Frequency of essential elements in required advanced pharmacy practice experiences (FEER - APPE).

INTRODUCTION: This study evaluated student reported achievement of essential elements (EE) across three required advanced pharmacy practice experiences (APPEs) to identify differences in the frequency of each EE during different delivery modalities. METHODS: APPE students from three different programs were assigned a self-assessment EE inventory after required acute care, ambulatory care, and community pharmacy APPEs between May 2018 and December 2020. Using a four-point frequency scale, students reported exposure to and completion of each EE. Pooled data were analyzed to compare differences in frequencies of EE during standard and disrupted delivery. All standard delivery APPEs were in-person, but during the study period APPEs shifted to a disrupted delivery using hybrid and remote formats. Frequency changes were reported as combined data and compared between programs. RESULTS: A total of 2191 of 2259 (97%) evaluations were completed. Acute care APPEs had a statistically significant change in frequency of evidence-based medicine elements. Ambulatory care APPEs had a statistically significant decrease in the frequency of reported pharmacist patient care elements. Community pharmacy had a statistically significant decrease in frequency in each category of EE except practice management. Statistically significant differences between programs were observed for select EEs. CONCLUSIONS: The frequency of EE completion during disrupted APPEs revealed minimal change. Acute care was the least impacted whereas community APPEs experienced the greatest change. This may be attributable to shifts in direct patient interactions during the disruption. Ambulatory care was impacted to a lesser degree, potentially due to utilization of telehealth communications.

Teaching Pharmacy Students and Residents Patient-Centered Care Through Interviewing Veterans.

Objective. To incorporate the My Life, My Story program into pharmacy learners' training and assess its impact on the learners' self-reported patient-centered care competencies.Methods. Fourth professional year (P4) pharmacy students and first and second year (PGY-1 and PGY-2) pharmacy residents at a veterans health care facility were instructed to identify a patient to interview during their rotation. Following a guide provided to them, the learners conducted an interview and wrote their patient's story. Learners also completed anonymous, voluntary, pre- and post-activity surveys online intended to assess their patient-centered care competencies and report the impact of and overall perceptions about the experience. The total number of learners and stories were tracked by reviewing patients' medical records.Results. Between July 2016 and February 2019, 34 pharmacy learners completed 40 veterans' life stories. The participants included 28 P4 pharmacy students and four PGY-1 and two PGY-2 pharmacy residents. Of the 34 learners, 9 (26%) completed the optional, anonymous pre-activity survey and 16 (47%) completed the post-activity survey. On a Likert scale (1=poor to 5=excellent), learners reported a significant improvement in their ability to let the patient tell their story, view the patient as a whole person, and show care and compassion. Overall, participants reported that the learning experience was a good use of their time to a great (56%) or large (28%) extent and helped them to foster a positive relationship with their patients.Conclusion. Integrating the My Life, My Story program into pharmacy learning experiences may assist in developing patient-centered care skills in the clinical setting.

Comparing total medical expenditure between patients receiving direct oral anticoagulants vs warfarin for the treatment of atrial fibrillation: evidence from VA-Medicare dual enrollees.

BACKGROUND: Direct oral anticoagulants (DOACs) are an alternative to warfarin for treatment of atrial fibrillation (AF). Evidence demonstrating the efficacy and safety of DOACs has primarily been from clinical trial settings. The real-world effectiveness of DOACs in specific nontrial populations that differ in age, comorbidity burden, and socioeconomic status is unclear. OBJECTIVE: To compare total downstream medical expenditure between AF patients treated with warfarin and DOACs dually enrolled in the Veterans Affairs (VA) Healthcare System and fee-for-service Medicare. METHODS: This was an exploratory treatment effectiveness study that analyzed VA administrative data and Medicare claims. We examined patients with an incident diagnosis for AF and initiated warfarin or DOAC treatment between 2012 and 2015. The primary outcome was total medical expenditure over 3 years following treatment initiation. To address potential informative censoring, we applied a multipart estimator that extends traditional 2-part models to separate differences between groups due to survival and cost accumulation effects. Inverse probability weighting was applied to address potential treatment selection bias. RESULTS: We identified 31,276 and 17,021 patients receiving warfarin and DOACs, respectively. Mean unadjusted (SD) expenditure was higher for warfarin ($56,265 [$96,666]) compared with DOAC patients ($32,736 [$52,470]). Compared with patients receiving DOACs, adjusted 3-year expenditure was $25,688 (P < 0.001) higher for patients receiving warfarin. CONCLUSIONS: VA patients with AF initiating warfarin incurred markedly higher downstream expenditure compared with similar patients receiving DOACs. The benefits of DOACs found in previous clinical trials were present in this population, suggesting that these DOACs may be the preferred option for treatment of AF in older VA patients. DISCLOSURES: This study was funded by a VA Health Services Research and Development Investigator Initiated Research Award (IIR 15-139). Support for VA/CMS data was provided by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Health Services Research and Development, VA Information Resource Center (Project Numbers SDR 02-237 and 98-004). The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs, the University of Washington, Northeastern University, and Boston University. The authors declare no conflicts of interest. This research includes data obtained from the VHA Office of Performance Measurement (17API2), which resides within the Office of Analytics and Performance Integration (API), under the Office of Quality and Patient Safety (QPS; formerly known as RAPID). An oral presentation documenting a subset of the findings from this study was presented at the 2020 AcademyHealth Annual Research Meeting, delivered virtually on July 29, 2020.

