The effects of denitrification parameterization and potential benefits of spatially targeted regulation for the reduction of N-discharges from agriculture.

Diffuse nitrate leaching from agricultural areas is a major environmental problem in many parts of the world. Understanding where in a catchment nitrate is removed is key for designing effective land use management strategies that protect water quality, while minimizing the impact on economic development. In this study we assess the effects of spatially targeted nitrate leaching regulation in a basin with limited knowledge of the complexity of chemical heterogeneity. Three alternative nitrate reactivity spatial parameterizations were incorporated in a catchment-scale flow and transport model and used to evaluate the effectiveness of four possible spatially targeted regulation options. Our findings confirm that denitrification parameterization cannot be numerically determined based on model inversion alone. Detailed field based characterization using physical and geochemical methods should be considered and incorporated in the numerical inversion scheme. We also demonstrate that there are potential benefits of implementing spatially targeted regulation compared to spatially uniform regulation. Focusing regulation in areas where nitrate residence time is short, such as riparian zones or areas with low natural N-reduction, results in greater reduction of N-discharges through groundwater. Significantly improved efficiencies can be expected when delineation of management zones considers the chemical heterogeneity and groundwater flow paths. These improved efficiencies are achieved by adopting management rules that regulate land use in discharge sensitive areas, where leaching changes contribute the most to the catchment nitrate discharges. In our case study, regulation in discharge sensitive zones was twice as efficient compared to other management options.

Pharmacist contributions to the ten essential services of public health in three National Association of Boards of Pharmacy regions.

BACKGROUND: Pharmacists have contributed to improved population health through the delivery of public health services, but their contributions often go unrecognized within the larger health care system. OBJECTIVES: To determine pharmacist perceptions of their contributions to the 10 essential services of public health and to compare those contributions among pharmacists in Iowa, North Dakota, and Manitoba. METHODS: Licensed pharmacists in Iowa, North Dakota, and Manitoba were sent an online survey of their perceived level of achievement of the 10 essential services of public health. RESULTS: A total of 649 pharmacists completed the survey. The 3 essential services that scored the highest overall were enforce laws and regulations that protect health and ensure safety, inform and educate people about health issues, and participate in ongoing training beyond continuing education requirements. Contributions of pharmacists to the 10 essential services of public health were previously evaluated by frequency of citation in the published literature. There was relative agreement between what was reported in the literature and what was determined by survey. One exception was "enforce laws and regulations that protect health and ensure safety," which was rarely reported in the literature but was reported in the survey to be the most frequently delivered service. CONCLUSION: Pharmacist contributions to improved population health should be reported with the use of the 10 essential services of public health. This will increase recognition of pharmacist contributions and better align the disciplines of pharmacy and public health. In particular, pharmacists should consider ways to increase their level of involvement in the community and in partnership with other health care professionals.

Perceived sustainability of community telepharmacy in North Dakota.

OBJECTIVES: To assess the sustainability of the business model underlying the North Dakota Telepharmacy Project (NDTP). SETTING: Of the 38 community pharmacy organizations (14 central, 24 remote), 27 organizations (11 central and 16 remote sites) in North Dakota provided a useable set of responses (71.1% response rate). A twelfth organization (a community pharmacy) ceased operations over the study's time frame and was not included in the data analysis. PRACTICE DESCRIPTION: Emphasis is placed on NDTP community telepharmacies, because the community telepharmacy business model is more established than hospital telepharmacies. Yet little is known about the long-run financial viability of telepharmacies. PRACTICE INNOVATION: Originally funded by a series of federal grants, the goal of the NDTP was to create the infrastructure necessary to support the development of telepharmacy sites. A 48-item questionnaire assessed the self-reported operational, financial, and community impacts of a community telepharmacy. EVALUATION: The questionnaire was administered from December 2015 to February 2016 to all NDTP community telepharmacy owners-managers. Thus, 1 participant (owner-manager) addressed both central and remote-site locations served by a pharmacy. RESULTS: Most respondents reported that their telepharmacy sites (especially remote sites) generate small positive financial returns for the organization. Respondents also reported that the closure of their remote sites would significantly harm the communities they serve. CONCLUSION: NDTP aims of restoration and retention have been achieved via the investment and shared decision making with pharmacy owners in North Dakota. The telepharmacy model is sustainable, even if it does not generate significant economic profit.

