INNOVATIONS in pharmacy

Incorporating Evidence-Based Teaching into Pharmacy Education: A Report on the Use of Educational Theory in the Backward Design of a Drug Information Course

Chris Wisniewski — 2024-08-23

Background: One way to incorporate evidence-based teaching into healthcare education is through backward design, a pedagogical design process that starts with creating learning outcomes, then moves to assessments, followed by content creation. This study uses backward design as a framework to present an applied experience of evidence-based teaching in the design and refinement of an introductory drug information course presented in the first year of a traditional 4-year PharmD curriculum. Case Description: In addition to backward design, evidence-based teaching methods included scaffolding, pass-fail grading standards, formative assessments, flipped classroom, and gamification. Additionally, innovative assessment techniques and teaching activities were created. The full evolution of this course, along with student performance, student perceptions, faculty workload and faculty experience, are described. Case Themes: Overall, using evidence-based methodologies led to improved organization and enhanced faculty and student satisfaction. Data showed students performed well based on both assessment and course averages. Faculty workload was substantial during the initial development of the course and was mitigated once structure and organization had been better optimized over years of revision. Impact: This report provides a model for others to incorporate evidence-based teaching methods into course design in both incremental and large-scale changes. The incorporation of these ideas takes time and work from faculty but this effort has the potential to yield improved student learning and perception. Dedication to continuous review and revision of developed educational content is encouraged. Faculty found this experience rewarding and felt that it made them better and happier educators.

“I think deprescribing is very needed in our society:” Healthcare Professional Students Perceptions of Deprescribing Education

Alina Cernasev — 2024-09-20

Introduction: Deprescribing is a complex and pivotal process in the healthcare system that requires the involvement of different healthcare professionals as well as patients and family members. Given the multifaceted healthcare professionals involved in deprescribing, fostering interdisciplinary healthcare teams during the didactic and experiential educational engagement is imperative. Thus, this study aimed to to characterize healthcare professional students’ opinions on the importance of an interdisciplinary approach to deprescribing during the didactic and experiential components of the curriculum.

Methods:This qualitative study was conducted with healthcare professional students enrolled in a professional degree program at one Mid-South health science located in the US. Focus groups were conducted via an online platform over three months in 2022, and recruitment continued until thematic saturation was achieved.Using Thematic Analysis, the corpus of the transcribed data was imported into the Dedoose®, a qualitative software that facilitated the analysis.

Results: A total of 36 healthcare professional students participated in four focus groups. Three themes emerged from the data: 1) setting the stage for deprescribing, 2) developing interprofessional deprescribing simulations, 3) potential positive patient outcomes. In the first theme, the healthcare professional students describe current challenges in the deprescribing process that call attention to the interprofessional nature of deprescribing. The second theme demonstrates the necessity of developing interprofessional simulations to educate healthcare professional students in the practice of deprescribing. Finally, in the third theme, the healthcare professional students illustrate the potential of interprofessional education on deprescribing to improve patient outcomes.

Conclusion:The data highlights that there was strong agreement between extant literature and health professions participants on barriers to deprescribing, including interprofessional communication issues, and on the recommendation to enact interprofessional healthcare simulation education on deprescribing. In addition, the potential benefits of increased interprofessional education will provide immeasurable benefits and create an ample understanding of the roles of health professionals. These findings suggest that deprescribing focused interprofessional healthcare simulation educational activities should be conducted and assessed.

Teaching Homeopathy in U.S. Pharmacy Schools

Esra'a Khader — 2024-08-22

Objectives: Pharmacists often advise patients on the use of over-the counter (OTC) medications. Such a class of medications that is growing in popularity is homeopathic products. Little is known about student pharmacists are being educated about homeopathy. The objectives of this study were to describe homeopathic topics being taught in pharmacy schools and to evaluate faculty views about pharmacists’ roles in counseling patients about homeopathic products.

