Incorporation of Innovative Strategies for Patient Education in Pharmacist-Led Transition of Care Initiatives.

As patients transition between health care settings, they are at an increased risk of adverse events and medication errors as a result of medication changes and miscommunication. Pharmacists have traditionally provided transitions of care (TOC) services, including patient education, in a face-to-face manner with the goal of reducing medication errors and enhancing patient safety and understanding. However, changes in care delivery models, a burdened health care workforce, and diminishing resources necessitate innovative approaches for the provision of patient education within TOC. Pharmacists should consider novel approaches to expand scope, reduce barriers, and creatively use existing resources to optimize patient education in TOC.

Guidance for Qualitative Research Manuscripts in Pharmacy Education.

The goal of this Best Practice Review is to support researchers in successfully preparing and publishing qualitative research in pharmacy education. Standard practice from the literature and journals' guidance from related fields were reviewed, and recommendations and resources applicable to qualitative research in pharmacy education were compiled for researchers planning to conduct and publish qualitative research. This review provides recommendations, not requirements, for publication in the Journal and is intended to be a guide, especially for authors and reviewers relatively new to the field of qualitative research. Additionally, researchers planning to publish their qualitative research are advised to review available best practices and standards, such as the Consolidated Criteria for Reporting Qualitative Research checklist and the Standards for Reporting Qualitative Research. Given the diverse methodology of qualitative research, it is important for authors to provide sufficient details and justifications of selected methods for transparency and to report collected results in a manner that allows reviewers and readers to adequately assess the validity of their study and the applicability of the findings.

Managing the "Three Cs" of Academic Literature Authorship: Contributions, Credit, and Conflict.

Dissemination of information through publications is central to academic research, as well as professional advancement. Although seemingly a straightforward endeavor, publication authorship may present challenges. Although the International Committee of Medical Journal Editors defines authorship based on 4 required criteria, contemporary interdisciplinary collaborations can complicate authorship determinations. However, communication that occurs early and frequently in the research and writing process can help to prevent or mitigate potential conflicts, while a process for defining authorship contributions can aid in awarding proper credit. The Contributor Roles Taxonomy (CRediT) defines 14 essential roles of manuscript authors that can be utilized to characterize individual author contributions toward any given publication. This information is useful for academic administrators when evaluating contributors of faculty during promotion and tenure decisions. In the era of collaborative scientific, clinical, and pedagogical scholarship, providing faculty development, including statements of credit in the published work, and developing institutional systems to capture and assess contributions are key.

A Scoping Review of Student Pharmacist-Led Transitions-of-Care Initiatives.

OBJECTIVES: To identify and evaluate the current literature pertaining to student pharmacist-led transitions-of-care (TOC) initiatives and to inform pharmacy educators regarding the current and future roles of pharmacy learners in TOC. FINDINGS: A total of 14 articles were identified describing student-led initiatives in care transitions to the inpatient setting and from the inpatient to the outpatient setting. In most studies, student pharmacists involved in delivering TOC services were completing either an advanced pharmacy practice experience or an introductory pharmacy practice experience and were most commonly performing services such as admission medication history and reconciliation. The studies evaluated the impact of student-led TOC services through the identification or resolution of medication-related problems, interventions, and/or discrepancies and included limited and conflicting results pertaining to patient care-based outcomes. SUMMARY: Student pharmacists are involved in delivering and leading a variety of TOC services in the inpatient setting and postdischarge period. These student-led TOC initiatives not only provide added value to patient care and the health system but also enhance students' preparation and readiness for pharmacy practice. Colleges and schools of pharmacy should incorporate learning experiences into the curriculum that equip students to contribute to TOC efforts and promote continuity of care across the health system.

Measuring and assessing well-being: A cross-sectional study of first- to third-year student pharmacists.

