Patient engagement in first cycle comprehensive chemotherapy consultation pharmacist services and impact on patient activation.

BACKGROUND: Healthcare systems and policy makers worldwide are demonstrating interest in shared decision making, which requires patient activation. Patient activation can be measured using a validated tool called the patient activation measure-10. First cycle comprehensive chemotherapy consultation services (3CS) is provided by an oncology pharmacy team member during a patient encounter at the beginning of the patient's treatment for cancer. METHODS: This was a single center, prospective, non-randomized, observational clinical study in patients with cancer who required a new chemotherapy plan. A baseline patient activation measure-10 survey was administered and a pharmacy team member met with the patient to complete the first cycle 3CS encounter. Within two business days of that encounter, a second patient activation measure-10 survey was administered, and thus, patients served as their own control. RESULTS: Forty-nine patients who met the inclusion criteria were enrolled, of which 36 completed the study. Mean patient activation measure-10 scores measured at baseline and two business days after the 3CS encounter were significantly different (68.5 ± SD 14.7 vs. 75.0 ± SD 14.3, p = 0.001). This difference persisted when evaluated by gender (female: 70.0 ± SD 14.8 vs. 81.6 ± SD 10.5, p = 0.001; male: 66.1 ± SD 14.8 vs. 70.8 ± SD 14.7, p = 0.022). CONCLUSION: This study demonstrates that cancer patients had significantly increased patient activation scores after engagement in a 3CS encounter provided by an oncology pharmacy team. Further studies are needed to verify these data in a larger population, different healthcare settings, and to evaluate for patients who have solid tumor malignancies.

Continuous Care Provided Through Comprehensive Medication Management in an Acute Care Practice Model.

BACKGROUND: Pharmacy practice models that foster pharmacists' accountability for medication-related outcomes are imperative for the profession. Comprehensive medication management (CMM) is an opportunity to advance patient care. OBJECTIVE: The objective of this study was to evaluate the impact of a CMM practice model in the acute care setting on organizational, patient, and financial outcomes. METHODS: Three adult service lines focused on at-risk patients identified using internal risk stratification methodology were implemented. Core CMM elements included medication reconciliation, differentiated clinical pharmacy services, inpatient MTM consultations, discharge services, and documentation. Mixed methods compared the effect of the CMM model before and after implementation. Historical patients served as comparative controls in an observational design. Pharmacists completed a 60-minute interview regarding their experiences. Qualitative data were analyzed using thematic coding to characterize perception of the model. RESULTS: Three pharmacists implemented the model on cardiology, hematology/oncology, and surgery transplant services and provided services to 75 patients during the study. A total of 145 medication-related problems were identified and resolved. CMM was associated with a nonsignificant reduction of 8.8% in 30-day hospital readmission rates ( P = 0.64) and a 24.9% reduction in 30-day hospital utilization ( P = 0.41) as well as a significant reduction of 86.5% in emergency department visits ( P = 0.02). Patients receiving discharge prescriptions from our outpatient pharmacies increased by 21.4%, resulting in an 11.3% increase in discharge prescription capture and additional revenue of $5780. Themes identified from qualitative interviews included CMM structure, challenges, value, and resources. CONCLUSION: This study demonstrated successful implementation of a CMM model that positively affected organizational, patient, and financial outcomes.

Post-Hospital Discharge Care: A Retrospective Cohort Study Exploring the Value of Pharmacist-Enhanced Care and Describing Medication-Related Problems.

