while on a TDF-containing regimen was 67.1% compared with 74.6% on alternative ART. CONCLUSION: Renal dysfunction caused by TDF was fully reversible in 37.5% of patients. Improvement to at least 50% of baseline was seen in 96.4% of patients. Viral suppression was not compromised when patient was switched from TDF to an alternative nucleoside reverse transcriptase inhibitor.

Perceptions, Barriers, and Knowledge of Inpatient Glycemic Control: A Survey of Health Care Workers.

OBJECTIVES: To assess knowledge and perceptions of health care workers regarding optimal care for patients with hyperglycemia and identify commonly perceived barriers for the development of a hospital-wide education program. RESEARCH DESIGN AND METHODS: A cross-sectional design was utilized to survey health care workers involved in managing hyperglycemia in an urban, community teaching hospital. Each health care worker received a survey specific to their health care role. RESULTS: Approximately 50% of questions about best clinical practices were answered correctly. Correct responses varied across disciplines (n, mean ± standard deviation [SD]), that is, physicians (n = 112, 53% ± 26%), nurses (n = 43, 52% ± 35%), pharmacists (n = 20, 64% ± 23%), dietitians (n = 5, 48% ± 30%), and patient care assistants (n = 12, 38% ± 34%). Most health care workers perceived hyperglycemia treatment to be very important and that sliding scale insulin was commonly used because of convenience but not efficacy. CONCLUSION: Knowledge regarding hyperglycemia management was suboptimal across a sample of health care workers when compared to clinical best practices. Hyperglycemia management was perceived to be important but convenience seemed to influence the management approach more than efficacy. Knowledge, perceptions, and barriers seem to play an important role in patient care and should be considered when developing education programs prior to implementation of optimized glycemic protocols.

Pharmacists levels of emotionality and career success correlates: an exploratory study.

OBJECTIVE: The objectives of this study were to (1) examine the relationships between Emotional Thinking Scale (ETS) scores and demographic variables such as income, years worked as a pharmacist, and hours worked per week and (2) determine the distribution of ETS scores among this sample of pharmacists. These objectives are significant to explore because they may provide important data regarding effective and ineffective pharmacist work-related behaviors that affect career and life success. METHOD: A convenience sample of practicing pharmacists was selected. Participants completed the 8-item ETS and a demographic survey. The ETS predicts how an individual's thoughts might influence his or her emotions and behaviors. Researchers analyzed participant's ETS scores with his or her demographic responses. Data were analyzed using SPSS statistical software. RESULTS: One hundred twenty-five pharmacists completed the survey. Twenty-one percent of the sample scored between slightly high and very extremely high on the ETS. "often being incapacitated by strong feelings" correlated negatively with annual income r = -.309 (P = .008); "relying on feelings to deal with complex situations" correlated negatively with annual income r = -.253 (P = .026), with the "number of years practicing pharmacy" r = -.317 (P = .007), and "number of hours worked each week" r = -.317 (P = .007); and "focusing on details thus losing the big picture" was correlated negatively with annual income r = .215 (P = .05). These findings are consistent with the previous ETS research. CONCLUSION: The variables of interest in this study were negatively but significantly related. Emotional thinking scores decreased with pharmacy practice experience and may be counterproductive for career goals. Entry-level pharmacy education and continuing education programs may help develop self-awareness to this issue.

Interdisciplinary HIV care--patient perceptions.

