A standardized patient counseling rubric for a pharmaceutical care and communications course.

OBJECTIVE: To restructure a required pharmaceutical care and communications course to place greater emphasis on communication skills and include a high-stakes assessment. DESIGN: A standardized counseling rubric was developed for use throughout the pharmacy curriculum and the counseling laboratory practicals were changed to high-stakes assessments. ASSESSMENT: An annual mid-semester and end-of-semester high-stakes patient-counseling objective structured clinical examination (OSCE) conducted prior to and after revision of the course and counseling rubric documented improvements in students' scores. Performance on the post-course annual assessment patient counseling OSCE improved compared to that on the pre-course (p<0.001). CONCLUSION: The 2010 course revision improved students' medication counseling abilities and readiness to practice. Major course revisions should be undertaken only after input from all stakeholders and with data to support the need for change.

Pharmacy students provide care comparable to pharmacists in an outpatient anticoagulation setting.

OBJECTIVE: To evaluate whether student participation in ambulatory clinics influenced the percentage of therapeutic international normalized ratio (INR) results among patients on chronic warfarin therapy. METHODS: Medical records in outpatient anticoagulation clinics managed by pharmacists under physician protocol were reviewed retrospectively in 2 university-affiliated clinics in Amarillo and Lubbock, TX. Pharmacy student activities included patient interviews, vital sign measurements, fingersticks, counseling, and documentation. Patient visits were conducted by a precepted pharmacy student or a pharmacist without a student, and the INR was measured at the subsequent patient visit. RESULTS: Records of 1,958 anticoagulation patient visits were reviewed; 865 patients were treated by pharmacists, and 1093 were treated by precepted students. The follow-up INR was therapeutic for 48.5% of third-year (P3) students' patients, 45.6% of fourth-year (P4) students' patients, 51.2% of residents' patients, and 44.7% of pharmacists's patients (p = 0.23). Eight variables were associated with the follow-up INR (baseline INR, warfarin noncompliance, held warfarin doses, a warfarin dosage adjustment, diet change, alcohol use, tobacco use, and any medication changes). CONCLUSION: Student participation in the patient-care process did not compromise patient care and no significant difference in patient outcomes was found between patients in an anticoagulation clinic cared for by precepted students and those cared for by pharmacists.

Quality of care of a pharmacist-managed diabetes service compared to usual care in an indigent clinic.

BACKGROUND: This study evaluates the quality of care of a pharmacist-managed diabetes clinic focused on an indigent population and compares that quality of care to usual care in the same health care setting. METHODS: Two groups of subjects were evaluated by retrospective review of medical records. The experimental group (n = 47) consisted of patients whose care was facilitated by a clinical pharmacist (medication initiation and modification, laboratory and physical assessment) in addition to routine physician care. A control group (n = 45) consisted of patients not referred to the pharmacy service whose care was provided solely by a physician. Changes in glycemic, blood pressure, and lipid control were assessed as were use of specific medications. RESULTS: After an average of 1.8 years of follow-up, a larger reduction in hemoglobin A1C was observed in the experimental group (2.0%) compared to the control group (1.2%), but the difference was not statistically different. Both groups experienced significant improvements in blood pressure control with a higher absolute increase from baseline in the experimental group compared to the control group (34% vs. 22% respectively, P < 0.001). Low-density lipoprotein-cholesterol levels in the control group fell by 2 mg/dL, while a 29 mg/dL reduction was observed in the experimental group (P < 0.001). While aspirin, angiotensin-converting enzyme inhibitor, and angiotensin receptor blocker therapies were not different between the two groups, statin therapy was significantly improved in the experimental group (from 23% to 68%) compared to the control group (from 33% to 44%) (P = 0.038). CONCLUSIONS: Many key diabetes quality of care outcomes in an indigent population were significantly improved in patients whose diabetes management was facilitated by a clinical pharmacist.