Evaluation of Interprofessional Delivery of Diabetes Medication Management Training Among Family Medicine Residents.

OBJECTIVE: Diabetes-related care makes up approximately 24% of outpatient clinic visits. Therefore, confidence and understanding of diabetes management is necessary for family medicine residents. METHODS: We developed a combined lecture and simulation lab curriculum utilizing a registered nurse and pharmacist to deliver education to 20 family medicine learners. Pre and post surveys of the educational material were completed in 2 sections including one gauging medical knowledge and a second part gauging level of comfort. RESULTS: Of the learners who participated, fourteen completed the pre-post surveys. Most (53%) respondents improved their scores, while 20% scored the same 27% scored worse. The overall average score increased 57% to 70% and improvement was statistically significant (P < .05). All learners improved confidence by at least 1 point. CONCLUSION: An interprofessional team utilizing a lecture curriculum focusing on providing education on effective prescribing, medication safety profiles, and resource availability, showed improvement in confidence but mixed knowledge benefit. Further modifications to the curriculum may yield further educational gains.

Evaluation of a hybrid medication synchronization training module for pharmacy technicians.

BACKGROUND: Medication synchronization involves coordinating a patient's medications to a single date each month. Medication synchronization programs close gaps in care and improve adherence compared with automatic refill-processing programs. Patients are 2-6 times more adherent to medications when enrolled in a medication synchronization program. Medication synchronization has historically been driven by pharmacists; however, pharmacy technicians are in a unique position to logistically run this service. OBJECTIVE: This study aimed to develop a training program for pharmacy technicians regarding medication synchronization and assess changes in knowledge and confidence before and after implementing a training program. PRACTICE DESCRIPTION: An independent community pharmacy in North Carolina. Pharmacists provide medication therapy management, reimbursed clinical services, medication synchronization, and immunizations. PRACTICE INNOVATION: The training program included medication synchronization basics, patient enrollment process, processing a synced patient, and a hands-on practice session. EVALUATION METHODS: Technicians took a pre-training survey assessing knowledge and confidence before immediately completing a one-on-one pharmacist-led training session with a hands-on component regarding medication synchronization. Technicians took the same post-training survey 2 weeks after completing the training session and using medication synchronization in daily workflow. Pre- and post-training scores were assessed using a paired samples t test. RESULTS: Ten technicians completed the training program; 40% of the technicians were certified and 30% were enrolled in a PharmD program. The mean pre-training knowledge score was 78% (7.1 of 9 points), the mean post-training knowledge score was 92% (8.3 of 9 points), and the mean difference between the pre- and post-training knowledge scores was 13.4% (1.2 points), with a statistically significant difference (P = 0.0026). Confidence with conducting a medication synchronization call increased from 7.2 to 9.6 on a 10-point Likert scale, and confidence scores increased regarding incorporating medication synchronization into workflow from 6.9 to 8.7. CONCLUSION: The standardized technician training program increased knowledge and confidence in technicians regarding managing a medication synchronization program.

Earthquakes, Hurricanes, Pandemics: Pharmacy Students Impacting Pharmacy Practice in Puerto Rico Through Medication Therapy Management Services During Disasters.

BACKGROUND: Community-based medication therapy management advanced pharmacy practice experiences (MTM APPE) can engage pharmacy students in public health initiatives, including emergency response preparedness, to successfully impact patient care. This study aimed to evaluate pharmacy students' perceptions of their experience on an MTM APPE during disasters in Puerto Rico. METHODS: After completing the MTM APPE during times of hurricanes, earthquake or pandemic, pharmacy students were asked to voluntarily participate in a questionnaire about their perception of assisting during a disaster. The survey consisted of 5 questions. Four questions were based on a Likert scale with answers choices ranging from Agree, Not Sure, Disagree, or Not Applicable. One question requested free text comments from participants. RESULTS: Sixteen students completed the survey. Pharmacy students agreed that the MTM APPE taught them the clinical skills needed to assist and educate individual patients and the community that suffered from a disaster, and that the role of the pharmacist is vital when a disaster disrupts a community's health-care system. CONCLUSIONS: Training in emergency response to disasters should be a considered component of MTM APPE.

