Advancing learning to advance pharmacy practice.

OBJECTIVES: The objectives of this commentary are to: 1) describe advancements in the continuing professional development (CPD) model over the past decade; 2) detail an updated CPD cycle; and 3) describe how practitioners' adoption of the CPD approach may facilitate the advancement of pharmacy practice. SUMMARY: CPD is a self-directed, ongoing, systematic, and outcomes-focused approach to an individual's lifelong learning that is applied into practice. The 6 components of reflect, plan, learn, evaluate, apply, and record + review, described in a revised depiction of the CPD cycle, have evolved over the past 10 years alongside the evolution of the profession of pharmacy. The thinking around the value of building CPD habits has also advanced. New emphasis is being placed on mechanisms for applying and sharing CPD-related work, as well as the importance of employer support of CPD. CONCLUSION: As practice change has progressed, the individual's need to learn has also changed. To succeed in the evolving health care system, regular, robust, and intentional CPD is needed. Moreover, for learning to have maximum impact, it must facilitate, motivate and result in changes in learner behavior. Employers, educators, and pharmacy organizations should facilitate lifelong learning by creating CPD supportive environments that foster learner success and community. The adoption of a CPD approach by pharmacy practitioners may facilitate the advancement of pharmacy practice.

Do ACE Inhibitors/Angiotensin II type 1 receptor antagonists reduce hospitalisations in older patients with heart failure? A propensity analysis.

BACKGROUND: Randomised controlled trials have shown a reduced risk of heart failure (HF) hospitalisation among users of ACE inhibitors (ACEIs) or angiotensin II type 1 receptor antagonists (angiotensin receptor blockers [ARBs]), but these results have limited generalisability. Some observational studies have also demonstrated reductions in hospitalisation but are potentially affected by non-random treatment selection. OBJECTIVE: To assess the effect of ACEI/ARB therapy on all-cause and HF-related hospitalisations among older adults using a propensity model to adjust for treatment-selection bias and focusing on consistent medication use as the exposure of interest. METHODS: A retrospective cohort study of continuously enrolled, older (age > or =60 years) Kansas Medicaid beneficiaries with HF, using data from May 1999 to April 2000. A propensity analysis was used to identify a comparison group of untreated persons that were otherwise clinically similar to treated persons. The effect of regular ACEI/ARB use on hospitalisations was estimated using multivariable logistic regression models. The HF sample included 887 subjects, of whom 235 (27%) received regular ACEI/ARB therapy. To be considered a regular user of ACEI/ARB therapy ('treated'), we required evidence that a subject obtained at least 80% of their intended daily supply. The main outcome measure was the effect of regular ACEI/ARB use on all-cause and HF-related hospitalisations. RESULTS: Treated subjects were matched against an equal number of untreated persons, for a final sample of 470 persons. The mean age of both treated and untreated subjects was 81 years. Regular ACEI/ARB use did not alter the adjusted odds ratio (AOR) of all-cause hospitalisation (AOR = 1.04, 95% CI 0.71, 1.52), which occurred in 40% of the sample, or the odds of an HF-related hospitalisation (AOR = 1.01, 95% CI 0.65, 1.57), which occurred in 22.6% of both groups. CONCLUSION: Although randomised controlled trials have shown that ACEI/ARB treatment is associated with reduced hospitalisations in patients with HF, this benefit was not observed in our study. Further study of ACEI/ARB outcomes is needed in a larger sample of older subjects with HF.

Clinical pharmacists as key members of the patient-centered medical home: an opinion statement of the Ambulatory Care Practice and Research Network of the American College of Clinical Pharmacy.

The American College of Clinical Pharmacy (ACCP) Ambulatory Care Practice Research Network (PRN) considers the role of clinical pharmacists to be fundamental to the success of the Patient-Centered Medical Home (PCMH) model. Within the PCMH, pharmacists can improve the health of populations by participating in activities that optimize medication management. Multiple published articles support clinical pharmacist involvement in the PCMH with regard to promotion of team-based care, enhanced access, care coordination, and improved quality and safety of care. A survey of clinical pharmacist members of ACCP who operate in such a model depict a variety of activities, with some members pioneering new and innovative ways to practice clinical pharmacy. Although this is a significant opportunity for pharmacists in the primary care setting, a unified vision of pharmacy services is needed. It is our hope that with continued efforts focused on obtaining national provider status, clinical pharmacy can use the PCMH model to solidify the future of primary care pharmacy. The following is an opinion statement of the ACCP Ambulatory Care PRN regarding the vital role of clinical pharmacists in the PCMH.

Evaluation of the impact of a continuing professional development worksheet on sustained learning and implementing change after a continuing pharmacy education activity.