BACKGROUND Medication-related problems occur at high rates during care transitions. Evidence suggests that pharmacists are well-suited to identify and resolve medication-related problems during hospital admission and at discharge. Additional evidence is needed to understand the impact of face-to-face pharmacist visits in primary care after discharge. The purpose of the study was to describe medication-related problems found during face-to-face pharmacist visits in a medical home after hospital discharge.METHODS A retrospective cohort study was conducted within an academic primary care center staffed by family medicine trained physicians that evaluated patients who attended a hospital follow-up visit with pharmacist-enhanced care (N = 86) versus usual care (N = 86). The primary objective was to describe medication-related problems identified by pharmacists using a modified individualized Medication Assessment and Planning tool for patients receiving pharmacist-enhanced care. Secondary analyses were also conducted to compare 30-day and 60-day hospital readmission and emergency department visit rates in those exposed to pharmacist-enhanced care versus those who were not.RESULTS At baseline, the mean hospitalizations in the prior year were 1.1 ± 1.7 (pharmacist-enhanced care) and 0.76 ± 1.2 (usual care), indicating a low initial readmission risk. Of patients receiving pharmacist-enhanced care, 97.7% were found to have at least 1 medication-related problem, with an average of 4.36 medication-related problems per patient. The 30-day readmission rate was lower, but not significantly different between groups (8.1% for pharmacist-enhanced care versus 12.8% for usual care; adjusted odds ratio (OR), 0.47; 95% confidence interval (CI), 0.16-1.36).LIMITATIONS Limitations include the retrospective cohort study design and small sample size. Medication-related problems were identified and collected prospectively during pharmacist visits.CONCLUSION Medication-related problems are ubiquitous after hospital discharge. Larger prospective studies will be needed to understand the potential value of pharmacist-enhanced care during hospital follow-up visits on readmission rates in low-risk patient populations receiving care within a primary care medical home.

Redesigned Entrustable Professional Activity (EPA) Assessments Reduce Grade Inflation in the Experiential Setting.

OBJECTIVE: This study aims to evaluate the impact of redesigning an entrustable professional activities (EPAs) assessment tool on the accuracy of student performance assessment within pharmacy education. METHODS: The study used retrospective programmatic data for students on clinical rotations over a 3-year period and compared entrustment levels assigned by preceptors with suggested entrustment levels. This tool was redesigned to separate formative EPA feedback from final grade determination. Data were analyzed using chi-squared tests to identify trends in students ABOVE, AT, or BELOW the suggested entrustment levels. Additionally, to account for intercohort variability, the relationship between students ABOVE the suggested level of entrustment and postgraduate metrics was examined. RESULTS: After the implementation of the revised tool, there was a significant decrease (-3%) in the percentage of students scoring ABOVE the suggested entrustment levels and an increase in the percentage of students scoring AT (+1%) or BELOW (+2%) the suggested entrustment levels. Changes were also observed in individual patient care settings, with a decrease in grade inflation and an increase in accurate assessments. North American Pharmacist Licensure Examination (NAPLEX) pass rates, residency match rates, and grade point average did not correlate with entrustment levels. CONCLUSION: The redesigned EPA assessment tool demonstrated a decrease in grade inflation resulting in more accurate assessments. The tool's focus on holistic grading and narrative descriptors contributed to better alignment between preceptor assessment and school-suggested achievement levels. This study suggests that EPA assessments in pharmacy education could benefit from a stronger emphasis on formative feedback and the use of holistic assessment methods for final grade determinations. The findings underscore the potential advantages of considering a separation between EPA scoring and final grades, prompting the Academy to explore their assessment practices to better reflect student performance in clinical experiences.

Preceptor perceptions of a redesigned entrustable professional activity (EPA) assessment tool in pharmacy practice experiences.

INTRODUCTION: The purpose of this study was to determine pharmacy preceptor perceptions of an entrustable professional activity (EPA) evaluation tool redesigned in 2019 and launched for use in May 2020. METHODS: Participants received an optional survey in June 2021 regarding their perceptions of the redesigned EPA assessment tool. The survey used a combination of open- and closed-ended questions regarding preceptor perceptions of the revised form, including perceptions of accuracy, usability, ease of use, grading, EPAs, and form layout. Preceptor perceptions were measured using seven-point Likert-type items and analyzed with descriptive statistics. Open-ended items were coded by at least two faculty members using qualitative content analysis. RESULTS: We received 106 responses (19.5% response rate) and analyzed a total of 91 responses. Most questions related to perceived accuracy were rated positively, and preceptors indicated it was easier to assign grades and provide feedback on EPAs using the new form. Preceptors agreed that EPAs indicated when students on clinical rotations excel and when they need to improve. Preceptors reported they could effectively evaluate students and do so in a way that saves them time. Overall, preceptors agreed that the form instructions helped them accurately assess student performance, and the new narratives helped them remember the assessment standards. CONCLUSIONS: Overarchingly, preceptors perceived that the new EPA assessment tool allowed them to provide feedback and grades more accurately, efficiently, effectively, and easily. This information will assist our institution in determining next best steps for EPA assessment tool updates.

