Engaging early experiential learners to improve quality at a VA medical center - a cross-sectional analysis.

PURPOSE: An innovative population health-based introductory pharmacy practice experience (IPPE) leveraging a Veterans Affairs (VA) and college of pharmacy collaboration was implemented in fall 2019. All second-year pharmacy students from the college actively engage in the evaluation of the medical records of veterans identified using population health management tools as needing additional care or experiencing a gap in care. This study examines the clinical impact of the experience on the care of patients at the partnering VA medical center. METHODS: Course and patient records were reviewed to enumerate the number and types of interventions performed as part of the IPPE from fall 2019 to spring 2021. Descriptive statistics were used to report clinical impact. Where relevant, t test analysis was used to compare pre- and postintervention clinical values. RESULTS: A total of 1,794 medical records were reviewed. An average of 2.67 interventions were completed for each of the 615 veterans receiving an intervention. A total of 155 patients were identified as needing routine laboratory tests (eg, glycated hemoglobin), with 48.4% of patients receiving recommended laboratory tests within 3 months. Thirty-three veterans were eligible for prescription renewals, resulting in 43 medication orders. Thirty-six veterans were recommended to take a statin medication, and statin therapy was initiated in 11, resulting in a significant decrease in the mean (SD) low-density lipoprotein cholesterol concentration (-42.4 [30.3] mg/dL, P < 0.05). Eight hundred immunizations were recommended for 632 veterans, and 286 recommendations were verbally accepted. CONCLUSION: This study demonstrates that a population health-based IPPE can provide significant clinical support to the care of patients within the VA health system.

Assessing student pharmacists' ability to recognize and categorize interventions during an introductory pharmacy practice experience.

INTRODUCTION: Introductory pharmacy practice experiences (IPPEs) prepare students for advanced pharmacy practice experiences (APPEs) by reinforcing patient care skills learned in the didactic curriculum. Current literature does not assess pharmacy students' abilities to accurately recognize and categorize interventions in IPPEs or APPEs. This study evaluated the impact of incorporating paper-based simulated encounters and video answer keys to train students to accurately recognize and categorize interventions during an IPPE. METHODS: During longitudinal IPPEs, first-, second-, and third-year students reviewed four patient case scenarios that mimicked authentic patient encounters. Students were tasked with recognizing and categorizing interventions and were provided answer key videos after each assignment. Total scores for the proportion of correct and incorrect intervention options selected were calculated and compared over time. Students and faculty mentors completed post-study questionnaires designed to assess perceived improvement in students' capability to recognize and categorize interventions. RESULTS: A series of repeated measures analyses of variance were statistically significant (P < .05) for total scores and proportion of correctly selected and incorrectly selected intervention options. Students' accuracy to correctly recognize and categorize interventions improved by 8% over four case scenarios. The proportion of correctly selected interventions increased by 65%, and the proportion of incorrectly selected intervention options decreased by 49% based on mean percent scores. CONCLUSIONS: Patient case scenario assignments and video recorded answer keys were useful tools to teach students how to document interventions. Exposure to documenting interventions during IPPEs helps prepare students for documenting interventions during APPEs.

Development and Validation of a Rubric to Evaluate Diabetes SOAP Note Writing in APPE.

Objective. To develop and establish validity for a grading rubric to evaluate diabetes subjective, objective, assessment, plan (SOAP) note writing on primary care (PC) advanced pharmacy practice experiences (APPEs), and to assess reliability and student perceptions of the rubric. Methods. Ten PC APPE faculty members collaborated to develop a rubric to provide formative and summative feedback on three written SOAP notes per APPE student over a 10-month period. Correlation analyses were conducted between rubric scores and three criterion variables to assess criterion-related validity: APPE grades, Pharmaceutical Care Ability Profile Scores, and Global Impression Scores. Inter-rater and intra-rater reliability testing were completed using Cohen's kappa and Intraclass Correlation Coefficients (ICC). Student perceptions were assessed through an anonymous student survey. Results. Fifty-one students and 167 SOAP notes were evaluated using the final rubric. The mean score significantly increased from the first to second SOAP note and from the first to third SOAP note. Statistically significant positive correlations were found between final rubric scores and criterion variables. The ICC for inter-rater reliability was fair (.59) for final rubric scores and excellent for intra-rater reliability (.98 to1.00). Students responded that the rubric improved their ability (84.9%) and confidence (92.4%) to write SOAP notes. Conclusion. The rubric may be used to make valid decisions about students' SOAP note writing ability and may increase their confidence in this area. The use of the rubric allows for greater reliability among multiple graders, supporting grading consistency.

