Pilot Evaluation of Generation Rx Ambassadors Virtual Training to Prepare Students for Medication Safety Outreach.

Objective. To describe the creation of a virtual training program (Generation Rx Ambassadors) and evaluate a pilot offering's impact on knowledge and perceived abilities in delivering medication safety outreach through the Generation Rx program.Methods. Generation Rx (GenRx) is a prevention education program used by student pharmacists to teach safe medication practices in the community. An asynchronous virtual course, called Generation Rx Ambassadors (Ambassadors), was developed to train facilitators on best practices for GenRx delivery. The training was piloted in a mixed student cohort and evaluated using a preprogram/postprogram survey assessing participants' objective knowledge gains and self-perceived abilities to appropriately deliver GenRx education.Results. Fifty-two health sciences undergraduate and graduate students as well as Doctor of Pharmacy (PharmD) students completed the pilot offering of Ambassadors. Regardless of degree status or discipline, participants demonstrated significant knowledge gains for all outcomes except defining medication misuse behaviors (for which there was initial strong mastery). Prior to Ambassadors training, many participants indicated a perceived ability to effectively deliver GenRx education; however, corresponding objective knowledge assessment did not support this belief. Training through the Ambassadors program appropriately aligned participants' perceived abilities with actual content knowledge for most program learning outcomes.Conclusion. These pilot findings suggest that Ambassadors is an effective training tool on best practices for GenRx delivery. More generally, this work reiterates a need to formally train student pharmacists ahead of community outreach activities, particularly in the prevention education arena. Future evaluation will focus on replicating this study with an expanded cohort size and assessing participants' ability to deliver GenRx education in community-based settings.

Educating international students about medication access and usage in the US: A pilot project.

OBJECTIVE: To (1) describe an educational program for international students about medication access and use, (2) assess perspectives on the session Participants: A College of Pharmacy and Office of International Affairs at a large, public university presented on the U.S. pharmacy system during biannual international student orientation. Methods: During seven, 20-minute presentations, a facilitator discussed the role of pharmacists, defined terms, and reviewed processes. Anonymous, voluntary post-presentation surveys were analyzed to identify common themes. Results: An 86% response rate was achieved (n = 1496). Majority of students (98%) found this workshop helpful; a majority felt comfortable filling a prescription (96%) or asking the pharmacist a question (97%). More than 95% understood key terms. Common themes included health insurance and cost. Conclusions: This educational model equipped international students with knowledge to navigate the U.S. medication use system. Other universities may apply the program to prepare international visitors to access and safely use medications.

Retrospective assessment of the quality of diabetes care in a rural diabetes clinic in Western Kenya.

BACKGROUND: Sub-Saharan Africa continues to face the highest rate of mortality from diabetes in the world due to limited access to quality diabetes care. We assessed the quality of diabetes care in a rural diabetes clinic in western Kenya. METHODS: To provide a comprehensive assessment, a set of clinical outcomes, process, and structure metrics were evaluated to assess the quality of diabetes care provided in the outpatient clinic at Webuye District Hospital. The primary clinical outcome measures were the change in HbA1c and point of care blood glucose. In assessing process metrics, the primary measure was the percentage of patients who were lost to follow up. The structure metrics were assessed by evaluating different facets of the operation of the clinic and their accordance with the International Diabetes Federation (IDF) guidelines. RESULTS: A total of 524 patients were enrolled into the diabetes clinic during the predefined period of evaluation. The overall clinic population demonstrated a statistically significant reduction in HbA1c and point of care blood glucose at all time points of evaluation after baseline. Patients had a mean baseline HbA1C of 10.2% which decreased to 8.4% amongst the patients who remained in care after 18 months. In terms of process measures, 38 patients (7.3%) were characterized as being lost to follow up as they missed clinic visits for more than 6 months. Through the assessment of structural metrics, the clinic met at least the minimal standards of care for 14 out of the 19 domains recommended by the IDF. CONCLUSION: This analysis illustrates the gains made in various elements of diabetes care quality which can be used by other programs to guide diabetes care scale up across the region.

Integration of contraceptive services into anticoagulation management services improves access to long-acting reversible contraception.

OBJECTIVE: Integration of services is a promising way to improve access to contraception in sub-Saharan Africa, but few studies have evaluated this strategy to increase access to contraception among women requiring anticoagulation. Our objective was to evaluate a model of care integrating contraceptive counseling and provision within an anticoagulation management clinic in Eldoret, Kenya, to determine the impact on long-acting reversible contraception (LARC) use. STUDY DESIGN: We performed a prospective observational study of reproductive-age women referred for integrated services from the anticoagulation management clinic at Moi Teaching and Referral Hospital from March 2015 to March 2016. All participants received disease-specific contraceptive counseling and provision, free reversible methods (excluding hormonal intrauterine devices [IUDs]) and follow-up care. We compared LARC use 3 months postintervention to preintervention using the proportions test. Logistic regression analysis was used to determine factors related to use of contraceptive implants and copper IUDs. RESULTS: Of 190 participants, 171 (90%) completed 3-month follow-up. There was a significant increase in contraceptive implant use from 10% to 19%, p=.02, and injectable contraceptive use from 14% to 24%, p=.013. There was a concomitant decrease in the use of no method/abstinence from 57% to 39% (33% decrease, p<.001). Younger age, having at least one child and discussing family planning with a partner were predictive of LARC use. CONCLUSION: Integrating contraceptive services into an anticoagulation management clinic increases the use of highly effective contraception for women with cardiovascular disease. Implementation of similar models of care should be evaluated within other sites for chronic disease management. IMPLICATIONS: A model of care integrating contraceptive counseling and provision into anticoagulation management services is an effective strategy to improve LARC and overall highly effective contraceptive use among women with cardiovascular disease requiring anticoagulation. This model of care may be utilized to prevent maternal morbidity and mortality among this high-risk population.

Diabetes in sub-Saharan Africa - from policy to practice to progress: targeting the existing gaps for future care for diabetes.

The global prevalence and impact of diabetes has increased dramatically, particularly in sub-Saharan Africa. This region faces unique challenges in combating the disease including lack of funding for noncommunicable diseases, lack of availability of studies and guidelines specific to the population, lack of availability of medications, differences in urban and rural patients, and inequity between public and private sector health care. Because of these challenges, diabetes has a greater impact on morbidity and mortality related to the disease in sub-Saharan Africa than any other region in the world. In order to address these unacceptably poor trends, contextualized strategies for the prevention, identification, management, and financing of diabetes care within this population must be developed. This narrative review provides insights into the policy landscape, epidemiology, pathophysiology, care protocols, medication availability, and health care systems to give readers a comprehensive summary of many factors in these domains as they pertain to diabetes in sub-Saharan Africa. In addition to providing a review of the current evidence available in these domains, potential solutions to address the major gaps in care will be proposed to reverse the negative trends seen with diabetes in sub-Saharan Africa.