Barriers and facilitators to implementing simulation into pharmacy programs globally.

BACKGROUND: MyDispense is a simulation software developed by Monash University that has been utilized by over 200 institutions worldwide to educate pharmacy students. However, little is known about the processes by which it is used to teach dispensing skills to students and how they use it to facilitate critical thinking in an authentic environment. This study aimed to understand and investigate how simulations are used to teach dispensing skills in pharmacy programs globally, and to determine the opinions, attitudes and experiences of pharmacy educators towards MyDispense and other simulation software within their pharmacy program. METHODS: Purposive sampling was used to identify pharmacy institutions for the study. A total of 57 educators were contacted, 18 responded to the study invitation, 12 were MyDispense users and 6 were non-users. Two investigators conducted an inductive thematic analysis to generate key themes and subthemes to provide insight into the opinions, attitudes and experiences towards MyDispense and other simulation software used specifically for dispensing within pharmacy programs. RESULTS: 26 pharmacy educators were interviewed, of which 14 were individual interviews and four were group interviews. Intercoder reliability was investigated and a Kappa coefficient of 0.72 indicated substantial agreement between both coders. Five main themes were identified: "dispensing and counseling", which encompassed discussions about how dispensing techniques were taught, the time allocated for students to practice their skills and the use of software other than MyDispense; "description of MyDispense use" includes discussions about the setup of the software, how dispensing skills were taught prior to using MyDispense as well as its use in student assessments; "barriers to MyDispense use", covers discussions about the obstacles users have faced; "facilitators to use MyDispense", includes discussion about the various motivators to using MyDispense and lastly "future use and suggested improvements" of MyDispense are covered by the interviewees. CONCLUSION: The initial outcomes of this project evaluated the awareness and utilization of MyDispense and other dispensing simulations by pharmacy programs globally. By addressing the barriers of use, promotion of the sharing of MyDispense cases can assist in creating more authentic assessments, as well as improving staff workload management. The outcomes of this research will also facilitate the development of a framework for MyDispense implementation, thus streamlining and improving the uptake of MyDispense by pharmacy institutions globally.

Does the national competency standards framework for pharmacists in Australia support the provision of behaviour change interventions?

ISSUE ADDRESSED: Australian pharmacists are increasingly moving towards the provision of patient-centred professional pharmacy services for chronic disease management. Some of these services are targeted towards improving patients' health and wellbeing through the facilitation of patient-driven health behaviour change. This paper investigates whether the provision of behaviour change interventions by Australian pharmacists is adequately underpinned by the current competency framework. METHODS: The foundation and behaviour change competences within each of the domains in the generic health behaviour change competency framework (GHBC-CF), was mapped to the Australian pharmacist competency framework. RESULTS: Although the Australian competency framework underpins most of the foundation and behaviour change competences of the GHB-CF required to undertake low-intensity interventions, for medium to high-intensity interventions four specific task-related competences need to be addressed. These are F12 'Ability to recognise barriers to and facilitators of implementing interventions', BC4 'ability to agree on goals for the intervention', BC5 'capacity to implement behaviour change models in a flexible but coherent manner' and BC6 'capacity to select and skilfully apply most appropriate intervention method'. CONCLUSION: Additional training is necessary if pharmacists aspire to provide behaviour change interventions for chronic disease management, in particular those that are complex as they involve changes to multiple health behaviours. SO WHAT?: The identification of these gaps is critical and can potentially be addressed in postgraduate training programs and as pharmacy curricula are updated.

Competencies and training of health professionals engaged in health coaching: A systematic review.

OBJECTIVE: A systematic review was undertaken in order to evaluate the competencies of primary healthcare professionals who are engaged with health coaching patients with chronic health conditions. METHODS: The databases CINHAL, EMBASE, PubMed, PsychINFO and SCOPUS were searched to identify peer reviewed papers referring to competencies of health professionals engaged in health coaching. RESULTS: Nine key competencies that health professionals met and which resulted in successful patient outcomes from health coaching were identified. Comparisons of the core health coaching competencies to the competencies for coaches established by the International Coaching Federation and European Mentoring and Coaching Council showed considerable overlap. However, the comparison also reiterated the need for competencies specific to health coaches to be made explicit. DISCUSSION: Health coaching has been shown to improve the health outcomes in patients with chronic health conditions. As such, there is a need to build an evidenced-based competency framework specific to health coaches. At present, the lack of a competency framework on which to base health coach training could significantly impact the outcomes of patients receiving health coaching. Practical implications include improving regulation and quality of health coaching, and more importantly, the health outcomes of patients receiving the service.

The health coaching competency gap - Analysis of pharmacist competency frameworks from Australia, Canada, New Zealand the United Kingdom and the United States of America.