PURPOSE: Stress may negatively influence the health and academic performance of healthcare professional students and correlates with stress and burnout as a healthcare professional. This study measured student pharmacist well-being and compared the well-being of first- through third-year student pharmacists. METHODS: In fall 2019, the investigators administered an online survey to first- through third-year student pharmacists to assess student pharmacist well-being. Items included the World Health Organization-5 Well-being Index (WHO-5) and demographic variables. Descriptive and inferential statistical analyses were performed. Descriptive statistics were used to measure well-being, and a Kruskal-Wallis H test was used to determine whether there were differences between professional years. RESULTS: Approximately 64.8% of student pharmacists (n = 248 of 383) completed the survey. Overall, 66.1% of respondents were female (n = 164) and 31% of respondents were Caucasian (n =77), while 31% (n =77) were African American; the majority ranged in age from 24 to 29 years. There was not a statistically significant difference in WHO-5 score between the different classes (P = 0.183), with an average WHO-5 score out of 100 of 38.2 for first-year students, 41.2 for second-year students, and 41.04 for third-year students, showing poor well-being for students in all 3 professional years. CONCLUSION: Because of emergent evidence of increased stress and negative outcomes in university students, it is imperative that pharmacy programs expand their efforts in assessment of student pharmacist well-being. While this research manuscript revealed poor well-being in all 3 professional years, it did not identify a statistically significant difference in WHO-5 score between classes. Individualized well-being interventions in all professional years may help students improve their well-being.

Description and financial impact of ambulatory care pharmacy team interventions within an underserved patient population.

PURPOSE: The purpose of this study was to characterize and quantify the types of interventions made by an ambulatory care pharmacy team (ACPT), evaluate the financial impact of such interventions, and create a cost template for the interventions using the health system's intervention documentation system. SUMMARY: We conducted a retrospective, single-center cohort study covering the period from July 1, 2018, to June 30, 2020. Eligible participants included patients aged 18 years or older who had an appointment at the ambulatory care clinic and received a pharmacy consult. Most patients were uninsured. Data collected included intervention types, specific interventions, the economic impact per intervention, the average cost avoidance per intervention, the total economic impact, and the total cost avoidance. The ACPT documented a total of 1,334 interventions during the 2-year study period. The 4 major categories of interventions included patient counseling, drug utilization review, medication therapy management, and drug information. Each category was further subdivided into subcategories, for a total of 18 distinct subcategories. The economic impact per intervention was approximately $30. The average cost avoidance was estimated to be $357.62 per intervention, with a total economic impact of $40,020 and cost avoidance of $477,065 for the study period. CONCLUSION: Pharmacist interventions resulted in a significant amount of economic impact and cost avoidance for the health system. Using the data from the study, we created a cost estimate to indicate the value of each ambulatory care intervention by using the health system's intervention documentation system.

Asynchronous Conferencing Through a Secure Messaging Application Increases Reporting of Medical Errors in a Mature Trauma Center.

Background: Medical errors occur frequently, yet they are often under-reported and strategies to increase the reporting of medical errors are lacking. In this work, we detail how a level 1 trauma center used a secure messaging application to track medical errors and enhance its quality improvement initiatives. Methods: We describe the formulation, implementation, evolution, and evaluation of a chatroom integrated into a secure texting system to identify performance improvement and patient safety (PIPS) concerns. For evaluation, we used descriptive statistics to examine PIPS reporting by the reporting method over time, the incidence of mortality and unplanned ICU readmissions tracked in the hospital trauma registry over the same, and time-to-loop closure over the study period to quantify the impact of the processes instituted by the PIPS team. We also categorized themes of reported events. Results: With the implementation of a PIPS chatroom, the number of events reported each month increased and texting became the predominant way for users to report trauma PIPS events. This increase in PIPS reporting did not appear to be accompanied by an increase in mortality and unplanned ICU readmissions. The PIPS team also improved the tracking and timely resolution of PIPS events and observed a decrease in time-to-loop closure with the implementation of the PIPS chatroom. Conclusions: The adoption of clinical texting as a way to report PIPS events was associated with increased reporting of such events and more timely resolution of concerns regarding patient safety and healthcare quality.

Well-Being May Be the Missing Component of Professionalism in Pharmacy Education.

