A Systematic Review of APPE Readiness Assessments Utilized by US Schools of Pharmacy.

OBJECTIVE: The 2016 Accreditation Council for Pharmacy Education standard 25.8 requires schools of pharmacy to assess student readiness for Advanced Pharmacy Practice Experiences (APPEs). We performed a systematic review to identify how schools of pharmacy in the United States assess student readiness for APPE rotations in accordance with Accreditation Council for Pharmacy Education accreditation guidelines. FINDINGS: From a search of 6 databases, we identified 1053 unique studies, of which 11 were eligible for inclusion in our review. The most commonly reported assessment method was the use of a capstone course; however, these courses varied significantly from school to school in duration, resources used, and content. Regardless of the specific approach used, first-time and overall pass rates were high. SUMMARY: We found that while most studies reported using some type of capstone course for APPE readiness assessment, there was variability in how these courses were structured and the assessment methods used within the courses. The future 2025 standards may dictate a more uniform structure for readiness assessments; however, further research is needed to identify best practices regarding the assessment of APPE readiness.

Tapinarof cream 1% once daily for the treatment of adults with mild to severe plaque psoriasis: A novel topical therapy targeting the aryl hydrocarbon receptor.

Plaque psoriasis is a chronic, immunemediated skin disease characterized by scaly, erythematous, pruritic plaques. The effects of psoriasis are often debilitating and stigmatizing, significantly impacting patients' physical and psychological well-being and quality of life. Current guideline-recommended psoriasis therapies (topicals, oral systemics, and biologics) have substantial limitations that include overall efficacy, safety, tolerability, sites of application, disease severity, and duration and extent of body surface area treated. Due to these limitations, psoriasis treatment regimens often require combination therapy, especially for moderate to severe disease, leading to increased treatment burden. Psoriasis is also associated with increased indirect costs (eg, reduced work productivity), leading to greater total costs expenditures. Thus, more effective, safe, well-tolerated, and cost-effective therapeutic options are needed. Tapinarof cream 1% once daily is a first-in-class, nonsteroidal, topical aryl hydrocarbon receptor agonist approved by the US Food and Drug Administration in 2022 for the treatment of plaque psoriasis in adults. Tapinarof cream has been evaluated in plaque psoriasis, including 2 pivotal phase 3 trials (NCT03956355 and NCT03983980) and a long-term extension trial (NCT04053387). These trials demonstrated high rates of complete skin clearance with tapinarof cream, durable effects while on treatment (a lack of tachyphylaxis for up to 52 weeks), an approximately 4-month remittive effect off therapy after achieving complete clearance and stopping treatment (ie, duration during which psoriasis does not recur off therapy), and no rebound effects after cessation of therapy. According to the US Food and Drug Administration-approved prescribing information, tapinarof may be used to treat plaque psoriasis of any severity and in any location, has no restrictions on duration of use or extent of total body surface area treated, and has no contraindications, warnings, precautions, or drug-drug interactions. Tapinarof cream is thus an efficacious, well-tolerated, steroid-free topical option that addresses many of the limitations of current recommended therapies. Here we review current knowledge on the physical, psychological, and financial burdens of plaque psoriasis and identify how the clinical profile of tapinarof cream can address key treatment gaps important in the management of plaque psoriasis and patient quality of life. In this article, we aim to assist pharmacists and other managed care practitioners by providing an evidence-based overview of tapinarof cream to support patient-centric decision-making.

Tapinarof cream 1% once daily for the treatment of adults with mild to severe plaque psoriasis: A novel topical therapy targeting the aryl hydrocarbon receptor.