What types of nursing facilities are more likely to adopt a pharmacist's medication review recommendations?

BACKGROUND: Few studies in the literature have analyzed the determinants of pharmacist drug therapy recommendations in nursing facility settings, and those that have focus primarily on accepted/rejected recommendations by disease state. OBJECTIVE: To identify the set of nursing facility characteristics that are more likely to adopt a pharmacist's medication review recommendations. DESIGN: Cross-sectional, retrospective methods are used to examine 53 licensed nursing facilities receiving medication review services from a small independent consultant pharmacist practice with no ties to vendor pharmacy functions. SETTING: Nursing facilities in rural areas of central and western Minnesota in 2008. INTERVENTION: Medication review services. MAIN OUTCOME MEASURES: The number of recommendations made and accepted, which are aggregated to the level of the nursing facility. Poisson regression analysis is used to identify those nursing facility characteristics that predict total recommendations and total accepted recommendations. Data obtained from Medicare's Web site on each nursing facility's operating characteristics and quality indicators serve as covariates. RESULTS: At the 5% level, patient census (positively), greater certified nursing assistant staffing hours (positively), multisite facilities (positively), resident residency councils (negatively), and greater perceptions of registered nurse quality (negatively) predict a greater number of recommendations. Patient census (positively), greater licensed practical nurse staffing (negatively), having residency councils (negatively), and greater perceptions of registered nurse quality (negatively) significantly predict the number of accepted and implemented recommendations. CONCLUSION: Institutional specific factors, most notably, quality-of-care indicators, may affect a nursing facility's acceptance of a pharmacist's drug therapy review.

Differences in medication errors between central and remote site telepharmacies.

OBJECTIVE: To examine differences in dispensing errors within community telepharmacy practices by comparing error rates across central sites (community telepharmacy sites with pharmacists present) and the corresponding remote sites, which are staffed by registered technicians and overseen by the central site pharmacist. DESIGN: Cross-sectional pilot study with a test group (remote sites) and comparison group (central sites). SETTING: 24 rural community telepharmacies (14 remote sites and 10 central sites). PARTICIPANTS: Pharmacy staff. INTERVENTION: The Pharmacy Quality Commitment (PQC) reporting system was integrated into the North Dakota Telepharmacy Project and used to track dispensing errors over a 45-month period. Both pharmacists and pharmacy technicians were trained on the use of the PQC system. The PQC system focused on two quality-related events (QREs): a "near miss" (i.e., a mistake discovered by the pharmacy staff before a medication reaches the patient) and an "error" (i.e., a mistake discovered after the patient leaves the pharmacy with the medication). MAIN OUTCOME MEASURES: The distribution of QREs across central and remote sites. RESULTS: The remote (central) telepharmacy group reported 47,078 (62,480) prescriptions and a QRE rate of 1.34% (1.43%). QREs at the remote sites were more likely than at the central sites to be caught at the final pharmacist check (58.2% vs. 40.8%, P < 0.01) and less likely to be caught by the patient (0.17% vs. 0.28%, P < 0.01). Remote sites were more likely to include incorrect directions (18.9% vs. 13.4%, P = 0.01) in the medication entry process. CONCLUSION: QRE rates for remote site and central site telepharmacies were consistent with each other and with national estimates in traditional community pharmacies. However, significant differences between central and remote sites existed based on how QREs arose and how they were caught. Pharmacists must recognize this fact and use diligence when working in a telepharmacy setting.

Aquifer heterogeneity controls to quality monitoring network performance for the protection of groundwater production wells.