The traditional competency frameworks for coaches, the International Coaching Federation (ICF) and the European Mentoring and Coaching Council (EMCC) disregard the differences in expertise required among the diverse professions that may provide coaching. A recent systematic review has identified competencies specific to health professionals who health coach. There are increasing workload pressures in primary care; pharmacists can potentially shift to the greater provision of health promotion services, such as health coaching. The provision of such services needs to be underpinned by competency frameworks, which support the role of pharmacists as health coaches. This analysis identifies the competency gaps for pharmacists if they are to take on the role of health coaching. The enabling competencies of health coaches were compared to the competency frameworks of pharmacists from Australia (AUS), Canada (CAN), New Zealand (NZ), the United Kingdom (UK) and the United States of America (USA). Correlations between the international pharmacist competency frameworks and the competencies enabling health coaching showed that entry to practice pharmacists from AUS, CAN and NZ all require training enabling the health coaching competency 'demonstrates confidence', whereas competency frameworks for pharmacists from both the UK and the USA included all competencies required to health coach. Although pharmacists from the countries examined had most of the competencies required to health coach, gaps within the international pharmacist competency frameworks were apparent, university curricula addressing these gaps would equip entry to practice pharmacists with the knowledge and understanding to confidently provide emerging professional pharmacy services such as health coaching.

A pharmacist health coaching trial evaluating behavioural changes in participants with poorly controlled hypertension.

BACKGROUND: To investigate whether pharmacist health coaching improves progression through the stages of change (SOC) for three modifiable health behaviours; diet, exercise, and medication management in participants with poorly controlled hypertension. METHODS: In this four-month controlled group study two community-based pharmacists provided three health coaching sessions to 20 participants with poorly controlled hypertension at monthly intervals. Changes in participants' stages of change with respect to the modifiable health behaviours; diet, exercise, and medication management were assessed. To confirm the behaviour change outcomes, SOC were also assessed in a control group over the same period. RESULTS: Statistically significant changes in the modifiable health behaviours- medication management (d = 0.19; p = 0.03) and exercise (d = 0.85; p = 0.01) were apparent in participants who received health coaching and were evident through positive changes in the SOC charts. The participants in the control group did not experience significant changes with respect to the SOC. This was parallel to a decrease in mean systolic blood pressure from session one to session four by 7.53 mmHg (p < 0.05, d = - 0.42) in participants who received health coaching. Improvements to medication adherence was also apparent in these participants, evident from the mean scores for the Adherence to Refills and Medications Scale (ARMS), which decreased significantly from a mean of 15.60 to 13.05 (p < 0.05) from session one to four. CONCLUSIONS: Pharmacist health coaching produced promising health outcomes in participants with poorly controlled hypertension. Pharmacists were able to facilitate a positive behaviour change in participants. However, larger participant cohorts are needed to explore these findings further. TRIAL REGISTRATION: Australia New Zealand Clinical Trials Registry ACTRN12618001839291 . Date of registration 12/11/2018.

Pharmacist health coaching in Australian community pharmacies: What do pharmacy professionals think?

Health coaching is a service provided to patients by healthcare professionals for the purposes of disease management and health risk prevention. Internationally, pharmacist health coaching services provided to patients with chronic health conditions have produced beneficial health outcomes. Despite this, the service is not currently provided within Australian community pharmacies. This study evaluates the knowledge, opinions and attitudes of leaders within the pharmacy profession about the concept of health coaching as a service in community pharmacy. Semi-structured interviews with leaders in the pharmacy profession were carried out. Pharmacy leaders were interviewed until data saturation was reached; 10 pharmacists were interviewed. The interviews were transcribed verbatim and analysed thematically; extracts from the transcripts were compared and categorised to establish themes and subcategories. Analysis of the transcripts indicated the emergence of two main themes and 10 subcategories. The main themes were as follows: 'positive view of health coaching in Australian community pharmacy' and 'barriers to integrating health coaching into Australian community pharmacy'. There was an overall perception that health coaching within community pharmacies would be valued by the Australian community. Interviewees held differing perceptions of pharmacists' capability to effectively coach pharmacy clients and suggested that the main impediments to its introduction related to remuneration for the service. The findings indicated that there is a potential for pharmacists to provide a health coaching service in community pharmacies, but that remuneration is a fundamental barrier. The research also indicated the need to clearly identify the knowledge, skills and attitudes needed to health coach and to identify whether potential gaps in the competencies of Australian community pharmacists exist.

A systematic review of pharmacy health coaching and an evaluation of patient outcomes.

BACKGROUND: Pharmacy health coaching is a nascent topic offering promise on several fronts. There is considerable benefit to discerning the contributions thus far and future directions of pharmacy health coaching and research of the topic. OBJECTIVE: The objective of this review was to synthesize the available empirical evidence regarding pharmacy health coaching and to define it. METHODS: This systematic review followed the PRISMA guidelines. CINHAL, EMBASE, PubMed, PsychINFO and SCOPUS) were searched (2000-2017) to identify sources related to pharmacy health coaching. Included articles were reviewed for their definition and outcomes of health coaching as well as recurring terms/themes pertaining to health coaching. RESULTS: Ten papers met the eligibility criteria. The results of each empirical study as well as the definitions were used to identify the key outcomes associated with pharmacy health coaching and were then cross tabulated. The most commonly occurring outcome of health coaching was an improvement in a health outcome of a target population. An improvement in medication management/adherence and the relationship between health professionals was equally evident. Lastly, an improved attitude towards drug therapy was referred to more often than the cost-effectiveness of health coaching. CONCLUSIONS: The evaluations enabled the formulation of a grounded definition of health coaching.