Method: A mixed method design collected information about teaching homeopathy in US pharmacy schools. Online surveys were distributed to 3,300 pharmacy practice faculty members representing all schools accredited in the US. Frequencies were calculated to describe faculty characteristics and their responses. Moreover, 18 interviews of faculty involved with teaching homeopathy were conducted to learn about homeopathy teaching and expectations about roles of pharmacists in counseling patients.

Results: Survey data were collected from 365 respondents, with 51.2% of the respondents teaching in public universities, 49.6% having PGY1 training and 35.8% being associate professors. Over half (84 of 137) of the responding schools of pharmacy reported teaching homeopathy to pharmacy students. In addition, most interviewed faculty emphasized that pharmacists should be knowledgeable and able to counsel patients effectively on homeopathic products.

Conclusion: Over half of schools of pharmacy are teaching students about homeopathy topics. Further, there was support for pharmacists being able to counsel effectively about homeopathic products.

Accessibility of Diabetes Therapy Management for Patients with Visual Impairment

Cambrey Nguyen — 2024-08-22

Introduction: According to the Centers for Disease Control, 11.8% of adults diagnosed with diabetes have severe vision difficulty or blindness, a complication of uncontrolled diabetes. The study evaluated the accessibility features of the most commonly used injectable products for diabetes and blood glucose monitors and obtained recommendations from manufacturers regarding use of these products in patients with visual disabilities. Additionally, accessibility of the medication guides was assessed using a checklist and screen reader.

Methods: Selection of the most commonly prescribed insulin products, GLP-1 receptor agonist drugs, and blood glucose monitors were identified from the ClinCalc DrugStats database and ADA list. The accessibility features of these products were determined from the medication guides and verification of the information with the manufacturers were done in August 2022. All medication guides were then assessed using a checklist and tested with a screen reader for accessibility. Descriptive statistics were used to report the data.

Results: No injectable products or glucose monitoring systems were fully accessible and manufacturers advised to use the product with caution and/or required assistance from a caregiver or family member. In evaluating the 14 medication guides for accessibility using the checklist, the most common issues were lack of structured headings to help with navigation, no descriptions for images, and tables did not have appropriate headers.

Conclusions: Due to the lack of accessible features on diabetes medical devices and glucose monitoring systems, healthcare professionals can seek alternatives to assist this patient population to effectively manage their therapy.

Development, Pilot, and Evaluation of a Qualitative Documentation Tool for Pharmacists to Share High Impact Patient Intervention Stories

Alex William Middendorf — 2024-08-21

Background: Community pharmacists are often the most accessible member of the healthcare team to many patients and play a key role in managing their chronic conditions, such as diabetes or heart disease, through expanded pharmacy services like Medication Therapy Management. Despite their accessibility, pharmacy services are often underutilized due, in part, to a lack of adequate reimbursement models for pharmacy services. There is a need for qualitative data to be collected to indicate the full impact of those services and why they are so important in a patient’s healthcare journey.

Methods: An online Patient Stories Reporting Tool (PRST) was developed to allow outpatient pharmacists to document their perspectives of select direct patient care encounters that they felt showcased their value. In a pilot test, the PSRT was distributed to pharmacists from a partnering pharmacy organization. Qualitative data was collected, assessed by project team members, and organized by intervention types. For select stories, the otherwise undocumented nuances of delivered services and their impact were considered.

Results: Forty-seven stories were reported by 17 pharmacists across 13 practice sites from August 2021 to March 2023. Three types of key interventions delivered were identified including General Patient Education (7 stories), Medication Optimization (20 stories), and Cost Reduction (20 stories). Given the nature and scope of this initial pilot, one story for each of the three most prevalent intervention types was identified as exemplifying the types of stories the tool can collect.

Conclusions: The three selected stories help to characterize the services pharmacists provide, the important nuances of pharmacist-patient interactions, and the value of sharing these stories through tools like the PSRT. Through these stories, the PSRT also begins to record the nuances of pharmacist interventions and the impact they can make in a patient’s healthcare journey. Potential applications of the tool are multivarious including leading to improvements in the perception of pharmacists’ roles on the healthcare team and justifying reimbursement models.