A groundwater monitoring network surrounding a pumping well (such as a public water supply) allows for early contaminant detection and mitigation where possible contaminant source locations are often unknown. This numerical study investigates how the contaminant detection probability of a hypothetical sentinel-well monitoring network consisting of one to four monitoring wells is affected by aquifer spatial heterogeneity and dispersion characteristics, where the contaminant source location is randomized. This is achieved through a stochastic framework using a Monte Carlo approach. A single production well is considered that results in converging non-uniform flow close to the well. Optimal network arrangements are obtained by maximizing a weighted risk function that considers true and false positive detection rates, sampling frequency, early detection, and contaminant travel time uncertainty. Aquifer dispersivity is found to be the dominant parameter for the quantification of network performance. For the range of parameters considered, a single monitoring well screening the full aquifer thickness is expected to correctly and timely identify at least 12% of all incidents resulting in contaminants reaching the production well. This proportion increases to a global maximum of 96% for a network consisting of four wells and very dispersive transport conditions. Irrespective of network size and sampling frequency, more dispersive transport conditions result in higher detection rates. Increasing aquifer heterogeneity and decreasing aquifer spatial continuity also lead to higher detection rates, though these effects are diminished for networks of 3 or more wells. Statistical anisotropy has no effect on the network performance. Earlier detection, which is critical for remedial action and supply safety, comes with a significant cost in terms of detection rate, and should be carefully considered when a monitoring network is being designed.

Substance use attitudes and behaviors at three pharmacy colleges.

The objective of this study was to profile and compare alcohol and other drug (AOD) use attitudes and behaviors in three pharmacy colleges. Student surveys of AOD use attitudes and behaviors were conducted at one southwestern and two midwestern pharmacy colleges. Response was 86.5% (566/654). Reported past-year use included alcohol 82.8%, tobacco 25.4%, and marijuana 6.9%. Past-year AOD-associated events included blackouts 18.2%, class or work under influence 7.8%, patient care under influence 1.4%, lowered grades or job evaluations 5.8%, legal charges 2.7%, and heavy drinking 29.0%. Family histories of alcohol or drug problems were reported by 35.5% and 13.1%, respectively. A number of significant differences in AOD use attitudes and behaviors between the three colleges were identified. Pharmacy students reported a number of risky drug-use attitudes and behaviors in this survey. Student AOD prevention, assistance, and education should be proactively addressed by pharmacy colleges.

Do remote community telepharmacies have higher medication error rates than traditional community pharmacies? Evidence from the North Dakota Telepharmacy Project.

OBJECTIVE: To evaluate the differences in medication dispensing errors between remote telepharmacy sites (pharmacist not physically present) and standard community pharmacy sites (pharmacist physically present and no telepharmacy technology; comparison group). DESIGN: Pilot, cross-sectional, comparison study. SETTING: North Dakota from January 2005 to September 2008. PARTICIPANTS: Pharmacy staff at 14 remote telepharmacy sites and 8 comparison community pharmacies. INTERVENTION: The Pharmacy Quality Commitment (PQC) reporting system was incorporated into the North Dakota Telepharmacy Project. A session was conducted to train pharmacists and technicians on use of the PQC system. A quality-related event (QRE) was defined as either a near miss (i.e., mistake caught before reaching patient; pharmacy discovery), or an error (i.e., mistake discovered after patient received medication; patient discovery). MAIN OUTCOME MEASURE: QREs for prescriptions. RESULTS: During a 45-month period, the remote telepharmacy group reported 47,078 prescriptions and 631 QREs compared with 123,346 prescriptions and 1,002 QREs in the standard pharmacy group. Results for near misses (pharmacy discovery) and errors (patient discovery) for the remote and comparison sites were 553 and 887 and 78 and 125, respectively. Percentage of "where the mistake was caught" (i.e., pharmacist check) for the remote and comparison sites were 58% and 69%, respectively. CONCLUSION: This study reported a lower overall rate (1.0%) and a slight difference in medication dispensing error rates between remote telepharmacy sites (1.3%) and comparison sites (0.8%). Both rates are comparable with nationally reported levels (1.7% error rate for 50 pharmacies).

Parallel Simulation in Subsurface Hydrology: Evaluating the Performance of Modeling Computers.

