Impact of educational intervention by community pharmacists on asthma clinical outcomes, quality of life and medication adherence: A systematic review and meta-analysis.

WHAT IS KNOWN AND OBJECTIVE: Community pharmacists can play an important role in controlling chronic diseases. This study aimed to evaluate the effects of pharmacists' educational interventions in the community pharmacy settings on asthma control and severity, quality of life (QOL) and medication adherence. METHODS: Databases PubMed, Scopus and Web of Science were searched for evidence regarding asthma severity and control, QOL, and medication adherence after pharmacists' interventions in community pharmacy settings. Twenty-one studies were eligible for qualitative and quantitative analysis. Indices and questionnaires were used in the studies, such as Asthma-related quality of life (IAQLQ), Asthma Control Test (ACT), Perceived Control of Asthma Questionnaire (PCAQ), inhaler technique (IT), Asthma Control Questionnaire (ACQ), 36-Item Short Form survey (SF-36) and peak expiratory flow rate (PEFR). The outcomes were extracted, pooled and analysed as percentages, means, standard deviations and errors, and 95% confidence intervals (CIs). RESULTS AND DISCUSSION: Community pharmacists in all studies educated and followed up the asthmatic patients, addressing the outcome measures. Pharmacists underwent training courses of at least a day. Standardized mean differences for the indices were pooled as follows: IAQLQ -0.241 (95% CI, -0.362 to -0.121), ACT 0.14 (95% CI, 0.02 to 0.27), PCAQ -0.15 (95% CI, -0.28 to 0.01), IT 0.79 (95% CI, 0.05 to 1.54), ACQ -0.50 (95% CI, -0.69 to -0.30), SF-36 0.39 (95% CI, 0.16 to 0.62), PEFR 0.13 (95% CI, 0.01 to 0.26) and asthma symptoms score -0.34 (95% CI, -0.49 to -0.18). WHAT IS NEW AND CONCLUSION: Pharmacists' educational interventions in community pharmacy settings could significantly improve asthma severity and control, QOL and medication adherence.

Continuous learning through platforms.

The health crisis situation we have experienced caused by the SARSCoV-2 virus  has changed our daily life in numerous aspects, including those related to  training (undergraduate, postgraduate, and continuing education, etc). Training  activities, conferences, lectures, face-to-face workshops were suspended until  the Health Situation was over. Alternatives to face-to-face training were needed  to guarantee the continuity of these activities. Online training, teaching and  evaluation emerged as a relatively fast, simple, operational and flexible solution. Universities and faculties promoted online teaching through virtual  classes. The Spanish Society of Hospital Pharmacy supported this initiative by  signing an agreement with the Board of Deans and Chancellors of Pharmacy to  make it possible for undergraduate students to continue their studies and  supervised practices in hospital pharmacy departments. Specialized training was  affected. Pharmacy residency programs were significantly modified by hospital  pharmacies to be able to provide the new clinical and research activities  required, everyday, by the pandemic situation. Postgraduate and residency  training were also negatively affected. Again, online activities made up for  restrictions to face-to-face teaching and training. The Spanish Society of Hospital Pharmacy promoted continuing education and provided updated information on  the SARS-CoV-2 virus through its website. Thus, numerous virtual sessions,  lectures and webinars have been held, and high-quality material was offered to  provide up-todate knowledge, on the pharmacological management of patients  with COVID-19. Online teaching and education has demonstrated to be an  invaluable tool for hard times. During the lockdown, technology has kept us  closer and has emerged as an ally. Many of us have found a new means of  communication, information, and training. The Spanish Society of Hospital  Pharmacy has substantially contributed to make it possible.