Promover a capacitação da pessoa idosa para o uso seguro da medicação: intervenção de enfermagem comunitária / Promoting the training of elderly people for the safe use of medicines: community nursing intervention

Introdução: O aumento da esperança de vida, é um facto, no entanto esse facto acarreta consigo a multimorbilidade e consequentemente a polimedicação, em esquemas terapêuticos muitas vezes complexos, podendo levar a problemas de segurança no uso de medicamentos. As Pessoas Idosas, fruto das alterações fisiológicas e da diminuição das capacidades físicas e/ou cognitivas representam um grupo especialmente vulnerável a esta problemática. Aos enfermeiros, é reconhecida competência para intervir na capacitação da Pessoa Idosa, mobilizando estratégias que possam dar resposta às necessidades identificadas, capacitando-as para o autocuidado e promovendo o uso seguro da medicação. Objetivo: "Promover a capacitação para o uso seguro da medicação, num grupo de idosos residentes na área de intervenção duma Unidade de Cuidados na Comunidade do ACeS Oeste Sul". Metodologia: Este projeto foi desenvolvido recorrendo a metodologia do Planeamento em Saúde, como suporte teórico foi ancorado na Teoria de Enfermagem do Défice de Autocuidado. Para o diagnóstico de situação foi utilizada a escala de Medida de Adesão ao Tratamento, complementada por questões sobre gestão do regime terapêutico e dados sociodemográficos através da aplicação dum questionário a uma amostra de 80 Pessoas Idosas. Identificaram-se problemas, definiram-se objetivos e metas. Tendo em conta que o diagnóstico de situação revelou défice de autocuidado na gestão do regime medicamentoso e défice de conhecimentos relacionados com uso do medicamento, foi selecionada como estratégia de intervenção a Educação para a Saúde. Foram realizadas sessões em grupo e elaborados ferramentas de suporte em complementaridade à informação transmitida nessas sessões. Resultados: A avaliação do projeto demonstrou que após as intervenções de enfermagem desenvolvidas houve aquisição de conhecimentos sobre uso seguro da medicação por parte dos participantes. As metas propostas foram atingidas e 100% dos participantes recomendariam estas sessões de Educação para a Saúde a outras pessoas, o que demonstra a sua satisfação com as mesmas.(AU)

Introduction: The increase in life expectancy, albeit a positive, carries with it multimorbidity, which in turn is treated via polimedication, consisting in often complex therapeutical schemes, that can create health problems related to the way by which the necessary medicines are taken. The elderly people, due to physiological changes and their decreased motor and/or cognitive functions, represent an especially vulnerable group. It is expected of nurses to Empower elderly people, by employing strategies adequate to the identified needs, improving their ability to take care of themselves and promoting the safe use of their medications. Objective: To promote the safe use of medications, amongst a group of elderly people residing in the intervention area of community care unit in the ACeS Oeste Sul. Methodology: This project was developed using Health Planning Methodology, with theoretical support in the Self-care Deficit Nursing Theory. For monitoring the development of the situation, the adherence-to-treatment scale was used, complemented by questions on the therapeutical regimen and sociodemographic data of 80 elderly people, gathered via survey. Problems were identified and goals were established. Shortcomings in self-care regarding the medicine taking regiment, and knowledge pertaining to the usage of medications were discovered, thus education for health was used as an intervention strategy. Group sessions were carried out, and tools were developed to support and complement the information transmitted in these sessions. Results: After the nursing interventions, the knowledge in safe use of medication ta of the participants increased. The goals were achieved and 100% of participants would recommend the education for health sessions to others, showing their satisfaction with them.(AU)

[Effects of Learning on the Confidence to Provide Medication Education for Pharmacy Students].

Japan passed a law that eliminated discrimination against persons with disabilities in 2016. Health care providers must comply with this law and are required to deepen their understanding of disabilities and take action to eliminate discrimination based on a higher level of awareness. Pharmacists need to better understand hearing disabilities to effectively communicate and provide medication education to deaf and hard of hearing (HH). This study examined the understanding about deaf and HH communities and the effects of learning through a lecture and hearing loss simulation experiences on 151 students in Daiichi University of Pharmacy to improve their understanding deaf and HH communities and ability to communicate effectively with deaf and HH patients in providing medication education in April 2018. Before the learning, 125 students indicated a lack of confidence in their ability to communicate medication education due to a lack of understanding. However, 26 students responded that they could communicate with deaf and HH patients despite their misunderstandings about deaf and HH communities and the features of such communication. After the learning 132 students indicated they had the confidence to interact with deaf and HH patients in communication for medication education. This study suggests that students need to learn about deaf and HH communities and develop communication skills to interact with them for medication education. Taking these steps may contribute to creating an educational program to facilitate communication and improve medication education for deaf and HH through effective communication by pharmacists.

