Evaluating Patient Perceptions on PrEP Screening and Referral in the Acute Care Setting.

Pre-exposure prophylaxis (PrEP) for HIV is highly effective, yet uptake has been limited. We measured PrEP knowledge, eligibility, and referral willingness among patients receiving emergency or acute care in Washington, DC. We surveyed HIV-negative patients with STI-related complaints on HIV risk behaviors, PrEP knowledge, eligibility, and willingness for PrEP referral. Among 174 participants, 70% were PrEP unaware and 33% were PrEP eligible. Most participants (81%) supported learning more, 64% would consider taking PrEP, and 28% agreed to immediate referral. Willingness to learn more about PrEP suggests referral from non-traditional settings may increase uptake. Further evaluation of this approach is warranted.

Assessment of feasibility and outcomes of a salivary cortisol collection protocol in five American Indian communities.

We evaluated the feasibility and outcomes of administering a naturalistic saliva collection procedure and assessment in American Indian (Indigenous) communities. We focus on Indigenous adults living with type 2 diabetes given the "epidemic" of the disease disproportionately impacting many tribal groups. Data are from community-based participatory research (CBPR) involving 5 tribal communities. Participants were randomly selected from tribal clinic records. The sample includes 188 adults living with type 2 diabetes (56% female; age range = 18-77 years; M age = 46.3 years). Participants provided a total of 748 saliva samples, representing 4 samples/participant on a single day with instructions for collection at 4 time points: upon waking, 1 h after waking, 2 h after waking, and at 8 PM. Saliva sample times were recorded by participants on paper and electronically via placement in a Medication Event Monitoring System (MEMS®) bottle. Overall, 67% of samples were completed within 10 min of protocol instructions and 91% of participants provided at least one useable sample (79% provided four useable samples). Noncompliance, behavioral and environmental factors were not robustly associated with deviations in observed cortisol indices. Results suggest that home-based, community interviewer-involved protocols yields valid data with high compliance. The success of this study was facilitated by exemplary efforts of tribal community-based interviewers and our overall CBPR approach.Lay summaryAuthentic efforts for tribal community partnerships in research are critical to successfully implementing biological assessments with American Indians given legacies of research misconduct and mistrustOur Community-Based Participatory Research with 5 tribes yielded high participant compliance to a home-based salivary cortisol collection protocolLack of compliance to salivary cortisol protocol and medication usage were not consistently associated with observed cortisol indices.

Perceptions and Prevalence of Alcohol and Cigarette Use Among American Indian Adults With Type 2 Diabetes.

IN BRIEF This study examined community perceptions and prevalence of alcohol use and cigarette smoking among American Indian adults with type 2 diabetes. Results revealed normative rates and perceptions of smoking and negative views and low rates of alcohol use. Participants reported high levels of household indoor smoking and comorbid high-risk drinking and smoking. The high smoking rate among the adult American Indians in this study is especially problematic given the increased risk of cardiovascular problems related to both smoking and type 2 diabetes. The results underscore the importance of considering substance use behaviors and beliefs as a component of overall health and well-being for people with diabetes.

Relationship between self-efficacy and patient knowledge on adherence to oral contraceptives using the Morisky Medication Adherence Scale (MMAS-8).

