Developing and Implementing an Entrustable Professional Activity Assessment for Pharmacy Practice Experiences.

Objective. To develop, implement, and validate an entrustable professional activity (EPA) assessment tool that could be used to calculate course grades for experiential students in all practice environments. Methods. An EPA assessment tool was developed and directly mapped to 18 EPAs, and a criterion, or passing score, for each EPA was established for all practice experiences. The EPA assessment tool was implemented in the college's experiential program during summer 2018 and comparative outcomes and reliability of the EPA assessment tool were assessed within the core advanced pharmacy practice experiences (APPEs). Results. The EPA assessment tool reliability was strong (Cronbach's alpha=0.93), with preceptor-suggested grades and grades calculated using the EPA assessment tool equivalent in 95% of completed APPEs. All nonequivalent calculated-preceptor grade pairs were evenly split between one grade higher than scored and one grade lower than scored. Conclusion. The EPA assessment tool is a reliable and valid instrument for assessing EPA achievement in the APPE year. Future work should focus on determining the longitudinal utility of the EPA tool by comparing outcomes in introductory and advanced pharmacy practice experiences.

Factors associated with medication adherence and persistence of treatment for hypertension in a Medicaid population.

BACKGROUND: Non-adherence with antihypertensive therapy is a significant problem. Prior research has generally focused upon one drug or one drug class. Current information across multiple antihypertensive drug classes is limited. OBJECTIVES: To describe the initial treatment of recipients of Louisiana Medicaid with newly-diagnosed hypertension; evaluate differences in adherence and persistence rates among multiple antihypertensive drug classes; and test the association of drug classes, race, gender, age and comorbidity with adherence and persistence to drug therapy. METHODS: In a retrospective analysis of administrative claims data, initial therapy was described by type and drug class for 4544 Medicaid recipients with newly-diagnosed hypertension. Recipients were placed into cohorts based upon drug classes (diuretics, beta-blockers, angiotensin-II receptor blockers, angiotensin converting enzyme inhibitors, and calcium channel blockers). Persistence with drug therapy and Medication Possession Ratios (MPR) were calculated for 6-month and 12-month periods following diagnosis. Drug class and demographic variables were used as predictor variables in logistic regression analyses of persistence and MPR. RESULTS: Recipients in the study group were primarily female (66%) and Black (65%). Recipients initially were treated with monotherapy (33%), multiple drugs (11%), fixed combinations (8%) or no drugs (48%). After one year, 62% of recipients were not receiving drug therapy. Persistence rates by cohort ranged from 26% to 42% at 6-months following diagnosis, and 14%-28% at 12-months. The proportion of recipients by cohort with MPRs of 0.8 or above ranged from 43% to 60% at 6-months and 25%-42% at 12-months. Race, comorbidities, and initial drug therapy were significant predictors of both persistence and MPR. CONCLUSIONS: Within this study group, adherence and persistence to medication therapy were less than optimal. Future efforts to improve compliance with medication therapy could be focused upon specific groups having poor adherence and/or persistence within the drug class cohorts analyzed in this study.

Simulation-based learning about medication management difficulties of low-vision patients.

OBJECTIVE: To implement and evaluate a simulation activity and related assignments within a geriatric elective to teach pharmacy students about the medication management difficulties experienced by low-vision patients. DESIGN: Students wore low-vision simulation goggles while engaging in medication management tasks. Students also reflected on their experiences in journals and developed modalities to improve low-vision patients' access to prescription information. ASSESSMENT: Results of a perception survey indicated that students were able to identify and differentiate among various low-vision medication management difficulties. Students' reflections suggested that they recognized the challenges encountered by low-vision patients. All patient assistance project submissions were suitable for the targeted populations and medication management difficulties. Peer review and student feedback of the activities were favorable. CONCLUSION: Through this low-vision goggle simulation exercise and other activities, students were able to identify the medication management difficulties encountered by low-vision patients and propose solutions to their drug information access problems.

Low vision simulator goggles in pharmacy education.

OBJECTIVE: To develop simulator goggles that produce disease-specific characteristics of selected low vision conditions for use in pharmacy education. METHODS: Individual sets of simulator goggles were developed for glaucoma, cataracts, macular degeneration, diabetic retinopathy, and retinitis pigmentosa. Students rated the presence and severity of disease-specific characteristics after wearing each pair of goggles while manipulating medication-related materials. RESULTS: One hundred students completed the study. Characteristic symptoms for each disease state were experienced at a moderate to severe level (p < 0.0001). Subjects indicated a high level of agreement among symptom ratings for each disease (Kendall's coefficient = 0.82). CONCLUSIONS: Low vision simulator goggles reliably produced the characteristics of selected conditions experienced in a medication management environment. Further studies are needed to identify suitable patient-centered learning activities using these goggles.

Implementing a referral to telephone tobacco cessation services in Louisiana community pharmacies: a pilot study.

BACKGROUND: With one of the highest rates of tobacco dependence in the nation, Louisiana has been searching for economical and effective methods for assisting patients in cessation efforts. Community pharmacists are in an excellent position to promote tobacco cessation due to their availability to patients. The "Ask-Advise-Refer" model is a short intervention in which patients desiring to quit smoking are referred to free tobacco cessation telephone counseling services. OBJECTIVE: To evaluate the implementation of the Ask-Advise-Refer model in a sample of Louisiana pharmacies and identify barriers experienced by pharmacists when identifying and referring appropriate patients. METHODS: Nine pharmacists from across the state implemented the Ask-Advise-Refer model in their community pharmacies. Each pharmacist submitted a weekly tally sheet consisting of number of patients asked about tobacco dependence, number of patients not ready to quit, number referred to tobacco cessation telephone counseling, number enrolled in study, and amount of time involved with interventions. Additionally, participating pharmacists completed a self-administered survey at the completion of the pilot study to determine opinions on barriers to widespread implementation of the program. RESULTS: Over a 6-month period, the 9 pharmacists asked 5429 patients about tobacco dependence. Of the 657 self-identified tobacco-dependent patients, 478 (72.8%) were not ready to quit, and 179 (27.2%) indicated that they were ready to quit tobacco in the next 30 days. Of the patients ready to quit, 169 (94.4%) were referred to telephone counseling services to assist in their cessation efforts. CONCLUSIONS: Louisiana community pharmacists have the ability to screen and identify tobacco-dependent patients ready to quit tobacco use, but barriers exist that prevent a large number of these patients from being referred to available, free cessation counseling.