The Effect of a Tailored Health Education Programme on Medication Management in the Elderly.

BACKGROUND: Empowering the elderly by education programs can decrease medication problems, morbidity, and mortality. METHODS: A cross-sectional study to identify trends and baseline medication management among the elderly in nursing homes followed by an interventional study (tailored educational programme) offered within the same population followed by reassessment of the same medication management domains. RESULTS: There was no effect regarding nursing home participants' medication knowledge before and after intervention, while there were variable degrees of significant statistical differences in how the participants obtain and take their medications as well as their total deficiency scores before and after intervention. Other domains were also variably affected. CONCLUSION: It is vital to ensure that patients have sufficient knowledge regarding their medications and how to handle and administer them. Different domains may variably be affected by educational programmes mainly due to preassessment deficits. Educational programmes need to be tailored according to the requirements of the population targeted.

Impairment for Medication Management in Older Adults: Validity of a Family Report Measure.

Objectives: Medication nonadherence can have significant consequences for the health of older adults. Difficulty managing medications is often a sign of cognitive impairment, and monitoring is an early caregiving task for family members. This study examined a screening tool for independence in medication management.Methods: Reliability and validity of the screening tool were assessed in a sample of 152 female care partners for a relative aged 65+years.Results: The tool showed sound test-retest reliability, convergent and discriminant validity, and test utility, such that medication assistance was not better predicted by a global rating of cognitive impairment.Conclusions: In context of cognitive impairment, detection of medication mismanagement could be improved in both primary care and specialty health encounters through adoption of this single-item screening tool.Clinical Implications: This single-item report can be used to quickly facilitate discussions of medication management and cognitive impairment screening in office visits. The item also shows promise for efficient measurement of impairment in medication management than typical IADL assessment language.

Medication management in older adults and interprofessional education: A needs assessment.

Elderly, multi-morbid patients are at high risk for suffering adverse drug events. Safe medication management is a key process in preventing these adverse events, and requires interprofessional teamwork. We performed a needs assessment survey of graduating medical students and faculty to evaluate student training in medication management, in particular students' preparedness in the three minimum geriatrics competencies pertaining to medication management, interprofessional educational opportunities, and optimal learning methods. Response rates were 45/105 (43%) for students and 38/93 (41%) for faculty. The majority of students felt that they did not receive sufficient training in medication management in older adults. Faculty either agreed with students or were unsure whether students received sufficient training. Neither students nor faculty felt that students were extremely prepared to carry out the three minimum geriatrics competencies at the time of medical school graduation. Students and faculty identified direct patient care experiences as the optimal learning method, and inappropriate medications as the highest priority topic. Students and faculty felt that students do not receive sufficient interprofessional educational opportunities. The results of this study are currently being used to create customized interprofessional educational experiences for medical students related to medication management in older adults.

Development of medication-related counselling skills in senior medical students: a checklist-based approach.

BACKGROUND: Effective communication between healthcare providers and patients has been established as a vital element in medication compliance and patient safety. Medical curricula worldwide include medication-related counselling skill as a learning outcome for medical graduates. However, this aspect of health-care training is frequently informal and poorly structured in most medical schools. This paper provides an interesting view of students' experiences of using a checklist-based approach to develop and practice patient counselling in relation to prescribed medications. METHODS: The authors describe introduction of a thirteen item "Patient Education Checklist" (PEC) as part of an optional checklist based exercise (CBE) in year 4 and 5 clinical blocks. Students consulted PEC to discuss relevant practical issues related to medication intake with their patients. Students were expected to submit reflective case summaries regarding their experience of using PEC to counsel patients over a two-week period. The textual data from student submissions was analysed using inductive content analysis. RESULTS: We received 13 year4 and 17 year5 student submissions. A content analysis of student reflections identified four dominant themes 1.Enhancement in self-confidence in relation to patient education (86.7%), 2. PEC perceived useful for patient counselling (83.3%), 3. Recognising variation in health literacy levels of patients (50%), 4.Fear of overloading the patient with information (23.3%). Students realised the need to present the medication related knowledge in simple language and tailor the amount of information as per patients' understanding. Student reflections included interesting observations about the wide variation in health literacy of patients and insights into patients' concerns and frequent misconceptions about medicines. CONCLUSION: Students perceived PEC as a useful tool in adding focus and structure to student patient interactions. They report that it substantially improved their confidence and added quality to patient encounters. Future research is required to assess the effect of CBE on medication compliance and therapeutic outcome. PEC might serve as a useful resource for pharmacy and nursing students.