PURPOSE: The purpose of this paper is to gauge patients' service perceptions of an interdisciplinary human immunodeficiency virus (HIV) clinic, which uses infectious disease physicians, medical residents, clinical pharmacists, nurses, social workers and students in HIV primary-care delivery. DESIGN/METHODOLOGY/APPROACH: Adult patients coming to the HIV clinic for a return visit to the interdisciplinary team completed a questionnaire based on a previously validated HIV-specific patient satisfaction study (n = 104). Fourteen modified items assessing overall care-quality and ten original items assessing interdisciplinary services were included. FINDINGS: Respondents reported high satisfaction levels with the clinic's services. The mean score for the care-quality items was 3.79 (possible 4). The interdisciplinary care items mean score was 3.69 (possible 4). For non-physician disciplines, respondents indicated that nurses, pharmacists and social workers played important roles in their clinic care. RESEARCH LIMITATIONS/IMPLICATIONS: Bias associated with patient selection and survey methods limit the generalizability. The study has implications for measuring interdisciplinary care provided at HIV clinics. ORIGINALITY/VALUE: This HIV outpatient care interdisciplinary model is not widely in use. Results are important for those involved in HIV service development and improvement. Findings support integrating non-physician providers into routine outpatient HIV medical visits.

A quantitative professionalism policy in a community pharmacy introductory pharmacy practice experience.

OBJECTIVE: To determine whether implementing a quantitative professionalism policy would lead to improved behaviors in an introductory pharmacy practice experience (IPPE) and to evaluate students' attitudes about professionalism expectations in the IPPE. DESIGN: A policy using quantitative parameters for assessing unprofessional behaviors was developed and implemented in the community pharmacy IPPE after discrepancies were identified in the way professional expectations were assessed. ASSESSMENT: The quantitative professionalism policy reduced the number of assignments submitted post deadline (p<0.05). There was no change in students' attitudes towards professional behaviors after the implementation of the policy. CONCLUSION: The quantitative professionalism policy was effective in changing some of the students' professional behaviors in an IPPE.

Allied health profession students' attitudes toward the patient role in treatment decision-making.

BACKGROUND: The concordance model of patient care requires decision-making to be a shared process whereby healthcare providers take patients' understanding of their illness and concerns into consideration. The extent to which providers involve patients in decision-making differs by discipline. In order for patients to receive better interdisciplinary care, the lack of congruence among providers to involve patients in decision-making must be addressed. AIM: To examine the attitudes of students in nursing, respiratory care, and pharmacy toward concordance and whether attitudes differed across these three allied health professions. METHODS: A cross-sectional, exploratory design was used. Two hundred seventy-six students enrolled in four courses (2 nursing, 1 respiratory care, and 1 pharmacy) completed the LATCon II scale over a 4-week period. Reliability of the LATCon II scale was examined using Cronbach alpha. Descriptive and bivariate analyses were conducted using SPSS version 17.0. RESULTS: Two hundred sixty-eight students participated in the study. Of them, 97.8% supported concordance, and no significant difference was found among the three professions. Few considered patients' contributions to be important or decision-making a mutual process. Demographic factors were not significant. CONCLUSION: Students held positive attitudes toward concordance, and similar attitudes toward concordance bode well for interprofessional collaboration in healthcare. Strategies to improve concordance attitudes and practice need to be explored.

Journal clubs during advanced pharmacy practice experiences to teach literature-evaluation skills.

OBJECTIVE: To determine pharmacy students' attitudes and academic performance related to journal club during 2 advanced pharmacy practice experiences (APPEs). DESIGN: Fourth-year pharmacy students were required to complete 3 journal club assignments during drug information and internal medicine APPEs. ASSESSMENT: A majority (91.3%) of the 105 students who responded to a 21-item survey instrument indicated that journal club assignments during the drug-information APPE were valuable to their understanding of research design and statistics. Students who completed the drug-information APPE before the internal medicine APPE scored higher on their understanding of the strengths and weaknesses and the clinical relevance of studies and had a higher learning slope (p = 0.01) than did students who completed the internal medicine APPE first. CONCLUSION: Incorporating journal clubs into APPEs is an effective means of teaching literature-evaluation skills to pharmacy students.

Patient preferences for shared decisions: a systematic review.

