Pharmacists as Frontline Responders During COVID-19: Roles and Responsibilities Need to be Revisited.

The ongoing pandemic has disrupted the health care system, creating challenges for health care workers and patients alike. As workflows and job responsibilities have been adapted to provide care to coronavirus-infected patients, many primary care services have been postponed. This change has led to significant financial impacts that will be difficult to overcome. Ambulatory care pharmacists can help fill gaps both in access to primary care services and in the financial deficit, if given the opportunity to practice at the top of their skillset and bill for their face-to-face and telehealth services both during and after the pandemic.

Student Pharmacists' Use of Patient-Centered Communication Skills During an Introductory Pharmacy Practice Experience.

Objective. To assess how Doctor of Pharmacy (PharmD) students use patient-centered communication (PCC) during a community pharmacy introductory pharmacy practice experience (IPPE). Methods. All first-year student pharmacists at the University of Arkansas for Medical Sciences completed a required course in patient-centered communication that included training in motivational interviewing. After subsequently completing their first IPPE, the students submitted written reflections on their use of PCC during the experience. The reflections were de-identified and template analysis was conducted. With this method, predetermined codes are established, and a constant comparison method is used to finalize overarching themes. The students' overall level of reflection was assessed and each reflection was coded. Discrepancies were resolved through in-depth discussion and negotiated consensus. Results. Of the 116 student reflections submitted, 951 codes were applied. Six overarching themes were identified: acknowledgement of motivational interviewing skills/components; philosophy of patient-centeredness; barriers to using PCC or motivational interviewing; benefits from use of PCC; demonstration of good general communication skills; and perceptions of patient encounters. Approximately 46% of students reflected at a level three or higher (ie, personal insight or intended behavior change). Conclusion. First-year student pharmacists successfully used PCC skills during their IPPE. These findings demonstrate the impact that a PCC course can have on students' overall patient-centeredness and highlights barriers that students struggle to overcome. Other pharmacy schools may benefit from implementing a similar PCC course. Activities that reiterate these skills and provide additional opportunities to practice PCC are necessary throughout the curriculum.

Assessing guideline-concordant prescribing for community-acquired pneumonia.

Background Current reports of outpatient antimicrobial prescribing practices may overestimate guideline concordance since they address only drug selection. Appropriate stewardship should consider all prescribing criteria (i.e., dose, frequency, duration, and route of administration) to fully assess guideline concordance. Objective Using a community-acquired pneumonia (CAP) example, the aims of this pilot study were to estimate guideline concordance in adult patients 18 years or older when all prescribing criteria are considered, and provide recommendations to optimize treatment. Specific objectives were to determine which medications were most commonly prescribed for high-and low-risk patients, respectively, and determine if prescription parameters typically meet guideline recommendations. Methods This historical (retrospective) chart review at a large, non-emergent, outpatient academic practice included adult cases of CAP identified by ICD-9 codes, 481.x-486.x, 480.x and 487.x, diagnosed between July 1, 2014 and June 30, 2015. Patients were stratified into low- or high-risk categories based on presence of comorbidities and recent antibiotic use. Descriptive statistics were used to profile the sample and estimate aggregate guideline appropriateness, based on Infectious Disease Society of America/American Thoracic Society guidelines. Cases that were not prescribed an antibiotic at the index visit were excluded from assessment of concordance. Results Of the 101 total episodes identified, 49% were treated with an antibiotic. Of the 45 cases that met low-risk criteria, seven of the 24 treated cases (29%) received an appropriate antibiotic. When considering all prescription elements, all seven cases were congruent, for a composite concordance rate of 29%. Of the 56 cases that met high-risk criteria, 13 of the 25 treated cases (52%) received an appropriate antibiotic, although two cases were prescribed a suboptimal dose, and one case was prescribed a suboptimal duration, dropping composite concordance to 40%. Overall, prescribing was concordant in 17 of the 49 treated cases (35%). Conclusion Concordance with current guidelines in this local sample is suboptimal. In the low-risk group, when the correct medication was chosen, dose, duration, and frequency were appropriate. Consideration of dose and duration of treatment decreased the rate of concordant prescribing in the high-risk group.