Cranberry Products for the Prophylaxis of Urinary Tract Infections in Pediatric Patients.

OBJECTIVE: To evaluate the existing data regarding the use of cranberry products for the prevention of urinary tract infections (UTIs) in pediatric patients. DATA SOURCES: A literature search of Medline databases from 1966 to June 2015 was conducted. STUDY SELECTION AND DATA EXTRACTION: The databases were searched using the terms "pediatrics," "children," "cranberry," "cranberry juice," and "urinary tract infections." The identified trials were then searched for additional references applicable to this topic. DATA SYNTHESIS: A total of 8 clinical trials were identified that examined the use of cranberry products, mostly juice, for the prevention of UTIs in children. Three trials examined the use in otherwise healthy children. Five trials examined the use in pediatric patients with underlying urogenital abnormalities of which 2 compared cranberry to antibiotics. In healthy pediatric patients, cranberry use was associated with a reduction in the overall number of UTIs and a decrease in the number of antibiotic days per year for UTI treatment. In patients with urogenital abnormalities, results were conflicting, with some studies showing no reduction in UTIs compared with placebo, but others demonstrating a significant reduction. However, cranberry products had similar efficacy when compared with both cefaclor and trimethoprim. All studies used a wide variety of doses and frequencies of cranberry, making specific product recommendations difficult. CONCLUSIONS: Cranberry appears effective for the prevention of UTIs in otherwise healthy children and is at least as effective as antibiotics in children with underlying urogenital abnormalities. However, recommendations for cranberry dosing and frequency cannot be confidently made at this time. Larger, well-designed trials are recommended.

A critical appraisal of and recommendations for faculty development.

The 2009-2010 American Association of Colleges of Pharmacy (AACP) Council of Faculties Faculty Affairs Committee reviewed published literature assessing the scope and outcomes of faculty development for tenure and promotion. Relevant articles were identified via a PubMed search, review of pharmacy education journals, and identification of position papers from major healthcare professions academic organizations. While programs intended to enhance faculty development were described by some healthcare professions, relatively little specific to pharmacy has been published and none of the healthcare professions have adequately evaluated the impact of various faculty-development programs on associated outcomes.The paucity of published information strongly suggests a lack of outcomes-oriented faculty-development programs in colleges and schools of pharmacy. Substantial steps are required toward the development and scholarly evaluation of faculty-development programs. As these programs are developed and assessed, evaluations must encompass all faculty subgroups, including tenure- and nontenure track faculty members, volunteer faculty members, women, and underrepresented minorities. This paper proposes AACP, college and school, and department-level recommendations intended to ensure faculty success in achieving tenure and promotion.

Implementation of a weight management pharmaceutical care service.

BACKGROUND: Obesity, a national epidemic, is one of the leading causes of preventable morbidity and mortality in the US. Pharmacists can play an integral role in weight management. Offering weight management services provides an opportunity to increase public awareness of pharmaceutical care and attract patients to pharmacy programs. OBJECTIVE: To describe the implementation and evaluate outcomes of a weight management pharmaceutical care service in a stand alone pharmaceutical care center on a college campus. METHODS: A retrospective review of data was conducted on 289 patient charts to evaluate the change in weight, body mass index (BMI), percent body fat, and weight-related health conditions in patients who participated in the Healthy Habits program. RESULTS: The net change (change in values observed from first to last appointment) in weight was a loss of 1021.8 kg. The maximum weight change (change seen from the first appointment to the lowest value obtained during the program) was a loss of 1530.5 kg. These values correspond to a net mean weight loss of 3.6 kg per patient (10% of baseline weight) and a maximum mean weight loss per patient of 5.5 kg (15% of baseline weight). Eighty-three patients were able to decrease their BMI category and 76 patients had a decrease in risk status from baseline. CONCLUSIONS: The Auburn University Pharmaceutical Care Center's Healthy Habits program has been successful in helping patients decrease total body weight, BMI, and risk of weight-related complications. In addition, the program has increased the opportunity to identify other pharmaceutical care needs of patients and help establish the role of pharmacists in the management of obesity.

Devices for ambulatory and home monitoring of blood pressure, lipids, coagulation, and weight management, part 2.