Enhancing student pharmacist professionalism through co-curricular efforts has gained much attention in pharmacy education since release of the Accreditation Council for Pharmacy Education's Standards 2016. Interestingly, traditional and current definitions and attributes of professionalism do not include components of well-being; instead, the ideas of altruism and self-sacrifice predominate. However, providing students with the tools, resources, and time needed to invest in themselves to maintain their well-being is imperative as this in turn allows them to fulfill the pharmacy profession's standards of professional conduct and engagement. Although classic interpretations may seem to conflict, practicing self-care to promote personal well-being is thankfully not in opposition to being an altruistic, self-sacrificing professional. This commentary explores the interplay between the two constructs and postulates that some issues related to student pharmacists' unprofessional behavior can be linked to a lack of well-being. Therefore, pharmacy educators should consider incorporating well-being initiatives into efforts focused on refining student pharmacist professionalism.

A Scoping Review of Well-being Assessment and Interventions in Student Pharmacists.

Objective. To review the literature assessing student pharmacist well-being and the impact of well-being-associated interventions.Findings. Of the 15 studies included, six assessed student pharmacist well-being while nine evaluated the impact of a well-being intervention. While various approaches exist to assessing student pharmacist well-being, the body of literature suggests, overall, that student pharmacist well-being is poor. Since well-being is multifaceted and individualized, some pharmacy schools have identified various ways to incorporate tailored well-being activities, including mindfulness, into required, elective, and cocurricular experiences within the Doctor of Pharmacy program, with varying outcomes.Summary. This review highlights the limited and variable information available on the assessment of student pharmacist well-being as well as unique strategies to incorporate well-being initiatives into Doctor of Pharmacy curricula. Schools of pharmacy should identify the well-being needs of student pharmacists through a standardized well-being assessment instrument and provide meaningful well-being resources and interventions within the curriculum. There is a growing need for faculty to invest in student pharmacist mental wellness in addition to academic success. Future accreditation standards will inform the Academy on how to advance well-being initiatives.

Comparing perceptions of student abilities in diabetes self-management education and support among students, faculty and patients.

BACKGROUND AND PURPOSE: Diabetes self-management education and support (DSMES) equips patients with diabetes with the knowledge needed for appropriate management. The purpose of this study was to compare perceptions of student confidence/aptitude held by students, pharmacy faculty preceptors, and patients regarding student teaching of a DSMES class. EDUCATIONAL ACTIVITY AND SETTING: The study was a prospective assessment of fourth-year ambulatory care advanced pharmacy practice experience students. Students taught a single DSMES class and evaluated their confidence using a 14-item survey before and after the class. Patients who participated in the class and a pharmacy faculty observer completed the same instrument. Responses were compared using Friedman and Wilcoxon signed-rank tests, as appropriate. FINDINGS: Twenty-six students completed the survey. Overall, students' self-perceived confidence scores significantly increased for all questions after teaching the DSMES class (P < .001 for all questions). Confidence scores among students and faculty preceptors were similar with no significant differences in perceived confidence. There were some significant differences found among student and patient scores, with patients assessing student's perceived self-confidence higher than the students on three items (P < .05). SUMMARY: Student pharmacists' perceptions of their own confidence and abilities improved from before to after teaching a DSMES class. Student and faculty preceptor confidence scores were similar. There were few differences between student and patient confidence scores, with patients rating students highly on their perceived confidence in teaching a DSMES class. Patient feedback is important to consider when evaluating student confidence and abilities.

Varied Factors were Associated with Different Types of Self-Care in Heart Failure.

Poor self-care is prevalent in patients with heart failure and adversely affects heart failure symptoms, hospitalization, and mortality. Adherence rates to different types of self-care vary in patients with heart failure. The purpose of this study was to examine factors associated with medication adherence, dietary sodium adherence, and symptom management in patients with heart failure. Data were collected using questionnaires, Medication Electronic Monitoring System, and 24-hour urine sodium output (N = 94). In logistic regression analysis, social support, education level, and race were associated with medication adherence (p = .002). Gender, race, perceived control, and depressive symptoms were associated with dietary sodium adherence (p = .030). Gender, education level, and depressive symptoms were associated with symptom management (p = .006). Different factors were associated with each type of self-care. Thus, clinicians need to manage each type of self-care by considering factors associated with it.

Description of a novel co-curricular professional engagement program for student pharmacists.