BACKGROUND: Preconception care, including family planning, is a vital component of healthcare for women of reproductive age. An average female spends the majority of her reproductive life trying to prevent a pregnancy. In order to prevent unintended pregnancy, women often rely on the use of hormonal contraceptives. In the United States, the majority of hormonal contraceptive users are prescribed oral contraceptive pills (OCPs). Reduced adherence to OCPs decreases their ability to prevent pregnancy. The study aimed to measure OCP adherence among female college students, and explore the relationship between OCP adherence, knowledge, and self-efficacy. METHODS: This cross-sectional study recruited a random sample of female college students to participate in an online survey. OCP adherence was based on the 8-item Morisky Medication Adherence Scale (MMAS-8). Secondary reporting of medication adherence included participant reports of the number of missed OCP doses in the previous month and typical month of use. RESULTS: Of the 5000 invited, 1559 (31.3%) completed the survey. Of those responding, 670 (41.3%) reported use of OCPs. A total of 293 (44.3%) OCP users met criteria for low adherence, 241 (36.4%) met criteria for medium adherence, and 128 (19.3%) met criteria for high adherence. Those with high adherence had higher self-efficacy (P < 0.001) and perceived knowledge (p < 0.001). After controlling for other factors, self-efficacy (b = .37) and perceived knowledge (b = .09) remained associated with OCP adherence. CONCLUSION: Less than 20% of respondents met the criteria for high adherence to OCPs. Self-efficacy and knowledge were associated with higher OCP adherence. Targeted interventions from healthcare providers, health educators, and other adherence related media to increase the knowledge and self-efficacy of patients using OCPs may improve adherence rates. Additional research is needed to evaluate the impact of innovative interventions focused on social and behavioral patient factors, like knowledge and self-efficacy, on adherence to OCPs.

Rates and consequences of posttraumatic distress among American Indian adults with type 2 diabetes.

This study examined the prevalence of screened posttraumatic stress disorder (PTSD) and associated diabetes-related outcomes. A sample of American Indian adults with type 2 diabetes (n = 218) participated in interviewer-administered surveys. Using a cutoff of 3 on the Primary Care PTSD screener, 21.8 % of participants screened positive for PTSD. PTSD symptoms were negatively associated with self-rated health status and positively associated with past year hospitalization after controlling for several demographic factors, but not after controlling for depressive symptoms. Past month frequency of hyperglycemia symptoms was not related to PTSD symptoms. When grouped by mental health conditions (neither screened PTSD nor depressive symptoms, screened PTSD only, depressive symptoms only, and both), those with both screened PTSD and depressive symptoms reported the highest proportion of any past month hyperglycemia, past year hospitalization, and low self-rated health status. Screened PTSD, especially in those with comorbid depressive symptoms, is an important consideration in diabetes care.

Commentary: Making Space for Reading as a Faculty Member.

In academia, significant emphasis is given to the importance of writing. However, reading may be given less prominence in faculty work lives. The purpose of this commentary is to explore the educator's relationship with academic reading, habits that support this practice, and points of reflection for creating space for reading in our professional lives. The authors engaged in a reflexivity exercise and discussion of our own motivations, emotions, and experiences associated with reading, and how these may change across our careers. We discuss the need to make space for reading in our work, and additionally, provide recommendations for better integrating the habit of reading into our professional lives.

Mining for Retention Gems and Unearthing Identity and Belonging.

OBJECTIVE: To determine the relationship between first-year retention and variables related to professional engagement and professional, academic, and personal identities. METHODS: This study evaluated data from 3 cohorts of students at a private 0-6 college of pharmacy. A theoretical and conceptual framework linking professional identity and retention informed the study. Professional engagement scores from the first semester of pharmacy school served as a surrogate of professional identity. Grade point average (GPA) and traditional demographic variables (eg, gender, race/ethnicity, in-state resident) served as surrogates of academic and personal identities, respectively. Logistic regression models were used to determine the relationship between first-year retention and identity variables. RESULTS: Belonging, a domain of professional engagement, was positively related to first-year retention. In multivariable models, belonging and cumulative GPA were associated with increased odds of retention, while in-state status was associated with decreased odds. In separate models for those with GPA ≥3.00, and<3.00, belonging was associated with first-year retention in both. Belonging was also associated with first-semester retention, but not second-semester retention. CONCLUSION: A decision to leave a Doctor of Pharmacy program is complex, but the vast majority of the literature in pharmacy education appears to focus most intently on academic variables, including GPA. This study demonstrates that belonging, an important element in professional identity formation, remains related to first-year retention, even after controlling for grades and other personal variables. This finding unearths several theory-informed gems and strategies that educators may employ to enhance retention.

Well-being Content Inclusion in Pharmacy Education Across the United States and Canada.