The molecular pathogenesis of cholestasis in sepsis.

Sepsis-induced cholestasis is a complication of infection. Infections cause systemic and intrahepatic increase in proinflammatory cytokines which result in impaired bile flow ie. cholestasis. Several other mediators of impairment in bile flow have been identified under conditions of sepsis such as increased nitric oxide production and decreased aquaporin channels. The development of cholestasis may also further worsen inflammation. The molecular basis of normal bile flow and mechanisms of impairment in sepsis are discussed.

Peer assessment of professional performance by hospitalist physicians.

BACKGROUND: The clinical collaborations among hospitalist physicians create opportunities for peer evaluation. We conducted this study to generate validity evidence for a scale that allows for peer assessment of professional performance. METHODS: All of the hospitalist physicians working for >1 year at our hospital were asked to assess each of their physician colleagues along eight domains and name three colleagues whom they would choose to care for a loved one needing hospitalization. A mean composite clinical performance score was generated for each provider. Statistical analyses using the Pearson coefficient were performed. RESULTS: The 22 hospitalist physician participants were confident in their ability to assess their peers' clinical skills. There were strong correlations between the domains of clinical excellence (r > 0.5, P < 0.05). Being selected as a doctor whom colleagues would choose to take care of their loved ones was highly correlated with high scores in the domains of humanism, diagnostic acumen, signouts/handoffs, and passion for clinical medicine, and higher composite clinical performance scores (all r > 0.5, P < 0.05). High scores on the Press Ganey questions correlated with peer assessment of humanism (r = .78, P = 0.06). CONCLUSIONS: The correlation among scale items, the composite clinical performance score, and the variable "a doctor whom you would choose to care for a loved one" provides validity evidence to our assessment scale. Such measurements may allow hospitalist groups to identify top performers who could be recognized, rewarded, and held up as role models and weaker performers who may need focused training or remediation.

Using transjugular intrahepatic portosystemic shunts for complications of cirrhosis.

Transjugular intrahepatic portosystemic shunt (TIPS) decompresses the portal venous system. TIPS has been used to manage the complications of portal hypertension in cirrhosis, including variceal hemorrhage and refractory ascites. The uncoated TIPS stents are limited by stent stenosis; however, the introduction of coated stents has decreased this. With the introduction of coated stents, we must reevaluate the utility of TIPS in the management of complications of portal hypertension.

Prebiopsy localisation of impalpable breast lesions.

Prebiopsy localization of impalpable breast lesions (IBL) assures removal of suspicious mammographically detected lesions. Specimen radiograph of the excised specimen is mandatory to confirm complete excision. The aim of this study was to audit our series of percutaneous hookwire localization and to determine the positive biopsy rate of the mammographically detected impalpable breast lesion in our center. Thirty-eight patients with suspicious IBL underwent excision biopsy under mammographic localization in our unit from late February 1998 to May 2003. The excised specimen is immobilized and compressed within the Transpec device. This device incorporates a reference grid visible in the specimen radiograph. Hence, the target lesion marked in the reference grid of the specimen radiograph will allow precise examination and exact localization of the suspicious lesion by the pathologist. The positive biopsy rate for malignant lesion was 26.3%, the majority fall in the range of 40-59 age group. Thirty-two (84.2%) of the patients had clustered micro-calcifications, 4 (10.5%) had impalpable mass lesions and in 2 (5.3%) spiculated lesions were seen on the preoperative mammogram. Mammographic feature of clustered micro-calcification accounts for all the malignant lesions in our series. Utilization of Transpec device has shown to be practical, reliable and cost effective in the management of IBL. Nonetheless, it should be emphasized that optimal specimen radiography and pathological correlation requires close cooperation between radiologist, surgeon and pathologist.

Clinical and endoscopic features of peptic ulcer bleeding in Malaysia.

The characteristics of patients and the endoscopic features of 196 patients with bleeding peptic ulcer in a multi-ethnic population were investigated. There was a male preponderance (M: F= 6.3: 1) and their mean age was 63.5 years. The prevalence of peptic ulcer bleeding in the Malays and Indians was similar to the ethnic distribution of population. However, the Chinese were over represented. Nearly 40% of patients studied had at least one co-existing medical illness. Hypertension and ischaemic heart disease were the most common diseases. History of non-steroidal anti-inflammatory drug usage was identified in 48% of the patients and it was the commonest risk factor associated with bleeding ulcers. More than 80% of bleeding ulcers were located in the duodenum and the pylorus. Endoscopic features of active bleeding or recent bleed were identified in more than 60% of the patients. The study notes that bleeding peptic ulcer is a serious and a potentially life threatening condition. It is a disease of the elderly and, with the steadily increasing elderly population in the country, the admissions rates of peptic ulcer bleeding is expected to rise. There is a need to plan for appropriate technical support, critical care facilities and expertise to avoid unacceptable outcomes.