INTRODUCTION: Development of professionalism is essential for student pharmacists. This paper describes the development of a novel co-curricular professional engagement program for student pharmacists. METHODS: At admission, all student pharmacists are enrolled in a faculty-developed professional engagement program. The program was designed to address various key elements of Standards 3 and 4 of the Accreditation Council for Pharmacy Education Accreditation Standards. The program requires student pharmacists to complete a variety of required and electives activities each professional year. Student progression and completion of these activities is monitored and evaluated by an assigned faculty member. Each year, the program is reviewed using various measures, including activity completion rate and student feedback. RESULTS: Approximately 1000 student pharmacists, across four years and seven cohorts of students, have completed at least one portion of the program. All students in the aforementioned groups completed the program in its entirety. Example activities included professional seminars and professional organization involvement, leadership, and community service. Program activities were mapped to key elements of Standards 1 through 4 with an emphasis on Standards 3 and 4. Student feedback was used for continuous quality improvement, and programmatic revisions were made. CONCLUSIONS: The development and implementation of a co-curricular professional engagement program offered the opportunity for student pharmacists to actively participate in a variety of experiences supporting accreditation standards. Other colleges of pharmacy may benefit from the adoption of a similar program to support student pharmacist professional development.

Facilitation of a multisite student topic discussion series using web-based conferencing technology.

INTRODUCTION: While technology's use and impact in the classroom setting is well-documented in literature, use during experiential education is less defined. Our objectives were to assess the change in clinical knowledge and application skills following a multisite topic discussion (TD) series using web-based conferencing technology during ambulatory care advanced pharmacy practice experiences (APPEs) and to assess student perceptions of learning through use of this modality. METHODS: A multisite TD series was created using web-based conferencing technology for students assigned to a clinical faculty member's ambulatory care APPE. Five topic discussions were conducted during each five-week rotation block covering disease states integral to ambulatory care practice. Pre- and post-assessments were administered to assess student learning and a survey was administered to assess student perceptions of learning. RESULTS: A total of 151 students were invited to participate in the study with 114 (75.5%) included in the final analysis. Overall student performance improved significantly from 53.3 ± 12.7% on the pre-assessment to 65.8 ± 14.3% on the post-assessment, with student performance on the post-assessment improving significantly in all topic areas. Students perceived that the TD series enhanced their learning and ability to apply clinical information while creating an online learning community. CONCLUSIONS: The addition of a multisite TD series using web-based conferencing technology successfully enhanced student knowledge. Student perceptions of this new web-based learning community were positive overall, despite some technological limitations. The results of this study support the use of web-based conferencing technology to enhance student learning during APPEs.

Impact of Student Pharmacists Teaching a Diabetes Self-Management Education and Support Class.

Objective. To evaluate student pharmacists' knowledge of diabetes and self-perceptions of aptitude and confidence before and after teaching a diabetes self-management education and support (DSMES) class. Methods. Students enrolled in an advanced pharmacy practice experience (APPE) in ambulatory care were randomly assigned to the intervention group (taught a DSMES class) or control group (did not teach a DSMES class) between June 2016 to April 2018. Students self-assessed their aptitude and confidence using a 14-item pre- and post-intervention survey instrument. Additionally, participants completed a 10-item diabetes knowledge evaluation at baseline and during week three or four of the APPE. Results. Forty-six students participated in the study (26 students in the intervention group and 20 in the control group). Students in the intervention cohort demonstrated a significant improvement in their knowledge score (81.8% post-intervention vs 68.4% pre-intervention). Students in the control cohort did not experience a significant change in knowledge scores from pre- to post-intervention evaluation (70.0% vs 74.1%). The intervention cohort achieved a significantly greater improvement in confidence scores compared to the control group (11.8 vs 6.7 increase in scores, respectively). Conclusion. A student pharmacist team-taught DSMES class resulted in significant improvement in diabetes knowledge, aptitude, and confidence. Student pharmacist participation in a DSMES class may improve knowledge and enhance confidence, while offering an opportunity to advance the pharmacy practice model in ambulatory care.

Pharmacy student perceptions regarding understanding of and confidence in literature evaluation following a student-led journal club.