Objective. To describe the landscape of well-being content inclusion across schools and colleges of pharmacy in the United States and Canada through identification of content implementation, incorporation, and assessment.Methods. A cross-sectional survey was distributed to all accredited schools and colleges of pharmacy in the United States (n=143) and Canada (n=10). Survey questions included curricular and cocurricular timing, frequency, assessment strategies, and support for well-being initiatives, using a framework of eight dimensions (pillars) of wellness to categorize content.Results. Descriptive data analyses were applied to 99 completed surveys (65%), 89 (62%) in the United States and 10 (100%) in Canada. Well-being content was most prevalent within the cocurricular realm and incorporated into didactic and elective more than experiential curricula. The most content came from intellectual, emotional, and physical pillars, and the least content came from financial, spiritual, and environmental pillars. Less than 50% of schools and colleges of pharmacy include well-being within their strategic plans or core values. Funding is primarily at the level of the university (59%) or the school or college of pharmacy (59%). Almost half of respondents reported inclusion of some assessment, with a need for more training, expertise, and standardization.Conclusion. Survey results revealed a wide range of implementation and assessment of well-being programs across the United States and Canada. These results provide a reference point for the state of well-being programs that can serve as a call to action and research across the Academy.

Addressing food insecurity and chronic conditions in community health centres: protocol of a quasi-experimental evaluation of Recipe4Health.

INTRODUCTION: Chronic conditions, such as diabetes, obesity, heart disease and depression, are highly prevalent and frequently co-occur with food insecurity in communities served by community health centres in the USA. Community health centres are increasingly implementing 'Food as Medicine' programmes to address the dual challenge of chronic conditions and food insecurity, yet they have been infrequently evaluated. METHODS AND ANALYSIS: The goal of this quasi-experimental study was to evaluate the effectiveness of Recipe4Health, a 'Food as Medicine' programme. Recipe4Health includes two components: (1) a 'Food Farmacy' that includes 16 weekly deliveries of produce and (2) a 'Behavioural Pharmacy' which is a group medical visit. We will use mixed models to compare pre/post changes among participants who receive the Food Farmacy alone (n=250) and those who receive the Food Farmacy and Behavioural Pharmacy (n=140). The primary outcome, fruit and vegetable consumption, and secondary outcomes (eg, food security status, physical activity, depressive symptoms) will be collected via survey. We will also use electronic health record (EHR) data on laboratory values, prescriptions and healthcare usage. Propensity score matching will be used to compare Recipe4Health participants to a control group of patients in clinics where Recipe4Health has not been implemented for EHR-derived outcomes. Data from surveys, EHR, group visit attendance and produce delivery is linked with a common identifier (medical record number) and then deidentified for analysis with use of an assigned unique study ID. This study will provide important preliminary evidence on the effectiveness of primary care-based strategies to address food insecurity and chronic conditions. ETHICS AND DISSEMINATION: This study was approved by the Stanford University Institutional Review Board (reference protocol ID 57239). Appropriate study result dissemination will be determined in partnership with the Community Advisory Board.

The Role of Social Support in the Management of Type 2 Diabetes Mellitus among American Indians: A Qualitative Study.

The purpose of this study is to gain insights of American Indian (AI) communities on the role of social support in type 2 diabetes (T2D) management. Social support is a means of enhancing social and personal resources that can address underlying stressors that contribute to T2D inequities and represents a potential channel of intervention to improve management of T2D in these communities. This community-based participatory research included AI adults from the Bois Forte and Lac Courte Oreilles Bands of Ojibwe and consisted of focus groups that were conducted with people with T2D, social support persons, and service providers. Overall findings underscore the importance of social support in T2D management, especially in providing emotional support, fulfilling an appraisal function, and enabling positive health behaviors. It is also important for policies and practices to consider the social and cultural contexts, particularly the socio-historical context of life within AI communities that has inevitably shaped certain mindsets that may present barriers to care-seeking and optimal T2D management. These findings can inform interventions related to T2D management, especially in incorporating social support and complementing community strengths in achieving a broader goal of reducing diabetes inequities in AI communities.

Identifying Low Pharmaceutical Calculation Performers Using an Algebra-Based Pretest.