Monte Carlo uncertainty analysis, model calibration and optimization applications in hydrology, usually involve a very large number of forward transient model solutions, often resulting in computational bottlenecks. Parallel processing can significantly reduce overall simulation time, benefiting from the architecture of modern computers. This work investigates system performance using two realistic flow and transport modeling scenarios, applied to various modeling hardware, to provide information on the expected performance of parallel simulations and inform investment decisions. We investigate how performance, measured in terms of speedup and efficiency, changes with increasing number of parallel processes. We conclude that the maximum performance achieved by parallelization can range from 40% to 100% of the theoretical limit, with the lower increases associated with multi-CPU servers. The number of parallel processes required to maximize performance is application dependent, and in contrast to common practice, often needs to be significantly larger than the total number of system CPU cores. Further testing is required to better understand how the physical problem being simulated affects the optimal number of parallel processes needed. Finally, when laptops are considered for modeling applications, careful consideration should be given not only to the specifications but also to the intended use designated by the manufacturer.

Appraisal of the entrustable professional activities interprofessional team member domain performed by North Dakota pharmacists.

OBJECTIVE: To quantify the use of the interprofessional team member (ITM) domain of entrustable professional activities (EPAs) by North Dakota pharmacists across practice sites, roles in practice, and by preceptor status. METHODS: Survey methods were used to characterize the self-reported frequency with which pharmacists undertake core EPAs and supporting tasks in the ITM domain. The survey was administered to registered pharmacists practicing in North Dakota (n=990) during the fall of 2018, of which 457 (46.1%) responded. After eliminating responses with incomplete or missing information, 119 responses were available for analysis. RESULTS: For the overall EPA ITM domain, "Collaborate as a member of an interprofessional team population" pharmacists reported performing these activities an average (mean) of 3.3 times per month (SD=2.3). Within this domain, the highest reported example activity was "Use setting appropriate communication skills when interacting with others" (mean=4.1, SD 1.8), followed by "Communicate a patient's medication-related problem(s) to another health professional" (mean=3.3, SD 2.0), and "Contribute medication-related expertise to the team's work" (mean=3.1, SD=2.2). ITM domain and supporting example activities were performed at a greater rate in hospitals, community health centers and long-term-care facilities. For most items, preceptors reported a greater use of activities, than did non-preceptors. CONCLUSIONS: North Dakota pharmacists currently complete tasks outlined in the ITM domain of the EPAs, although their contributions are varied by task, role, and preceptor status.

Identifying characteristics that allow pharmacy technicians to assume unconventional roles in the pharmacy.

OBJECTIVE: To identify aspects of pharmacy technicians' experience, training, practice setting, and location that influence whether technicians undertook roles traditionally performed by pharmacists. DESIGN: Descriptive, nonexperimental, cross-sectional study. SETTING: North Dakota in 2005. PATIENTS: All 456 pharmacy technicians registered in North Dakota (response rate 42.1% [n = 192]) actively working in a pharmacy-related practice setting. INTERVENTION: A survey was developed based on workforce studies of pharmacists and pharmacy technicians. The survey asked technicians to report demographic characteristics, education, experience, pharmacy setting, and community practice size. Respondents also were asked to identify whether they routinely performed specific tasks in the pharmacy, some of which are not typically performed by technicians. MAIN OUTCOME MEASURES: Eight "unconventional" tasks performed by technicians were selected as the focus of the analysis: compounding oral medications under the supervision of a pharmacist, compounding topical medications under pharmacist supervision, preparing third-party billing, requesting a refill authorization from a prescriber, taking patient medication history information, ordering stock from a wholesaler, taking new prescriptions over the telephone, and counseling patients on nonprescription medications. RESULTS: For each task, a binary logit model was used to identify the characteristics that significantly affected whether technicians performed a task. The practice setting was the most pervasive determinant of whether technicians performed specific tasks. Educational background and certification played a secondary role in influencing whether technicians performed each of these tasks. CONCLUSION: Pharmacy technicians are able to take on a larger role in pharmacy practice. However, technicians' abilities to fill these expanded roles may be limited and depend on various factors, including practice setting, acceptance by pharmacists, and technician experience.

Rural public health education as a pharmacist-led team endeavor.

