Student attitudes regarding timing of immunization training within the pharmacy curriculum: Optimizing immunization training in pharmacy schools in the United States.

INTRODUCTION: The pharmacist's role in vaccination efforts continues to increase; therefore, it is essential to ensure that pharmacy students receive effective training to be confident and competent administering immunizations. The purpose of this research was to assess the impact of immunization training timing on students' hands-on experience and perception during pharmacy school. METHODS: One hundred forty-five pharmacy schools were surveyed to determine details of their immunization training programs. A follow-up survey was sent to select schools to determine student comfort immunizing during introductory pharmacy practice experiences (IPPEs) and paid employment in pharmacy settings. Quantitative data regarding the number of immunizations delivered during IPPEs and work was collected. Questions also assessed attitudes regarding timing of immunization training and missed opportunities to immunize. RESULTS: Results indicated students trained during their third professional year (PY3) were less comfortable giving immunizations during their IPPEs or work than those trained during the first professional year (PY1) or second professional year (PY2) (IPPE P < .01; work P < .01 PY1; P = .01 PY2). PY3s were more likely to prefer training earlier in the curriculum. PY2s and PY3s were more likely to believe the timing of their immunization training caused missed opportunities to deliver immunizations. The earlier the immunization training occurred in the curriculum, the more vaccinations the student administered. CONCLUSIONS: Providing immunization training programs to pharmacy students earlier in their curriculum provides students with superior experience and instills confidence.

Placement and Integration of Pathophysiology, Anatomy, and Physiology Within the Doctor of Pharmacy Curriculum.

Objective. To examine the placement of pathophysiology, anatomy, and physiology within the curricula of US pharmacy schools and colleges for variations in program length, prerequisites, institution type, geographic region, and establishment date.Methods. The websites of 146 pharmacy programs were examined for information related to pathophysiology, anatomy, and physiology courses and instruction. Eight programs listed uninterpretable or incomplete website data and were excluded, producing a final sample size of 138 programs. Data were analyzed to determine differences in curricular placement, credit hours, and integration.Results. The majority (65.3%) of pathophysiology courses were incorporated into the curriculum by integration, while some (14.5%) had both stand-alone and integrated pathophysiology courses. The remaining programs (20.2%) had stand-alone pathophysiology courses only. Of those with stand-alone pathophysiology courses, the mean number of credit hours was 5. Most programs (76.1%) required anatomy and/or physiology as a prerequisite or as part of the professional program, with significantly more public programs than private programs requiring it as a prerequisite (77.9% vs 48.6%).Conclusion. Pathophysiology is taught in diverse formats throughout US pharmacy schools, with the only consensus among programs being that it belongs in the professional curriculum. While the majority of programs teach pathophysiology as an integrated course, stand-alone courses are also common. There is also great diversity in the type of instruction used in anatomy and physiology courses. While every program requires students to complete anatomy and physiology courses, these are commonly taught as part of the professional curriculum or are prerequisites. Overall, there are few significant differences in the instruction of these subjects among US pharmacy schools.

Non-Doctoral and Dual Degree Offerings in US Pharmacy Schools.

Objective. To determine the number and types of non-terminal degree programs offered at US schools and colleges of pharmacy. Methods. The websites of 136 schools and colleges of pharmacy that offered the Doctor of Pharmacy (PharmD) degree and were accredited by the Accreditation Council for Pharmacy Education were examined to see if they also offered any non-terminal degrees. The school web sites were also compared to identify any variations in degrees offered based on class size, institution type (public or private), and age of program. Results. Thirty programs did not offer any additional degree programs. Twenty-three schools (17%) offered a bachelor's degree(s) program, 17 of which were standalone Bachelor of Science programs, five were restricted availability or pass-through degrees and one offered both. Restricted availability is a bachelor's degree given to students who reach milestones in the PharmD program, but they must be in the PharmD program to receive the degree. Research-based and administrative-based master's degree programs were offered by 56 (41.1%) and 28 (20.6%) schools respectively. Finally, 92 (67.6%) schools offered dual degree programs where students could simultaneously earn their PharmD and an additional degree. Conclusion. Given the challenges that US pharmacy schools face with decreasing applicants and lower enrollment in PharmD programs, they may find this data helpful as they consider solutions such as adding additional degree programs.

