INNOVATIONS in pharmacy

Bracketology in Pharmacy Education: The Impact of March Medication Madness on Student Engagement and Knowledge

2023-11-12T21:27:29-06:00

Introduction. Gamification is being used in pharmacy education as a learning strategy to engage learners with educational content in innovative ways. Bracketology is one type of gamification that has not been described in pharmacy education literature. The goal of implementing a March Medication Madness activity was to increase student engagement and knowledge. The associated study aimed to assess activity goal achievement.

Innovation. The March Medication Madness project was developed for use in a capstone course offered in the final semester of the didactic pharmacy curriculum. Students created medication related pearls which were paired together in a 32-team tournament style bracket. Students then completed brackets to predict the winning pearls and voted biweekly to determine the most clinically significant pearl. Student knowledge was assessed pre- and post-activity along with a post-activity perception assessment.

Critical Analysis. Most students either agreed or strongly agreed that the activity increased understanding and stimulated interest in course material, while adding an element of fun to the course. There was a statistically significant increase (t₅₁=3.34, p=0.002) in the average percentage of multiple-choice questions students answered correctly from the pre-test (57.7%±1.5%) to the post-test (63.1%±1.9%). Pearls that progressed the farthest within the voting were no more likely to be associated with an increase in knowledge than pearls that were eliminated in the first two rounds.

Next Steps. Implementation of a bracketology activity was perceived as fun and engaging for students, and they felt that it aided in their understanding of course material. However, the actual increase in knowledge was limited. This shows the importance of structuring gamification in a way that truly provides educational value and enforces the need to make modifications to the activity for future iterations to promote student learning.

Using a Preceptor Development Series in Writing and Publication to Improve Residency Research Manuscripts

2023-08-07T05:52:50-05:00

Description of the Problem: Rates of pharmacy residency research projects making it to peer review and publication are low (between two and seven percent). Little is known about the influence of preceptor development on moving projects to peer-review and publication.

The Innovation: The primary objective was to describe the effect of a preceptor development series on writing and overall manuscript quality leading to submission to a peer-reviewed publisher. Three pharmacy preceptors assigned to a post-graduate year 1 residency project were enrolled in a six-week series focused on writing, peer-reviewed publishing, and advancing resident research to publication. Each preceptor was tasked with implementing development series content in their resident research mentorship.

Critical Analysis: Resident project manuscripts were assessed using a previously published 34-item evaluation tool. All papers were blinded for independent evaluation by two investigators. Nine papers were evaluated: three from preceptors who participated in the development program and six from preceptors who did not participate. The mean summary scores for papers with preceptors who participated versus those who did not were 5.8 and 5.4, respectively, on a 10-point scale. Additionally, papers from preceptor participants were noted to achieve satisfactory scores on evaluation tool items 85.3% of the time versus 74.7% of the time for non-participants.

Next Steps: Participation in a six-week preceptor development program on advancing resident writing and research to publication provided preceptors the tools needed to mentor higher quality manuscripts ready for publication. Residency programs may consider designing and implementing such a series to promote preceptor and resident research publication.

Modifying Pharmacy Enrollments by Employment Realities

2023-09-12T11:33:55-05:00

Objective: The objective of this commentary is to consider the fluctuations in pharmacy school enrollments and to review some of the strategies employed in other health care professions as well as to consider policies that might lead to a closer balance between admissions to PharmD programs and employment opportunities. Such a balance provides superior job stability, decreased underemployment, and greater attractiveness to study pharmacy.

Findings: Pharmacy school entry requirements and standards have been relaxed to accommodate as many students as possible due to current declining applicant numbers. As a result, there are more pharmacist graduates than there are available jobs each year to the point that the job outlook for pharmacists may continue to go down in the future unless something is done to address the problem. Stricter entry requirements could help produce a higher quality pharmacy workforce in the future and relieve this disparity.