Value of Pharmacy Students Performing Population Management Activity Interventions as an Advanced Pharmacy Practice Experience.

Objective. To assess the value of an advanced pharmacy practice experience in which students engaged in population health management (PHM) activities for a managed care setting. Methods. Students were provided with a list of patients, trained on the requirements for each PHM activity and completed them independently. The students reviewed the electronic record for each patient on their list to identify those who were non-adherent to dual antiplatelet therapy (DAPT) within one year of coronary stent placement, non-adherent to beta blockers (BB) within six months post-acute myocardial infarction, or with renal dysfunction and requiring dose adjustment of lipid-lowering therapy. Students coded each intervention based on predefined categories such as patient education, medication discontinuation, or medication reconciliation, and then if necessary were reviewed with the pharmacy preceptor. The primary investigator determined the intervention to be either actionable or non-actionable. The primary outcome was the proportion and type of interventions made by each student. The secondary outcome was clinical pharmacist time offset. A retrospective, data-only pilot study was conducted to determine the outcomes from the program over four years. Results. Forty-six students made 3,774 interventions over the study period, 37% of which were categorized as actionable. The most common actionable interventions were providing patient education (52%), verifying prescription adherence (23%), and medication therapy adjustment (10.5%). Over the study period, an estimated 765.6 hours of clinical pharmacist time was offset, or approximately 191.4 hours per academic year. Conclusion. This study demonstrated that a population health management approach can be used successfully within an APPE. This approach can result in offset pharmacist time for precepting organizations, while offering meaningful clinical interventions for patients and learning opportunities for students.

Impacting Student Self-Efficacy and Beliefs of Medication Therapy Management Through a Two-Week Elective.

Objective. To develop and introduce an intensive, two-week Foundations of Medication Therapy Management (MTM) elective course into the Doctor of Pharmacy curriculum, and to determine whether the course impacted students' self-confidence in their abilities to perform MTM services and future plans and beliefs about implementing MTM in practice. Methods. The MTM course was an interactive learning environment where students performed actual comprehensive medication reviews within a real-world documentation platform. A 20-item, Likert-scale survey was administered before and after the course to measure students' confidence in learned skills, future plans for using MTM, and beliefs about MTM. Results. Students reported a significant improvement in 10 MTM-specific skill domains. There were significant changes in students' self-confidence in their ability to provide MTM services and in their beliefs about MTM-related services. Students reported overall improvement in self-perceived MTM specific skills. There was no significant change in students' willingness or plans to engage in MTM-related practice in the future. Conclusion. The findings showed that following participation in an MTM elective course, student pharmacists' perceived ability to deliver MTM care increased and their opinions about MTM services improved. Providing a brief MTM elective course that used first-person case studies may empower student pharmacists to confidently perform MTM services in subsequent courses and in their future practice.

Exploring how medical students learn with the help of a digital presentation: a qualitative study.