Drug-drug interactions with glucagon-like peptide-1 receptor agonists.

OBJECTIVE: To review drug interaction studies of glucagon-like peptide-1 receptor agonists (GLP-1RAs) and concurrent oral medications. DATA SOURCES: PubMed was searched (to December 5, 2011) using the terms exenatide, liraglutide, albiglutide, and lixisenatide. The search was limited to studies published in English and conducted in adults. Abstracts from the American Diabetes Association Scientific Sessions from 2004 through 2011 were also searched. STUDY SELECTION AND DATA EXTRACTION: All abstracts were screened for eligibility, which consisted of studies reporting the effects of GLP-1RA administration on the pharmacokinetics and pharmacodynamics of concurrent oral medications. Data extracted from eligible trials included study and population characteristics; pharmacokinetic parameters including maximum concentration (C(max)), time to maximum concentration (t(max)), and area under the concentration-time curve (AUC); and pharmacodynamic properties. DATA SYNTHESIS: Our search identified 254 potentially relevant articles; of those, 11 articles evaluating 15 drug interactions were reviewed. Only 1 study was conducted in patients with type 2 diabetes. Equivalence in AUC was demonstrated in the majority of drug interactions studied (11 of 15). The AUCs of acetaminophen and lovastatin were decreased after exenatide administration and those of lisinopril and digoxin were decreased after liraglutide administration. In 10 studies, GLP-1RAs decreased the C(max) and, in 14 studies, prolonged the t(max) of study drug. Pharmacokinetic properties of drugs and differences in study design can explain differences in interaction potential. CONCLUSIONS: GLP-1RAs may produce clinically significant interactions with drugs that require achievement of target peak concentrations or a rapid onset of action. Studies in patients with type 2 diabetes are needed to further assess and allow comparison of several GLP-1RA agents' impact on steady-state pharmacokinetics and pharmacodynamics of concomitant oral medications.

Exogenous glucagon-like peptide-1 for hyperglycemia in critically ill patients.

OBJECTIVE: To review literature evaluating the safety and efficacy of exogenous glucagon-like peptide-1 (GLP-1) for hyperglycemia in critically ill patients. DATA SOURCES: PubMed was queried (inception to September 3, 2011), using the search term glucagon-like peptide-1. The search was limited to studies published in English and conducted in humans. Regular and late-breaking abstracts from the American Diabetes Association Scientific Sessions in 2009 and 2010 were also searched using the same search term. STUDY SELECTION AND DATA EXTRACTION: All abstracts were screened for eligibility, which consisted of studies reporting the effects of intravenous GLP-1 administration on glycemic control in critically ill patients. Data extracted from eligible trials included study and population characteristics, measures of glycemic efficacy, and safety. DATA SYNTHESIS: Our search resulted in the identification of 2105 potentially relevant articles; of those, 7 were reviewed. All included publications evaluated the use of intravenous GLP-1 (1.2-3.6 pmol/kg/min) compared with insulin or placebo infused for 4.5-72 hours in critically ill patients. The majority (n = 4) of studies included only patients from a surgical intensive care setting, and 71% (n = 5) of trials included those with a history of diabetes. Relative to insulin or placebo, GLP-1 therapy effectively lowered blood glucose concentrations in all trials. Out of 81 total study participants receiving GLP-1, only 4 had documented hypoglycemia (<60 mg/dL), 4 reported nausea, and 2 experienced vomiting. No other serious adverse events were reported. CONCLUSIONS: All trials reviewed suggest that GLP-1 may be a promising agent for the management of hyperglycemia in critically ill patients, regardless of diabetes status. Additional studies in more heterogeneous intensive care settings comparing GLP-1 with insulin, the current standard of care, are necessary. These studies should evaluate long-term safety and effectiveness of GLP-1 therapy on morbidity and mortality outcomes in critically ill populations.