Pharmaceutical Telemonitoring for Patients with Psychiatric Disorders: Implementation Description

Camila Lima — 2024-08-26

Telecare has exhibited efficacy in managing various chronic clinical conditions and presents potential in the surveillance of patients with psychiatric disorders, an area necessitating further investigation. Herein, we delineate an adjunct for pharmacotherapeutic oversight of individuals with psychiatric disorders receiving care at a public mental health outpatient facility. This manuscript serves as an implementation dossier detailing the progression of a preliminary trial. The non-probabilistic sample consisted of 21 patients, monitored between January 2022 and October 2022. Predominantly, schizophrenia constituted the primary psychiatric disorder among the cohort, accounting for 61.9% of cases. Across 79 remote consultations, averaging 3.8 consultations per patient, text messages constituted 52% (41/79) of the interactions. Throughout the telemonitoring process, diligent monitoring of patients' self-reported concerns was facilitated, permitting pharmaceutical interventions encompassing health advisories (52.7%) and recommendations for therapeutic adjustments (34.4%). Consequently, telemonitoring yielded an augmented pharmaceutical support framework for psychiatric patients, thereby presenting a plausible avenue for enhancing accessibility within public healthcare institutions.

Cost-Effectiveness Analysis of Pharmacist-Led Diabetes Management Across Primary Care Clinics

Cynthia King — 2024-09-18

Purpose: Ambulatory care pharmacists (ACPs) on healthcare teams improve patient outcomes and help manage multiple chronic disease states.¹ ACPs have demonstrated clinical benefit but need to show sustainability. The primary objective of this study is to determine the cost effectiveness of utilizing ACPs for diabetes mellitus (DM) management.

Methods: This was a retrospective, multi-site cohort study of 406 diabetic patients, > 18 years of age, with a HbA1c of > 8%, receiving primary care services within an academic health system between May 2015 to March 2018. In the ACP group, the ACP + primary care provider (PCP) + endocrinology managed patients’ DM compared to the PCP group, where DM was managed by PCP + endocrinology. To assess cost effectiveness of an ACP, costs of services were evaluated along with changes in HbA1c per patient per year.

Results: The ACP cost was $126 for each additional HbA1c percent lowered. The cost associated with moving one additional patient with HbA1c > 9% to HbA1c < 9% was $612. Based on facility fee billing, the ACPs cover approximately 70% of their annual salary and benefits from face-to-face visits. Change in HbA1c over 12 months was -2.5% in the ACP group and in the PCP group +1.08% (p<0.001). Based on quality metrics at 12-months, the ACP group met the goal of 75% of patients having a HbA1c < 9% and being prescribed a statin vs. the PCP group only met the metric for statin use.

Conclusions: ACPs led to significantly improved clinical outcomes with marginal up-front costs that could lead potential future cost savings through reductions in DM related complications or improving incentivized returns by achieving goal quality metric levels.

Prevalence and Predictors of Non-Benzodiazepine Use in Patients with Alcohol Withdrawal Syndrome in United States Emergency Departments – a cross-sectional study

Kirolos Zakhary — 2024-09-17

Purpose:

Benzodiazepines are the mainstay treatment in Alcohol Withdrawal Syndrome (AWS), though they have the potential for abuse and cognitive side effects. Non-benzodiazepines are of growing interest for treatment of AWS; however, the prevalence of non-benzodiazepine use remains unknown. The purpose of this study is to evaluate the prevalence and predictors of non-benzodiazepine use for AWS in the Emergency Department (ED).

Methods:

A cross-sectional, retrospective study utilizing data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) spanning the years 2014-2020 investigated patients presenting to the ED with AWS. The primary outcome of this study is the prevalence of patients with AWS who received non-benzodiazepine treatment during their ED visit. The secondary outcome was the identification of predictor variables for non-benzodiazepine use. A multivariate logistic regression with a backward elimination approach was employed to identify predictor variables.