OBJECTIVE: To examine the state of public health provision and education in North Dakota and to identify the current and potential future roles pharmacists and pharmacy educators play in these activities. SETTING: Rural, medically underserved areas of North Dakota, as well as professional training sites for the practitioners working in these areas. PRACTICE DESCRIPTION: Practice sites encompass both rural community pharmacies and critical-access hospital pharmacies. The primary education practice site is North Dakota State University. PRACTICE INNOVATION: Pharmacists in rural North Dakota are proactive leaders in providing public health care to their patients. For example, they participate in a statewide diabetes disease management project similar to the Asheville, NC, project. Pharmacy educators are leading the formation of a new interprofessional Master of Public Health program. MAIN OUTCOME MEASURE: Development of an interprofessional public health education program that allows for greater collaboration among rural health practitioners. RESULTS: The new degree program is successfully negotiating the academic approval process. CONCLUSION: Because of the efforts of pharmacists and pharmacy educators, North Dakota is better prepared to face current and future public health challenges.

Preliminary evaluation of medication therapy management services in assisted living facilities in rural Minnesota.

OBJECTIVES: While pharmacists are providing medication therapy management (MTM) services, few programs have been assessed for outcomes, particularly those in rural areas. The objectives are to: 1) categorize the number and type of drug-therapy problems (DTPs) that were identified by consultant pharmacists in assisted living facilities, 2) assess resident and administrator satisfaction of consultant pharmacist MTM services, and 3) assess the direct costs of providing MTM services and make some preliminary inferences about the program's economic viability. DESIGN: We conducted a cross-sectional, pilot study at 14 assisted living facilities over a 12-month period. SETTING: 14 rural assisted living facilities. PATIENTS: Assisted living facility residents. INTERVENTION: MTM visits were performed by a consultant pharmacist based on the MTM model developed by the American Pharmacists Association. MAIN OUTCOME MEASURES: Patient satisfaction, clinical (DTPs), and economic costs. RESULTS: 130 residents were enrolled with a mean age of 86 years, with 77.7% female. Residents were taking an average of 13 medications (range = 1-29), including prescription and nonprescription drugs. Common medical conditions were hypertension (80.0%), hyperlipidemia (37.7%), and diabetes (20.8%). Residents had an average of 9 comorbidities (range = 2-16) and 304 DTPs (mean 2.3 per resident). Residents reported high mean satisfaction levels with the pharmacist and the services provided. Direct costs of the intervention were $20,372.96, which suggests that only modest gains in overall patient health (or a few major avoided adverse events) caused by the intervention are necessary to ensure the program's economic viability. CONCLUSION: Through the use of MTM programs to resolve medication problems, pharmacists can improve patient satisfaction with care among assisted living facility residents.

Evaluation of the entrustable professional activities (EPAs) of the population health promoter domain by North Dakota pharmacists.

BACKGROUND: Entrustable Professional Activities (EPAs) are a list of professional tasks that pharmacy educational organizations support, and accreditation organizations encourage, for assessment by colleges and schools of pharmacy. OBJECTIVE: This manuscript evaluates the perceived frequency of performing EPAs in the population health promoter (PHP) domain among pharmacists practicing in North Dakota. METHODS: This survey evaluated the self-reported EPA activities of registered pharmacists living and practicing in North Dakota. For EPAs and supporting tasks in the 6 domains (including the PHP domain), respondents were asked to self-report the number of times during the last 30 days that they perform the task, using a 6 point response scale (0, 1, 2, 3, 4, 5 or more times). There were 990 pharmacists surveyed, and 457 (46.1%) of pharmacists responded. RESULTS: Within the PHP domain, pharmacists reported performing "Minimize adverse drug events and medication errors" most frequently (mean=3.4, SD=2.0), followed by "Ensure that patients have been immunized against vaccine-preventable diseases" (mean=2.3, SD 2.3), "Maximize the appropriate use of medications in a population" (mean=2.2, SD 2.3), and "Identify patients at risk for prevalent diseases in a population" (mean=1.3, SD=1.9). In these Core EPAs PHP domains, the clinical pharmacists reported the highest level, followed by pharmacy managers and staff pharmacists. CONCLUSIONS: Pharmacists in North Dakota currently perform some population health promoter activities, but not at a consistent and high level. Most of the health prevention activities were medication-related and oriented towards individual patients (micro-level), rather than at a community (population-based) macro-level.