Plaque psoriasis is a chronic, immunemediated skin disease characterized by scaly, erythematous, pruritic plaques. The effects of psoriasis are often debilitating and stigmatizing, significantly impacting patients' physical and psychological well-being and quality of life. Current guideline-recommended psoriasis therapies (topicals, oral systemics, and biologics) have substantial limitations that include overall efficacy, safety, tolerability, sites of application, disease severity, and duration and extent of body surface area treated. Due to these limitations, psoriasis treatment regimens often require combination therapy, especially for moderate to severe disease, leading to increased treatment burden. Psoriasis is also associated with increased indirect costs (eg, reduced work productivity), leading to greater total costs expenditures. Thus, more effective, safe, well-tolerated, and cost-effective therapeutic options are needed. Tapinarof cream 1% once daily is a first-in-class, nonsteroidal, topical aryl hydrocarbon receptor agonist approved by the US Food and Drug Administration in 2022 for the treatment of plaque psoriasis in adults. Tapinarof cream has been evaluated in plaque psoriasis, including 2 pivotal phase 3 trials (NCT03956355 and NCT03983980) and a long-term extension trial (NCT04053387). These trials demonstrated high rates of complete skin clearance with tapinarof cream, durable effects while on treatment (a lack of tachyphylaxis for up to 52 weeks), an approximately 4-month remittive effect off therapy after achieving complete clearance and stopping treatment (ie, duration during which psoriasis does not recur off therapy), and no rebound effects after cessation of therapy. According to the US Food and Drug Administration-approved prescribing information, tapinarof may be used to treat plaque psoriasis of any severity and in any location, has no restrictions on duration of use or extent of total body surface area treated, and has no contraindications, warnings, precautions, or drug-drug interactions. Tapinarof cream is thus an efficacious, well-tolerated, steroid-free topical option that addresses many of the limitations of current recommended therapies. Here we review current knowledge on the physical, psychological, and financial burdens of plaque psoriasis and identify how the clinical profile of tapinarof cream can address key treatment gaps important in the management of plaque psoriasis and patient quality of life. In this article, we aim to assist pharmacists and other managed care practitioners by providing an evidence-based overview of tapinarof cream to support patient-centric decision-making.

Medication affordability discussions with older adults in primary care.

Introduction: Cost is a major barrier to medication accessibility. While a minority of adults experience problems affording their medications, older adults are particularly vulnerable due to increased polypharmacy and fixed incomes.Clinicians can help reduce cost-related non-adherence and improve medication affordability; however, opportunities to improve affordability are often missed due to failure of the patient or clinician to discuss the issue. Objective: Identify the incidence and resolution of cost-related conversations between patients and clinicians during primary care visits. Methods: We conducted this quality improvement project at a primary care office. Student pharmacists observed in-person encounters with patients ≥65 years of age and documented the incidence of cost-related conversations and who initiated the conversation. After the visit, they asked if the patient had affordability issues. Patients and clinicians were blinded to the study purpose and hypothesis. Results: Students observed 79 primary care visits. Cost conversations (medication or non-medication related) occurred in 37% (29/79) of visits. Having concerns about affordability did not impact the likelihood of conversation about non-medication related healthcare costs (RR = 1.21 95% CI 0.35-4.19, p = 0.67) or medication related costs (RR = 0.86 95% CI 0.13-5.65, p = 1.0). Conclusion: Our results indicated that cost conversations did not routinely occur at our site. Failure to discuss costs, especially for patients with underlying cost concerns, may lead to cost related non-adherence and worse outcomes.

Electronic Cigarettes: Their Role in the Lives of College Students.

BACKGROUND: Electronic cigarettes have increased in popularity amongst college-aged adults. Although often advertised as smoking cessation tools, students have taken to them as their primary exposure to nicotine. For many reasons, e-cigarettes are extremely convenient and have become the most common tobacco products among this generation. OBJECTIVE: To assess perceptions and reasons for e-cigarette use in college students. METHODS: A 20 question online Qualtrics® survey was distributed to college students aged 18 and above across the United States. All responses were anonymous and data were analyzed using quantitative and qualitative inferential and descriptive statistics. RESULTS: Of those who used e-cigarettes, 67.7% are not likely to smoke when they are upset or sad, 56.8% disagree that stress is a factor, and 83.5% cited that alcohol was involved when smoking. Most respondents, 74% (n = 467), associated smoking with emotions of happiness, joy or peace. 43.7% who associated e-cigarettes with happiness or peace were more likely to agree that stress was an influence versus 26.5% for those who did not (p = 0.004). CONCLUSION: Results show a high prevalence of e-cigarette usage among college-aged students. Emotional pleasurable connections with e-cigarettes, similar to traditional cigarettes, play a role in their use. This information will allow healthcare professionals to tailor educational messages surrounding cessation.

