Evaluating the impact of a flipped classroom model based on cognitive science of learning strategies in a pharmacotherapy course.

INTRODUCTION: The purpose of this study was to determine the impact of a flipped classroom method based on cognitive science of learning strategies on student performance and experience in a third-year pharmacotherapy course. METHODS: The cognitive science of learning flipped classroom (CSL-FC) strategies in this study included pre-class learning (Preview), in-class application to cases (Retrieval), after-class learning (Spaced Retrieval), and post-module reflection (Deliberate Reflection) in a required pharmacotherapy course. During fall 2017, one instructor piloted the CSL-FC method. During fall 2018, this method expanded to four instructors. All other instructors used traditional lecture-based methods. The same multiple-choice exam questions were used both years. The average exam question scores between teaching methods were compared by independent t-test. Student focus groups were conducted after the 2017 semester. In 2018, students were surveyed using a 5-point Likert rating (1 = strongly agree, 5 = strongly disagree) to evaluate their experience. RESULTS: The 2017 and 2018 classes included 132 and 137 students, respectively. During the two years, exam question scores were significantly better with CSL-FC (n = 136 questions) compared to traditional (n = 110 questions) (88.8% vs 84.9%, respectively; P = .02). The focus group analysis revealed three main themes including a "love-hate relationship," "time," and "it works." Student agreement to the survey question "the cognitive science of learning flipped classroom helped me learn" was 2.18 (SD 1.12). CONCLUSIONS: Implementing a flipped classroom approach based on cognitive science of learning strategies positively impacted student performance and experience in a pharmacotherapy course.

Determining the impact of an interprofessional simulation focused on social determinants of health among pharmacy students.

INTRODUCTION: The purpose of this study was to determine the impact on pharmacy students' self-perception of knowledge, skills, collaborative behavior, and satisfaction after participating in an interprofessional (IP) simulation focused on social determinants of health (SDOH) and substance use. METHODS: Pharmacy students completed a voluntary questionnaire after participating in an IP simulation focused on SDOH and substance use where they collaborated with social work (SW) students. Questions assessed the students' understanding and knowledge of SDOH and students' confidence in asking patients about their substance use, willingness to refer patients to SW, and satisfaction with the simulation. The data were analyzed using a Wilcoxon signed-rank test. RESULTS: Results of pharmacy students' (N = 68) self-reported knowledge of SDOH and skills addressing and counseling on SDOH were improved following an IP simulation. No statistically significant change was observed in students' confidence when asking about or advising a patient on their substance use. There was a positive, significant change in how likely pharmacy students would refer patients to SW (P < .001) in their future practice. CONCLUSIONS: This simulation proved to be an effective way to improve pharmacy students' self-reported knowledge of SDOH and skills for assessing and counseling on resources for SDOH. The simulation was effective in exposing pharmacy students to the role of social workers on the team and how they address SDOH and substance use issues.

Assessing Self-Perceived Interprofessional Collaborative Competency on Advanced Pharmacy Practice Experiences Through Interprofessional Simulations.

Objective. To implement and assess the impact of Doctor of Pharmacy (PharmD) students participating in a required interprofessional (IP) simulation during an advanced pharmacy practice experience (APPE). Methods. Fourth-year PharmD students completing APPEs were required to participate in one of three IP simulations during the 2016-2017 academic year to improve their interprofessional teamwork and collaboration skills. Pharmacy student self-perception of IP competence was measured by the Interprofessional Collaborative Competency Attainment Survey (ICCAS), administered in a retrospective pre-/post-test design. Responses were analyzed using descriptive statistics to obtain an overview of the data. Paired t tests were used to compare the pre- and post-test results. Results. During the 2016-2017 academic year, 157 PharmD students were assigned to complete an IP simulation. Student scores on the six subscales of the ICCAS (communication, collaboration, roles and responsibility, collaborative patient-centered approach, conflict management, and team functioning) were compared. Scores in all categories significantly increased after completion of the simulation. Conclusion. Following participation in an IP simulation, PharmD students felt competent to engage in IP collaboration, and this, along with their performance on APPEs, determined their practice-readiness for IP teamwork upon graduation.

Potential best practices for assessment of interprofessional team-ready behaviors on APPEs.

