Engaging early experiential learners to improve quality at a VA medical center - a cross-sectional analysis.

PURPOSE: An innovative population health-based introductory pharmacy practice experience (IPPE) leveraging a Veterans Affairs (VA) and college of pharmacy collaboration was implemented in fall 2019. All second-year pharmacy students from the college actively engage in the evaluation of the medical records of veterans identified using population health management tools as needing additional care or experiencing a gap in care. This study examines the clinical impact of the experience on the care of patients at the partnering VA medical center. METHODS: Course and patient records were reviewed to enumerate the number and types of interventions performed as part of the IPPE from fall 2019 to spring 2021. Descriptive statistics were used to report clinical impact. Where relevant, t test analysis was used to compare pre- and postintervention clinical values. RESULTS: A total of 1,794 medical records were reviewed. An average of 2.67 interventions were completed for each of the 615 veterans receiving an intervention. A total of 155 patients were identified as needing routine laboratory tests (eg, glycated hemoglobin), with 48.4% of patients receiving recommended laboratory tests within 3 months. Thirty-three veterans were eligible for prescription renewals, resulting in 43 medication orders. Thirty-six veterans were recommended to take a statin medication, and statin therapy was initiated in 11, resulting in a significant decrease in the mean (SD) low-density lipoprotein cholesterol concentration (-42.4 [30.3] mg/dL, P < 0.05). Eight hundred immunizations were recommended for 632 veterans, and 286 recommendations were verbally accepted. CONCLUSION: This study demonstrates that a population health-based IPPE can provide significant clinical support to the care of patients within the VA health system.

Impact of interdisciplinary education on pharmacy student knowledge and comfort with counseling on drug-nutrient interactions.

INTRODUCTION: Drug-nutrient interactions (DNIs) can negatively impact the medication use process and cause patient harm. Education in basic nutrition is often not included within pharmacy school curricula despite pharmacists needing to be proficient in identifying sources of potentially interacting nutrients. We evaluated the impact of an online education module about common DNIs and their sources on fourth-year student pharmacist knowledge, comfort with counseling, and perceived importance of DNIs. METHODS: Fourth-year pharmacy students participating in their first community pharmacy advanced pharmacy practice experience (APPE) were incentivized to view an educational module developed by pharmacists and a dietitian. Pre- and post-assessments were given to determine the impact of the module on knowledge, comfort with counseling, and perceived importance of DNIs. An end-of-rotation assessment was administered to examine the use of module information during the APPE. Pre- and post-assessment responses were compared utilizing paired t-test analyses. RESULTS: The pre- and post-module assessment results demonstrated statistically significant increases in knowledge, comfort, and perceived importance. Baseline knowledge scores increased from 65% to 80% and comfort increased for all included medication classes, most notably for bisphosphonates, angiotensin converting enzyme inhibitors, and angiotensin receptor blockers. Perception of DNI importance increased across all classes. Students reported identifying DNIs at least weekly during the five-week APPE. CONCLUSIONS: An educational module about DNIs increased student knowledge, comfort with counseling, and perceived importance in fourth-year pharmacy students. Students reported encountering DNIs weekly during a community pharmacy rotation and found the module information useful.

Evaluation of the impact of enhanced virtual forms and gamification on intervention identification in a pharmacist-led ambulatory care clinic.

Background: Adoption of healthcare technology in the ambulatory care setting is nearly universal. Clinical decision support system (CDSS) technologies improve patient care through the identification of additional care opportunities. With the movement from paper-based to electronic clinical intake forms, the opportunity to improve identification of gaps in care utilizing CDSS in the ambulatory care setting exists. Objective: To evaluate the impact of CDSS-enhanced digital intake forms, with- and without aspects of gamification, on the identification of intervention opportunities in an ambulatory care pharmacy setting. Methods: Patients were invited to complete visit intake paperwork via virtual forms as part of a CDSS-enhanced mobile application designed to identify potential interventions based on patient age, sex, disease state(s), and user-provided information. Patients were randomized to receive optional patient-specific health questions 1) with or 2) without elements of gamification. Gamification elements included trivia questions, fun facts, and the chance to win a prize. A retrospective review was used to assess interventions identified for a random sample of patients seen within the same time frame who did not utilize the mobile application. Interventions were compared across groups utilizing ANOVA. t-tests were used for a subgroup analysis. Results: From January to May 2019, 353 potential interventions were identified for 220 study participants. 0.44 (±0.82), 1.8 (±2.0) and 2.1 (±1.8) interventions per participant were identified for the control, virtual forms, and virtual forms + gamification groups, respectively. Significant differences in intervention identification across groups were found using a one-way ANOVA (F = 17.46, p < .001). Post hoc analysis demonstrated a significant difference in interventions identified for those completing 50-100% (n = 32) and those completing less than 50% (n = 18; p < .001) of the optional health questions in the virtual forms + gamification group. Conclusions: Utilization of CDSS-enhanced clinical intake forms increased identification of potential interventions, though gamification did not significantly impact this identification.