Efficacy and safety of long-acting glucagon-like peptide-1 receptor agonists compared with exenatide twice daily and sitagliptin in type 2 diabetes mellitus: a systematic review and meta-analysis.

BACKGROUND: Long-acting glucagon-like peptide-1 receptor agonists (LA-GLP-1RAs) may deliver additional therapeutic benefits over other available incretin-based therapies. OBJECTIVE: To pool results of randomized controlled trials comparing the efficacy and safety of maximum dose LA-GLP-1RAs (liraglutide, exenatide once weekly) with exenatide twice daily and dipeptidyl-peptidase-IV inhibitors in patients with type 2 diabetes. METHODS: We searched PubMed, Cochrane Central Register of Controlled Trials and Database of Systematic Reviews, EMBASE (all from inception-December 2010), and abstracts presented at the American Diabetes Association Scientific Sessions in 2009 and 2010 to identify English-language reports of studies of at least 24 weeks' duration. The primary endpoint was mean change in hemoglobin A(1c) (A1C) from baseline to study endpoint. Weighted mean differences or odds ratios and their 95% confidence intervals for each outcome relative to control were calculated as appropriate. RESULTS: A1C was reduced favoring LA-GLP-1RAs compared with exenatide twice daily and sitagliptin (weighted mean difference [WMD] -0.47% [95% CI -0.69 to -0.25] and WMD -0.60% [95% CI -0.75 to -0.45], respectively). Odds ratios greater than 1 favored LA-GLP-1RAs for reaching the A1C target goal of less than 7%. Fasting plasma glucose (FPG) was reduced and favored the LA-GLP-1RA-based regimens. Exenatide demonstrated significantly greater reductions in postprandial glucose (PPG) after the morning and evening meals, compared with LA-GLP-1RAs. Body weight was reduced similarly between LA-GLP-1RAs and exenatide, but favored LA-GLP-1RAs in the sitagliptin comparator trials. LA-GLP-1RA therapy was not associated with severe hypoglycemia or acute pancreatitis. Compared with exenatide twice daily, vomiting was reduced significantly with LA-GLP-1RAs (OR 0.55; 95% CI 0.34 to 0.89); there was a trend toward decreased nausea (OR 0.58; 95% CI 0.32 to 1.06) and no difference in the incidence of diarrhea (OR 1.03; 95% CI 0.67 to 1.58). CONCLUSIONS: Compared with other incretin-based therapies, LA-GLP-1RAs produce greater improvement in A1C and FPG. They provide lesser effect on PPG, similar reduction in body weight, and result in a potentially favorable adverse event profile compared with exenatide twice daily.

Family support is associated with success in achieving weight loss in a group lifestyle intervention for diabetes prevention in Arab Americans.

OBJECTIVE: We have recently shown the feasibility of a community-based, culturally-specific, Diabetes Prevention Program-adapted, goal-oriented group lifestyle intervention targeting weight loss in Arab Americans. The objective of this study was to examine factors associated with weight-loss goal attainment at 24-weeks of the lifestyle intervention. METHODS: We assessed the relationship among demographic, psychosocial, and behavioral measures and the attainment of > or =7% decrease of initial body weight among 71 lifestyle intervention participants. RESULTS: Weight loss goal of > or = 7% of body weight was achieved by 44% of study participants. Demographic and psychosocial factors were not associated with weight loss. Individuals attaining the weight loss goal were more likely to have family support during the core curriculum sessions (70% vs 30%; P=.0023). Decrease in body weight was positively correlated with attendance at sessions (r=.46; P=.0016) and physical activity minutes (r=.66; P<.0001) and negatively correlated with reported caloric intake (r=-.49; P=.0023), fat intake (r=-.52; P=.0010), and saturated fat intake (r=-.39; P=.0175) in women; these trends were similar but not significant in men. CONCLUSIONS: Family support was an important predictor of attainment of the weight loss goal. Family-centered lifestyle interventions are likely to succeed in curtailing the rising epidemic of diabetes in the Arab-American Community.