OBJECTIVES: Empirical literature on patient decision role preferences regarding treatment and screening was reviewed to summarize patients' role preferences across measures, time and patient population. METHODS: Five databases were searched from January 1980 to December 2007 (1980-2007 Ovid MEDLINE, Cochrane Database of Systematic Reviews, PsychInfo, Web of Science and PubMed (2005-2007)). Eligible studies measured patient decision role preferences, described measures, presented findings as percentages or mean scores and were published in English from any country. Studies were compared by patient population, time of publication, and measure. RESULTS: 115 studies were eligible. The majority of patients preferred sharing decisions with physicians in 63% of the studies. A time trend appeared. The majority of respondents preferred sharing decision roles in 71% of the studies from 2000 and later, compared to 50% of studies before 2000. Measures themselves, in addition to patient population, influenced the preferred decision roles reported. CONCLUSION: Findings appear to vary with the measure of preferred decision making used, time of the publication and characteristics of the population. PRACTICE IMPLICATIONS: The role preference measure itself must be considered when interpreting patient responses to a measure or question about a patient's preference for decision roles.

Pharmacogenomics: assessing educational exposure, confidence in knowledge and training elements of pharmacists.

AIM: This study assessed pharmacist's knowledge and confidence in pharmacogenomics (PGx)-related concepts, and determined their needs with regard to education and training in PGx. METHODS: A cross-sectional survey instrument was sent via postal mail to pharmacists (n = 319) who were randomly selected from the New York State database of licensed pharmacists. Descriptive and bivariate statistics were performed. RESULTS: The response rate was 32% (n = 102). The majority (83%) of respondents had been exposed to basic concepts in genetics, while PGx was not an integral part of their education. Most respondents indicated being somewhat confident in their knowledge of PGx-related concepts. In addition, 64% of respondents reported being interested in attending 1-10 h of continuing education programs in PGx, and 42% of respondents indicated being interested in obtaining a certificate in PGx. CONCLUSION: Educational program development in the format of continuing education or certificate is needed to improve pharmacists' education, confidence and training needs in PGx.

A needs assessment for development and provision of medication therapy management services in New York City.

OBJECTIVES: To (1) assess the current extent of medication therapy management (MTM) provision in NYC; (2) investigate New York City pharmacists' attitudes, efforts, interest, and challenges in providing MTM; and 3) examine factors influencing pharmacist interest in providing MTM. METHODS: A cross-sectional design was utilized to survey New York City pharmacists attending a continuing education program. The survey questionnaire contained items pertaining to the extent of MTM currently provided by the pharmacists, attitudes, efforts, and interest in providing MTM and challenges to provision of MTM. RESULTS: A total of 93 out of 123 attendees (73.81%) completed the survey. Pharmacists provided an average of 1.65 (± 0.36) MTM services as defined by the APhA and NACDS framework. Pharmacists had slightly positive attitudes toward provision of MTM and were very interested in providing some MTM services. There was a positive correlation between pharmacist attitude toward MTM and interest in providing MTM (r = .31, P = .016). Of all the 6 challenges to provision of MTM listed in the survey, respondents indicated that additional time to be spent with patients and additional pharmacists would be the most difficult to overcome. CONCLUSIONS: This study serves as an assessment of the needs of New York City pharmacists with regard to provision of MTM services.

Concordance between observer reports and patient survey reports of pharmacists' communication behaviors.