United States Physician Preferences Regarding Healthcare Financing Options: A Multistate Survey.

Background: Not much is currently known about United States (US) physicians' opinions about healthcare financing, specifically subsequent to the creation and implementation of the Affordable Care Act (ACA). Objectives: A four state survey of practicing US based physicians' opinions about healthcare financing following ACA passage and implementation. Methods: Physician leaders practicing in the state of New York, Texas, Colorado and Mississippi were surveyed. Two factor analyses (FA) were conducted to understand the underlying constructs. Results: We determined the final response rate to be 26.7% after adjusting it for a variety of factors. Most physicians favored either a single payer system (43.8%) or individualized insurance coverage using health savings accounts (33.2%). For the single-payer system, FA revealed two underlying constructs: System orientation (how the physicians perceived the impact on the healthcare system or patients) and individual orientation (how the physicians perceived the impact on individual physicians). Subsequently, we found that physicians who were perceived neutral in their attitudes towards physician-patient relationship and patient conflict were also neutral in reference to system orientation and individual orientation. Physicians who were perceived as stronger on the physician-patient relationship were more supportive of a single-payer system. Conclusion: This study brings attention to the paradox of social responsibility (to provide quality healthcare) and professional autonomy (the potential impact of a healthcare financing structure to negatively affect income and workload). Efforts to further reform healthcare financing and delivery in the US may encounter resistance from healthcare providers (physicians, mid-level prescribers, pharmacists, or nurses) if the proposed reform interferes with their professional autonomy.

Regional Variation in Pharmacist Perception of the Financial Impact of Medicare Part D.

The objective of this study was to perform a nationwide investigation of the financial performance of community pharmacies in the United States since the inception of Medicare Part D. A nationwide, cross-sectional survey of pharmacists was conducted in 2013. The 43-item online survey collected information about demographics, financial implications of Part D on community pharmacy and patients, provision of Medication Therapy Management (MTM) services and opinions about Medicare Part D 2010 updates. The adjusted response rate was 22.3% (419/1885). A majority of respondents (75.6%) reported a stable or increased prescription volume since 2006 but only 40.4% indicated that the financial performance of their pharmacy as either excellent or good during the same period. Owners and part-owners of rural independent pharmacies were more likely to report a below average or poor financial performance (75.0%). The provision of MTM services was not related to the financial performance of the pharmacy. Nearly half (44.7%) of pharmacy owners or part-owners indicated that they were considering selling their pharmacy, with most (94.1%) reporting that their decision to sell was due to the Part D financial pressures. However, the decision to sell was not related to the change in financial performance since 2006 or the volume of prescriptions dispensed.

Patient centred medical home (PCMH) and patient-practitioner orientation: Is there a relationship?

BACKGROUND: The patient-centred medical home (PCMH) and utilisation of a patient-centred care approach have been promoted as opportunities to improve healthcare quality while controlling expenditures. OBJECTIVES: To determine the penetration of PCMH within physician practices, and to evaluate physician attitudes towards patient-practitioner orientation. The ultimate objective was to explore relationships between the patient-practitioner orientation of respondents and the presence of PCMH elements within their practice. METHODS: A survey instrument was developed following a comprehensive literature review. Lead physicians practicing in four states were surveyed. RESULTS: The adjusted response rate was 26.7%. Responses indicated increased utilisation of PCMH elements (electronic medical records, e-mail and telephone consultations, and physician performance monitoring and feedback) compared with previous research. Within a logistic regression model, medical school graduation year (1990 or later >prior to 1990), practice size (group >solo), and percentage of time allocated to patient care (less >more) were significant predictors of working in a high PCMH alignment setting. Physician and practice characteristics did not predict the level of patient-practitioner orientation, though rural physicians were more patient-centred than urban physicians. A non-linear correlation between patient-practitioner orientation and the likelihood of practicing in a low or high PCMH-aligned practice was observed. CONCLUSIONS: There is a non-linear correlation between patient-practitioner orientation and the likelihood of a physician practicing in a low or high PCMH-aligned practice. The ability of a physician to work in a PCMH setting or practicing patient-centred care can go beyond a physician's aspirations to work and practice in that manner.