Summary: Pharmacy schools try to accommodate as many students as possible creating a job disparity between the number of available jobs and pharmacists seeking work. Suggestions can include stricter entry requirements, a certificate of need-type program, and other means to balance this misalignment.

Exposing Pharmacy Residents to Implementation Science

2024-04-06T15:14:59-05:00

The American Society of Health-System Pharmacists (ASHP) aims to improve patient care by innovating pharmacy practices. ASHP-accredited pharmacy residencies require projects that enhance pharmacy practice, focusing on effective project management and quality improvement. However, only a few of these innovations smoothly become part of routine clinical practice. One solution worth exploring involves teaching Implementation Science in residencies. Exposing residents and mentors to Implementation Science offers two main benefits. Firstly, it helps learn from failed interventions by considering alternative thoughts and grasping environmental influences, leading to smarter decisions in future implementations. Secondly, applying implementation science improves patient care by turning evidence-based practices into practical actions, ensuring better care, consistency across healthcare setups, fewer errors, and tailoring innovative services to specific institutional needs. Exposing pharmacy residents to implementation science pushes forward pharmacy practice by actively applying evidence-based innovations in broader pharmacy or clinical practice.

Flip the Script: Changing Documentation Standards and Establishing Best Practices for Pharmacists in a Primary Care Setting

2024-04-18T09:39:51-05:00

Background

Documentation of clinical encounters continues to be a challenge to implement in practice and there is a lack of literature or evidence regarding documentation best practices in pharmacy. In order to inform documentation practices at an academic pharmacy clinic, a quality assurance (QA) initiative was implemented at the UBC Pharmacists Clinic (Clinic).

Goals:

The goal of this QA initiative was to determine what facilitators and barriers existed for the pharmacists in a primary care setting and improve the efficiency of consultation note writing.

Description:

Phase 1 conducted an online survey among Clinic pharmacists to assess each clinician’s documentation practice at baseline. Phase 2 implemented new interventions that could advance these skills. There were four main interventions introduced: 1) revised consultation note templates, 2) a documentation “checklist” to standardize expectations for documentation, 3) a “decision tree” to guide what type of note should be sent following consultations, 4) a documentation “guide” providing tips and examples to improve writing skills and 5) a peer-feedback workshop, where clinicians exchanged consultation notes, provided 1:1 feedback and shared main learning outcomes in a group discussion. During Phase 3, pharmacists re-answered the same survey questions 10 months later. This allowed for a direct comparison of documentation practices and skills before and after the interventions.

Effectiveness:

After the interventions, pharmacists reduced the time to complete their notes by nearly 14 min (from 48 to 34 minutes). In addition, the Clinic has since changed their approach to documentation by starting consultation notes with the clinical assessment and recommendation, followed by subjective and objective information, as opposed to the traditional SOAP format that the previous template followed. The revised note structure resulted in an increased uptake of template use from 37% to 100%. Furthermore, prior to the interventions and workshop, the majority of pharmacists ranked writing consultation notes as the most burdensome aspect of their daily workflow. Afterwards, the level of burden in writing consultation notes reduced significantly. Based on the results of the surveys as well as feedback acquired during this process, the traditional format of the Clinic’s consultation note template was permanently changed, to allow for the most important element, the recommendations, to be documented first. These findings can be used to inform how students are taught documentation and improve the quality of documentation by pharmacists in team-based or primary care settings.

A Retrospective Review on HIV Pre-Exposure Prophylaxis in Davao City

2024-06-20T12:48:44-05:00

Objectives: Evaluating the adherence to HIV Pre-Exposure Prophylaxis (PrEP) is essential for increasing its utilization and decreasing the risk of HIV transmission among Davao City's vulnerable groups.

Methods: The research method utilized in the study is a quantitative, retrospective, descriptive research design. This method was employed to retrospectively review the de-identified data, which involved the fill and refill dates of PrEP and tablets supplied, to calculate the Proportion of Days Covered (PDC) among individuals in Davao City from January 2021 to December 2023. The study also included some demographic characteristics such as age and gender.