Results:

A total of 2,300 unweighted ED visits included over the study years. When weighted, this represented over 15.2 million ED visits. Across the study period, 3.1% (95% CI, 1.6-6.1%) of patients received non-benzodiazepines. Positive predictors of non-benzodiazepine use included the year 2020 compared to 2014 (OR 6.32, 95% CI, 1.39-28.73) and comorbid depression (OR 4.13, 95% CI, 1.38-12.36). Negative predictors of non-benzodiazepine use included ages 18-40 compared to ages 41-64 (OR 0.34, 95% CI, 0.13-0.91), nursing home residence compared to private residence (OR 0.02, 95% CI, 0.001-0.80), and the South compared to the Midwest region of the United States (OR 0.19, 95% CI, 0.07- 0.51).

Conclusion:

This study found that non-benzodiazepine use, despite being less common, is becoming more prevalent. Further research is needed to determine the optimal dosing and duration of non-benzodiazepines for AWS. Understanding the factors influencing the prescription patterns of non-benzodiazepines can contribute to informed decision-making and improve the management of AWS.

Assessment of Metformin Intolerance: A Retrospective Chart Review

Pilar Murphy — 2024-08-23

Objective: The aim of the present study is to determine similarities between patients with type 2 diabetes not on metformin therapy compared to patients on metformin therapy at a resident-led primary care clinic. Methods: An exploratory, single-center retrospective chart review was performed on patients 18 years and older with a documented diagnosis of type 2 diabetes seen at the University of Arkansas for Medical Sciences Family Medicine Clinic in Little Rock, Arkansas. Of the 2452 patients who met criteria for the study, 1085 patients did not have a documented metformin allergy. A subset of 216 patients who were not currently prescribed metformin and had no documented metformin allergy were further examined and compared to the 869 patients who were prescribed metformin. We sought to determine reasons for nonuse by evaluating their EPIC electronic health record. Information on these patients such as race, gender, hemoglobin A1c (A1c), kidney function, stated metformin intolerance, and comorbid disease states such as neuropathy, chronic kidney disease (CKD), ulcerative colitis, and irritable bowel syndrome were collected. Further examination was performed to determine why patients were not on metformin therapy and potential similarities between metformin intolerant patients. Results: The results of the study indicated a significant difference between metformin users and non-users in relation to body mass index (BMI) and diagnosis of CKD. Metformin non-users were found to have significantly lower mean BMI (30.87 vs. 35.43; p-value <0.0001), and significantly higher rates of CKD (25.93% vs 14.73%; p-value <0.0001) as compared to metformin users. BMI value of patients (coefficient: 0.2033, p value: <0.0001) was found to be significantly and positively correlated with metformin use, and CKD (coefficient: - 0.1191, p-value: <0.0001) was found to be significantly and negatively correlated with metformin use. A1c levels for patients not on metformin therapy were evaluated. Most non-metformin patients fell in prediabetic A1c levels ranging from 5-6.4% (84 patients; 38.89%), and 31 patients (14.35%) should be on insulin therapy according to guidelines. Conclusion: The results demonstrated that patients with lower BMI, CKD, or A1c in the prediabetic range were less likely to be prescribed metformin.

Community-Based Pharmacists’ Perspectives on Prescribing Authority for the Minor Ailments and Contraceptive Service in British Columbia

Karen Dahri — 2024-09-20

Background

Recent changes to legislation in British Columbia (BC) have expanded the scope of pharmacist-provided services to include pharmacist prescribing for minor ailments and contraception (PPMAC). The purpose of this study was to gather community-based pharmacists’ perspectives on these changes to practice.

Methods

This was a cross-sectional online survey study. The study population was pharmacists practicing in community settings in BC. A 28-question survey was developed to capture the uptake of prescribing in the pharmacists’ practices, their views on PPMAC, educational supports, and workplace-specific questions. Invitations to participate were disseminated by using fax, social media platform posts, and email.

Results

A total of 246 participants completed all or part of the survey. A majority felt they should be able to assess and prescribe for minor ailments and contraception, and were satisfied with the regulatory changes. Pharmacists had varying degrees of comfort with prescribing for specific patient populations, with the highest for patients >75 years of age and lowest for patients with renal disease. Respondents felt that patients who were without a primary care provider or did not have easy access to walk-in clinics would benefit the most from PPMAC. Pharmacists expressed concerns about their workplace’s level of support for their providing these new services to patients.