An Exploration of Preceptor-Provided Written Feedback on Entrustable Professional Activities During Early Practice Experiences.

Objective. To explore and evaluate open-ended feedback on entrustable professional activities (EPAs) provided by preceptors to Doctor of Pharmacy (PharmD) students completing their first practice experience.Methods. A retrospective review was conducted of qualitative data collected from preceptor evaluations of student pharmacists who had completed a two-month practice experience in either community or health-system pharmacy at the end of their first professional year. Preceptors had used a validated EPA framework to assess students. A codebook was developed around the EPA framework and sub-coding was used to indicate positive, negative, or neutral assessment within each EPA. After several rounds of coding, consensus was reached for all codes by two investigators. A dependability audit was implemented to ensure the trustworthiness of the findings.Results. Preceptor evaluations of 153 student pharmacists were included in the study. Eighty students (52.3%) had completed a community experience and 73 (47.7%) had completed a health-system experience between May and August 2018. The preceptors at both practice settings provided overwhelmingly positive feedback on all EPAs. Opportunities to optimize preceptor-provided feedback were identified. The feedback provided by the preceptors in health-system and community practice settings focused on knowledge and behavior, respectively, with both emphasizing students' skill-based performance.Conclusion. This study provides valuable insight into optimizing preceptor-provided written feedback on EPAs. Conducting deeper analysis of preceptor feedback using focus groups or structured interviews is suggested to further explore preceptors' provision of EPA assessment to student pharmacists practicing in real-world settings.

Risk perception for developing diabetes among pharmacists.

BACKGROUND: Emerging evidence implies that differences in risk perception between healthcare professionals and the lay public exist. OBJECTIVE: To compare the actual risk status versus the personal risk perceptions for developing diabetes among pharmacists. METHODS: Perceived risk was measured in this cross-sectional study with the validated Risk Perception Survey for Developing Diabetes (RPS-DD). The RPS-DD has 4 main subscales aimed at capturing multiple dimensions of perceived risk and is scored on the following scale: 1 (almost no risk), 2 (slight risk), 3 (moderate risk), and 4 (high risk). Actual risk was assigned according to the American Diabetes Association (ADA) Diabetes Risk Test. Differences between higher and lower ADA risk participants were analyzed. Regression analyses were conducted to examine risk factors associated with pharmacists' self-reported perception for developing diabetes. RESULTS: Pharmacists (N = 218, 46.2 +/- 12.2 years [mean +/- SD], 47.7% male, 85.9% white) completed the survey. The Comparative Disease and Environmental Risk mean subscale scores were 1.98 +/- 0.43 and 1.86 +/- 0.41, indicating slight risk perceptions for the subscales, respectively. The single-item self-reported perceived risk for developing diabetes was 2.25 +/- 0.90, indicating a slight to moderate perceived risk for this disease. The Optimistic Bias score was 2.60 +/- 0.64, suggesting a trend toward more optimistic bias and a lower perceived risk for the development of diabetes. The Personal Control score was 3.38 +/- 0.47, illustrating that pharmacists endorsed personal control over the development of diabetes. Higher ADA risk participants reported less optimistic bias compared with lower risk respondents (p = 0.005). Comparative disease risk perception (correlation [r] = 0.38; p < 0.0001) and degree of optimistic bias (r = -0.49; p < 0.0001) emerged as the only predictors for diabetes related risk perception CONCLUSIONS: Pharmacists exhibited a slight to moderate risk perception for developing diabetes, reported a trend toward more optimistic bias, and demonstrated personal control over developing diabetes. Significant comparisons between higher and lower risk respondents were observed only with the optimistic bias subscale.