Objective. To determine whether a pretest assessing algebra-based problem-solving skills could aid in identifying those who may underperform in calculations course assessments and whether this provides additional value beyond preadmission and demographic characteristics.Methods. Student pharmacists were screened for algebraic problem-solving skills using an 18-item pretest taken the semester prior to a course containing pharmaceutical calculations content. These scores were compared to students' later performance on pharmaceutical calculations assessments. Linear regression models were computed to determine the relationship between pretest scores and pharmaceutical calculations performance after controlling for preadmission factors and demographic characteristics.Results. The median pretest score was 15 out of 18 possible points, with scores ranging from 5 to 18 points. After controlling for age, gender, American College Testing (ACT) scores, and high school grade point average (GPA), scores on the algebra-based, word-problem pretest were associated with performance on pharmaceutical calculation assessments.Conclusion. This research demonstrates the ability of a pretest aimed at identifying deficiencies in algebraic problem-solving skills to identify those at risk of failing to obtain mastery of pharmaceutical calculations, even after controlling for demographics, prior grades, and prior standardized test scores. Identifying these students is a first step towards implementing tailored interventions to improve students' algebra-based word problem skills to prevent deficiencies in pharmaceutical calculations mastery before class even begins.

Evaluation and Revision of the Kiersma-Chen Empathy Scale.

Objective. This study aimed to provide further validity evidence for the Kiersma-Chen Empathy Scale (KCES) by analyzing data collected from multiple administrations of the scale and conducting cognitive interviews of students in pharmacy and nursing programs to identify needed revisions.Methods. De-identified data from previous administrations of the KCES were used to evaluate the scale. Evidence of response process was enhanced through cognitive interviews with 20 pre-pharmacy and pharmacy students at Cedarville University. After survey revisions, the cognitive interview process was repeated with 10 University of Wyoming nursing students.Results. Based on psychometric data and cognitive interviews, the KCES was revised as follows: key components of cognitive and affective empathy were retained, scaling was changed to reflect necessity and empathy ability, negatively worded items were removed, and the single scale was converted into two parallel subscales.Conclusion. This study used data from thousands of geographically and professionally diverse samples. Based on potential problems identified in quantitative analyses, cognitive interviews with nursing and pharmacy students were conducted, and modifications to the KCES were made. Further psychometric validation is needed regarding the KCES-R.

Management, entrepreneurship, continuing professional development, and leadership education in United States doctor of pharmacy curricula: A scoping review.

BACKGROUND: As doctor of pharmacy (PharmD) curricula must fulfill accreditation standards emphasizing managerial skills, entrepreneurship, continuing professional development (CPD), and leadership, there is interest among faculty to incorporate high-quality, evidence-based educational strategies. To date there has not been a comprehensive review of these four topics in one paper; therefore, we aimed to describe the landscape of the published literature and areas for future research. METHODS: A keyword search of Academic Search Complete/Premier and OvidMedline databases identified articles published between 1 January 2000 and 31 December 2020. Inclusion criteria included primary, peer-reviewed literature describing the implementation and evaluation of teaching methodologies on aspects of management, entrepreneurship, CPD, or leadership in United States PharmD programs. Titles and abstracts were screened for inclusion. Key information regarding instructional design and assessment were retrieved to develop narrative summaries of activities and outcomes and to chart the student year of study, sample size, mode of delivery (didactic/experiential/co-curricular), type of experience (required/optional), and learning activity. RESULTS: Thirty-five articles met inclusion criteria and were categorized: management (n = 12), entrepreneurship (n = 2), CPD (n = 7), and leadership (n = 14). The articles provided example activities that faculty across the country can consider implementing. Identified gaps included a focus on episodic and/or optional experiences and a relative lack of objective and longitudinal assessment practices. IMPLICATIONS: This review describes educational methodologies for management, entrepreneurship, CPD, and leadership that can be replicated or adapted. Additional reports of innovative educational practices assessed through valid and reliable methods are needed.

Establishing Validity Evidence for Parallel Patient-Provider Empathy Scales to Drive Self-reflection.