La situación de crisis sanitaria que hemos vivido con motivo de la pandemia causada por el virus SARS-CoV-2 ha cambiado nuestro día a día en muchos aspectos, incluidos los relacionados con nuestra formación (de  pregrado, especializada, continuada, etc.). Se suspendieron las actividades docentes, congresos, charlas y talleres presenciales hasta la  resolución de la situación sanitaria. Era necesario buscar alternativas a la  presencialidad que garantizasen la continuidad de estas actividades. La  formación, docencia y evaluación en línea se presentaba como una solución  relativamente rápida, sencilla, operativa y flexible. Desde las universidades y  facultades se promovía la docencia en remoto con material docente y clases  virtuales. La Sociedad Española de Farmacia Hospitalaria ha facilitado esta  iniciativa al firmar un convenio con la Conferencia de Decanos de Farmacia para  que estudiantes matriculados en Prácticas tuteladas, y en formación en un  servicio de farmacia hospitalaria, pudieran seguir con sus estudios de pregrado. La formación especializada resultó afectada. Los planes de formación de los farmacéuticos internos residentes requirieron cambios  importantes por la necesidad de dar respuesta desde los servicios de farmacia a  las nuevas actividades asistenciales y de investigación que se producían, cada día de manera cambiante, en la situación de pandemia. La formación continuada de los especialistas (y residentes) quedó también alterada. De nuevo, las  actividades en línea permitieron salvar, en cierto grado, el déficit de actividades  docentes y formativas. A través de su página web, la Sociedad Española de  Farmacia Hospitalaria promovió la formación continuada y el seguimiento de la  actualidad sobre la pandemia por el virus SARS-CoV-2; organizó sesiones  virtuales, jornadas y talleres en formato webinar y proporcionó material de alta  calidad que facilitaba el conocimiento, en tiempo real, de la gestión del  tratamiento farmacológico en pacientes con COVID-19. La aplicación de la  docencia y formación en línea ha demostrado ser una herramienta  imprescindible en tiempos complicados, como los vividos. Durante el  confinamiento, la tecnología nos ha acercado y se ha convertido en la gran  aliada. También ha supuesto el descubrimiento, para muchos de nosotros, de  una nueva manera de comunicarnos, informarnos y formarnos. La Sociedad  Española de Farmacia Hospitalaria ha colaborado de manera importante a que  esto sea así.

Establishing an investigational drugs and research residency at an academic medical center.

PURPOSE: The development, structure, and implementation of an innovative residency program designed to help meet a growing need for pharmacists with specialized expertise in investigational drug use and clinical research are described. SUMMARY: Clinical research has become an increasingly complex field, but prior to 2017 there were no U.S. specialty residency training programs focused on pharmacists' role in drug development and the care of patients enrolled in clinical trials. In 2016 Johns Hopkins Hospital (JHH) launched an initiative to develop residency training standards specific to the areas of investigational drug use and clinical research. The residency development process consisted of creation of a residency development committee; a needs assessment, including formation of a diverse panel of internal and external experts to guide identification of key competency areas and development of residency goals and objectives; design of the program's structure, including a framework for required and elective rotations; submission of an application for pre-candidate status to the ASHP Commission on Credentialing; and recruitment efforts. CONCLUSION: The JHH investigational drugs and research residency, a combined PGY1 and PGY2 program with 5 competency areas, 14 goals, and 49 objectives, was granted pre-candidate status by ASHP in November 2016. The first resident began the program in June 2017.

Implementation of a pharmacogenomics education program for pharmacists.

PURPOSE: The development, implementation, and evaluation of a pharmacogenomics education program for pharmacists in a large, integrated multicampus health system are described. SUMMARY: Pharmacogenomics has been described as tailoring medications to each patient's unique genetic sequence with the goals of minimizing harmful effects and optimizing therapeutic effects. Pharmacists are uniquely trained to lead the implementation of pharmacogenomics in clinical care. After assessment of pharmacists' comfort with pharmacogenomics, different approaches were explored to develop, pilot test, and disseminate pharmacogenomics education across a multicampus academic medical center. Limited success with large-audience, single-lecture didactic education led to development and delivery of targeted, competency-based online modules using the institution's academic virtual learning environment and course management system. Implementation steps included (1) collaboration with the Mayo Clinic Center for Individualized Medicine to create an interprofessional development team and project charter, (2) galvanizing pharmacy leadership support across multiple campuses, (3) development of competency-based interactive modules, and (4) assessment of the quality of and learner satisfaction with the modules. Significant improvements in competency scores were observed with each module and across the multiple campuses. Satisfaction with the education program was assessed at the end of a 4-module series. CONCLUSION: A pharmacogenomics educational program targeting pharmacists was developed through interprofessional collaboration and provided a novel opportunity to construct an educational infrastructure to support enterprise health-system campuses with limited educational resources.

Evaluating the online platform of a blended-learning pharmacist continuing education degree program.

BACKGROUND: Distance-based continuing education opportunities are increasingly embraced by health professionals worldwide. METHODS: To evaluate the online component of a blended-learning degree program for pharmacists, we conducted a structured self-assessment and peer review using an instrument systematically devised according to Moore's principles of transactional distance. The web-based platform for 14 courses was reviewed by both local and external faculty, followed by shared reflection of individual and aggregate results. RESULTS: Findings indicated a number of course elements for modification to enhance the structure, dialog, and autonomy of the student learning experience. CONCLUSION: Our process was an important exercise in quality assurance and is worthwhile for other health disciplines developing and delivering distance-based content to pursue.

Impact of Stewardship Interventions on Antiretroviral Medication Errors in an Urban Medical Center: A 3-Year, Multiphase Study.