A Nationwide Study of Pharmacists' Perception of the Impact of Medicare Part D on the Pharmacist-Patient Relationship.

BACKGROUND: Medicare Part D was implemented in 2006, introducing change to the community pharmacy marketplace, with profound disruption to independent pharmacy operations across the United States. AIMS: To understand pharmacist perceptions about Part D and their perceived obligation to address Part D issues on behalf of their beneficiaries. METHODS: A nationwide, cross-sectional survey of pharmacists was conducted between April and July 2013. The 43-item online survey collected information about demographics, implications of Part D on community pharmacy and patients, and beliefs about ideal pharmacy practice. RESULTS: Pharmacists reported more responsibility to address prior authorization issues (55.3% strongly agree or agree) than dispensing preferred medications (43.5%) or addressing patient copayment issues (38.1%). Predictors of the perceived responsibility to assist patients varied and included practice site, pharmacist age, pharmacy prescription volume, and pharmacy financial performance. DISCUSSION: Financial concerns continue to be the most significant issue following Part D implementation. The degree to which pharmacists feel responsible for addressing patient Part D concerns is variable and dependent on a variety of factors. Pharmacists who felt a personal responsibility to address patient copayment issues reported a better pharmacy financial performance, a larger increase in prescription volume, and a better pharmacist-patient relationship since Part D implementation. CONCLUSION: Nationwide, Part D financial concerns remain significant. Pharmacists can assist patients with managing cost issues, which can help alleviate pharmacy financial concerns. Many pharmacists practicing at independent locations do not feel responsible for addressing patient cost concerns, which may inadvertently impart a negative financial effect upon their pharmacy.

An Elective Course to Foster Interest in Academic Pharmacy Career Opportunities.

Objective. To create an elective course to foster student interest in pursuing a career in academic pharmacy. Design. The course met for two hours once weekly throughout the semester and required student attendance at the AACP Annual Meeting. The course included didactic instruction, a student-designed individual teaching seminar, design and implementation of a research project for presentation at a national meeting, and drafting of a manuscript suitable for publication in a peer-reviewed journal. Assessment. Student evaluations revealed strong agreement that the course met the stated objectives. Follow-up correspondence indicated that almost 70% were likely to pursue an academic career and felt the course gave them advantages over their peers in this regard. Conclusion. The outcomes from this elective course and follow-up surveys confirmed that the majority of participants were planning on pursuing an academic pharmacy career and felt the course increased their readiness to do so.

Design and Implementation of a Professional Development Course Series.

Objective. To design and implement a longitudinal course series focused on professional development and professional identity formation in pharmacy students at Western New England University. Methods. A four-year, theme-based course series was designed to sequentially and longitudinally impart the values, attributes, and characteristics of a professional pharmacist. Requirements of the course include: goal planning and reflective assignments, submission of "Best Works," attendance at professional meetings, completion of service hours, annual completion of a Pharmacy Professionalism Instrument, attendance at Dean's Seminar, participation in roundtable discussions, and maintenance of an electronic portfolio. Though the Professional Development course series carries no credit, these courses are progression requirements and students are assessed on a pass/fail basis. Results. Course pass rates in the 2015-2016 academic year for all four classes were 99% to 100%, suggesting the majority of students take professional development seriously and are achieving the intended outcomes of the courses. Conclusion. A professional development course series was designed and implemented in the new Doctor of Pharmacy program at Western New England University to enhance the professional identity formation of students.