Exploring the formation of patient satisfaction in rural community telepharmacies.

OBJECTIVES: To apply a previously validated patient satisfaction questionnaire within rural community telepharmacies in an effort to identify the underlying factors determining satisfaction with those services and to assess whether the latent structure(s) of patient satisfaction varies depending on delivery mode or communityspecific factors. DESIGN: Descriptive, nonexperimental, cross-sectional study. SETTING: Eight rural community telepharmacy sites (seven in North Dakota and one in Minnesota) in fall 2005. PATIENTS: 400 potential participants in rural communities (response rate 24% [n = 96]) whose primary community pharmacy is a telepharmacy site. INTERVENTION: PATIENTS visiting a pharmacy to have at least one prescription filled were asked to complete a survey and mail responses to the investigators. The survey contained 37 questions, the first 20 of which were adapted from a well-established, validated survey instrument. MAIN OUTCOME MEASURE: Patient satisfaction with rural community telepharmacy services; patient responses to 20 questions in the survey were used as main outcome variables. RESULTS: Applying factor analysis to the data yielded a single dimension of patient satisfaction. CONCLUSION: A previous application of this instrument in a traditional community pharmacy setting yielded two interrelated latent constructs ("friendly explanation" and "managing therapy"). Our analysis suggests that the formation of patient satisfaction in rural community telepharmacies is much simpler in that patients form a single construct exhibiting high mean and median values. Anecdotal evidence from the literature suggests that the formation of a single construct reflects patients' desire to retain a point of access to health care in their communities.

Impact of Achieved Tenure and Promotion on Faculty Research Productivity at a School of Pharmacy.

OBJECTIVE: Critics of the promotion and tenure system contend that promotion and tenure may lead to a decline in research productivity ("dead wood phenomena") by those faculty. To assess this perception, we compiled the publications and grants at the time of application for promotion, and again through 2017 for the same faculty following promotion and/or tenure. METHODS: Promotion documents at a school of pharmacy at a public Midwestern university were assessed. Mean publication rates and grant dollars per year per faculty member were compared to the same group of faculty (n=13) pre and post-promotion. RESULTS: At the time of promotion to associate professor, mean numbers of total publications per year per faculty in the pharmacy practice department were 1.1, compared to 1.4 post-promotion. For pharmaceutical sciences department faculty, corresponding means were 5.0 and 4.1, respectively. At the time of promotion to full professor, mean numbers of total publications per year for pharmacy practice faculty were 7.0, compared to 7.2 post-promotion. For pharmaceutical sciences faculty, corresponding means were 3.5 and 4.7, respectively. For grant activity, both associate professors and full professors increased the mean total dollars per year from pre-promotion to post-promotion for both departments. CONCLUSION: Research productivity at this school of pharmacy continues to be either maintained or increased since promotion for the collective group of faculty. This evidence runs counter to the perception that promotion and tenure may lead to decreased scholarly productivity. The study provides a roadmap for other schools/colleges to quantify research productivity and make comparisons to national mean levels reported in the literature.

Study Abroad Course for Pre-pharmacy and Pharmacy Students to Learn About Global Health.

Objective. To design, implement, and assess a study abroad course in Ireland for pre-professional and Doctor of Pharmacy (PharmD) students. Methods. An elective study abroad course was created for pre-professional and PharmD students at North Dakota State University. The course included comparison of the US and Ireland's health care delivery systems and participation in history and cultural experiences in Ireland. Prior to the trip, students and preceptors attended seminars related to the culture of Ireland. The three-week trip to Ireland took place between the spring and summer semesters in 2016. Student assignments while abroad included completion of a self-reflection journal with daily entries describing what the student learned and how the experience impacted them, and completion and presentation of a term paper comparing Ireland's pharmacy system with that in the United States. Pre- and post-travel surveys were conducted to assess students' perceptions of and learning from the experience, and to identify areas for course improvement. Results. Students' evaluations of the course and travel experiences were positive. However, students' perceptions of their cultural awareness were largely unchanged. Conclusion. The course was well received by students. Other PharmD programs may benefit from implementing similar study abroad experiences.

