The addition of women's health initiatives to an established remote population health introductory pharmacy practice experience.

BACKGROUND: In 2018, a Department of Veterans Affairs (VA) primary care service and a school of pharmacy collaborated to offer introductory pharmacy practice experiences (IPPEs) in population health. Working remotely from the VA facility, students spent 2 hours per week using information from VA clinical dashboards and electronic health records (EHRs) to perform population health activities. Beginning August 2020, women's health initiatives were incorporated. OBJECTIVE: The objective was to evaluate student learning and productivity in an established remote population health IPPE that included women's health initiatives during a coronavirus disease (COVID-19)-related university closure. PRACTICE DESCRIPTION: During 2 IPPE semesters, activities of second-year student pharmacists were tracked. The course is typically conducted remotely at the university; however, owing to COVID-19 restrictions, students completed the course from their homes. Students were granted remote access privileges to VA's EHR and precepted by VA clinical pharmacists using Microsoft Teams. Students performed prescription drug monitoring program activities; reviewed outside medical records for breast and cervical cancer screening results, laboratory test results for diabetes, and medication safety monitoring; and documented progress notes. PRACTICE INNOVATION: Population health IPPEs can be tailored each semester to include a variety of initiatives. Activities are conducted remotely, eliminating the need for space and computers at the VA facility. The remote design enabled students to continue the IPPE during COVID-19 restrictions. EVALUATION: Students completed a survey about their confidence performing population health activities at baseline and at the completion of the IPPE. Student workload data were collected over 2 semesters. RESULTS: A total of 70 students reviewed 8865 health records and documented 5322 progress notes. Statistically significant improvements in student's reported abilities were reported from baseline to course completion such as explaining breast and cervical cancer screening recommendations. CONCLUSION: Incorporating women's health initiatives into a remote population health IPPE assisted the VA facility with population health activities and increased students' perceived skill.

Remote introductory pharmacy practice experiences focused on veterans prescribed chronic opioid therapy.

PURPOSE: The Department of Veterans Affairs (VA) Northern California Health Care System (NCHCS) uses a dashboard to identify monitoring needs for veterans prescribed chronic opioid therapy (COT). Schools of pharmacy require introductory pharmacy practice experiences (IPPEs); however, resources for providing IPPEs at medical facilities are limited. This article describes collaboration by a primary care service and a school of pharmacy to provide services for patients prescribed COT through remote access to the VA electronic health record (EHR) system. SUMMARY: Pharmacy students in a required population health IPPE provided clinical services for veterans remotely. Students were supervised by VA clinical pharmacists and granted remote EHR access privileges. Using personally owned laptops and VA cell phones, students performed prescription drug monitoring program (PDMP) activities, reviewed urine drug screening (UDS) results, called patients to assess pain, and documented progress notes. Students completed an assessment on the first and final days of the experience; a retrospective analysis was conducted to examine differences in student knowledge of and confidence in providing COT-focused services. The dashboard scorecard and student workload were tracked over a 1-year period. In that year, 143 students wrote 7,001 PDMP notes, reviewed 6,130 UDS results, and documented 202 pain assessments. Statistically significant improvements were reported in students' level of confidence in performing population health activities for patients prescribed COT, including interpreting PDMP and UDS results and talking with patients. CONCLUSION: The ongoing collaboration provides real-world population management experiences for future pharmacists and supports monitoring requirements for veterans prescribed COT. The program has helped NCHCS accomplish its teaching mission without dedicating clinic workspace or computers and gain an additional team to address quality measures and support population health activities.

A Module in Medication Safety Involving Remote Access and Review of Veterans' Health Records.

Objective. To describe and assess the effectiveness of an ambulatory care introductory pharmacy practice experience (IPPE) module in medication safety monitoring that was conducted remotely for first- and second-year pharmacy students in collaboration with a Department of Veterans Affairs (VA) health care system.Methods. A module in medication safety was developed and piloted as part of a required, one-unit IPPE in ambulatory care. The module encompassed three sessions of the 15-week course. Working remotely at the school under the direct supervision of VA clinical pharmacists, students accessed the electronic health records (EHRs) of veterans for whom methotrexate, sulfasalazine, or mineralocorticoid receptor antagonists had been prescribed as such patients require ongoing laboratory monitoring to screen for adverse drug effects. After reviewing the record, students ordered laboratory tests under the prescriber's name, documented notes in the patient's EHR, and sent laboratory reminder letters to patients. Students completed a brief survey at the beginning and end of the course. Differences in survey responses were compared using the Wilcoxon signed rank test.Results. Fifty-eight students reviewed 148 patient records, including non-VA electronic records, and ordered laboratory tests for 79 patients. On the follow-up survey at course completion, students reported significant changes in their ability to monitor laboratory tests, use an actual (non-simulated) EHR to perform patient care, and explain the role of a clinical dashboard to conduct population health activities.Conclusion. Remotely conducting an ambulatory care IPPE course in which pharmacy students used an actual EHR to participate in medication safety monitoring for ambulatory patients expanded the pharmacy school's ability to provide crucial practice experience. Other pharmacy schools struggling with logistical challenges and limited resources should explore this approach to fulfilling the experiential education requirements for pharmacy students.

Adherence and outcomes of patients treated with dabigatran: pharmacist-managed anticoagulation clinic versus usual care.

PURPOSE: The results of a study to determine whether pharmacist monitoring in the crucial first months of dabigatran therapy in patients with atrial fibrillation or flutter can help optimize adherence and stroke-prevention outcomes are presented. METHODS: A retrospective preimplementation-postimplementation study was conducted at a Veterans Affairs (VA) hospital to evaluate dabigatran adherence and treatment outcomes in a group of patients whose therapy was monitored by anticoagulation clinic (ACC) pharmacists (n = 20) and a historical comparison group (n = 48) that received usual care (UC). The primary endpoint was the medication possession ratio (MPR) averaged across each group over three months (acceptable adherence was defined as an MPR of ≥80%); three secondary endpoints (dabigatran-related bleeding and incident stroke and venous thromboembolism) were evaluated. RESULTS: Relative to the UC group, ACC-monitored patients were significantly more likely to have undergone recommended baseline laboratory tests before dabigatran initiation (p = 0.02). ACC patients were also more likely to have MPR values of ≥80% at the end of the three-month follow-up period (25% of patients versus 10% of patients), although the difference was not statistically significant; the mean MPR values in the ACC-monitored and UC groups were 93.1% and 88.3%, respectively. Aside from one episode of major gastrointestinal bleeding, none of the evaluated adverse outcomes occurred in either group. CONCLUSION: VA patients treated with dabigatran for nonvalvular atrial fibrillation or flutter and followed by a pharmacist-managed ACC did not differ significantly from similar patients receiving UC in the proportion adherent with dabigatran therapy or in the frequency of minor or major bleeding episodes. Thromboembolic events and strokes were absent in both groups.