BACKGROUND: The web-based presentation software Prezi was used to create a digital presentation in order to facilitate antibiotic knowledge in an undergraduate course on infectious diseases in the Karolinska Institutet Medical Programme. It was unclear how the students used this in their learning, and there is a lack of research on using Prezi presentations in higher education, as well as on learner-content interaction in blended learning in general. METHODS: A qualitative study design was used for an in-depth exploration of the students' experiences of using the presentation in their studies. Students were interviewed using a semi-structured interview guide. The interviews were transcribed verbatim and analysed using qualitative content analysis. RESULTS: Two main themes emerged from the analysis. Firstly, the students experienced that they own their learning: the presentation provided flexibility in studying and increased engagement in the learning process. Secondly, the presentation was part of a superficial learning process: students saw it as a complement to other educational activities, but expressed that there was an absence of pedagogical encounters which prevented the information in the presentation to be placed in a larger context. CONCLUSIONS: The Prezi presentation when used as an e-learning tool was a useful part of and a complement to blended learning in medical education but cannot replace face-to-face learning situations, especially not when the content of the course is complex, such as in the case of antibiotics. The learning objectives should be connected to a learning theory and made explicit for the students. Students should receive instructions and support during the course on how to use new e-learning tools. Continuous pedagogical interaction with feedback and reflection between students, teachers, and patients should be provided to enhance deep learning.

Use of simulation from high fidelity to low fidelity in teaching of safe-medication practices.

OBJECTIVE: To evaluate the effects of simulation techniques on learning outcomes in the teaching of safe drug applications to first year nursing students. METHODS: The semi-experimental study was conducted from February to April 2017, and comprised nursing students of Acibadem Mehmet Ali Aydinlar University. This student satisfaction and selfconfidence in learning scale, medication practice via oral route checklist, and pre- and post-test for safe drug application knowledge Assessment were used for data collection. Following the theoretical lectures, case studies, task trainer practices and scenario with standardised patient were carried out. Baseline knowledge, during-the-scenario performanceand post-scenario level of student's satisfaction and self-confidence were evaluated. Data was analysed using SPSS 18. RESULTS: Of the 58 subjects, 51(87.9%) were female. The overall mean age of the sample was 20.69±1.02 years. There was a statistically significant difference between students' knowledge levels before and after the scenario (p<0.05). Mean performance scoreon safe medication practice was 65.70±5.83. A significant weak positive correlation was found between the students' scores on satisfaction with the simulation and knowledge levels as well as the performance and self-confidence scores (p<0.05 each). Also, there was a strong correlation between the scores on self-confidence scale and the knowledge levels (p<0.01). CONCLUSIONS: Simulation had a positive effect on learning outcomes..

Hábitos de prescripción y conocimientos sobre analgésicos opioides en profesionales de la Pediatría / Prescription habits and knowledge of opioid analgesics in Pediatric Health Professionals

Introducción: El dolor es uno de los síntomas que más sufrimiento produce en cualquier enfermedad y constituye un problema básico de salud en todo el mundo, con frecuencia infra tratado, sobre todo en el área de la Pediatría, con especial déficit en la prescripción de analgésicos opioides. Objetivo: Caracterizar los conocimientos sobre analgésicos opioides y su prescripción por profesionales de la Pediatría. Material y Métodos: Se aplicó un cuestionario construido ad hoc y validado por el método Delphi, a 43 profesionales de la pediatría de tres Hospitales de la provincia La Habana durante el periodo comprendido entre marzo 2017 a marzo 2018. Resultados: Los conocimientos sobre Farmacología de los analgésicos opioides fueron insuficientes en un 81,3 por ciento, regular en un 13 por ciento y buenos en el 5,7 por ciento. Las barreras en la prescripción de opioides más frecuentes fueron el temor a la depresión respiratoria (71,9 por ciento), la escasez de opioides en el Cuadro Básico de Medicamentos (56,3 por ciento) y el temor a la dependencia (36,3 por ciento). Se prescriben opioides sólo en el 39,5 por ciento de los casos, la codeína y el tramadol son los más frecuentemente prescritos. En el 55,8 por ciento de los participantes la formación y superación en analgesia fue insuficiente, en el 28 por ciento regular y solo en el 16,2 por ciento se consideró buena. Conclusiones: Los conocimientos farmacológicos deficientes relativos a los opioides y la baja disponibilidad de estos fármacos son los factores que más influyen en el manejo deficiente del dolor en Pediatría(AU)