PURPOSE: The equipment and methods used for ambulatory and home monitoring of blood pressure, lipids, coagulation, and weight management are discussed. SUMMARY: Over 100 million people in the United States have one or more chronic diseases, such as diabetes, hypertension, and asthma. With the goal to improve health while reducing costs and the overall health care burden, ambulatory and home monitoring by pharmacists and patients are receiving more attention. Ambulatory and home monitoring of blood pressure, cholesterol, coagulation, and weight management (including devices for assessing overweight and obese patients, heart rate monitors, and pedometers) are convenient for clinicians and patients. Such monitoring provides pharmacists with an opportunity to differentiate their practices. Studies suggest that patients who are involved in ambulatory and home monitoring take a more active role in their health and may have better adherence to a prescribed diet and medication regimens. Studies also show that ambulatory and home monitoring, if done correctly, provide clinicians with a large quantity of reliable readings for future therapeutic decisions. Devices are also a means for pharmacists to increase their provision of pharmacy services. Ambulatory monitoring is billable in many clinic settings, and the devices can be a profitable addition to prescription services. CONCLUSION: Many devices are available to assist patients and clinicians in monitoring blood pressure, lipids, coagulation, and weight management. Familiarity with the devices will help in their proper selection and use.

Devices for ambulatory and home monitoring of blood pressure, lipids, coagulation, and weight management, part 1.

PURPOSE: The equipment and methods used for ambulatory and home monitoring of blood pressure, lipids, coagulation, and weight management are discussed. SUMMARY: Over 100 million people in the United States have one or more chronic diseases, such as diabetes, hypertension, and asthma. With the goal to improve health while reducing costs and the overall health care burden, ambulatory and home monitoring by pharmacists and patients are receiving more attention. Ambulatory and home monitoring of blood pressure, cholesterol, coagulation, and weight management (including devices for assessing overweight and obese patients, heart rate monitors, and pedometers) are convenient for clinicians and patients. Such monitoring provides pharmacists with an opportunity to differentiate their practices. Studies suggest that patients who are involved in ambulatory and home monitoring take a more active role in their health and may have better adherence to prescribed diet and medication regimens. Studies also show that ambulatory and home monitoring, if done correctly, provide clinicians with a large quantity of reliable readings for future therapeutic decisions. Devices are also a means for pharmacists to increase their provision of pharmacy services. Ambulatory monitoring is billable in many clinic settings, and the devices can be a profitable addition to prescription services. CONCLUSION: Many devices are available to assist patients and clinicians in monitoring blood pressure, lipids, coagulation, and weight management. Familiarity with the devices will help in their proper selection and use.

Suspected beta-antagonist-induced thrombocytopenia.

OBJECTIVE: To report a case of possible beta-antagonist-induced thrombocytopenia. CASE SUMMARY: A 44-year-old African American woman with systemic lupus erythematosus developed thrombocytopenia. Splenic sequestration was suspected, but the rise in platelets after splenectomy was temporary. Bacterial and viral etiologies were ruled out, since thrombocytopenia continued 6 months after splenectomy. Her medications acetaminophen, amitriptyline, amlodipine, beta-antagonists, and diphenhydramine were suspected. Nadolol and labetalol were started immediately prior to splenectomy. Six months after splenectomy, the woman was hospitalized for pneumonia; the platelet count was 50 x 10(3)/mm(3). Nadolol was discontinued on day 2. Within 24 hours, the platelet count rose to 128 x 10(3)/mm(3) and exceeded 200 x 10(3)/mm(3) by day 7. Labetalol was discontinued on day 8, but no additional significant rise occurred. The patient developed thrombocytopenia one year later when placed on nadolol and famotidine during admission for a gastrointestinal bleed. The platelet count decreased during the admission. Both drugs were discontinued after the last platelet count (100 x 10(3)/mm(3)). The platelet count had normalized by the follow-up visit 16 days later and remained normal until the patient's death almost a year later. DISCUSSION: Thrombocytopenia is not a common adverse effect of beta-antagonist therapy. As of February 1, 2005, only 4 case reports of suspected beta-antagonist-associated thrombocytopenia have been published in English, and the medications cited are unavailable within the US. After splenectomy, the thrombocytopenia might have resolved if the beta-antagonists had not been present. Since thrombocytopenia resolved within 24 hours of discontinuation of nadolol, it is likely that the continued thrombocytopenia was beta-antagonist induced. The likelihood that the beta-antagonist caused the adverse event is possible according to the Naranjo probability scale. CONCLUSIONS: The temporal association between the discontinuation of nadolol and the rise in platelets suggests that the thrombocytopenia resulted from nadolol.