Valued characteristics of community pharmacy residency applicants.

OBJECTIVES: To determine the attributes of postgraduate year 1 (PGY1) community pharmacy residency applicants and candidates that are most appealing to community residency program directors (CRPDs). DESIGN: A 22-question online survey, designed to collect residency demographics, desirable characteristics for consideration for interview invitation (applicants), and characteristics that should be displayed during an interview (candidates). SETTING: American Society of Health-System Pharmacists (ASHP)-recognized community pharmacy residency programs (CPRPs). PARTICIPANTS: The CRPDs of 109 ASHP-recognized CPRPs throughout the United States. INTERVENTION: Not applicable. MAIN OUTCOME MEASURES: Minimum applicant requirements; rank order of valued characteristics at application and interview stage of hiring process. RESULTS: The response rate was 71/109 (65.1%). Applicant work experience in chain pharmacy (90.1%) and independent pharmacy (77.5%) was most highly valued by CRPDs, with 85.9% preferring applicants with a minimum of 1 year or more of community pharmacy experience. A large majority of CPRPs (91.4%) indicated a preference for applicants who have been an officer of a student organization. Among CPRPs that required minimum grade point averages (GPAs), a mean GPA of 2.88 ± 0.34 was reported (range 2.0 to 3.5; mode 3.0). Pharmacy work experience (68.1%) and letters of recommendation (59.4%) were most frequently cited as top factors in the decision-making process for selecting candidates to interview. At the interview stage, CRPDs rated interest and knowledge about the residency (62.3%), time management and prioritization (50.7%), and self-awareness and commitment to improvement (43.5%) as the most important skills for candidates to demonstrate. CONCLUSION: Community pharmacy work experience, organizational leadership experience, and positive letters of recommendation appear to be the most valued attributes of a community pharmacy residency applicant. Applicants should consider aligning themselves with these characteristics to successfully match to a community pharmacy residency.

The Role and Responsibilities of Pharmacy Student Government Associations in Pharmacy Programs.

Objective. To identify student government designs used by pharmacy programs and to examine their functions, duties, and relationships with other student organizations. Methods. A 21-question survey was developed and distributed to pharmacy deans, who were asked to forward the survey to the leader of their student government organization. Results were analyzed in aggregate. Results. Seventy-one programs responded (56%). Of respondents, 96% had a pharmacy student government association (PSGA). Programs officers generally consisted of a president (87%), secretary (81%), vice-president (79%), and treasurer (70%). Functions of the PSGAs included oversight of fundraisers (76%), on-campus events (69%), social events (61%), organizational meetings (59%), and off-campus events (57%). Approximately half (45%) of PSGAs were part of a larger, university-wide student government. Conclusion. While student government organizations are nearly universal in pharmacy programs, their oversight of other student organizations, as well as their involvement within a larger university-wide student government, varies greatly.

Comparison of Introductory Pharmacy Practice Experiences Among US Pharmacy Programs.

OBJECTIVE: To identify the various IPPE designs utilized by US pharmacy programs. METHODS: A 20-question survey was developed and distributed to experiential affairs professionals at 129 pharmacy institutions nationwide addressing school demographics and IPPE design. Results were analyzed in aggregate. RESULTS: Ninety-three schools responded (72%). Eighty-nine percent of those reported beginning IPPE experiences in the first professional year, although there was a great variation regarding whether the IPPE was held while didactic classes were in session or during school breaks. The number of required practice experiences varied. Institutions prohibited students from completing rotations in the same pharmacy chain (72%) or hospital (70%) where employed, and from completing 2 rotations at the same site (62%). Fifty-seven percent utilized faculty members as preceptors. 51% allowed a maximum of 2 students per preceptor per practice experience. CONCLUSION: While clear trends existed in IPPE curricula, institutions incorporated aspects that addressed unique needs. Further research can determine the benefits and drawbacks of different IPPE designs.

AMCP Format dossier requests: manufacturer response and formulary implications for one large health plan.