Introduction: Pain is one of the symptoms that causes more suffering in any disease. It also constitutes a basic health problem all over the world, which is frequently under-diagnosed mostly in the area of Pediatrics with a special deficit in the prescription of opioid analgesics. Objective: To characterize the knowledge of opioid analgesics and their prescription made by pediatric health professionals. Material and Method: An ad hoc questionnaire, which was validated by the Delphi Method, was applied to 43 pediatricians of three Hospitals in Havana province from March 2017 to March 2018. Results: The knowledge of the pharmacology of opioid analgesics was insufficient in 81.3 percent, regular in 13 percent, and good in 5,7 percent. The most frequent barriers in the prescription of opioids were the fear to respiratory depression (71,9 percent), scarcity of opioids in the Basic Drugs Chart (56,3 percent), and the fear to addiction (36,3 percent). Opioids are prescribed only in 39,5 percent of the cases, being codeine and tramadol the ones that are more frequently prescribed. In 55.8 percent of the inquired cases, the formation and updating in analgesia was insufficient, in 28 percent it was fairly good, and only in 16.2 percent it was considered good. Conclusions: The insufficient pharmacologic knowledge of opioids and the poor availability of these drugs are the factors that most influence on the inadequate management of pain in Pediatrics in our study(AU)

Exploratory implementation of a blended format escape room in a large enrollment pharmacy management class.

BACKGROUND AND PURPOSE: Adapting the popular entertainment activity "Escape Rooms" for educational purposes is an innovative teaching method with the potential to improve the learning experience. This implementation of an educational escape room explored the feasibility of using a blended online/offline escape room activity in a large enrollment pharmacy management course. EDUCATIONAL ACTIVITY AND SETTING: An educational escape room activity based on a mixture of online and paper-based clues was designed and implemented in the human resources module of a third professional year pharmacy management course with 141 students. The proof of concept was assessed via an instructor post-activity feasibility analysis and a log of estimated time for all design, development, and delivery components. The instructional objectives of creating a fun, engaging, and collaborative method of teaching were evaluated through an anonymous online student survey. FINDINGS: The blended environment escape room was implemented successfully. Student perceptions of the activity were generally very positive. In comparison with a typical classroom experience, 91% (n = 126) of participants indicated they were more engaged in thinking about the problems and 89% (n = 123) enjoyed the escape room more. SUMMARY: With an instructional design that addresses logistical requirements, educational escape rooms can be conducted in courses with large enrollments. Time requirements for this type of teaching method are substantial, but reasonable, if the activity is repeated in subsequent semesters. Educational escape rooms can be used to provide a more enjoyable student experience that immerses them as active participants in the learning environment.

The impact of a required course on third year pharmacy students' perceived abilities and intentions in providing medication therapy management.

BACKGROUND AND PURPOSE: To examine the impact of a Medication Therapy Management (MTM) course on third-year pharmacy students' (P3s) perceived abilities and intentions to provide MTM services before and after the course. EDUCATIONAL ACTIVITY AND SETTING: An anonymous 48-item self-administered survey was administered to P3s before and after the MTM course. Forty-six items using a 5-point Likert scale (1 = strongly disagree to 5 = strongly agree) measured abilities in MTM provision using the following seven subdomains: general MTM ability (GA), medication therapy review (MTR), medication-related problems identification/recommendations (MRPIR), disease measurement/monitoring (DM), communication (CO), follow-up/referral (FR), and billing/documentation (BD). Two items assessed intent to provide MTM in practice. Descriptive statistics, Cronbach's alphas, and paired t-tests were used. FINDINGS: All enrolled P3s (n = 110) completed both surveys. Subdomain Cronbach's alphas ranged from 0.70-0.97. Paired t-test showed no significant difference in intention to provide MTM before and after the course; however, the results revealed a significant increase in perceived abilities (before vs. after, respectively) regarding MTR (3.2 ± 0.6;4.2 ± 0.4; p < 0.0001), MRPIR (3.3 ± 0.6;4.2 ± 0.4; p < 0.0001), DM (4.2  ±  0.6;4.5  ±  0.5; p = 0.0004), CO (3.9 ± 0.5; 4.3 ± 0.4; p < 0.0001), FR (3.7±0.8;4.2±0.6; p = 0.0002), and BD (2.4±0.9;3.9±0.8; p < 0.0001). DISCUSSION AND SUMMARY: A required MTM course with both didactic and experiential components were instrumental in improving P3s' perceived abilities to provide MTM services. Additional research is needed to understand why students' intention to provide MTM did not change pre- to post-course completion.

A novel advanced pharmacy practice experience training model focused on medication therapy management delivery within provider offices.

