Portfolio use and practices in US colleges and schools of pharmacy.

OBJECTIVES: To identify the prevalence of portfolio use in US pharmacy programs, common components of portfolios, and advantages of and limitations to using portfolios. METHODS: A cross-sectional electronic survey instrument was sent to experiential coordinators at US colleges and schools of pharmacy to collect data on portfolio content, methods, training and resource requirements, and benefits and challenges of portfolio use. RESULTS: Most colleges and schools of pharmacy (61.8%) use portfolios in experiential courses and the majority (67.1%) formally assess them, but there is wide variation regarding content and assessment. The majority of respondents used student portfolios as a formative evaluation primarily in the experiential curriculum. CONCLUSIONS: Although most colleges and schools of pharmacy have a portfolio system in place, few are using them to fulfill accreditation requirements. Colleges and schools need to carefully examine the intended purpose of their portfolio system and follow-through with implementation and maintenance of a system that meets their goals.

Impact of statin use on heart failure mortality.

BACKGROUND: There is conflicting data regarding the mortality benefit of statins in patients with heart failure. The objectives of our study were to determine whether statin therapy is associated with decreased all-cause mortality and to assess the effect of incremental duration of therapy. METHODS: We studied 10,510 consecutive patients from the Veterans Affairs health system with a diagnosis of heart failure from January 2002 through December 2006. Mean follow-up was 2.66 years. Statin use and duration of therapy were identified. Veterans were classified into four groups based on duration of statin use during the study period (none, 1-25%, 26-75% and >75% use of statins). Logistic regression was performed to identify the association between incident statin use and all-cause mortality following a diagnosis of heart failure. The Kaplan-Meier method was employed to assess for differences in survival time between the four statin use classifications. RESULTS: Statin use was significantly associated with decreased all-cause mortality following a diagnosis of heart failure after controlling for age, gender, concurrent medications and comorbid diagnoses [χ(3)(2) (N = 10,510) = 1077.82, p < 0.001]. The benefit was seen within a relatively short duration (within 1 year) after starting statins, and in patients with <25% use of statins, there was no mortality benefit. CONCLUSION: Veterans who were not exposed to statin therapy at any time during the study period were 1.56 times more likely to suffer all-cause mortality.

A survey of pharmacy students' experiences with gambling.

OBJECTIVES: To assess gambling among pharmacy students using the South Oaks Gambling Screen (SOGS). METHODS: Six hundred fifty-eight pharmacy students enrolled at Creighton University were surveyed to determine the extent and characteristics of their gambling. RESULTS: Four hundred eighty-eight students (74.2%) participated (mean age was 26.6 years and 63.4% were female). Almost two-thirds (63.1%) gambled at least once during the past 12 months. Slightly more than 16% (80) of students were identified as "at-risk" (SOGS scores of 1 to 2). Another 5% (24) were likely to be problem gamblers (SOGS scores of 3 to 4), while 1% of students were identified as probable pathological gamblers (SOGS scores > or = 5). Students who gambled were significantly more likely than non-gamblers to be single males. Gamblers with a score > or = 1were significantly more likely to report gambling had affected their relationships with others, compared to casual gamblers. CONCLUSIONS: Gambling is a common activity among pharmacy students. While the incidence of problem gambling is relatively small, the percentage of our students who may be at-risk for gambling-related problems is noteworthy.

National Survey of Volunteer Pharmacy Preceptors: effects of region, practice setting, and population density on responses.

OBJECTIVES: To survey volunteer pharmacy preceptors regarding experiential education and determine whether differences in responses relate to such factors as geographic region, practice setting, and population density. METHODS: An online survey was sent to 4396 volunteer experiential preceptors. The survey consisted of 41 questions asking the preceptor to comment on the experiential education environment. Experiential education administrators from 9 schools of pharmacy administered the survey to their volunteer preceptors in all regions (Northeast, Midwest, South, and West) of the United States, in various pharmacy practice settings, and areas of differing population densities. RESULTS: A total of 1163 (26.5%) preceptors responded. Regionally, preceptors in the West disagreed more than those in the Midwest and the South that they had enough time to spend with students to provide a quality experience and also required compensation less often than their counterparts in the Northeast and South. Concerning practice settings, hospital preceptors accepted students from more schools, had greater increases in requests, turned away more students, and spent less time with the students compared to preceptors in other settings. Population density differences reflected that preceptors at urban sites took and turned away more students than those at rural sites. Preceptors from rural areas spent more time with students and felt they were spending enough time with their students to provide quality experiences when compared to other preceptors. CONCLUSIONS: The results of this national volunteer preceptor survey may assist pharmacy school leaders in understanding how location, practice type, and population density affect experiential education, preceptor time-quality issues, and site compensation so they can take necessary actions to improve quality of student practice experiences.