BACKGROUND: The Academy of Managed Care Pharmacy (AMCP) Format for Formulary Submissions, a template for health plans to use in developing formulary submission guidelines, has been widely adopted since its initial release in 2000. Many health plans request a dossier (a standardized set of clinical and economic evidence prepared by pharmaceutical manufacturers) to provide information for consideration during the formulary decision-making process. While dossier quality has reportedly improved over time, there is no recent research examining the response rate to dossier requests and the quality of dossiers received. OBJECTIVE: To perform an evaluation of pharmaceutical manufacturers. response to a request for a product dossier prepared using the AMCP Format, and to determine if dossier receipt was associated with a favorable formulary placement. METHODS: The pharmacy and therapeutics (P&T) committee of a mid-Atlantic health plan with approximately 3 million members reviewed 43 drug products from February 2004 through December 2005. A university-based clinical evaluation subcontractor requested dossiers in the AMCP Format by telephone and e-mail from the manufacturers. drug information center about 8 weeks before the committee meeting. A retrospective evaluation of the materials received from the manufacturers was performed. A logistic regression model was developed to determine if dossier receipt increased the likelihood of second-tier copayment formulary placement for new product reviews. RESULTS: Dossiers were requested for 43 products. We received dossiers for 25 products (58%), other drug information (e.g., journal reprints, product labeling) for 10 products (23%), a formulary kit for 4 products (9%), and no response for the remaining 4 products (9%). Of the 25 dossiers, 21 (84%) generally followed the AMCP Format. Unlocked interactive budget impact models were included in 5 dossiers (20%), and modeling reports (without an unlocked interactive model) were included in 12 dossiers (48%). Dossiers were more likely to be received when the time between U.S. Food and Drug Administration (FDA) approval and dossier request was >/- 4 months (65% vs. 27% when <4 months; P <0.05) and when requested from a large manufacturer (top 25 in sales) compared with smaller manufacturers (75% vs. 43%; P <0.05). Dossier receipt did not improve a product.s likelihood for preferred formulary placement; none of the new products for which dossiers were received were assigned to the second copayment tier compared with 33% of the new products with no supporting dossier. The logistic regression model failed to find any correlation between dossier receipt and preferred formulary placement. CONCLUSIONS: Manufacturers met the request for a dossier nearly three fifths of the time. The dossiers were of high quality and generally followed the AMCP Format; the models included in dossiers varied widely in their design and utility. The product manufacturer.s size and the time between FDA approval and dossier request influenced the likelihood of dossier receipt. Receipt of a dossier did not appear to influence the likelihood of a product attaining preferred formulary status.

Rates of discontinuation and change of glaucoma therapy in a managed care setting.

BACKGROUND: Comparing discontinuation and change rates of glaucoma pharmacotherapies provides insight as to which agents perform more effectively. OBJECTIVE: To quantify the rates of discontinuation and change of different glaucoma therapies. METHODS: This retrospective, observational study using managed care administrative claims data included patients who were between 20 and 64 years of age and received at least 1 prescription for 1 of the following glaucoma agents as monotherapy: betaxolol, brimonidine, latanoprost, or timolol. Patients receiving any glaucoma medication during the 180 days prior to their index prescription were excluded, as were those who did not have continuous plan enrollment during this period. The primary outcome measures were the discontinuation and change (switching/adding on) of the index glaucoma medication. Rates of discontinuation and change were compared using a proportional hazard model. RESULTS: A total of 1006 patients comprised the final study population. Approximately 62% of patients discontinued their index glaucoma medication, and 18% of patients changed to a different therapy within 18 months of starting therapy. Among those discontinuing therapy, latanoprost patients remained on therapy the longest (mean: 217 days) compared to other study cohorts (range: 182 to 184 days). Compared with latanoprost, patients initiated on any of the other agents were more likely to discontinue or change therapy. CONCLUSIONS: This study indicates that latanoprost therapy results in a lower rate of discontinuation or change compared to patients started on betaxolol, brimonidine, or timolol.