BACKGROUND AND PURPOSE: Pharmacist-delivered medication therapy management (MTM) services are an important part of practice, and students should be trained in MTM provision. Current MTM utilization falls short of the potential benefits that pharmacists could provide, and there are barriers to successful MTM completion. New MTM models need to be explored to demonstrate the pharmacist's role on the medical team and to provide models for cost saving to insurers. EDUCATIONAL ACTIVITY AND SETTING: This manuscript describes a novel grant-funded MTM model supported by fourth year pharmacy students in partnership with several medical clinics. Qualifying patients receive MTM services in the provider office. Students are responsible for maintaining day-to-day operations of the MTM program. FINDINGS: Twe pharmacy students completed their MTM training through this model between April 2016 and September 2017. 123 patients received MTM services, with the average time spent with patients estimated at 41 min. A total of 238 patient encounters were provided. Poor adherence, inappropriate drug dose/dosage form or frequency, and patient side effects were the most common problems addressed. Students reported high satisfaction with this model. DISCUSSION: Providing MTM services, directly in the medical clinic, represents an innovative model of care where students have multiple interprofessional interactions. The extended period of time spent with patients is not supported by reimbursement rates, suggesting an expansion may be appropriate. Further cost analyses and health outcomes need to be collected to justify this increased expense. SUMMARY: This MTM model represents an important alternative to current practice and promotes interprofessional collaboration.

Development and evaluation of an elective course that incorporates a standard medication therapy management certificate program.

BACKGROUND AND PURPOSE: To describe the development and evaluation of a medication therapy management (MTM) elective that incorporates a nationally recognized certificate training program (CTP) by assessing changes in perceived abilities and values among student pharmacists, knowledge of course material, and performance conducting MTM services. Student satisfaction with course content and delivery model was also evaluated. EDUCATIONAL ACTIVITY AND SETTING: University faculty developed a didactic elective course to provide third-professional year student pharmacists with the opportunity to meet the learning objectives of the American Pharmacists Association (APhA) "Delivering Medication Therapy Management Services" CTP. Additional learning activities developed by course faculty included supplemental didactic content, reinforcement exercises, simulated patient interactions, self-reflections, and detailed faculty assessment and feedback. Pre- and post-course surveys collected information about student perceptions and values. Course grades for quizzes, midterm, follow-up, and final comprehensive medication review (CMR) assessments were retrospectively analyzed to assess student performance. Student satisfaction with course content and delivery methods was assessed via a survey. FINDINGS AND DISCUSSION: Student-reported perceived abilities improved across all survey items and there was high baseline agreement with MTM value statements. Quiz results suggested student achievement of course objectives. Student performance improved in most grading domains from the midterm to final assessment. A majority of students were satisfied with the course content and delivery methods. SUMMARY: Evaluation of student perceived abilities and values, performance, and satisfaction support the successful incorporation of the MTM CTP along with faculty-developed supplemental content and activities into a longitudinal elective course in the pharmacy curriculum.

Student Perceptions of the Pharmacist's Approach Across the Varying Levels of Medication Therapy Management Services.

Objective. To explore third-year pharmacy (P3) student perceptions of medication therapy management (MTM) after an introduction to the various levels of MTM services within an MTM course. Methods. A qualitative survey was conducted of 158 P3 students. Open-ended questions were used to explore students' thoughts, feelings, and perceptions related to the pharmacist's approach in MTM following a lecture establishing differences in roles and responsibilities between the varying levels of MTM. Emphasis was placed on the pharmacist's role when providing comprehensive medication management (CMM). CMM is a higher-level direct patient care service with a whole-patient focus that goes beyond medication or disease specific focuses of either a comprehensive medication review (CMR) or targeted medication review (TMR). Thematic analysis was performed and an inductive approach to data analysis was used. Results. The following five themes were identified: misperceptions entering the course, efficient delivery of MTM depends on understanding the differences between services, doctor of pharmacy education is a factor in confused MTM role expectations, role limitations exist and referrals to other providers, and the CMR meets unmet needs. Conclusion. Students noted initial confusion between their roles and responsibilities during a CMM versus a CMR. Pharmacy educators should address the varying roles and responsibility differences across MTM services within their curriculum.