Discussion

Most pharmacist respondents were supportive of and have begun prescribing for minor ailments and contraception in their practices. While they identified many perceived benefits to patient care, workplace barriers may hinder full provision of pharmacist prescribing in their practice.

Availability and Types of Pressure Ulcer Medications at Community Pharmacies in the Accra Metropolis of Ghana

Grace Lovia Allotey-Babington — 2024-09-09

Pressure ulcers (PU) arise from prolonged pressure on the skin and underlying tissue due to pathological changes in blood flow. They usually develop in people who are immobilized due to certain medical conditions. The incidence of chronic diseases such as cancer, cardio-vascular diseases are on the ascendency. These conditions, if not managed adequately could render patients incapacitated, leaving them bedridden for long periods. The chances of these individuals developing PU are very high. Currently in Ghana, information on medications for the management of various stages of PU are not readily available. Prevention of PU has been the goal of nursing care, however, in the case where preventive care is not successful, there should be effective and efficient medications for the management of the PU.

Method: The study was cross-sectional. A stratified sampling approach was used to select pharmacies from each town within the ten districts of the Accra Metropolis. Respondents enrolled into the study were Pharmacists working at the selected pharmacies. Data was collected using a structured questionnaire.

Results: 241 pharmacies were visited, out of which 192 respondents took part in the study. Approximately 83.3% of these pharmacies had pressure ulcer medications. Patronage of PU medications in the Accra metropolis is average, however, the medications listed by respondents had other indications other than PU. There were a lot more hydrophobic based dressings than hydrophilic-based dressings.

Conclusion: There are pressure ulcer medications available in pharmacies within the Accra metropolis of Ghana. Although the medications are averagely patronized, there are not many types available. Hydrophilic based dressings were not readily available.

Impact of Pharmacist Expertise on Acceptance Rates in a Comprehensive E-Consult Program within a Large Academic Health System

Carrie Freed — 2024-08-29

Background

Although electronic consults (e-consults) are utilized in healthcare systems by medical professionals, use of e-consults by pharmacy remains novel outside of niche disease states. Additional research is required to fill literature gaps to assist in optimizing the pharmacist’s role in e-consult programs.

Objective

This study aimed to assess the impact of pharmacist expertise on e-consult outcomes.

Methods

This study was a retrospective review of all pharmacy e-consults completed by pharmacists at a large academic health system between March 1st, 2020, and August 31st, 2022. This was deemed quality improvement and did not require Institutional Review Board approval. E-consults were identified using a report. Key data collection points included e-consult disease state, ordering provider, pharmacists' specialty, and recommendation result. The primary outcome was the difference in acceptance rates of expert versus non-expert pharmacist recommendations. Secondary outcomes included the overall implementation rate, implementation rate over time, acceptance rate between provider types, time to implementation, and pharmacist response time. Acceptance rates were compared between expert/non-expert dichotomy via Pearson chi-square test.

Results

A total of 375 e-consults met inclusion criteria and spanned 19 unique disease states. The three most common included diabetes mellitus (27.0%), pain management (13.1%), and mental health (11.0%). Nearly 60% of e-consults were in a disease with an expert. The provider acceptance rate was higher when e-consults were completed by an expert versus non-expert (62.6% versus 39.6% respectively, p = 0.002). The overall implementation rate was 51.8%. Physicians (MD/DOs) accepted the pharmacist’s recommendations 55.6% of the time, advanced practice registered nurses (APRNs) 64.7%, physician assistants (PAs) 100.0%, and other professionals 25.0% (p = 0.033). Mean time to recommendation implementation was 16.5 days (SD = 29.4 days). Mean time to pharmacist response was 1.1 days (SD = 1.4 days).

Conclusions

Comprehensive e-consult programs are more successful when integrating expert pharmacists.