BACKGROUND: Assessing the quantity and quality of pharmacist-patient communication is important to create strategies for improving communication. Findings from studies on pharmacist-patient communication differ on the extent of communication by pharmacists. This disagreement could be because of different methods of data collection, samples, and concepts used to measure communication. OBJECTIVES: This research compared findings from 2 widely used methods of data collection (survey and observation) to identify: (1) the extent to which pharmacists ask questions to patients and provide information on directions, side effects, and adverse effect, (2) agreement between observation and patient report data on pharmacist information giving and question asking, and (3) how patient perceptions of question asking vary according to the structure of the question asked. METHODS: A cross-sectional fieldwork design was used to collect data from a stratified random sample of 30 community pharmacies in Southeast and South-central Wisconsin. At each pharmacy, the dispensing pharmacist and 12 patients filling prescriptions were recruited. Each patient was observed for their interaction with the pharmacist and completed a survey while exiting the pharmacy. Both the survey and the observation tool consisted of items pertaining to recording of pharmacist information provision related to direction, side effects, and interactions, and pharmacist's question-asking behaviors. Descriptive analyses and correlations are reported. RESULTS: There was good agreement between the 2 methods regarding pharmacist information provision behaviors (r=0.091, P<.001), this was less true of question asking (r=0.28, P=.034). Certain types of questions showed greater concordance with the observed pharmacist questions. Patients were less likely to report having been asked a question when it took the form of a nonspecific closed-ended questions, that is, "Do you have any questions?" CONCLUSIONS: One of the most frequent questions pharmacists ask patients may not be either remembered or perceived by patients as a serious question, let alone an invitation to raise a concern. Secondly, during the selection of a specific method of data collection, researchers need to weigh strengths and weaknesses of various methods. Multimethod studies are encouraged.

Functions performed by paid pharmacy interns in hospitals in New York.

PURPOSE: The types of clinical and nonclinical activities performed by paid pharmacy interns in the hospitals in New York state were studied. METHODS: In November 2008, a list of hospitals in New York was obtained from the website of the New York State Department of Health. A survey was sent to each hospital's pharmacy director requesting information on hospital characteristics and whether the pharmacy department employed nongraduate pharmacy interns. For those hospitals that employed pharmacy interns, questions were asked about the number of nongraduate pharmacy interns employed, the shifts worked by interns, whether there was a minimum work-hour requirement for interns, the functions routinely performed by interns, and the percentage of interns who remained employed at the hospital upon licensure. RESULTS: Of the 184 surveys distributed, 96 responses (52.2%) were received. The majority of hospitals had 400 beds or fewer and were teaching institutions, and 45 employed pharmacy interns. The five functions reported most frequently were answering telephone calls (91%), preparing and distributing medications (82%), compounding nonparenteral medications (69%), compounding parenteral medications (62%), and responding to drug information queries (51%). The mean ± S.D. number of clinical activities performed by interns was 2.1 ± 2.1. The most frequently reported clinical activities were responding to drug information queries (51.1%), performing clinical interventions (33.3%), and completing adverse-drug-reaction reports (31.1%). CONCLUSION: Hospital pharmacy departments in New York utilized paid pharmacy interns to perform a variety of functions, including clinical activities. While there appears to be recognition that interns can perform clinical activities, the mean number of such activities was relatively low.

Frequency of and reasons for pharmacy residents breaching the National Matching Services applicant agreement.

PURPOSE: The frequency of and reasons for pharmacy residents breaching the National Matching Services (NMS) applicant agreement were evaluated. METHODS: An electronic survey was sent via e-mail to residency program directors of ASHP-accredited postgraduate year 1 pharmacy residencies in the United States. The survey instrument was developed based on an initial pilot survey used to test the clarity and reliability of the questions. The primary objective of the survey was to determine the frequency with which pharmacy residents breach the NMS applicant agreement and fail to report to their assigned site. Characteristics of ASHP- accredited residency programs with residents who breached the NMS agreement and any punitive action taken on these individuals were also analyzed. RESULTS: Of the 636 surveys sent to residency program directors, 302 complete surveys were returned, yielding a response rate of 47.5%. Twenty-six respondents (8.6%) indicated that within the past five years, they had matched candidates who failed to report to their assigned site. Of these respondents, 13 (50%) reported the candidate to ASHP; 11 (44%) took no action. Respondents indicated that they would be comfortable reporting all candidates who breach the NMS agreement to ASHP and placing the candidates' information on a list accessible electronically only to residency program directors. CONCLUSION: Less than 10% of residency program directors reported having residency candidates who breached the NMS applicant agreement. The majority of these respondents indicated that these residents were not their first choices. The most common reason for candidate withdrawal was family obligation.