Health-system implementation of a collaborative core curriculum for advanced pharmacy experiential education during the COVID-19 pandemic.

PURPOSE: A collaborative advanced pharmacy practice experience (APPE) education model established within a healthcare institution during the coronavirus disease 2019 (COVID-19) pandemic is described. SUMMARY: The COVID-19 pandemic caused a nationwide disruption of APPE pharmacy education. Healthcare institutions faced the challenge of educating APPE students while attempting to simultaneously de-densify work areas and reduce transmission risk for employees and patients. A pharmacist coordinator and pharmacist academic partners at a large teaching hospital created a collaborative common core curriculum model for resourceful implementation of APPE education. Healthcare network pharmacists, clinical pharmacist academic partners, and pharmacy residents delivered the curriculum to 35 pharmacy students over a 9-week time period. Main components of the curriculum included patient case discussions, topic discussions, journal club presentations, live continuing education (CE) webinars, and development of pharmacy technician CE programs. A majority of students reported positive experiences working with a variety of preceptors from different specialties (81%) and collaborating with students from other universities (62%). CONCLUSION: A health system can leverage institutional, network-wide, and academic partner resources to implement a collaborative APPE curriculum during challenging times such as those experienced during the COVID-19 pandemic.

The Emerging Global Tobacco Treatment Workforce: Characteristics of Tobacco Treatment Specialists Trained in Council-Accredited Training Programs from 2017 to 2019.

Tobacco use is projected to kill 1 billion people in the 21st century. Tobacco Use Disorder (TUD) is one of the most common substance use disorders in the world. Evidence-based treatment of TUD is effective, but treatment accessibility remains very low. A dearth of specially trained clinicians is a significant barrier to treatment accessibility, even within systems of care that implement brief intervention models. The treatment of TUD is becoming more complex and tailoring treatment to address new and traditional tobacco products is needed. The Council for Tobacco Treatment Training Programs (Council) is the accrediting body for Tobacco Treatment Specialist (TTS) training programs. Between 2016 and 2019, n = 7761 trainees completed Council-accredited TTS training programs. Trainees were primarily from North America (92.6%) and the Eastern Mediterranean (6.1%) and were trained via in-person group workshops in medical and academic settings. From 2016 to 2019, the number of Council-accredited training programs increased from 14 to 22 and annual number of trainees increased by 28.5%. Trainees have diverse professional backgrounds and work in diverse settings but were primarily White (69.1%) and female (78.7%) located in North America. Nearly two-thirds intended to implement tobacco treatment services in their setting; two-thirds had been providing tobacco treatment for 1 year or less; and 20% were sent to training by their employers. These findings suggest that the training programs are contributing to the development of a new workforce of TTSs as well as the development of new programmatic tobacco treatment services in diverse settings. Developing strategies to support attendance from demographically and geographically diverse professionals might increase the proportion of trainees from marginalized groups and regions of the world with significant tobacco-related inequities.

e-Cigarettes for smoking cessation: Do they deliver?

WHAT IS KNOWN AND OBJECTIVE: Electronic nicotine delivery systems (ENDS) are battery-powered devices that allow nicotine and/or other substances to be inhaled in aerosolized form. e-Cigarettes (electronic cigarettes), the most commonly used ENDS, have been proposed to be smoking cessation aids. However, despite the rapid surge in their popularity, little is known about long-term health consequences of e-cigarette usage. We assess published data to see if they deliver what they promise. COMMENT: e-Cigarettes may contain uncertain quantities of various ingredients, and evidence of adulteration has been identified. Flavouring agents can alter the pharmacokinetics of nicotine and have uncertain impact on the nature of e-cigarette use (eg ab initio use vs smoking cessation). WHAT IS NEW AND CONCLUSION: Although e-cigarettes have been proposed to be a safe approach to encouraging smoking cessation, there are inconsistencies in available data. And further data are needed regarding long-term implications of primary and secondary exposure to e-cigarette products.