Results: From 178 data entries collected, the age group of 25 to 34 years old was found to have the highest HIV PrEP use (52.3%), followed by those between 18 to 24 (30.9%), 35 to 44 (13.5%), and 45 years old and older (3.4%). Out of 178, only 2 clients were female. Furthermore, 73.6% of the 178 entries in the pharmacy records were identified to be taking PrEP daily. Descriptive statistics showed that the frequency of adherent clients across the years were 36.4%, 44.7% and 38.5%, respectively. Furthermore, the average PDC through the years was found to be 70.13%, 80.48%, and 72.8%. Age did not significantly affect adherence to PrEP during the years investigated (p-values > 0.05).

Conclusion: Adherence to PrEP improved consistently in 2022 but declined in 2023, showing erratic adherence rates. Furthermore, adherence to HIV PrEP in Davao City was found to be suboptimal and while there are clients who are adherent, many are not. The results emphasize the need for targeted interventions and suggest that other socio-behavioral factors may play a role in this. To improve adherence and prevent HIV contractions, both short-term actions like public education campaigns about HIV PrEP and long-term plans like incorporating PrEP into the community pharmacies can be contributive.

Implementing a Pharmacist-Led Primary Care Pharmacogenomics Medication Management Service

2024-04-29T17:43:40-05:00

Background: Pharmacogenomics (PGx) is a tool to guide optimal medication selection. Increased demand for personalized medicine and the growing occurrence of chronic diseases are drivers for pharmacogenomic medication management services. A review of implementation models identified a paucity of models delivering these services utilizing pharmacists in primary care. Standardization of this process remains a barrier to widespread implementation within health systems.

Purpose: Describe the process and measure the outcomes of developing an institutional guidance document and applying it to implement a pharmacogenomics medication management service at clinic sites within an integrated health system in the United States.

Method: A task force of pharmacists reviewed literature, guidelines, and institutional policies to create a comprehensive guidance document. The document included six minimum practice requirements for implementation in the primary care setting, and six additional recommendations. A retrospective chart review of all PGx visit types occurring from January 1, 2022 through September 30, 2022 was conducted.

Results: A pharmacist-led pharmacogenomics medication management service is now offered at all primary care sites within the health system. During the study timeframe, 1378 patients had a PGx visit, resulting in 1939 PGx visits. Of those visits, 1777 (92%) were referred by a primary care provider and 1675 (86.7%) were conducted by a primary care pharmacist. Twenty-nine primary care pharmacists offered the PGX service and 25 (89%) completed at least one visit. Patients were referred by providers from 56 of the 64 (87.5%) primary care departments.

Conclusions: Developing an institutional process and guidance document for the implementation of a new pharmacist-led pharmacogenomics medication management service at clinic sites within an integrated health system was beneficial in developing and standardizing the workflow. Dissemination of workflow expectations to the primary care providers and pharmacists resulted in adoption of the service.

Implementation of an Interprofessional Diabetes Management Clinic in the Rural Primary Care Setting

2023-10-30T11:12:45-05:00

Background: Access to a primary care provider is not guaranteed for many living in rural settings. Notably, rural populations experience a higher degree of burden from chronic diseases compared to urban-dwellers. For example, diabetes can go undiagnosed and undertreated with lack of primary care. To address these care gaps at a large, rural family medicine practice in western North Carolina, a multidisciplinary pharmacist-led diabetes clinic was developed.

Objectives: This article describes the implementation, evolution, and impact of the diabetes management clinic and explores future directions for improving the experience of patients and health care providers.

Practice Description and Innovation: The diabetes management clinic at Mountain Area Health Education Center (MAHEC) is a pharmacy resident-led interdisciplinary clinic incorporating nutrition and pharmacy learners to provide patient care in both telehealth and in-office settings. Since its inception in 2018, the clinic has facilitated meaningful learning opportunities for students and residents and helped patients manage their diabetes in a multifaceted approach.