Objective. Student pharmacists must cultivate self-awareness to ensure that they can assess their skill development and abilities, including affective domain skills such as empathy. External feedback can augment development, but validated assessments are needed for accuracy. Thus, the objectives of this study were to establish validity evidence for the revised version of the Kiersma-Chen Empathy Scale (KCES-R), compare student self-perceptions and simulated patient perceptions of student empathy using a parallel patient scale (KCES-PV), and evaluate student reflections on the encounter.Methods. Student pharmacists completed an assessment of their self-perceptions of empathy (KCES-R) before and after the patient encounter. Simulated patients completed the KCES-PV regarding the student pharmacists' empathy immediately after the encounter. Student pharmacists also watched their encounter videos and completed a self-reflection on their use of empathy. Responses were analyzed using statistical tests, whereas students' reflections were examined using thematic analysis.Results. Results showed that the KCES-R contains two factors with high internal consistency and can detect changes in empathy. Student pharmacists' self-perceptions of their empathy abilities appeared higher than when their empathy abilities were evaluated by simulated patients. Student pharmacists had a strong belief in the importance of expressing empathy during patient encounters and indicated a need for further development.Conclusion. This study provides validity evidence for the use of the KCES-R and presents a parallel scale that may be used by simulated patients. Validated parallel scales along with reflective practice could be a potential avenue to grow self-awareness and empathy by allowing students to receive feedback and then reflect on their perceived versus actual demonstration of the skill.

Concordance between a simpler definition of major depressive disorder and Diagnostic and statistical manual of mental disorders, fourth edition: an independent replication in an outpatient sample.

The diagnostic and statistical manual of mental disorders, fourth edition (DSM-IV) symptom criteria for major depressive disorder (MDD) are somewhat lengthy with several studies showing that clinicians have difficulty recalling all 9 symptoms. Moreover, the criteria include somatic symptoms that are difficult to apply in patients with medical illnesses. To address these problems, a simpler definition of MDD was developed that did not include the somatic symptoms. Previous reports found high levels of agreement between the simplified and full DSM-IV definition of MDD. However, the same research group has conducted all previous studies of psychiatric patients. The goal of the present study was to determine if a high level of concordance between the 2 definitions would be replicated in an independent setting. We interviewed 2907 psychiatric outpatients presenting for treatment at the Boston University Center for Anxiety and Related Disorders. A trained diagnostic rater administered a semistructured interview and inquired about all symptoms of depression for all patients. A high level of agreement was found between the DSM-IV and the simpler definition of MDD. The absolute level of agreement between the 2 definitions was 95.5% and the κ coefficient was 0.88. Thus, consistent with previous studies, a high level of concordance was found between a simpler definition of MDD and the DSM-IV definition. This new definition offers 2 advantages over the current DSM-IV definition-it is briefer, and it is easier to apply with medically ill patients because it is free of somatic symptoms. Implications of these findings for DSM-5 are discussed.

A longitudinal study of the stress of poor glucose control and diabetes distress.

Poor glucose control can be viewed as a stressor, possibly promulgating diabetes distress. We examined the relationship between perceived blood glucose control and diabetes distress over time using a partially controlled cross-lagged path analysis model. After controlling for demographics, control at 6 months was directly related to change in distress at 12 months. Subsequently, distress at 12 months was directly related to change in control at 18 months. Both 6-month control and distress had significant indirect effects on 18-month control and distress. This demonstrates the nuanced bi-directional relationship between the stress of poor perceived control and diabetes distress.

Is It Time for a Quality Rating System for Colleges of Pharmacy?

The quality of educational programs, including Doctor of Pharmacy (PharmD) programs, has largely escaped the societal trend towards public reporting. Recent criticisms of pharmacy academia by practitioners should prompt us to reexamine how the quality of pharmacy education is measured and reported to the public. In supporting greater transparency related to quality, important questions that should be addressed include: Is the current public reporting of quality indicators for pharmacy schools sufficient for determining the quality of education provided by a school? Can a quality rating system be developed that will not only provide a valid assessment of quality, but also be easy to interpret by potential applicants and employers? The intent of this commentary is to initiate a discussion centered around this issue and to encourage the development of a new measure of pharmacy school quality.