Barriers and facilitators to diabetes self-management in a primary care setting - Patient perspectives.

BACKGROUND: Diabetes self-management (DSM) is a key element in the overall management of type-2 diabetes (T2DM). Identifying barriers and facilitators to DSM and addressing them is a critical step in achieving improved health outcomes in this population. OBJECTIVE: To assess patient reported barriers and facilitators to self-management of T2DM in a primary care setting. METHODS: This cross sectional study combined patient survey data with electronic medical record (EMR) data. Patients (age≥18 years) with a recorded diagnosis of T2DM (ICD-9 code: 250. xx) and having ≥2 physician visits were identified from a physician group's EMR database. Patients were grouped based on their A1C levels: <7, 7-9, and >9. Information on demographics, knowledge of diabetes, attitudes, health beliefs, and level of self-management was collected through survey administration. Survey responses were linked to the EMR data, and additional patient information was extracted. RESULTS: A total of 2100 surveys were administered (700 in each A1C category) of which 210 responses were received (10% response rate). Mean age was 63.7 years ( ±11.79), 108 (51.4%) were males, and 197 (93.8%) were Caucasian. Age (X2 = 15.73, p < 0.01), insurance status (X2 = 12.03, p < 0.05), referral to an endocrinologist (X2 = 6.17, p < 0.05), level of self-management (X2 = 12.01, p < 0.05) and willingness to use insulin (X2 = 9.8, p < 0.01) were associated with glycemic variability. Level of self-management (X2 = 33.04, p < 0.01) and referral to an endocrinologist (X2 = 11.11, p < 0.01) were associated with readiness to change DSM behavior. Better self-management, older age, lower willingness to use insulin, and 'less than graduate level' education were significant predictors of glycemic stability. CONCLUSIONS: Self-management behavior of patients with T2DM is strongly associated with glycemic stability. Interventions directed towards improving self-management in this population may result in improved clinical outcomes.

A Pharmacist's Impact on 30-Day Readmission Rates When Compared to the Current Standard of Care Within a Patient-Centered Medical Home: A Pilot Study.

OBJECTIVE: To evaluate the effect transition of care follow-up and counseling performed by a pharmacist, within a physician's practice, can have on 30-day hospital readmissions among Medicare patients when compared to the current standard of care METHODS: A pharmacist telephonically contacted patients ≥65 years with Medicare insurance following hospital discharge to perform medication reconciliation, review discharge instructions, and schedule a follow-up appointment (n = 34). At this follow-up appointment, the pharmacist reviewed the patient's electronic medical record (EMR) and communicated recommendations to the physician. The current standard of care, which does not involve a pharmacist, at a similar local physician practice was used as a comparative group (n = 45) RESULTS: The difference in 30-day readmission rates did not reach statistical significance (P = .27); however, there was a trending decrease in the percentage of patients readmitted between the control and the intervention groups (26.7% vs 14.7%). Additionally, there was nearly a statistically significant decrease in readmission rates for those patients who interacted with the pharmacist face to face versus only telephonically (P = .05) CONCLUSIONS: These results impact the decision to continue and expand the pilot program and demonstrate that pharmacists in the ambulatory setting based within a patient-centered medical home have a potential role in decreasing 30-day hospital readmissions.

A pharmacist's contribution within a patient-centered medical home.

OBJECTIVES: To evaluate the impact of a pharmacist embedded in a primary care physician (PCP) group practice to assist in achieving patient-centered medical home (PCMH) accreditation by increasing chronic care measures through the use of angiotensin-converting enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB) medications in patients with concomitant diabetes mellitus (DM) and hypertension (HTN). SETTING: PCP practice in Pittsburgh, PA. PRACTICE DESCRIPTION: 16 decentralized PCPs linked by electronic health record system. PRACTICE INNOVATION: An academically based pharmacist provided medication management services to the PCP group for patients with DM and HTN using criteria developed by the quality committee of the practice. INTERVENTIONS: Using the electronic health records and inclusion criteria, a list of patients with concomitant DM and HTN and not currently taking ACEI or ARB medications was obtained. Patients were excluded based on predetermined criteria. Electronic messages were sent to PCPs responsible for the remaining patients. RESULTS: Across the 16 participating office locations, 5,258 patients were diagnosed with DM and HTN. Of these, 4,304 were already being treated with an ACEI or ARB medication (81.9%). Of the remaining 954 patients, the pharmacist determined that 784 met at least one of the exclusion criteria (82.2%). Recommendations were sent for the remaining 170 patients, and the pharmacist received 150 responses (88.2%). Physicians agreed with the recommendation to initiate therapy in 82 patients (54.7%), and therapy was started in 56 of those patients (68.3%). CONCLUSION: This project showed the positive effect of a pharmacist in helping a PCP group address quality projects relating to PCMH accreditation and improvements in care that can affect Medicare star ratings.