Evaluation Methods: A retrospective, cross-sectional study evaluated diabetes-related outcomes for 80 patients seen in the diabetes management clinic during twelve months of appointments. The primary outcome measure was change in A1c from baseline.

Results: Among patients with a follow-up A1c during the study (n=64), there was a mean reduction in A1c by 0.79% from baseline. Additionally, among those with a second follow-up A1c available (n=32), there was a mean reduction from baseline in A1c of 1.42%.

Conclusion: The utilization of pharmacy residents as part of an interdisciplinary diabetes management clinic can extend access to care for underserved patients. The clinic also serves as a structured teaching clinic for interdisciplinary learners, and it has contributed to positive clinical outcomes, strong interprofessional collaboration, and expansion of experiential education opportunities since its inception in 2018.

Pharmacy Interns’ Perception of Climate Change and Its Impact on Health

2024-04-11T13:56:04-05:00

Background: The effects of climate change are major threats to health and well-being. While the profession of pharmacy can make a difference through patient care activities or sustainability and advocacy efforts, literature detailing U.S. pharmacist and student pharmacist views on this topic is scant.

Objectives: To assess Ohio pharmacy interns’ knowledge and beliefs regarding climate change and human health as well as its relevance to pharmacy practice and education, and to compare and contrast their perceptions with those of Ohio pharmacists previously surveyed.

Methods: An anonymous 31-item electronic survey was emailed to a random sample of 500 pharmacy interns registered in Ohio with questions regarding climate change and health, climate change policy, potential roles for pharmacists and pharmacy interns, pharmacy education, and selected demographics. Data were analyzed using descriptive and nonparametric statistics, and responses collected from this study were compared with those from the Ohio pharmacist study conducted the previous year.

Results: Ninety-two interns completed the survey. The majority of respondents thought climate change is happening (87%), will harm human health in their community (68%), and is relevant to pharmacists or pharmacy practice (62%). Compared to registered pharmacists, pharmacy interns more often acknowledged these statements and more often identified roles in climate action. Sixty-two percent somewhat or strongly agreed that there should be more education about climate change and health in the pharmacy curriculum.

Conclusion: Ohio pharmacy interns participating in this survey recognized the impact of climate change on health, believed they roles in mitigating its effects, and wanted to learn more about it. As these are the first data assessing U.S. pharmacy interns’ perceptions of this topic, additional studies should be performed in other parts of the country. Increased education among student pharmacists may help propel the pharmacy profession to become a leader in climate action and sustainability.

The Risk of Venous Thromboembolism Events Resulting in Hospitalization following Exposure to Antipsychotic Medication in Pre-Disposed Adult Patients

2024-03-28T09:08:31-05:00

Introduction: The primary objective of this study was to compare the incidence of antipsychotic use in those with venous thromboembolism (VTE) resulting in hospital admission. This study expands upon current knowledge regarding VTE risk and antipsychotic use and investigates potential risk factors and lab values that may precede antipsychotic-induced coagulopathy.

Methods: This retrospective, case-control, chart review investigated patients admitted to an acute care hospital with either a VTE or non-VTE diagnosis. Primary outcome analysis compared the presence of an antipsychotic medication in patients who had a VTE versus those who did not. Secondary analysis included: 1) the duration, class, dose, frequency, and route of antipsychotic and 2) coagulation parameters, patient characteristics, and VTE risk factors.

Results: Analysis included 400 participants with 200 participants in each group (VTE and non-VTE). Of the 51 patients who received an antipsychotic, 29 (56.9%) developed or presented with a VTE. However, there was no significant difference in VTE development between groups when controlled for antipsychotic use (OR 1.37, 95% CI 0.76-2.50, P-value=0.30).