Faculty and student expectations and perceptions of e-mail communication in a campus and distance doctor of pharmacy program.

OBJECTIVE: To examine faculty members' and students' expectations and perceptions of e-mail communication in a dual pathway pharmacy program. METHODS: Three parallel survey instruments were administered to campus students, distance students, and faculty members, respectively. Focus groups with students and faculty were conducted. RESULTS: Faculty members perceived themselves as more accessible and approachable by e-mail than either group of students did. Campus students expected a shorter faculty response time to e-mail and for faculty members to be more available than did distance students. CONCLUSION: E-mail is an effective means of computer-mediated communication between faculty members and students and can be used to promote a sense of community and inclusiveness (ie, immediacy), especially with distant students.

An instructional model for a nonprescription therapeutics course.

OBJECTIVES: To design and implement curricular modifications to a nonprescription therapeutics course to better meet course objectives. DESIGN: Improvements included the addition of journaling, mastery grading, case studies, verbal examinations, educational mentors, and encouraging classroom participation. ASSESSMENT: Student course evaluations and grades were used to assess the impact of the pedagogical modifications. Course grades indicated that students succeeded in learning at the set mastery level of 80%. Course evaluations indicated students responded positively to the course modifications. CONCLUSION: Ongoing curricular modifications ultimately resulted in a course that met established course objectives.

Effectiveness of human anatomy education for pharmacy students via the Internet.

OBJECTIVE: To evaluate the overall effectiveness of a human anatomy course taught to distance-based and campus-based pharmacy students. DESIGN: A retrospective analysis of students' grades and course evaluations from 2003 through 2006 was conducted. ASSESSMENT: No significant differences in student performance by pathway were found for the 2003-2005 academic years (p > 0.05). However, distance-based students' percentage and letter grades were significantly higher in 2006 (p = 0.013 and p = 0.004 respectively). Comparison of course and instructor evaluations showed that students in the distance course held similar or more positive perceptions of the course than their campus peers. CONCLUSIONS: Similar performance by campus and distance students enrolled in a human anatomy suggests that a distance-based course can be used successfully to teach human anatomy to pharmacy students.

The Vermont Diabetes Information System (VDIS): study design and subject recruitment for a cluster randomized trial of a decision support system in a regional sample of primary care practices.

BACKGROUND: Despite evidence that optimal care for diabetes can result in reduced complications and improved economic outcomes, such care is often not achieved. The Vermont Diabetes Information System (VDIS) is a registry-based decision support and reminder system based on the Chronic Care Model and targeted to primary care physicians and their patients with diabetes. PURPOSE: To develop and evaluate a regional decision support system for patients with diabetes. METHODS: Randomized trial of an information system with clustering at the practice level. Ten percent random subsample of patients selected for a home interview. SUBJECT: and setting includes 10 hospitals, 121 primary care providers, and 7348 patients in 55 Vermont and New York primary care practices. RESULTS: We report on the study design and baseline characteristics of the population. Patients have a mean age of 63 years and a mean glycosolated hemoglobin A1C of 7.1 %. Sixty percent of the population has excellent glycemic control (A1 C < 7%); 45% have excellent lipid control (serum LDL-cholesterol <100 mg /dL and serum triglycerides <400 mg/dL). Twenty-five percent have excellent blood pressure control (<130/80mmHg). These results compare favorably to recent national reports. However, only 8% are in optimal control for all three of hyperglycemia, lipids and blood pressure. CONCLUSIONS: Our experience to date indicates that a low cost decision support and information system based on the Chronic Care Model is feasible in primary care practices that lack sophisticated electronic information systems. VDIS is well accepted by patients, providers and laboratory staff. If proven beneficial in a rigorous, randomized, controlled evaluation, the intervention could be widely disseminated to practices across America and the world with a substantial impact on the outcomes and costs of diabetes. It could also be adapted to other chronic conditions. We anticipate the results of the study will be available in 2006.

Student understanding of the relationship between the health professions and the pharmaceutical industry.