BACKGROUND: There is a high prevalence of HIV infection in Newark, New Jersey, with University Hospital admitting approximately 600 HIV-infected patients per year. Medication errors involving antiretroviral therapy (ART) could significantly affect treatment outcomes. The goal of this study was to evaluate the effectiveness of various stewardship interventions in reducing the prevalence of prescribing errors involving ART. METHODS: This was a retrospective review of all inpatients receiving ART for HIV treatment during three distinct 6-month intervals over a 3-year period. During the first year, the baseline prevalence of medication errors was determined. During the second year, physician and pharmacist education was provided, and a computerized order entry system with drug information resources and prescribing recommendations was implemented. Prospective audit of ART orders with feedback was conducted in the third year. Analyses and comparisons were made across the three phases of this study. RESULTS: Of the 334 patients with HIV admitted in the first year, 45% had at least one antiretroviral medication error and 38% had uncorrected errors at the time of discharge. After education and computerized order entry, significant reductions in medication error rates were observed compared to baseline rates; 36% of 315 admissions had at least one error and 31% had uncorrected errors at discharge. While the prevalence of antiretroviral errors in year 3 was similar to that of year 2 (37% of 276 admissions), there was a significant decrease in the prevalence of uncorrected errors at discharge (12%) with the use of prospective review and intervention. CONCLUSIONS: Interventions, such as education and guideline development, can aid in reducing ART medication errors, but a committed stewardship program is necessary to elicit the greatest impact.

Digital literacy knowledge and needs of pharmacy staff: A systematic review.

OBJECTIVE: To explore the digital literacy knowledge and needs of pharmacy staff including pharmacists, graduate (pre-registration) pharmacists, pharmacy technicians, dispensing assistants and medicine counter assistants. METHODS: A systematic review was conducted following a pre-published protocol. Two reviewers systematically performed the reproducible search, followed by independent screening of titles/abstracts then full papers, before critical appraisal and data extraction. Full articles matching the search terms were eligible for inclusion. Exclusions were recorded with reasons. Kirkpatrick's 4 level model of training evaluation (reaction, learning, behaviour and results) was applied as an analytical framework. RESULTS: Screening reduced the initial 86 papers to 5 for full review. Settings included hospital and community pharmacy plus education in Australia, Canada and the US. No studies of pharmacy staff other than pharmacists were identified. Main findings indicate that pharmacy staff lack digital literacy knowledge with minimal research evidenced at each level of Kirkpatrick's model. CONCLUSIONS: As a society, we acknowledge that technology is an important part of everyday life impacting on the efficiency and effectiveness of working practices but, in pharmacy, do we take cognisance, 'that technology can change the nature of work faster than people can change their skills'? It seems that pharmacy has embraced technology without recognised occupational standards, definition of baseline skills or related personal development plans. There is little evidence that digital literacy has been integrated into pharmacy staff training, which remains an under-researched area.

Making a Curricular Commitment to Continuing Professional Development in Doctor of Pharmacy Programs.

As outlined in the Accreditation Council for Pharmacy Education (ACPE) Standards 2016, colleges and schools of pharmacy must provide an environment and culture that promotes self-directed lifelong learning. Continuing professional development (CPD) serves as a model that can foster and support self-directed, lifelong learning. The benefits of adopting a CPD model include assistance with attaining Center for the Advancement of Pharmaceutical Education (CAPE) 2013 Outcomes, such as self-awareness. This model can also support the individualization of experiential learning and student action on feedback from curricular-level assessments. The major skills involved in CPD, such as reflection and documentation, are frequently addressed in pharmacy curricula. However, these skills may be developed in isolation or exercised for purposes other than learning. The aim of this statement is to aid schools in creating "CPD ready" practitioners by defining the skill sets involved in CPD and making recommendations for advancing CPD in curricula.

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.

Scottish pharmacists' perceptions and experiences of a practice-based small group learning pilot: a qualitative study.

INTRODUCTION: CPD is an important feature of healthcare professions and regulatory bodies consider it mandatory. Studies of CPD activity of pharmacists showed that 10% were undertaking no CPD. Practice-based small group learning (PBSGL) is a well-received and popular learning resource for GPs in Scotland. From 2011, a pharmacy pilot was undertaken: pharmacists were trained as peer-facilitators and existing PBSGL modules were adapted. Four NHS boards took part and this study aimed to explore the perceptions and experiences of pharmacists. METHODS: A qualitative research approach was adopted using focus groups and in-depth interviews. Interviews were audio-recorded and transcriptions made. Transcripts were coded and themes developed using grounded theory methods. RESULTS: Participants welcomed PBSGL: it was a feasible learning method, acceptable and had educational impact. They appreciated its interactive nature and discussions founded on their experiences in practice. Participants liked the self-reliance of PBSGL in that they were not dependent on specialist practitioners. There were logistical challenges that impacted on the success of group discussion; some pharmacists were less familiar with small group work. Pharmacists felt isolated during work and appreciated peer discussion. There was a tentative welcome to inter-professional learning but group composition and module topics might impact on the success of this. CONCLUSION: Pharmacists were able to change their learning practice in uni-professional PBSGL groups and were able to learn from each other. There may be further learning opportunities if pharmacists participate in inter-professional groups.