Appraisal of the entrustable professional activities (EPAs) patient care provider domain by North Dakota pharmacists.

BACKGROUND: Entrustable Professional Activities (EPAs) are the latest addition to a list of professional competencies that pharmacy educational organizations support, and accreditation organizations require, for assessment by colleges and schools of pharmacy. OBJECTIVE: The study's objective is to assess the use of Core EPAs in the patient care domain (by practice setting, position, and preceptor status) in contemporary pharmacy practice. METHODS: This survey assessed the EPA activities of pharmacists practicing in North Dakota. The pharmacists were asked "how many times in the past 30 days have you delivered the following services in your practice setting?" Response options were: 0, 1, 2, 3, 4, and 5 or more times. RESULTS: Of 990 potential respondents, 457 pharmacists (46.1%) returned a survey, and 107 (10.8%) answered every survey item in the patient care domain. Respondents reported that the highest rated activity items "Collect information to identify a patient's medication-related problems and health-related needs," and "Analyze information to determine the effects of medication therapy, identify medication-related problems, and prioritize health-related needs" were performed an average of 3.9 times per week (SD=1.8), and 3.8 times per week (SD=2.0), respectively. Both of these items, were reported for 70% of the respondents at 5 or more times per week. For these items, the highest reported practice setting was 'other' practice settings (e.g., long-term care, community health centers) followed by chains, hospitals, and independent pharmacies. By position, clinical pharmacists and preceptors reported the highest activity levels for most EPAs and supportive example tasks. CONCLUSIONS: This study provides empirical evidence suggesting (but not proving) that EPAs have potential as a means to assess outcomes in pharmacy education and practice. Our study sets the stage for future work that further refines and assesses core EPA activities and supportive example tasks to measure the impact of how this process relates to outcomes of care.

Assessment of Practice Management Entrustable Professional Activities by Pharmacists in North Dakota.

Objective. To quantify the use of core entrustable practice activities (EPAs) in contemporary pharmacy practice in North Dakota. Methods. Given the large number of core EPAs, this study focused on those supporting tasks categorized within the practice manager domain. The survey instrument was sent to all registered pharmacists living and practicing in North Dakota (n=990). This manuscript reports on the practice manager domain and the activities and examples of supportive tasks in this domain. Results. Four hundred fifty-seven (46.1%) of the pharmacists responded; however, only 102 survey instruments were fully completed and usable. Respondents rated the "fulfill a medication order" activity the highest EPA overall (mean=9.1, SD=2.7). The "oversee the pharmacy operations for an assigned work shift" activity (mean=7.8, SD=3.9) was also rated highly. Responses to "oversee the pharmacy operations for an assigned work shift" were significantly different between independent practice settings and all other practice settings. The manager was more likely than other pharmacy positions to report performing seven of the nine tasks within this EPA. Significant differences in five of nine tasks were found across pharmacies located in rural or more urban communities, including "assist in the evaluation of pharmacy technicians" and "identify pharmacy service problems and/or medication safety issues." Conclusion. This study provides empirical evidence suggesting that EPAs can be a useful means to assess outcomes in pharmacy education.

Is there a successful business case for telepharmacy?

The purpose of this study was to assess the financial operation of a Single Business Unit (SBU), consisting of one central retail pharmacy and two remote retail telepharmacies. Analyses of income statements and balance sheets for three consecutive years (2002-2004) were conducted. Several items from these statements were compared to the industry average. Gross profit increased from $260,093 in 2002 to $502,262 in 2004. The net operating income percent was 2.9 percentage points below the industry average in 2002, 3.9 percentage points below in 2003, and 1.3 percentage points above in 2004. The inventory turnover ratio remained consistently below the industry average, but it also increased over the period. This is an area of concern, given the high cost of pharmaceuticals and a higher likelihood of obsolescence that exists with a time-sensitive inventory. Despite these concerns, the overall trend for the SBU is positive. The rate of growth between 2002 and 2004 shows that it is getting close to median sales as reported in the NCPA Digest. The results of this study indicate that multiple locations become profitable when a sufficient volume of patients (sales) is reached, combined with efficient use of the pharmacist's time.