The Mediating Role of Diabetes Distress and Depressive Symptoms in Type 2 Diabetes Medication Adherence Gender Differences.

Background. Medication adherence is negatively related to both diabetes distress (DD) and depressive symptoms (DS). Past research suggests gender differences in adherence, DD, and DS. A gap exists in determining if gender differences in adherence are mediated by DD and DS, or if gender moderates differences in adherence by DD/DS. Aims. This study investigated the relationship between gender, DD, DS, and medication adherence and tested for mediating and moderating effects on medication adherence among American Indian adults with type 2 diabetes. Method. The Maawaji idi-oog mino-ayaawin (Gathering for Health) study was a community-based participatory research collaboration with five American Indian tribes. Participants, randomly recruited from clinic records, shared information during computer-assisted personal interviews. This study includes the 166 participants who reported using medications to treat their diabetes. The relationship between gender, DD, DS, and medication adherence are explored. Possible mediating and moderating effects on medication were tested using regression and path analysis. Results. Females had higher levels of DD and DS and lower levels of medication adherence. Higher levels of DD and DS were both associated with lower medication adherence. No evidence was found that gender moderates the relationship between DD or DS and medication adherence. Instead, DD and DS mediated the relationship between gender and medication adherence. Conclusions. Medication adherence differences in male and female patients may be attributable to DD and DS. The present research highlights both DD and DS as targets for clinicians and researchers alike.

Outcomes of a reflective parenting program among military spouses: The moderating role of social support.

The post-9/11 conflicts have taken a substantial toll on military families. Although positive effects of reintegration-focused programs are well-documented for service members, less is known about military spouses who are parents of young children. This article examines the outcomes of a formal reflective parenting program developed for military families who have very young children, and whether aspects of informal social support moderate spouse outcomes of anxiety, depression, and parenting stress. Data are drawn from a randomized, clinical trial (RCT) of 103 military families with children ages birth to 5 years of age. Structural equation models examined the main effects of the program and the relationship of 3 social support dimensions (perceived support, social connectedness and dyadic satisfaction) to program outcomes of interest. Analyses revealed a statistically significant reduction in anxiety in the treatment group, with a small effect size. No significant program effects emerged on parenting stress or depression. None of the social support dimensions was significantly associated with outcomes of interest. The interaction of dyadic support and treatment showed a significant moderate effect on parenting stress. Spouses with lower baseline satisfaction who were assigned to the treatment condition reported similar levels of parenting stress at baseline and posttest, whereas their counterparts in the waitlist condition reported significantly higher parenting stress at posttest compared with baseline. Findings suggest a targeted approach to preventive intervention for military spouses who are mothers of young children. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Stress-buffering versus support erosion: Comparison of causal models of the relationship between social support and psychological distress in military spouses.

Spouses of National Guard/Reserve (NG/R) military service members cope with deployment-related stressors (DRS) that may contribute to increased psychological distress. Research indicates that higher levels of social support are associated with reduced depression and anxiety in military spouses, but longitudinal relationships have not yet been examined bidirectionally. This study examines temporal relationships between 3 dimensions of social support (social connectedness, dyadic satisfaction, and perceived support), and psychological distress in a sample of NG/R spouses during the first year after a service member returns from deployment. Data from 103 military spouses were drawn from a larger intervention development study. Autoregressive cross-lagged panel analyses examined the stress-buffering and support erosion hypotheses over a 3-month period. DRS were measured by the cumulative number of deployments and duration of most recent deployment. Distress was assessed using latent variables of depression and anxiety. Statistically significant relationships emerged between initial levels of psychological distress and social connectedness at 3 months. Social support dimensions of dyadic satisfaction and perceived support did not predict subsequent levels of psychological distress. No significant relationships emerged between any dimension of social support at baseline and either form of psychological distress at 3 months. The support erosion hypothesis may more accurately describe the relationship between social support and psychological distress in this sample than the stress-buffering mechanism. During the first year of reintegration, social connectedness may be of particular relevance for NG/R spouses, as they may not have access to supports typically available to their active duty counterparts. (PsycInfo Database Record (c) 2020 APA, all rights reserved).