Conclusion: While primary study findings were not statistically significant, results support a weak association of exposure to antipsychotic(s) in VTE groups compared to control (non-VTE). Obesity significantly increased the odds of VTE whereas a history of type 2 diabetes significantly decreased the odds of VTE.

Diagnosis and Management of Daptomycin-Induced Acute Eosinophilic Pneumonia: A Case Report

2024-05-24T12:11:11-05:00

Daptomycin is a cyclic lipopeptide antibiotic that is indicated for the treatment of complicated skin infections and bacteremia caused by gram positive organisms. Acute eosinophilic pneumonia (AEP) is a rare, but serious adverse effect of daptomycin and caused by accumulation of eosinophils in the lung tissues, and can lead to respiratory failure. Early diagnosis and management of this condition is crucial to avoid severe complications, including death. Herein, we report a case of an elderly man who presented with signs and symptoms of AEP within two weeks of initiation of daptomycin for the treatment of MRSA bacteremia. The patient showed significant clinical improvement and decline in eosinophils upon discontinuation of daptomycin and starting a 5-day steroid course. Acute eosinophilic pneumonia should be kept in mind as a possible, although rare, adverse effect of daptomycin. Early recognition can be established through typical symptoms, eosinophilia, and chest X-ray showing pulmonary infiltrate. Rapid discontinuation of daptomycin with/without steroid therapy and supportive care usually results in significant clinical recover.

Somatization in Polypharmacy: Hiding in Plain Sight

2024-04-17T11:45:24-05:00

Polypharmacy and somatic symptom disorder (SSD) are common conditions clinicians see every day in practice. Polypharmacy is easy to identify and causation seems to be straightforward. However, SSD may not be so obvious and may be an underlying cause of the polypharmacy that may be more difficult to identify. Identifying SSD as a potential psychiatric cause for polypharmacy and understanding that adding more medications will not adequately resolve the patient’s symptoms is important to prevent polypharmacy from being exacerbated.

Leadership and Followership in Health Professions: A Systematic Review

2024-05-07T06:51:58-05:00

Objective: Leadership discussion, including leadership development programs, is common. However, discussion of followership as a component of leadership seems less frequently discussed. With a focus on leadership and followership, this investigation reviewed the health-professions education literature and characterized leadership-followership within health-professions education.

Methods: Using PubMed, ERIC, and Google Scholar, two investigators independently and systematically searched health-professions education literature for articles related to leadership and followership. Reports were categorized based on the articles by type, application, profession, leadership, and followership qualities.

Results: Eighty-one articles were included. More than half (48/81, 59%) were theoretical, 27% (22/81) empirical, 7% (6/81) commentaries, and 6% (5/81) letters-to-the-editor). Empirical studies did not share outcomes that could be meaningfully combined quantitatively by meta-analysis; however, the vast majority (96%) of theoretical articles discussed a healthcare-related application of leadership and followership (e.g., improving patient care, improving communication, improving organizational efficiency). Thus, a qualitative review was completed. Of the 81 articles, 57% (n=46) involved multiple professions, while 43% (n=35) focused on a specific profession [Nursing (n=16), Medicine (n=7), Others (n=5) Surgery (n=3), Pharmacy (n=2), Veterinary Medicine (n=2)]. While most articles (75%) discussed leadership qualities (with top qualities of effective communication, visionary, and delegating tasks), fewer (57%) discussed followership qualities (with top qualities of being responsible, committed, and supportive). Of note, some qualities overlapped in both leadership and followership (with top qualities of effective communication, being supportive, and providing/receiving feedback).

Conclusions: Leadership-Followership was described in many health-professions’ education literature. However, Pharmacy and Veterinary Medicine had substantially fewer articles published on this topic. Notably, followership did not receive nearly as much attention as leadership. Leadership has a dynamic and complex interaction with followership highlighting that an effective leader must know how to be an effective follower and vice versa. To improve leadership within healthcare teamwork, education should focus on both leadership-followership.