BACKGROUND: Journal clubs are commonly used by healthcare professionals, including pharmacists, as a means of analyzing and applying research to clinical practice. The purpose of this research is to determine if participation in student-led journal clubs impacts students' understanding of and confidence in literature evaluation. METHODS: First- through third-year pharmacy students attended co-curricular journal club sessions. Students attending these sessions completed a questionnaire (Journal Club Comprehension and Confidence Instrument [JCCCI]) immediately prior to [pre-survey] and following [post-survey] the journal club session (journal club group). The JCCCI was also delivered to student pharmacists not attending the co-curricular journal club sessions (control group). Wilcoxon Signed-Rank tests were used to compare the responses to the JCCCI questionnaire. Analysis was conducted using SPSS. This research was approved by the University's Institutional Review Board. RESULTS: A total of 182 student pharmacists completed the survey (journal club group, n = 52; control group, n = 130). There were significant differences in the pre- and post-survey of the journal club group in eight of the 10 competencies; "process", "background", "methods", "intervention/treatment", "statistical analysis", "results", "clinical significance" and "strengths/limitations". There were significant differences discovered between the journal club group (post-survey) and control group in three of the 10 competencies; "process", "importance", and "intervention/treatment". CONCLUSIONS: This study demonstrates that participation in a journal club yielded significant improvements in how students self-rated their confidence in and understanding of literature evaluation. Based on students' self-assessed understanding of and confidence in literature evaluation, student-led journal club sessions conducted outside of the traditional pharmacy curriculum offer a perceived benefit to students.

A comparison of baseline professional attitudes and behaviors among student pharmacists to inform a co-curricular professional engagement program.

BACKGROUND: Professionalism in pharmacy students is an area of great focus with the release of Accreditation Council for Pharmacy Education (ACPE) Standards 2016. This study assessed and compared student pharmacists' professionalism at one college of pharmacy to inform the implementation of a co-curricular professional engagement program. METHODS: Two validated instruments (Behavioral Professionalism Assessment Instrument [BPAI] and Pharmacy Professionalism Instrument [PPI]) were administered to assess baseline professionalism. Kruskall-Wallis tests compared responses among the three pharmacy classes. Analysis was conducted using SPSS. This research was approved by the Mercer University's Institutional Review Board. RESULTS: A total of 362 students completed the survey (75% response rate), of which 131 were first-year, 139 were second-year, and 92 were third-year students. There were significant differences in agreement among these classes of students as to whether a program focused on professional engagement was important and helpful (p < 0.001). Seven BPAI statements and five PPI statements demonstrated significant differences in the level of agreement among the professional years. These behaviors include: completing assignments independently and without supervision (p = 0.004); commitment to helping others (p = 0.004); reporting a medication error (p = 0.005); using time efficiently (p = 0.02); and being respectful (p = 0.04). DISCUSSION: At baseline, 12 statements were significantly different in the level of agreement among the three pharmacy classes. Differences may be explained by perceived professionalism (in first-year students) versus actual professional behaviors (second- and third-year students), as well as breadth and depth of experience. A co-curricular professional engagement program could increase student awareness of professionalism and professional behaviors and be tailored to meet assessed student needs.

Impact of a pharmacy team-led intervention program on the readmission rate of elderly patients with heart failure.

PURPOSE: The results of a study to determine whether pharmacy team-led postdischarge intervention can reduce the rate of 30-day hospital readmissions in older patients with heart failure (HF) are reported. METHODS: A retrospective chart review was performed to identify patients 60 years of age or older who were admitted to an academic medical center with a primary diagnosis of HF during the period March 2013-June 2014 and received standard postdischarge follow-up care provided by physicians, nurses, and case managers. The rate of 30-day readmissions in that historical control group was compared with the readmission rate in a group of older patients with HF who were admitted to the hospital during a 15-month intervention period (July 2014-October 2015); in addition to usual postdischarge care, these patients received medication reconciliation and counseling from a team of pharmacists, pharmacy residents, and pharmacy students. RESULTS: Twelve of 97 patients in the intervention group (12%) and 20 of 80 patients in the control group (25%) were readmitted to the hospital within 30 days of discharge (p = 0.03); 11 patients in the control group (55%) and 7 patients in the intervention group (58%) had HF-related readmissions (p = 0.85). CONCLUSION: In a population of older patients with HF, the rate of 30-day all-cause readmissions in a group of patients targeted for a pharmacy team-led postdischarge intervention was significantly lower than the all-cause readmission rate in a historical control group.

