Pharmacists' and general practitioners' pharmacology knowledge and pharmacotherapy skills.

Understanding differences in the pharmacology knowledge and pharmacotherapy skills of pharmacists and physicians is vital to optimizing interprofessional collaboration and education. This study investigated these differences and the potential influence of work experience. The pharmacology knowledge and pharmacotherapy skills of pharmacists, general practitioners (GPs), and trainees were compared, using a written assessment; 294 participants were included. Overall scores (mean ± SD) ranged from 69.3% ± 6.5% to 76.5% ± 9.5% for basic knowledge, 70.3% ± 10.8% to 79.7% ± 8.4% for applied knowledge, and 66.3% ± 21.1% to 84.7% ± 20.7% for pharmacotherapy skills (analysis of variance all P < .05). The pharmacists had the highest scores for all domains (P < .05), with the exception of pharmacist trainees, who had comparable scores for basic knowledge and pharmacotherapy skills (both P > .05). The GPs scored the lowest for pharmacotherapy skills (P < .05). More work experience was associated with better knowledge of applied pharmacology among pharmacists (by 2% per 10 work-years), but with poorer pharmacotherapy skills among pharmacists and GPs (by 3% and 4% per 10 work-years, respectively). In conclusion, pharmacists and GPs differ in their knowledge and skills, and these differences become more pronounced with more work experience. In general, pharmacists outperform pharmacist trainees, whereas GP trainees outperform GPs. These differences could be important for interdisciplinary collaboration and education.

Education on prescribing for older patients in the Netherlands: a curriculum mapping.

PURPOSE: Pharmacology and pharmacotherapy education is being increasingly integrated in medical curricula, which might lead to a specific loss of knowledge in these subjects. This, in turn, could lead to harmful prescribing errors, especially in vulnerable older patients. METHODS: Teachers who coordinated education in Dutch medical schools completed a structured interview on (geriatric) pharmacology and pharmacotherapy education. A list of core learning goals was developed. Pharmacology and pharmacotherapy education in general was compared to geriatric pharmacology and pharmacotherapy education. RESULTS: All Dutch medical schools participated. Contact hours for education in pharmacology and pharmacotherapy ranged from 39 to 107 h; ECTSs (representing 28 study hours) ranged from 0 to 3. The various curricula covered, on average, 79% of all learning goals for these subjects: knowledge 85%, skills 76%, and attitudes 66%; the curricula also covered specific geriatric goals: knowledge 87% and skills 65%. All geriatric learning goals were met if a geriatrician was among the coordinators. Half (4 of 8) of the medical schools lacked appropriate assessment procedures. Evaluation was mostly based on students' opinions. Teachers rated students as being moderately well prepared for daily practice. CONCLUSIONS: There are large differences in the quantity and quality of (geriatric) pharmacology and pharmacotherapy education in Dutch medical schools. In general, more time should be devoted to skills and attitude, and the assessment procedures should be optimized with high priority. Other curricula with a problem-based approach might benefit from the points of improvement described in this article.

Implementation of the WHO-6-step method in the medical curriculum to improve pharmacology knowledge and pharmacotherapy skills.