Exploratory Analysis of Entrustable Professional Activities as a Performance Measure During Early Pharmacy Practice Experiences.

Objective. To examine entrustable professional activities (EPAs) as an assessment tool for student pharmacists completing early practice experiences. Methods. Students completed a 2-month practice experience upon conclusion of their first year. Student performance on EPAs was assessed by preceptors and students at the midpoint and conclusion of the experience using a scale that ranged from dependent (1.0) to independent (5.0). Wilcoxon Signed-Rank Test assessed for differences between the midpoint and final evaluations on student self-evaluations and between the midpoint and final evaluation on preceptor-student evaluations. Cronbach's α assessed reliability of the EPAs. Results. From May to August 2016, 147 students completed a practice experience. Student-self and preceptor-student evaluations at the midpoint and final approximated a median score of 3.0 (IQR 2) and 4.0 (IQR 3), respectively, on EPAs 1-14. Analyses revealed statistically significant increases from midpoint to final evaluation for all constructs on both evaluations. Cronbach's α yielded scores of 0.98 for the preceptor evaluations and 0.95 for the student self-evaluation. Conclusion. There was an increase in student performance over time. The EPA statements may be a reliable assessment tool for student performance in pharmacy education.

Implementation of the flipped residency research model to enhance residency research training.

PURPOSE: The attainment of fundamental research skills to create and disseminate new knowledge is imperative for the advancement of pharmacy practice. Research training is an important component of postgraduate residency training; however, the traditional model of performing residency research has several limitations that have hindered the ability of residents to complete high-quality research projects. Therefore, our institution developed and implemented the flipped residency research model with the 2013-2014 pharmacy practice residency class. SUMMARY: The flipped residency research model modifies the research timeline to better align research activities with residents' abilities at specific time points during the year. In the 4 years following implementation of the flipped residency research model, our institution found improvements in a number of areas pertaining to the research process compared with an evaluation of the 7 years prior to implementation. A decrease in the number of reviews required from institutional review boards was observed, resulting in improved institutional review board efficiency. The flipped residency research model also addressed limitations surrounding manuscript development and submission, as demonstrated by an improved publication rate. Additionally, residents who participated in the flipped residency research model self-reported increased comfort with research-related abilities associated with study design, implementation, manuscript development and submission, and biostatistics. CONCLUSION: The modified research timeline of the flipped residency research model better aligns research activities with resident experiences and abilities. This realignment has translated to demonstrable impact in the success of residency projects and dissemination of results. Research is needed to investigate the impact of the flipped residency research model on longer term scholarly success.

Impact of an innovative partnership in patient care between an academic medical center department of pharmacy and a school of pharmacy.

PURPOSE: Pharmacy departments and schools of pharmacy have long held professional affiliations. However, the success of each entity is often not interdependent and aligned. In 2010, our institutions found ourselves in a position where the complementary motivations of each aligned to support a more meaningful and committed engagement, leading to the development of the Partnership in Patient Care. The impact of the partnership was evaluated 7 years postimplementation, and both the successes realized and the lessons learned are described. SUMMARY: The partnership provided many advantages to our pharmacy department and the school of pharmacy. This initial iteration of the partnership was a strong proof of concept that an intentional approach to the relationship between a school of pharmacy and a pharmacy department can lead to substantive improvements in a wide array of meaningful outcomes. We experienced an increase in the number of student rotation months completed, growth in the American Society of Health-System Pharmacists-accredited residency programs, and enhanced clinical services. However, the partnership was not without challenges. For instance, lack of a formalized tracking method made certain outcomes difficult to track. CONCLUSION: The purposeful establishment of the Partnership in Patient Care, built on the needs of a school of pharmacy and an academic medical center pharmacy department, allowed our institutions to develop an intertwined mission and vision. Over the initial years of the partnership, many successes were realized and lessons were learned. Both the successes and the challenges are serving as the foundation for future iterations of the partnership.