Validation of a survey tool assessing effectiveness of an educational intervention on the caring behaviors and referral activities of community pharmacists for migraineurs.

BACKGROUND: Community pharmacists are in an ideal position to ameliorate migraineur under-consulting, under-diagnosis, and under-treatment. Contemporary education/training on developing therapeutic alliances with patients and in advanced pharmacotherapy may further motivate pharmacists to impact the care of migraineurs. OBJECTIVES: The objectives of this study were to assess pharmacists' perceptions of a migraine training program and their self-assessment of subsequent impact on patient care and to develop and assess a tool evaluating the impact of the training program from the patients' perspectives: (1) for patients diagnosed with migraines - identify perceptions of care by pharmacists who have undergone specialty training in migraine vs. pharmacists who have not; and (2) for patients with recurrent headaches and not diagnosed with migraines - identify perceptions of pharmacist effectiveness and thoroughness, after specialty training, to identify a potential migraine diagnosis and referral for advanced care vs. pharmacists that have not undergone specialty training. METHODS: This study employed a mixed method survey design using community pharmacies from the Tulsa, Oklahoma and Pittsburgh, Pennsylvania greater metropolitan areas. Pharmacists from intervention pharmacies received specialty training on migraine and were surveyed on their current practices and about the education program. Approximately 1 month after the training, control and intervention pharmacists were surveyed on current practices. Additionally, patients from both pharmacies were surveyed to assess Migraine Disability Assessment (MIDAS) and pharmacists' delivery of care derived from the Pharmacists' Care of Migraineurs Scale (PCMS). Surveys were handed out for a period of 3-months. RESULTS: There were 16 pharmacists and 61 patients recruited. There was no difference in patient perceptions of pharmacists' care or in patient self-perceptions between migraineurs and recurrent headache sufferers. Ninety-two percent of pharmacists agreed that the program could be transferred to an internet-based educational program. The 14-item patient survey, however, demonstrated good internal consistency reliability, with each question having a Cronbach's alpha 0.80 or higher. CONCLUSIONS: There are few studies evaluating the role and potential impact community pharmacists can have on patients suffering from migraines or recurrent headaches. While no difference was found between the groups, the internal reliability of the survey questions and the need to address needs of migraineurs warrants tool dissemination and a larger-scale study.

An elective course on dermatological topics and cosmeceutical compounding.

OBJECTIVE: To implement and assess a pharmacy dermatology and cosmeceutical compounding elective course and its impact on graduates' careers. DESIGN: A 3-credit elective course that incorporated classroom lectures on ambulatory dermatologic diseases and cosmeceutical products with case studies, weekly quizzes, and a comprehensive business plan project was implemented in a doctor of pharmacy (PharmD) program in 2010. ASSESSMENT: Assessment instruments including weekly quizzes, a business plan project, and pre- and post-course tests were used to evaluate course content. Across 3 offerings of the course (2010, 2011, 2012), pre- and post-course test scores improved. Results of a postgraduate survey showed that 54% of respondents worked at a pharmacy offering compounding services, and 57% felt that the course played a significant or very significant role in their counseling on dermatologic conditions. CONCLUSIONS: Assessment methods revealed student learning of course content and the course appeared moderately beneficial to graduates' early careers. A more longitudinal analysis is needed to assess the course's impact on long-term career choices, particularly those dealing with compounding of cosmeceutical products.