INTRODUCTION: To determine potential best practices for assessment of team-ready behaviors of pharmacy students participating in interprofessional advanced pharmacy practice experiences (APPEs). METHODS: Preceptors received training on two interprofessional behavioral assessment tools, the modified interprofessional collaborator assessment rubric (mICAR) and individual teamwork observation and feedback tool (iTOFT). Preceptors evaluated students at midpoint and end of APPE using each tool. Preceptors completed a utility survey on each tool to determine a preference. Focus groups were conducted with a subset of preceptors to elicit further perspectives. Experts in interprofessional education (IPE) and accrediting board members were interviewed to determine a national perspective of best practices. RESULTS: Nineteen preceptors participated in the study. Of these, 12 completed all components of the study. No significant difference was found comparing utility of mICAR to iTOFT, although mICAR trended toward being easier to use/understand (p = 0.29). Focus group participants (n = 8) felt using a tool led to enhanced feedback and interprofessional experiences and all preferred mICAR. IPE experts and accrediting board members perceived best practices to include using a tool that aligns with IPE collaborative competencies, embedding the tool into existing APPE evaluation processes, and that is applicable to all health professional learners/evaluators. CONCLUSIONS: Preceptors preferred mICAR to iTOFT, though no significant difference was observed. Additional research is needed to confirm these results and for best practices to emerge. Future steps include evaluating interprofessional teamwork using a tool in a 360-evaluation of the individual learner by preceptors outside of the learner's own profession.

Cost of pain medication to treat adult patients with nonmalignant chronic pain in the United States.

BACKGROUND: Nonmalignant chronic pain (NMCP) is a public health concern. Among primary care appointments, 22% focus on pain management. The American Academy of Pain Medicine guidelines for NMCP recommend combination medication therapy (including analgesics, nonsteroidal anti-inflammatory drugs [NSAIDs], opioids, antidepressants, and anticonvulsants) as a key component to effective treatment for many chronic pain diagnoses. However, there has been little evidence outlining the costs of pain medications in adult patients with NMCP in the United States, an area that necessitates further consideration as the nation moves toward value-based benefit design. OBJECTIVES: To estimate the cost of pain medication attributable to treating adult patients with NMCP in the United States and to analyze the trend of outpatient pain visits. METHODS: This cross-sectional study used the National Ambulatory Medical Care Survey (NAMCS) data from 2000-2007. The Division of Health Care Statistics, National Center for Health Statistics, and the Centers for Disease Control and Prevention conducted the survey. The study included patients aged ≥18 years with chronic pain diagnoses (identified by the ICD-9-CM codes: primary, secondary, and tertiary). Patients prescribed at least 1 pain medication were included in the cost analysis. Pain-related prescription medications prescribed during ambulatory care visits were retrieved by using NAMCS drug codes/National Drug Code numbers. National pain prescription frequencies (weighted) were obtained from NAMCS data, using the statistical software STATA. We created pain therapy categories (drug classes) for cost analysis based on national pain guidelines. Drug classes used in this analysis were opioids/opioid-like agents, analgesics/NSAIDs, tricyclic antidepressants, selective serotonin reuptake inhibitors, antirheumatics/immunologics, muscle relaxants, topical products, and corticosteroids. We calculated average prices based on the 3 lowest average wholesale prices reported in the Red Book 2009 for maximum recommended daily dose. Total pain medication costs were calculated in 2009 and 2013 dollar values. The study analyzed NMCP-related outpatient visit trends and used time series analysis to forecast visits using U.S. population data and statistics. RESULTS: The total costs of prescription medications prescribed for pain were $17.8 billion annually in the United States. Cost estimates were captured based on a total of 690,205,290 (~690 million) weighted outpatient visits made for chronic pain from 2000 to 2007 in the United States. Of those patients, 99% received a medication that could be used for NMCP. Among the patients, 29% reported taking ≥5 medications. A linear trend of pain visits is visible, reporting change (from 11% to 14%) from 2000 to 2007 in the United States. All agents except opioids/opioid-like agents and analgesics/NSAIDs were further categorized as adjuvant therapy to create 3 major drug class categories. The largest 3 categories of pain therapy for the United States (annually) were analgesics/NSAIDs ($1.9 billion), opioids ($3.6 billion), and adjuvants ($12.3 billion). Despite having the highest prescription frequency nationally, analgesics/NSAIDS accounted for about 11% of the overall pain medication costs. This study found that adjuvant therapy accounted for 69% of the total pain medication costs. Among adjuvants, 33.5% of the cost was contributed by antirheumatics/immunologics. Other adjuvants included muscle relaxants (4.4%), topical products (8.6%), and corticosteroids (9.4%). CONCLUSIONS: This study demonstrated national prescribing costs and use within various drug categories of pain medications in a large outpatient population over an 8-year period in the United States. Policymakers, stakeholders, and health plan decision makers may consider this cost analysis, since they need to know how drug costs are being allocated. Moreover, information about costs and use of pain medications is valuable for the practitioner making individual patient care decisions, as well as for those who make population based decisions. This study reported an increasing trend of outpatient pain visits in the United States. Therefore, policymakers and health plan decision makers may expect a growing number of pain-related outpatient visits in coming years and allocate resources accordingly to meet the need.