Interventions involving spiritual and religious themes in pharmacy student patient encounters during advanced practice rotations.

INTRODUCTION: Patient spiritual and religious beliefs can impact their health care choices and outcomes. Pharmacists and other health care providers need to be prepared when these beliefs present changes from usual medical care. The objective of this research brief was to describe interventions related to spirituality and/or religion that are encountered by students during advanced pharmacy practice experience (APPE) patient care activities. METHODS: Fourth-year pharmacy students were asked to complete a web-based questionnaire defining the frequency and setting of patient care activities that incorporated spiritual beliefs during APPEs. Data analysis utilized descriptive statistics. RESULTS: Sixty-three students completed the questionnaire. The most common theme encountered was that of patient refusal of specific therapy based on patient's spiritual or religious beliefs. This result remained consistent across multiple practice settings, except in the community practice setting, where product substitution due to a religious forbidden ingredient was the most common theme encountered. CONCLUSIONS: Training for future and current pharmacists should provide them with the tools needed to navigate spiritual and religious-focused barriers, such as patient refusal of care and substitutes for religiously forbidden ingredients.

Frequency, setting and influential factors associated with pharmacy student-patient encounters involving spirituality and religiosity during advanced practice rotations.

INTRODUCTION: To identify (1) how often and in what settings pharmacy students include spirituality and religion and (2) what factors may influence how often students incorporate spirituality in patient care plans. METHODS: Fourth-year pharmacy students completed a questionnaire defining the frequency and setting of patient care activities that incorporated spiritual beliefs during advanced pharmacy practice experiences. Demographics, prior spirituality and health coursework, and self-identified measures of religiosity and spirituality were collected. Data analysis utilized descriptive statistics with nonparametric exploratory analysis. RESULTS: Sixty-three students completed the survey (31.7% response rate). While 11% of students asked patients about spiritual needs, 25.4% reported inclusion of spiritual factors in therapeutic plan creation. The general medicine rotation was the most common setting identified. Student frequency of religious service attendance, self-identified religiosity, and self-reported spirituality were associated with perceived importance of asking patients about spiritual needs (P < .05 for all). This did not impact whether students asked about or incorporated these topics (P > .05 for all). Students who did ask about or incorporate spiritual and religious issues had significantly greater comfort in discussing these and referring patients to a chaplain (P < .05 for all). CONCLUSIONS: Students are considering patients' spiritual needs in patient care activities. Greater student spiritual and religious practices positively influenced attitudes toward importance of asking about patient needs but did not influence student-reported behavior in patient care. Results highlight the need for instructors to consider how students' comfort levels and patient care setting influence addressing spiritual concerns.

Transition of stable patients from traditional anticoagulation clinic services to telephonic management.

Background Outpatient warfarin dosing and monitoring with telephonic anticoagulation management (TAM) could be an effective alternative to other more labor intensive management models. Objectives To evaluate the time in therapeutic range (TTR) and number of extreme INR values (<1.5 or >4.5) of a telephonic system of warfarin management for stable patients who currently utilized traditional anticoagulation management services (AMSs). Method A retrospective, observational cohort with three groups (1) patients transitioned from an office-based anticoagulation clinic to TAM, (2) patients continuously enrolled in office-based AMS, (3) patients continuously managed by usual physician care without specialized anticoagulation services (UPC). Data was collected for six months before and six months after transition. Results All groups demonstrated decreased TTR from baseline to active phase, with the TAM and AMS groups showing similar magnitude of reduction (-10.61 and -12.66% respectively) but UPC group producing a greater drop (-20.08%). The TAM and AMS groups had similar rates of extreme INR levels; UPC had higher numbers of extreme INRs in three of the four measurements. Conclusion Stable patients transitioned from office-based anticoagulation clinic to a telephonic model of management performed equally as well as those who continued traditional enrollment.