Impact of the fracture risk assessment on patient and physician behavior in osteoporosis prevention.

OBJECTIVE: To evaluate the impact of a pharmacist-directed osteoporosis screening program utilizing the fracture risk assessment (FRAX) tool on patient and physician behavior. METHODS: Postmenopausal women 45 to 65 years with Achilles T score <-1.0 not receiving bisphosphonate therapy were randomly assigned to a control or intervention group. All participants received a heel ultrasound and pharmacist education on risks of low bone mass. The intervention group received the FRAX and shared their results with their physician. Three months after screening, a telephonic questionnaire was administered to all participants. RESULTS: A total of 749 patients were screened, with 87 meeting the enrollment criteria (43 control and 44 intervention). Physician behavior was not different between the groups with respect to ordering vitamin D levels, prescription medication, or dual-energy x-ray absorptiometry scan. A significant difference in vitamin D supplementation occurred between the 2 groups (P = .024). At follow-up, 72.2% of responding participants increased daily calcium intake and 76.4% started or increased physical activity. CONCLUSION: Physician behavior was not influenced by FRAX results in the intervention group; however, positive patient behavior changes occurred in both groups. Primary prevention efforts conducted through heel ultrasound screening and pharmacist consultation led women to follow-up; however, awareness still needs to be raised of the value of FRAX in osteoporosis prevention.

Influence of Viscosity and Consumer Use on Accuracy of Oral Medication Dosing Devices.

Background: In response to numerous reports of overdoses with over-the-counter (OTC) liquid medications, the Food and Drug Administration has recommended that all OTC liquid drug products contain a measuring device but provided no recommendation on the type of device to be included. Objective: To evaluate the accuracy of liquid medication dosing devices (cup, dropper, syringe) in dispensing medications of varying viscosity in the laboratory and clinical settings. Methods: This experimental study evaluated dosing device accuracy. A pharmaceutics laboratory was used to evaluate accuracy under ideal conditions and subjects ≥18 years of age were recruited from community pharmacies to evaluate accuracy when used by consumers. Results: In the laboratory setting, the syringe was the most accurate for the more viscous formulations (cherry and grape suspension; 1% error, 1.2% error, respectively), and the dropper was the most accurate for the less viscous formulation (solution; 0.8% error). A volunteer sample of 320 participants was enrolled from the clinical setting. In the clinical setting, the syringe was most accurate, followed by the cup and then the dropper for all formulations (mean error, 2%, 14%, 33%, respectively). The cup was the most likely to overdose (mean, 5.7 mL), while the dropper was most likely to underdose (mean, 3.3 mL). Conclusions: The results of this study suggest that medication viscosity, consumer use, and dosing device contribute to dosing accuracy. The syringe appears to be the most accurate dosing device, accounting for differences in medication viscosity and the impact of consumer use.

Assessing student pharmacist impact on patient over-the-counter medication selection.

OBJECTIVE: To evaluate the financial and clinical outcomes of an over-the-counter (OTC) medication consultation performed by doctorate of pharmacy student pharmacists in a community pharmacy. DESIGN: Cross-sectional survey. SETTING: Independent and chain community pharmacy locations in Pittsburgh, Pennsylvania. PARTICIPANTS: Fourth professional year (PY4) advanced experiential student pharmacists on community rotations at the designated settings who performed OTC consultations and the participants of these encounters. MAIN OUTCOME MEASURED: Financial and clinical impact of an OTC consultation performed by student pharmacists on rotation. RESULTS: A total of 559 OTC consultations were offered in 5 participating community pharmacy settings over a period of 1 year. Student pharmacists initiated 62.4% of all documented interactions and 60.5% of all participants accepted the consultation offer. The student pharmacists' OTC recommendations resulted in significant cost savings to the participant. Those participants accepting consultation reported being more likely to consult with a pharmacist in the future. PY4 students were also able to demonstrate capability in impacting clinical outcomes on several occasions by implementing OTC medication changes due to patient safety concerns. CONCLUSION: Student pharmacist OTC consultations have the potential to positively impact both financial and clinical outcomes associated with the use of OTC medications.