BACKGROUND: Pharmaceutical sales representatives and direct-to-consumer advertising may influence physician practices, particularly prescribing. Identifying the relevant knowledge and attitudes students possess about the pharmaceutical industry may help professional curricula address these influences. PURPOSES: To assess knowledge and attitudes toward pharmaceutical industry marketing, ethical principles guiding drug company interactions, pharmaceutical sales representatives as a source of drug information, and confidence level in addressing consumers seeking a prescription from a direct-to-consumer advertisement among senior-level medical, PharmD, and nurse practitioner students. METHODS: A cross-sectional survey design was used to assess student knowledge and attitudes of four domains associated with the pharmaceutical industry. RESULTS: Significant deficiencies were noted in student knowledge of pharmaceutical marketing expenditures, professional ethics regarding interactions with drug companies, and accuracy of drug information from sales representatives. CONCLUSIONS: Health professional students' knowledge and attitudes toward the pharmaceutical industry are formed prior to graduation. Professional curricula must address the influences of sales representatives before postgraduate training.

Patient perceptions of a proton pump inhibitor therapeutic interchange program across the continuum of care.

OBJECTIVE: To determine if participation in a hospital-based proton pump inhibitor (PPI) therapeutic interchange program resulted in differences in patient perceptions related to clinical and humanistic outcomes. METHODS: A quasiexperimental repeated-measures study compared patients' perceptions in two groups (111 patients) at hospital admission, discharge, 3-4 days after discharge, and 2-3 weeks after discharge to detect differences across the continuum of care. Patient awareness of the hospital-based interchange also was examined. Clinical and quality-of-life outcomes were measured by using a condition-specific instrument modified for use with patients. Satisfaction and expectations were measured by using extent-of-agreement measures. Group 1 (60 patients) was prescribed omeprazole before admission, switched to lansoprazole during hospitalization, and discharged taking omeprazole. Group 2 (51 patients) was prescribed lansoprazole before admission and continued taking lansoprazole throughout hospitalization and after discharge. Patients who were unable to communicate or who had a substantial change in severity of illness (not attributable to gastrointestinal disorders) during the study were excluded. RESULTS: No significant differences were found between groups 1 and 2 for clinical outcomes, quality of life, extent to which expectations were met, or satisfaction at the four time periods. Nineteen (36%) of 53 surveyed patients in group 1 were not aware that their therapy had been interchanged while in the hospital. CONCLUSION: Patient-perceived outcomes and expectations of therapy across the continuum of care were not affected by a hospital-based PPI therapeutic interchange program.

Limited impact of sustained simple feedback based on soap and paper towel consumption on the frequency of hand washing in an adult intensive care unit.

OBJECTIVE: To determine whether hand washing would increase with sustained feedback based on measurements of soap and paper towel consumption. DESIGN: Prospective trial with a nonequivalent control group. SETTING: Open multibed rooms in the Omaha Veterans Affairs Medical Center's Surgical Intensive Care Unit (SICU) and Medical Intensive Care Unit (MICU). SUBJECTS: Unit staff. INTERVENTION: Every weekday from May 26 through December 8, 1998, we recorded daytime soap and paper towel consumption, nurse staffing, and occupied beds in the SICU (intervention unit) and the MICU (control unit) and used these data to calculate estimated hand washing episodes (EHWEs), EHWEs per occupied bed per hour, and patient-to-nurse ratios. In addition, from May 26 through June 26 (baseline period) and from November 2 through December 8 (follow-up period), live observers stationed daily for random 4-hour intervals in the MICU and the SICU counted actual hand washing episodes (CHWEs). The intervention consisted of posting in the SICU, but not in the MICU, a graph showing the weekly EHWEs per occupied bed per hour for the preceding 5 weeks. RESULTS: Directly counted hand washing fell in the SICU from a baseline of 2.68+/-0.72 (mean +/- standard deviation) episodes per occupied bed per hour to 1.92+/-1.35 in the follow-up period. In the MICU, episodes fell from 2.58+/-0.95 (baseline) to 1.74+/-0.69. In the MICU, the withdrawal of live observers was associated with a decrease in estimated episodes from 1.36+/-0.49 at baseline to 1.01+/-0.36, with a return to 1.16+/-0.50 when the observers returned. In the SICU, a similar decrease did not persist throughout a period of feedback. Estimated hand washing correlated negatively with the patient-to-nurse ratio (r = -0.35 for the MICU, r = -0.46 for the SICU). CONCLUSIONS: Sustained feedback on hand washing failed to produce a sustained improvement. Live observers were associated with increased hand washing, even when they did not offer feedback. Hand washing decreased when the patient-to-nurse ratio increased.