Reducing 30-Day All-Cause Rehospitalizations: A Pharmacist-Led Telehealth Service.

BACKGROUND: Use of skilled nursing facilities (SNFs) has grown as an intermediary step for patients unready to discharge to lower acuity care settings. Discharge planning from SNFs has become a critical component of the care continuum and may impact patient outcomes and facility payment status. Currently, the discharge process does not include a pharmacist-led comprehensive medication review.
OBJECTIVES: To determine the impact of a pharmacistdriven discharge consultation service on 30-day allcause rehospitalization. Secondary outcomes included hospital readmission diagnosis, discharge consultation times, number of pharmacist interventions, and patient satisfaction.
METHODS: The institutional review board approved this prospective cohort with a historical control pilot study to evaluate patients discharging from SNFs. Patients who provided informed consent were enrolled to participate in a video consultation service at the time of discharge. The primary outcome measured was 30-day hospital readmission rate postdischarge compared with one year prior.
RESULTS: One hundred ninety-six counseling sessions were performed at three facilities. The average time per discharge was 15.4 ± 3.3 minutes, average number of medications was 15.5 ± 6.2, and average Charlson Comorbidity Index was 5.6 ± 2.2. Patient readmission data were tracked by diagnosis and reported by facility.
CONCLUSION: A positive correlation between reduced readmission rates and participation in consultation service were observed. Second, positive patient satisfaction surveys indicated patients value medication education. The use of a pharmacist-led telehealth service like the one described in this study may lead to a reduction in facility readmission penalties and improve patient access to pharmacist services in remote locations.

The design and evaluation of a pilot covisit model: Integration of a pharmacist into a primary care team.

OBJECTIVE: To describe the integration and evaluation of a pharmacist into a primary care team utilizing a pilot covisit model to improve and expand care. SETTING: An urban satellite practice of a multisite, urban federally qualified health center. PRACTICE DESCRIPTION: Cincinnati Health Department is a large, multisite, federally qualified health center (FQHC) serving residents of southwest Ohio. This study took place at one satellite clinic-Millvale Health Center. PRACTICE INNOVATION: Redesigning the primary care team by integrating a pharmacist 1 day per week utilizing a covisit model. This was done to improve workflow in the management of patients with uncontrolled chronic disease, focusing on those with diabetes. EVALUATION: Changes in clinical outcomes of patients with diabetes using glycosylated hemoglobin (A1C) and systolic and diastolic blood pressures were compared with productivity information from covisits conducted between February 1, 2018, and May 30, 2019, using defined time frames. RESULTS: Improvement in A1C of 0.46% (n = 55, P = 0.059) and both systolic and diastolic blood pressure by 1.18/2.56 mmHg (n = 82, P = 0.459, P = 0.023, respectively) were seen in patients within the covisit model from baseline to final. Reductions in these markers were not correlated with the number of visits within the pilot model (A1C rs = 0.237, systolic blood pressure rs = 0.090, diastolic blood pressure rs = 0.115). A total of 95 patients with diabetes were seen at 147 covisit appointments; each patient had an average of 1.77 appointments within the model (range, 1-6). The most frequently discussed disease states included diabetes and hypertension, and visits were frequently 30 minutes or longer in duration. CONCLUSION: Integrating a pharmacist into a primary care team within a FQHC offers potential improvements in both productivity as well as chronic disease state markers.

The implementation and evaluation of health professions students as health coaches within a diabetes self-management education program.

BACKGROUND AND PURPOSE: The purpose of this article is to describe how health professions students were trained and incorporated as health coaches into a group diabetes self-management education (DSME) program in an underserved, urban federally qualified health center. EDUCATIONAL ACTIVITY AND SETTING: Nursing, pharmacy, and physical therapy students from three local colleges were provided health coach training and then integrated into the DSME program with faculty assistance. The students connected with the assigned participants both in person and via weekly telephone calls over a three-month time period, applying concepts learned and providing patient-centered support. FINDINGS: Students noted self-reported improvement in their own perceived knowledge, skills, and attitudes related to health coaching from both qualitative (weekly and end of experience reflections) and quantitative (pre- and post-survey) measures. Participants were also engaged in assessing the program directly via survey responses and indirectly via attainment of personal health-related behavior change goals based on American Association of Diabetes Educators Seven Self-Care Behaviors. SUMMARY: With appropriate training and support from faculty, health professions students were successfully incorporated into an existing DSME program in the role of health coach, gaining knowledge, skills, and attitudes needed to help patients make behavior change.

Motivational interviewing education: Creation and assessment of a learning module implemented among advanced pharmacy practice students.

BACKGROUND AND PURPOSE: The purpose of this prospective nonrandomized study (quasi-experimental), pre-/post-intervention design was to implement and assess a formal orientation training program for Advanced Pharmacy Practice Experience (APPE) students focusing on skills related to motivational interviewing (MI). EDUCATIONAL ACTIVITY AND SETTING: Students were assessed on their knowledge, perceived ability, and perceived need to incorporate MI in practice using a pre-/posttest. Ability was assessed via student-conducted patient interviews, and performance was compared to published standards. Satisfaction with the training program was reviewed using a Likert scale questionnaire. Fourteen APPE students from three colleges of pharmacy were enrolled based on pre-assigned community experience placement. Students participated in a didactic training phase consisting of on-line knowledge acquisition and assessments. A modeling phase was implemented with role-play experiences and simulated video assessments. A shadowing phase was incorporated consisting of students observing a preceptor prior to independently conducting patient interviews. Interactions were audio recorded and reviewed by a preceptor with verbal and written feedback provided twice monthly using a standardized rubric. FINDINGS: Data revealed statistically significant improvements in all categories of the pre-/posttest. MI ability results showed statistically significant improvements as well. Performance scores were higher than goal values in video simulated assessments. Overall student satisfaction with the training program was 4.3 out of 5. DISCUSSION AND CONCLUSIONS: Data suggests the training program increased students understanding and ability to perform MI in patient interviews. High quality of student performance is also suggested due to trained students' post scores being higher than goal values published by scoring manual.