BACKGROUND: Continuing professional development (CPD) continues to gain acceptance as a model for health care professionals to engage in lifelong learning. Little is known about how CPD participants use the experience to develop learning plans and implement new knowledge into practice. OBJECTIVE: The primary objective of this study was to evaluate the effectiveness of instruments designed to guide the pharmacist through a CPD process to plan and participate in continuing professional education activities at a national meeting. METHODS: The study was a case-control study of pharmacists randomized from the participants of the 2010 American Pharmacists Association Annual Meeting. The test group (n=47) was instructed to complete CPD planning worksheets designed to facilitate planning of their continuing pharmacy education activities before the meeting. The control group (n=58) did not have instructions beyond the meeting program. Both groups completed 3 surveys assessing components of the CPD processes: 1 before and 2 after the meeting. The surveys focused on confidence in abilities to identify, plan, and evaluate learning as well as implementation of practice change. RESULTS: Nearly all the test groups reported successful application of learning (95%) and achieving their designed learning plan (87%). Practice changes were implemented in more than half (60%) of the test groups after using a CPD process to plan their learning activities. There were no significant differences among groups regarding the outcome measures. CONCLUSIONS: Participants successfully used a CPD approach to meet their learning plans and achieve meaningful learning outcomes. Integration of CPD components into educational activities may help to promote practice change.

Pilot evaluation of a continuing professional development tool for developing leadership skills.

BACKGROUND: Strategies are needed to assure essential nonclinical competencies, such as leadership, can be gained using a continuing professional development (CPD) framework. OBJECTIVE: The objective of this study was to explore student pharmacists' utilization and perceived effectiveness of a CPD tool for leadership development in an elective course. METHODS: Students completed 2 CPD cycles during a semester-long leadership elective using a CPD tool. A questionnaire was used to measure students' perceptions of utility, self-efficacy, and satisfaction in completing CPD cycles when using a tool to aid in this process. RESULTS: The CPD tool was completed twice by 7 students. On average, students spent nearly 5 hours per CPD cycle. More than half (57.1%) scored themselves as successful or very successful in achieving their learning plans, and most (71.4%) found the tool somewhat useful in developing their leadership skills. Some perceived that the tool provided a systematic way to engage in leadership development, whereas others found it difficult to use. CONCLUSIONS: In this pilot study, most student pharmacists successfully achieved a leadership development plan and found the CPD tool useful. Providing students with more guidance may help facilitate use and effectiveness of CPD tools. There is a need to continue to develop and refine tools that assist in the CPD of pharmacy practitioners at all levels.

A leadership elective course developed and taught by graduate students.

OBJECTIVE: To develop and implement a flexible-credit elective course to empower student pharmacists to develop lifelong leadership skills and provide teaching practice opportunities for graduate students. DESIGN: An elective course focusing on leadership development for second- and third-year doctor of pharmacy (PharmD) students was designed and taught by 4 graduate students under the mentorship of 2 faculty members. Student pharmacists could enroll in a 1-, 2-, or 3-credit-hour version of the course. ASSESSMENT: Attainment of course objectives was measured using student pharmacist reflection papers and continuing professional development portfolios. Additionally, self-assessments of graduate students and faculty members delivering the course were conducted. In their responses on course evaluations, student pharmacists indicated they found the course a valuable learning experience. Graduate students found course development to be challenging but useful in developing faculty skills. CONCLUSION: This flexible-credit elective course taught by graduate students was an innovative way to offer formal leadership instruction using limited college resources.

A comprehensive approach to preceptor development.

OBJECTIVE: To assess the impact of a comprehensive preceptor development program. DESIGN: A comprehensive preceptor development program was designed that included live and recorded online programming, a preceptor manual, a preceptor newsletter, live events (local and regional), and one-on-one practice site visits. ASSESSMENT: Over 5,000 evaluations (1,900 pre-implementation and 3,160 post-implementation) of preceptor performance were completed by students. Students rated preceptors higher in items related to providing helpful midpoint and final evaluations after program implementation. Over 1,000 Web-based preceptor development activities were completed by preceptors from 2007 to 2011. Preceptors felt activities enhanced their current knowledge, skills, attitudes, and values, and more than 90% felt the core development activities would improve their current practice. CONCLUSION: A comprehensive approach to preceptor development that offered a variety of development and training opportunities received positive evaluations from preceptors and resulted in improved student evaluations of preceptors. A comprehensive development program should be made available to preceptors to foster their continuing professional development.

A five-state continuing professional development pilot program for practicing pharmacists.

OBJECTIVE: To determine whether a structured educational intervention would support pharmacists' utilization of a continuing professional development (CPD) model compared to pharmacist control subjects. METHODS: A prospective, randomized, observational case-control study of CPD was conducted in which pharmacists participated in several educational interventions, and study and control groups completed prestudy and poststudy survey instruments. RESULTS: Survey data from 57 pharmacists (n = 28 study, n = 29 control) were analyzed and significant outcomes from the CPD stages of reflect, plan, act, evaluate, and record were found between matched study subjects and study and control group comparisons. CONCLUSIONS: With appropriate training and support, pharmacists can utilize a CPD approach to their lifelong learning and professional development.