Use of a Team-Based Video Simulation to Complement a Lecture in Motivational Interviewing to Develop Students' Initial Attitudes and Skills.

Background: Motivational interviewing (MI) is increasingly recognized for its patient-centered approach to clinician-patient communication and often effective in evoking appropriate changes in patient behavior. Doctor of Pharmacy (PharmD) programs are increasingly incorporating MI education; however, doing so represents a challenge regarding availability of both time and labor capital. Case Description: This study reports on the use of a 90-minute software-based simulation and tutorial coupled with a 90-minute lecture in a 3-hour course session. In a subsequent session consisting of several brief interactions with standardized patients (SPs), students reflected upon their strengths and challenges as a result of attempting to apply the MI principles they learned during the educational intervention. Case Themes: Students' responses to a questionnaire delivered both before and after the simulation and lecture, showed improvements in several attitudinal components related to use of MI, as well as developing self-efficacies in deploying patient-centered communication strategies. A post-intervention survey without students' opportunity to study/prepare saw gains in student knowledge about MI. Case Impact: The measurements employed to determine student's attitude and knowledge showed good to very good internal consistency reliably based on calculated Cronbach's alpha and KR-20. Student reflections indicated their understanding of MI principles, even though they fell short of implementing them in large part during their encounters with SPs. Conclusion: Use of a video simulation undergone by teams of PharmD students coupled with a brief lecture might be an effective and efficient way of building a foundation for MI competency among PharmD students where instructors might lack labor capital and significant space in the curriculum.

Patient satisfaction with community pharmacy: comparing urban and suburban chain-pharmacy populations.

BACKGROUND: Patient satisfaction with pharmaceutical care can be a strong predictor of medication and other health-related outcomes. Less understood is the role that location of pharmacies in urban or suburban environments plays in patient satisfaction with pharmacy and pharmacist services. OBJECTIVES: The purpose of this study was to serve as a pilot examining urban and suburban community pharmacy populations for similarities and differences in patient satisfaction. METHODS: Community pharmacy patients were asked to self-administer a 30-question patient satisfaction survey. Fifteen questions addressed their relationship with the pharmacist, 10 questions addressed satisfaction and accessibility of the pharmacy, and five questions addressed financial concerns. Five urban and five suburban pharmacies agreed to participate. Data analysis included descriptive statistics and chi-square analysis. RESULTS: Most patients reported high levels of satisfaction. Satisfaction with pharmacist relationship and service was 70% or higher with no significant differences between locations. There were significant differences between the urban and suburban patients regarding accessibility of pharmacy services, customer service and some patient/pharmacist trust issues. CONCLUSIONS: The significant differences between patient satisfaction in the suburban and urban populations warrant a larger study with more community pharmacies in other urban, suburban and rural locations to better understand and validate study findings.

Cost of behavioral interventions utilizing electronic drug monitoring for antiretroviral therapy adherence.

OBJECTIVE: To provide data on the actual costs associated with behavioral ART adherence interventions and electronic drug monitoring used in a clinical trial to inform their implementation in future studies and real-world practice. METHODS: Direct and time costs were calculated from a multisite 3-arm randomized controlled ART adherence trial. HIV-positive participants (n = 204) were randomized to standard care, enhanced counseling (EC), or EC and modified directly observed therapy (mDOT) interventions. Electronic drug monitoring (EDM) was used. Costs were calculated for various components of the 24-week adherence intervention. This economic evaluation was conducted from the perspective of an agency that may wish to implement these strategies. Sensitivity analyses were conducted to examine costs and savings associated with different scenarios. RESULTS: Total direct costs were $126,068 ($618 per patient). Initial time costs were $53,590 ($262 per patient). Base cost of labor was $0.36/min. EC costs for 134 patients were $18,427 ($137 per patient) and mDOT for 64 patients cost $18,638 ($291 per patient). Total per patient costs were as follows: standard care = $880, EC = $1018, EC/mDOT = $1309. Removing driving costs evidenced the most variable impact on savings between the 3 study arms. The tornado diagram (sensitivity analysis) showed a graphical representation of how each sensitivity assumption reduced costs compared with each other and the resulting comparative costs for each group. CONCLUSIONS: This novel economic analysis provides valuable cost information to guide treatment implementation and research design decisions.