Comparison of 3 risk factor-based screening tools for the identification of prediabetes.

OBJECTIVE: To compare risk factor-based screening tools for identifying prediabetes. METHODS: Participants in an employer-based wellness program were tested for glycosylated hemoglobin (A1C) at a regularly scheduled appointment, and prediabetes risk factor information was collected. The likelihood of having prediabetes and the need for laboratory testing were determined based on 3 risk factor-based screening tools: the Prediabetes Screening Test (PST), Prediabetes Risk Test (PRT), and 2016 American Diabetes Association guidelines (ADA2016). The results from the screening tools were compared with those of the A1C test. The predictive ability of the PST, PRT, and ADA2016 were compared using logistic regression. Results were validated with data from a secondary population. RESULTS: Of the 3 risk factor-based tools examined, the PRT demonstrated the best combination of sensitivity and specificity for identifying prediabetes. From July 2016 to March 2017, 740 beneficiaries of an employer-sponsored wellness program had their A1C tested and provided risk factor information. The population prevalence of prediabetes was 9.3%. Analysis of a second independent population with a prediabetes prevalence of more than 50% of confirmed PRT's superiority despite differences in the calculated sensitivity and specificity for each population. CONCLUSION: Because PRT predicts prediabetes better than PST or ADA2016, it should be used preferentially.

Description of a pharmacist-led diabetes prevention service within an employer-based wellness program.

OBJECTIVES: To describe a pharmacist-led diabetes prevention service piloted within an employer-based wellness program. PRACTICE DESCRIPTION: A pharmacist-led ambulatory care clinic within a school of pharmacy that provides wellness services to university employees. PRACTICE INNOVATION: Implementation of a diabetes prevention service using opportunistic A1C screening within a biometric screening program. Patients with a prediabetes-level A1C from July 2016 to March 2019 were invited to participate in the National Diabetes Prevention Program (NDPP). EVALUATION: Comparison of baseline characteristics of participants with normal and elevated A1C. Evaluation of participation in the NDPP and changes in clinical values at the subsequent biometric screening appointment for individuals with a prediabetes-level AlC. RESULTS: A1C testing of 740 individuals identified 69 participants (9.3%) with a prediabetes-level A1C and 7 (1.0%) with a diabetes-level A1C. Compared with those with a normal A1C (< 5.7%), participants with an elevated A1C were more likely to be older, nonwhite, obese, and physically inactive, to have a sibling with diabetes, higher random blood sugar (RBS), lower high-density lipoprotein (HDL), and more likely to have hypertension. Twelve patients participated in the NDPP, although most attended only 1 session. Attenders had a significantly lower baseline weight and body mass index (BMI). There were no significant differences in the changes in A1C, BMI, weight, RBS, or HDL between attenders and nonattenders approximately 1 year later. CONCLUSION: This pilot demonstrated that opportunistic A1C testing could be incorporated into an ambulatory care clinic within a pharmacist-led employer-based wellness program. Uptake and retention of the NDPP were poor. Barriers to NDPP participation need to be investigated and addressed to improve service impact.

Maintaining Wolbachia in cell-free medium.

In this video protocol, procedures are demonstrated to (1) purify Wolbachia symbionts out of cultured mosquito cells, (2) use a fluorescent assay to ascertain the viability of the purified Wolbachia and (3) maintain the now extracellular Wolbachia in cell-free medium. Purified Wolbachia remain alive in the extracellular phase but do not replicate until re-inoculated into eukaryotic cells. Extracellular Wolbachia purified in this manner will remain viable for at least a week at room temperature, and possibly longer. Purified Wolbachia are suitable for micro-injection, DNA extraction and other applications.

Survival of Wolbachia pipientis in cell-free medium.

Wolbachia pipientis is an obligate intracellular bacterium found in a wide range of invertebrate taxa. While over ecological timescales Wolbachia infections are maintained by strict maternal inheritance, horizontal transfer events are common over evolutionary time. To be horizontally transferred between organisms, Wolbachia bacteria must pass through and survive an extracellular phase. We used BacLight live-dead staining, PCR, and fluorescence in situ hybridization to assess the ability for purified Wolbachia bacteria to survive in cell-free media. We found that purified Wolbachia bacteria were able to survive extracellularly for up to 1 week with no decrease in viability. While no replication was observed in the extracellular phase, purified Wolbachia bacteria were able to reinvade cells and establish stable infections at all time points. The ability of Wolbachia bacteria to survive outside host cells may increase the probability of successful horizontal transfer and the exploitation of new ecological niches. Our development of methods to purify and maintain viable Wolbachia bacteria from cultured cells will be useful for other researchers studying Wolbachia biology.