Improving pharmacist documentation of clinical interventions through focused education.

PURPOSE: The impact of a focused education initiative to increase pharmacists' documentation of clinical interventions is described. SUMMARY: A focused education initiative was developed to increase the consistency of pharmacists' documentation of clinical interventions in order to achieve pharmacy goals and to demonstrate the value of pharmacy services at Carolinas Medical Center in Charlotte, North Carolina. Education was provided through weekly pharmacy newsletter publications, weekly huddles, and monthly staff meetings. Pharmacy clinical specialists were tasked with providing examples of activities that should be documented as interventions, reviewing the selection of intervention categories to best capture the specific activity, and emphasizing the need for appropriate documentation. Monthly progress was monitored, and results were posted publicly to incentivize staff and assist with accountability. Increases in the number of clinical interventions was reported at monthly pharmacy staff meetings to reinforce the value of this process. The total number of pharmacy clinical interventions increased from an average of 12,493 per month in the first quarter of 2012 to an average of 27,978 per month in the second quarter of 2013, representing a 120% improvement. Associated cost-avoidance dollars also increased proportionally, such that the average cost-avoidance dollars in the second quarter of 2013 was $1.5 million per month. In addition, the pharmacy department far exceeded the health system's division of pharmacy targets for established quality indicators. Effects were sustained during the 12 months after completion of the education initiative. CONCLUSION: Implementation of a focused pharmacist education initiative led to increased numbers of clinical interventions reported and increased documentation of costs avoided.

Using an intervention mapping framework to develop an online mental health continuing education program for pharmacy staff.

INTRODUCTION: Current mental health policy in Australia recognizes that ongoing mental health workforce development is crucial to mental health care reform. Community pharmacy staff are well placed to assist people with mental illness living in the community; however, staff require the knowledge and skills to do this competently and effectively. This article presents the systematic planning and development process and content of an education and training program for community pharmacy staff, using a program planning approach called intervention mapping. METHODS: The intervention mapping framework was used to guide development of an online continuing education program. Interviews with mental health consumers and carers (n = 285) and key stakeholders (n = 15), and a survey of pharmacy staff (n = 504) informed the needs assessment. Program objectives were identified specifying required attitudes, knowledge, skills, and confidence. These objectives were aligned with an education technique and delivery strategy. This was followed by development of an education program and comprehensive evaluation plan. The program was piloted face to face with 24 participants and then translated into an online program comprising eight 30-minute modules for pharmacists, 4 of which were also used for support staff. The evaluation plan provided for online participants (n ≅ 500) to be randomized into intervention (immediate access) or control groups (delayed training access). It included pre- and posttraining questionnaires and a reflective learning questionnaire for pharmacy staff and telephone interviews post pharmacy visit for consumers and carers. RESULTS: An online education program was developed to address mental health knowledge, attitudes, confidence, and skills required by pharmacy staff to work effectively with mental health consumers and carers. DISCUSSION: Intervention mapping provides a systematic and rigorous approach that can be used to develop a quality continuing education program for the health workforce.

Implementation of a training program to improve pharmacy services for high-risk neonatal and maternal populations.

PURPOSE: A training program aimed at increasing pharmacists' role in the care of high-risk maternal, neonatal, and pediatric patients is described. SUMMARY: In preparation for the planned expansion of a large Ohio hospital's maternal and neonatal critical care services, the pharmacy department developed a training program to increase the knowledge and skill sets of staff pharmacists, especially those who lacked residency training. The program also supported the department's transition to an integrated patient-centered pharmacy practice model. Clinical practice guidelines, policy statements, and other sources were used to develop a series of 57 one-hour lectures on a wide range of topics in maternal-neonatal critical care. The lectures were delivered one morning each week, every other week, over 30 months, with additional case-based homework assigned; a passing score (80%) on all module examinations and homework assignments was required for continued course participation. Trainees who completed the voluntary program earned a certificate from the department head and continuing-education credit from the Ohio State Board of Pharmacy, and they were eligible to engage in expanded rounding and patient counseling activities. The program appeared to have a positive impact on patient satisfaction and efforts to reduce medication misadventures in the neonatal intensive care unit. CONCLUSION: The implementation of a training program to educate non-residency-trained pharmacists in selected areas of maternal, neonatal, and pediatric health care helped enable the expansion of pharmacy services to include admission, daily, and discharge counseling.