AIM: The only validated tool for pharmacotherapy education for medical students is the 6-step method of the World Health Organization. It has proven effective in experimental studies with short term interventions. The generalizability of this effect after implementation in a contextual-rich medical curriculum was investigated. METHODS: The pharmacology knowledge and pharmacotherapy skills of cohorts of students, from years before, during and after implementation of a WHO-6-step-based integrated learning programme were tested using a standardized assessment containing 50 items covering knowledge of basic (n = 25) and clinical (n = 24) pharmacology, and pharmacotherapy skills (n = 1 open question). All scores are expressed as a percentage of the maximum score possible per (sub)domain. RESULTS: In total, 1652 students were included between September 2010 and July 2014 (participation rate 89%). The WHO-6-step-based learning programme improved students' knowledge of basic pharmacology (mean score ± SD, 60.6 ± 10.5% vs. 63.4 ± 10.9%, P < 0.01) and clinical or applied pharmacology (63.7 ± 10.4% vs. 67.4 ± 10.3%, P < 0.01), and improved their pharmacotherapy skills (68.8 ± 26.1% vs. 74.6% ± 22.9%, P 0.02). Moreover, satisfaction with education increased (5.7 ± 1.3 vs. 6.3 ± 1.0 on a 10-point scale, P < 0.01) and as did students' confidence in daily practice (from -0.81 ± 0.72 to -0.50 ± 0.79 on a -2 to +2 scale, P < 0.01). CONCLUSIONS: The WHO-6-step method was successfully implemented in a medical curriculum. In this observational study, the integrated learning programme had positive effects on students' knowledge of basic and applied pharmacology, improved their pharmacotherapy skills, and increased satisfaction with education and self-confidence in prescribing. Whether this training method leads to better patient care remains to be established.

[Need for improvement in education on appropriate prescribing in elderly patients]. / Onderwijs in het voorschrijven aan ouderen moet beter.

Prescribing errors can cause great harm to patients. In the Netherlands, it is estimated that 7000 preventable medication-related hospitals admissions occur annually, caused in many cases by prescribing errors. Elderly patients are at greatest risk, since this patient demographic is most likely to be prescribed multiple medications. Robust education on appropriate prescribing is essential for all clinicians with the authority to prescribe. Currently, some issues still require improvement in the Netherlands: a) education continues to focus heavily on basic pharmacology knowledge instead of patient related pharmacotherapy skills, b) an appropriate assessment procedure on pharmacotherapy knowledge and skills is often lacking, c) there is no mandatory requirement for physicians to maintain their knowledge and skills in the field of pharmacotherapy during their working career. In this article we discuss means to improve this situation, with the overall aim to ensure that all vulnerable elderly patients are in safe hands with each physician.

Structured pharmaceutical analysis of the Systematic Tool to Reduce Inappropriate Prescribing is an effective method for final-year medical students to improve polypharmacy skills: a randomized controlled trial.

Medical students may not be adequately trained to prescribe appropriately to older adults with polypharmacy. This study addressed how to teach students to minimize inappropriate polypharmacy. Final-year medical students (N = 106) from two Dutch schools of medicine participated in this randomized controlled trial with a pre/posttest design. The Systematic Tool to Reduce Inappropriate Prescribing (STRIP) was used as the intervention. This medication review tool consists of five steps and is part of the Dutch multidisciplinary guideline on polypharmacy. Step two is a structured pharmaceutical analysis of drug use, assessed using six questions regarding undertreatment, ineffective treatment, overtreatment, potential adverse effects, contraindications or interactions, and dose adjustments. It is used in combination with the Screening Tool to Alert doctors to Right Treatment and the Screening Tool of Older Person's Prescriptions checklists. Students were asked to optimize the medication lists of real people, making use, or not, of the STRIP. The number of correct or potentially harmful decisions that the students made when revising the lists was determined by comparison with expert consensus. Students who used the STRIP had better scores than control students; they made more correct decisions (9.3 vs 7.0, 34%; P < .001, correlation coefficient (r) = 0.365) and fewer potentially harmful decisions (3.9 vs 5.6, -30%; P < .001, r = 0.386). E-learning did not have a different effect from that of non-E-learning methods. Students were satisfied with the method. The STRIP method is effective in helping final-year medical students improve their prescribing skills.

A comparison of medical and pharmacy students' knowledge and skills of pharmacology and pharmacotherapy.