Clinical outcomes of switching from insulin glargine to NPH insulin in indigent patients at a charitable pharmacy: The Charitable Insulin NPH: Care for the Indigent study.

OBJECTIVES: To assess the clinical outcomes of indigent patients with type 2 diabetes served by a charitable pharmacy after therapy change from insulin glargine to NPH insulin. DESIGN: This was a 24-week prospective pilot study. SETTING: Community charitable pharmacy. PARTICIPANTS: Underserved, financially disadvantaged adults with type 2 diabetes. INTERVENTION: Conversion from insulin glargine to NPH insulin. MAIN OUTCOME MEASURES: HbA1c, 30-day average blood glucose, number of suspected and confirmed hypoglycemic episodes, total insulin dose, and Morisky Medication Adherence Scale (MMAS) scores. RESULTS: Patients in both control and intervention groups improved in disease-state clinical markers, safety profile, and total insulin dose. MMAS scores were unchanged. CONCLUSION: There were no statistically significant differences in glycemic control or hypoglycemic episodes between the control (NPH insulin) or intervention group (insulin glargine to NPH insulin).

Learning across the curriculum: connecting the pharmaceutical sciences to practice in the first professional year.

OBJECTIVES: To facilitate the student's ability to make the connection of the core foundational basic science courses to the practice of pharmacy. DESIGN: In 2000, 10 faculty members from basic science and practice courses created and implemented an integrated Patient Care Project for which students chose a volunteer patient and completed 15 different assignments ASSESSMENT: Evidence of student learning, such as grades and reflective comments along with collected evaluative data, indicated an enhancement in students' perceived understanding of the connection between basic science and patient care. CONCLUSION: The Patient Care Project provided students an opportunity to use knowledge gained in their first-year foundational courses to the care of a patient, solidifying their understanding of the connection between basic science and patient care.

The design and evaluation of an interprofessional elective course with a cultural competence component.

Faculty from the Colleges of Nursing, Pharmacy, Social Work and Allied Health Sciences at the University of Cincinnati collaborated to create an elective course that focused on providing students the opportunity for interprofessional education (IPE) and cultural competence training. The course was designed around the educational principles described in the literature as most effective for IPE: interpersonal and small-group skills, face-to-face interaction, positive interdependence, individual accountability and group processing. Impact of the course was assessed using two questionnaires focusing on interdisciplinary interactions and cultural competence, respectively. The Student Attitude Questionnaire (SAQ) and Inventory for Assessing The Process of Cultural Competence Among Health Care Professionals-Revised (IAPCC-R) were administered to students prior to the start of the course and at the end of the course. The SAQ results indicated that students perceived the course to be beneficial in the following areas: interprofessional team work, professionalism, self-confidence, communication skills, and improved understanding of the roles of health professionals and the impact of each profession on patient care. The course also promoted students' progress on their personal and professional journeys toward cultural proficiency as noted by changes in their pre//post-course IAPCC-R scores. Students moved from being culturally aware to becoming culturally competent. The design and evaluation of this class can be used as a model by other universities to promote interdisciplinary team skills in health professions students and to provide additional opportunities for cultural competence training.

A service-learning elective to promote enhanced understanding of civic, cultural, and social issues and health disparities in pharmacy.

OBJECTIVES: To evaluate the effectiveness and impact of an elective service-learning course offered in cooperation with a charitable pharmacy providing services to the surrounding community. METHODS: The 33 students enrolled in the service-learning elective were given a 23-question preservice survey instrument and a 32-question postservice survey instrument. The survey instruments were designed to measure change in the students' perceived knowledge and understanding regarding civic, cultural, and social issues and health disparities. RESULTS: Significant differences in responses on the presurvey and postsurvey instruments suggested changes in students' attitudes and perceptions about the patients and the community in which they serve. CONCLUSIONS: Results of the survey indicated that by exposing students to issues affecting individuals and the community during this elective, a positive change in the student's perception of their knowledge and understanding of broader issues facing the community was observed. Service-Learning courses provide additional opportunities for students to develop as competent, engaged, and caring health care professionals.

An interdisciplinary approach to introducing professionalism.

OBJECTIVE: To provide interdisciplinary structured activities in academic and clinical settings for introducing the concept of professionalism to health professions students. DESIGN: Undergraduate and graduate students from 8 health care disciplines including pharmacy, nursing, communication sciences and disorders, dietetics and nutrition science, genetic counseling, advanced medical imaging, medical technology, and physical therapy participated in an orientation program focusing on interdisciplinary health care and professionalism, as well as a field experience. ASSESSMENT: Survey results from both components (orientation, n = 284; field experience, n = 123) indicated that the project was valuable in increasing students' awareness of (1) the importance of professionalism in the clinical setting and (2) the potential contributions of their profession to the health care team. CONCLUSION: Health professions curricula should include interdisciplinary learning opportunities that enhance collaboration, collegiality, and professionalism among future members of the health care team.