Pharmacy students' perceptions and emotional responses to aggressive incidents in pharmacy practice.

OBJECTIVE: To explore pharmacy students' experiences with and perceptions of aggressive incidents in pharmacy practice. METHODS: Data were taken from a survey completed by second-year pharmacy (P2) students and analyzed using a retrospective, cross-sectional design. Survey items were adapted using the following scales: Perception of Aggression Survey (POAS), List of Aggressive Incidents experienced by mental health staff, and List of Emotions experienced by nurses. RESULTS: The majority of respondents did not identify aggression as normal, instead perceiving it as a violent reaction and functional. The 3 most frequent aggressive incidents experienced were: verbal abuse to face (40%); verbal abuse on the phone (39%); and refusal to cooperate with instructions (34%). The 3 most frequent emotions reported were: frustration (70%), empathy (65%), and no pride in their profession (70% rarely-never). CONCLUSION: Pharmacy students reported experiencing aggressive incidents with patients in person and on the phone, and with patients not following instructions. Preparing future pharmacists in techniques to address and resolve patients' aggression must become a priority for pharmacy academia and further research in this area is needed.

Pharmacy students' attitudes toward a required public health course and developing a public health program.

OBJECTIVE: To determine pharmacy students' attitudes towards a required public health course and developing a public health program. METHOD: Two hundred ten first-year pharmacy students enrolled in a public health course at a large private pharmacy school were surveyed. A 24-item adjective rating scale and a 10-item scale were used to measure students' attitudes towards the course and developing a public health program. RESULTS: Of 198 respondents, two-thirds found the course to be extremely or very appealing, of practical value, and only slightly demanding and difficult. The majority of the students indicated that establishing a public health program would be an opportunity to help the community and make a difference. Few students indicated that it would be a poor use of time or an example of busy work. CONCLUSION: Pharmacy students had positive attitudes towards a required public health course and developing a public health program. Strategies to mold positive attitudes into actual behaviors of engaging in public health activities are needed.

Conceptualizing and measuring pharmacist-patient communication: a review of published studies.

BACKGROUND: Pharmacist-patient communication in community pharmacies has been studied for over 25 years with little effort to evaluate this research comprehensively. OBJECTIVE: The main objective of this review is to examine and summarize how researchers have conceptualized, defined, and measured pharmacist-patient communication across studies and identify gaps in the literature. METHODS: Articles were compiled from a search of (1) Medline, IPA, CINAHL, and PubMed databases using the keywords, "counseling", "patient communication", "patient counseling", "patient education", "patient consult( *)", and/or "pharmacists", (2) bibliographies of selected articles. The search generated 56 studies on community pharmacy, of which 39 studies met the inclusion criteria. RESULTS: Most studies (72%) have used the term patient counseling, although pharmacist-patient communication and patient education were also used. The definition of patient counseling varies across studies. Almost half of the studies (49%) conceptualized pharmacist-patient communication solely as a pharmacist information provision activity. A total of 16 studies (41%) also focused on pharmacists' interpersonal behavior in addition to the information provision activity of the pharmacist. In contrast, patient communication behavior and the exchange process between both parties has been understudied. A total of 16 studies (41%) used a retrospective design. All studies used a cross-sectional design, with varying modes of data collection such as mail surveys, telephone interviews, nonparticipant observation, and shopper studies. Taped encounters are rare. SUMMARY/IMPLICATIONS: This review revealed that most studies have focused on a one way communication of pharmacists to patients. A need for examining the patient-pharmacist dyad is apparent. Future research could explore a greater use of taped encounters to analyze the interactive communication process, affective components of communication such as collaborative problem solving, interpersonal relationship development, and the expertise that patients bring into the encounter.