AIM: Pharmacotherapy might be improved if future pharmacists and physicians receive a joint educational programme in pharmacology and pharmacotherapeutics. This study investigated whether there are differences in the pharmacology and pharmacotherapy knowledge and skills of pharmacy and medical students after their undergraduate training. Differences could serve as a starting point from which to develop joint interdisciplinary educational programmes for better prescribing. METHODS: In a cross-sectional design, the knowledge and skills of advanced pharmacy and medical students were assessed, using a standardized test with three domains (basic pharmacology knowledge, clinical or applied pharmacology knowledge and pharmacotherapy skills) and eight subdomains (pharmacodynamics, pharmacokinetics, interactions and side-effects, Anatomical Therapeutic Chemical Classification groups, prescribing, prescribing for special groups, drug information, regulations and laws, prescription writing). RESULTS: Four hundred and fifty-one medical and 151 pharmacy students were included between August 2010 and July 2012. The response rate was 81%. Pharmacy students had better knowledge of basic pharmacology than medical students (77.0% vs. 68.2% correct answers; P < 0.001, δ = 0.88), whereas medical students had better skills than pharmacy students in writing prescriptions (68.6% vs. 50.7%; P < 0.001, δ = 0.57). The two groups of students had similar knowledge of applied pharmacology (73.8% vs. 72.2%, P = 0.124, δ = 0.15). CONCLUSIONS: Pharmacy students have better knowledge of basic pharmacology, but not of the application of pharmacology knowledge, than medical students, whereas medical students are better at writing prescriptions. Professional differences in knowledge and skills therefore might well stem from their undergraduate education. Knowledge of these differences could be harnessed to develop a joint interdisciplinary education for both students and professionals.

Geriatric pharmacology and pharmacotherapy education for health professionals and students: a systematic review.

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT: The rate of medication errors is high, and these errors can cause adverse drug reactions. Elderly individuals are most vulnerable to adverse drug reactions. One cause of medication errors is the lack of drug knowledge on the part of different health professionals. Medical curricula have changed in recent years, resulting in less education in the basic sciences, such as pharmacology. WHAT THIS STUDY ADDS: Our study shows that little curricular time is devoted to geriatric pharmacology and that educational programmes in geriatric pharmacology have not been thoroughly evaluated. While interest in pharmacology education has increased recently, this is not the case for geriatric pharmacology education. Education on geriatric pharmacology should have more attention in the curricula of health professionals, given the often complex pharmacotherapy in elderly patients. Educational topics should be related to the known risk factors of medication errors, such as polypharmacy, dose adjustments in organ dysfunction and psychopharmacotherapeutics. AIMS: Given the reported high rates of medication errors, especially in elderly patients, we hypothesized that current curricula do not devote enough time to the teaching of geriatric pharmacology. This review explores the quantity and nature of geriatric pharmacology education in undergraduate and postgraduate curricula for health professionals. METHODS: Pubmed, Embase and PsycINFO databases were searched (from 1 January 2000 to 11 January 2011), using the terms 'pharmacology' and 'education' in combination. Articles describing content or evaluation of pharmacology education for health professionals were included. Education in general and geriatric pharmacology was compared. RESULTS: Articles on general pharmacology education (252) and geriatric pharmacology education (39) were included. The number of publications on education in general pharmacology, but not geriatric pharmacology, has increased over the last 10 years. Articles on undergraduate and postgraduate education for 12 different health disciplines were identified. A median of 24 h (from 15 min to 4956 h) devoted to pharmacology education and 2 h (1-935 h) devoted to geriatric pharmacology were reported. Of the articles on education in geriatric pharmacology, 61.5% evaluated the teaching provided, mostly student satisfaction with the course. The strength of findings was low. Similar educational interventions were not identified, and evaluation studies were not replicated. CONCLUSIONS: Recently, interest in pharmacology education has increased, possibly because of the high rate of medication errors and the recognized importance of evidence-based medical education. Nevertheless, courses on geriatric pharmacology have not been evaluated thoroughly and none can be recommended for use in training programmes. Suggestions for improvements in education in general and geriatric pharmacology are given.

Pertussis toxin-induced histamine sensitisation: an aspecific phenomenon independent from the nitric oxide system?