Evaluating patient knowledge and use of medication disposal in a Chinatown community pharmacy.

BACKGROUND: Drug take-back programs (TBPs) provide the opportunity to safely dispose of unused or expired medications (UEMs), potentially reducing the risk of environmental harm and morbidity. Data on patient perceptions and participation are limited, especially in underserved Asian populations. OBJECTIVE: This study aimed to evaluate medication disposal perceptions and behaviors through a free mail-in medication disposal program among patients in a Chinatown community pharmacy. METHODS: An institutional review board-approved Web-based survey was developed in English and Mandarin. Student pharmacists tabled at a Chinatown community pharmacy in Boston, Massachusetts. The patients were educated about safe medication disposal practices and invited to take the anonymous survey assessing medication disposal needs, practices, and beliefs accessed in person by using a quick response code. On survey completion, the patients were offered a disposal envelope. Envelope tracking numbers were used to evaluate medication disposal over a 9-month follow-up period. RESULTS: Sixty-two patients of Asian descent completed the survey, and 42 (67.7%) accepted an envelope. Forty-seven patients (75.8%) reported having access to UEMs. More than half indicated that TBPs were important to alleviate the risk of medication and environmental consequences despite low previous use (6.5%). Most patients felt more aware of TBPs (72.6%), an increased sense of the importance of TBPs (74.2%), and intent to participate in TBPs (69.4%), including using the envelope (75.8%). Three (4.8%) patients disposed of medications using the study-provided envelope during the 9-month follow-up. CONCLUSION: Patient education about TBPs and their importance may be effective in increasing TBP awareness in a population with low TBP use. Free disposal envelopes did not seem to be highly used within 9 months of receipt despite interest and access to UEMs. Future research should continue offering programs at no charge, evaluating barriers to free TBP use, and implementing follow-up procedures to increase envelope use.

Potential cost avoidance of pharmacy students' patient care activities during advanced pharmacy practice experiences.

OBJECTIVES: To evaluate the potential cost avoidance of student interventions documented by fourth-year (P4) student pharmacists during advanced pharmacy practice experiences (APPEs) in outpatient and inpatient settings. METHODS: The school-wide Web-based intervention database was retrospectively analyzed to review characteristics of interventions documented during the 2011-2012 APPE cycle. Potential cost avoidance for interventions was derived from a comprehensive literature review and adjusted to 2011 dollars based on the consumer price index for medical care. RESULTS: Eighty-seven students (71% of the graduating class) documented 5,775 interventions over 36 weeks, with an estimated potential total cost avoidance of $908,800. The intervention categories associated with the greatest cost avoidance were prevention of adverse drug events, provider education, and patient education. CONCLUSIONS: Fourth-year student pharmacists and their preceptors had a positive impact, contributing to potential cost avoidance in both the inpatient and outpatient pharmacy settings.

Providers' perceptions of student pharmacists on inpatient general medicine practice experiences.

OBJECTIVE: To assess health care providers' perceptions of student pharmacists involved as members of a general medicine team. METHODS: A brief, anonymous, online survey instrument was distributed to 134 health care providers at 4 major medical centers in Massachusetts who interacted with Northeastern University student pharmacists during inpatient general medicine advanced pharmacy practice experiences beginning in March 2011. The survey instrument assessed health care provider perception of student pharmacists' involvement, preparedness, clinical skills, and therapeutic recommendations. RESULTS: Of the 79 providers who responded, 96.2% reported that student pharmacists were prepared for medical rounds and 87.3% reported that student pharmacists were active participants in patient care. Also, 94.9% and 98.7% of providers indicated that student pharmacist recommendations were appropriate and accurate, respectively. The majority (61.8%) of providers believed that student pharmacist involvement on internal medicine teams was beneficial. CONCLUSIONS: Provider perceptions regarding student pharmacist participation on general medicine practice experiences were mostly positive.