Professional Stereotypes of Interprofessional Education Naive Pharmacy and Nursing Students.

Objective. To assess and compare interprofessional education (IPE) naive pharmacy and nursing student stereotypes prior to completion of an IPE activity. Methods. Three hundred and twenty-three pharmacy students and 275 nursing students at Mercer University completed the Student Stereotypes Rating Questionnaire. Responses from pharmacy and nursing students were compared, and responses from different level learners within the same profession also were compared. Results. Three hundred and fifty-six (59.5%) students completed the survey. Pharmacy students viewed pharmacists more favorably than nursing students viewed pharmacists for all attributes except the ability to work independently. Additionally, nursing students viewed nurses less favorably than pharmacy students viewed nurses for academic ability and practical skills. There was some variability in stereotypes between professional years. Conclusion. This study confirms the existence of professional stereotypes, although overall student perceptions of their own profession and the other were generally positive.

Liraglutide: A Glucagon-Like Peptide-1 Agonist for Chronic Weight Management.

OBJECTIVE: To review the efficacy and safety of liraglutide 3.0 mg for weight loss. DATA SOURCE: A literature search was performed using PubMed and MEDLINE from 2000 to 2016. The following key terms were used alone or in combination: glucagon-like peptide-1 agonist, liraglutide, obesity, overweight, and weight loss. Additional supporting literature was identified utilizing the reference lists of the preceding articles. STUDY SELECTION: Analyzed studies were published in English and investigated use of liraglutide and its impact on weight loss. DATA EXTRACTION: Clinical studies with a primary focus of liraglutide use in weight loss were included in this review. Author consensus determined final study inclusion. DATA SYNTHESIS: Management of obesity centers on behavior modification that includes diet and exercise; however, pharmacologic therapy may be used. Several studies have indicated that GLP-1 receptor agonists promote weight loss in patients with type 2 diabetes mellitus (T2DM). The efficacy of liraglutide 3.0 mg as a weight-loss agent in patients with and without T2DM was established in three SCALE™ clinical trials. Liraglutide 3.0 mg was generally well tolerated during clinical trials. Common adverse events were typically related to the gastrointestinal system (i.e., nausea, vomiting). CONCLUSION: Based on available evidence, liraglutide 3.0 mg appears to be a safe and effective addition to the pharmacologic armamentarium available for chronic weight management in the general population. However, there are limited data within the geriatric population. Clinicians should consider liraglutide's cost, route of administration, and concomitant drug therapy when deciding which patients are appropriate candidates for liraglutide therapy. ABBREVIATIONS: AE = Adverse events, AHA/ACC/TOS = American Heart Association/American College of Cardiology/ The Obesity Society, BMI = Body mass index, CV = Cardiovascular, FDA = Food and Drug Administration, GI = Gastrointestinal, GLP-1 = Glucagon-like peptide-1, HbA1c = Hemoglobin A1c, Kcal = Kilocalorie, LCD = Low-calorie diet, MTC = Medullary thyroid carcinoma, NHLBI = National Heart Lung and Blood Institute, NNH = Number needed to harm, PYE = Patient years of exposure, REMS = Risk Evaluation and Mitigation Strategy, SCALE™ = Satiety and Clinical Adiposity - Liraglutide Evidence in Non-diabetic and Diabetic individuals, T2DM = Type 2 diabetes mellitus.

Clinical considerations for insulin pharmacotherapy in ambulatory care, part two: review of primary literature and an evidence-based approach for treatment.

IN BRIEF This article reinforces the dosing guidance from the package inserts of available insulin products and supplemental information provided by the manufacturers of insulin products. It reviews and evaluates pertinent primary literature detailing algorithms for the initiation and titration of insulin therapy that have helped to shape current clinical practice guidelines. The article discusses the clinical applicability of the evidence on insulin pharmacotherapy and offers recommendations for initiation and titration of various insulin products for insulin-requiring people with type 2 diabetes in the ambulatory care setting.