Mechanisms were studied initially to develop an in vitro safety test for detecting pertussis toxin toxicity in acellular pertussis vaccines based on the histamine sensitisation test. Maximal contractions and sensitivities to different agonists and adrenoceptor-induced contractions in Ca2+-free medium of isolated rat small mesenteric resistance arteries were significantly reduced by in vivo [30 microg/kg, intravenously (i.v.), day 5] or in vitro (10 microg/ml, 2 h) pertussis toxin pretreatment. Pertussis toxin-induced decrease in sensitivity of small mesenteric resistance arteries to noradrenaline was endothelium-dependent. Nomega-nitro-L-arginine methyl ester (L-NAME) (100 microM, 20 min) did not reestablish the sensitivity to noradrenaline. In vivo L-NAME treatment (0, 1, 10 or 30 mg/kg) of pertussis toxin-pretreated (15 microg/kg) rats did not reduce pertussis toxin-induced enhancement of the histamine-induced decrease in blood pressure and histamine (10, 30, 100 or 300 mg/kg) induced mortality. Finally, in vivo pertussis toxin pretreatment sensitises rats for sodium nitroprusside (50 microg/kg/min). We conclude that pertussis toxin-induced histamine sensitisation is caused by an interference of pertussis toxin with the contractile mechanisms of vascular smooth muscle of resistance arteries which indicates only an indirect role for histamine in the histamine sensitisation test.

In vivo pertussis toxin treatment reduces contraction of rat resistance arteries but not that of mouse trachea.

In order to develop an in vitro method for detecting residual pertussis toxin activity in acellular pertussis vaccines, the effects of in vivo pertussis toxin treatment on contraction and relaxation properties of isolated mouse trachea and of isolated rat small mesenteric resistance arteries were studied. In vivo pertussis toxin treatment (24 or 72 microg/kg, intraperitoneally (i.p.)) did not affect contraction and relaxation properties of isolated BALB/c or NIH mouse trachea. In vivo pertussis toxin treatment (30 microg/kg, intravenously) significantly reduced noradrenaline- or KCl-induced maximal contraction and reduced sensitivity to noradrenaline in isolated male Wistar rat small mesenteric resistance arteries. However, in vivo pertussis toxin treatment did not affect relaxation properties of isolated rat small mesenteric resistance arteries. These results support the hypothesis that vasoconstriction-regulating mechanisms and not airway constriction mechanisms are involved in pertussis toxin-induced histamine sensitisation. The vasoconstriction-regulating mechanisms may provide a lead for further development of an in vitro method for measuring biologically active pertussis toxin in acellular pertussis vaccines based on mechanisms involved in the histamine sensitisation test.

Pertussis toxin relaxes small arteries with no vascular lesions or vascular smooth muscle cell injury.

Previous studies showed that pertussis toxin (PT) decreased agonist-induced contractions of isolated rat small mesenteric resistance arteries independently from endothelium, nitric oxide-synthase or intracellular calcium concentrations. In this study, it was investigated if the PT-induced decreased contractile properties of small mesenteric resistance arteries could be a consequence of a PT-induced vascular and/or smooth muscle cell injury, leading to loss of contractile functionality. Male Wistar rats were treated with PT (30 microg/kg, intravenously) and sections of isolated small mesenteric resistance arteries were investigated with light- and electron microscopy. Light microscopic investigation of cross-sectioned small mesenteric resistance arteries of control animals clearly showed a contracted phase, while PT-pretreated animals showed a relaxed smooth inner surface of the vessel, indicating a vasodilated state. Electron microscopic investigation showed that PT-pretreatment neither induced vascular lesions nor caused morphological or numerical changes in cell organelles such as contractile elements of vascular smooth muscle cells. In conclusion, the PT-induced decreased contractile properties of isolated rat small resistance arteries are not caused by a PT-induced vascular and/or smooth muscle cell injury.