Addition of thiazolidinedione or exenatide to oral agents in type 2 diabetes: a meta-analysis.

BACKGROUND: The introduction of several new therapeutic agents for the treatment of type 2 diabetes mellitus has led to significant challenges for providers in deciding which agent to select during the disease course. OBJECTIVE: To provide a relative comparison of the efficacy and safety of adding thiazolidinediones (TZDs) or exenatide to oral agents for the management of type 2 diabetes mellitus by performing meta-analyses of relevant published studies. METHODS: We systematically searched PubMed, MEDLINE, CINHAL, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, EMBASE (inception to March 2008 for all databases), and abstracts presented at the 2006 and 2007 American Diabetes Association conferences to identify all relevant publications. Studies were included in the analysis if they (1) were published in English, (2) were prospective, randomized, and controlled with placebo or comparator, (3) were at least 24 weeks' duration, (4) included nonpregnant adults with type 2 diabetes, (5) were full-text, peer-reviewed articles examining the efficacy of either TZDs (rosiglitazone or pioglitazone) or exenatide in combination with other oral drugs, and (6) included hemoglobin A(1C) (AIC) outcomes in a manner that allowed data analysis. We evaluated mean change in A1C levels, proportion of subjects reaching A1C goals of less than 7%, mean change in fasting plasma glucose (FPG) and body weight, and the occurrence of nonsevere hypoglycemia and gastrointestinal adverse events. RESULTS: A total of 5212 TZD and 3582 exenatide publications were identified. After critical evaluation, 22 publications met all of the inclusion criteria for the meta-analysis. A1C was reduced from baseline for TZDs (weighted mean difference -0.80%; 95% CI -1.10 to -0.50) and exenatide (weighted mean difference -0.60%; 95% CI -1.04 to -0.16). Compared with controls, TZD- and exenatide-based therapies had odds ratios greater than 1 for reaching A1C targets of less than 7% (TZD OR 2.27; 95% CI 1.22 to 4.24 and exenatide OR 2.90; 95% CI 1.28 to 6.55). FPG concentrations were reduced significantly from baseline in the TZD-based regimens (weighted mean difference -29.58 mg/dL; 95% CI -39.27 to -19.89), but did not achieve significance in the exenatide trials (weighted mean difference -8.77 mg/dL; 95% CI -28.85 to 11.31). Body weight was reduced with exenatide (weighted mean difference -2.74 kg; 95% CI -4.85 to -0.64) and increased in subgroup analyses for TZDs (weighted mean difference 2.19 kg; 95% CI 1.24 to 3.14). There was no significant association between TZD or exenatide therapy and the risk of nonsevere hypoglycemia. The odds ratios for nausea, vomiting, and diarrhea with exenatide relative to controls were 9.02 (95% CI 3.66 to 22.23), 4.56 (95% CI 3.13 to 6.65), and 2.96 (95% CI 2.05 to 4.26), respectively. CONCLUSIONS: TZDs and exenatide have modest but beneficial effects on glycemic control and are relatively safe in regard to the adverse events studied. TZDs produce greater improvement in glycemic control, while exenatide is associated with reduction in body weight.

Identifying the Presence of Cognitive Apprenticeship in the Layered Learning Practice Model.

Objective. To identify the presence of cognitive apprenticeship themes in the layered learning practice model (LLPM). Methods. Attending pharmacists who had implemented an LLPM completed an individual 90-minute face-to-face semi-structured interview. Three researchers independently reviewed transcripts to identify cognitive apprenticeship themes according to the framework's dimensions and sub-dimensions. Results. Of 25 eligible attending pharmacists, 24 (96%) agreed to participate. All core dimensions of the cognitive apprenticeship framework emerged during the interviews; however, preceptors varied in how they used the framework in the training of pharmacy learners at different levels. This variability was especially apparent within the sub-dimensions of the content and method domains. Conclusion. This study demonstrates that all four cognitive apprenticeship principles are being used in the clinical environments operationalizing the LLPM. These findings suggest that cognitive apprenticeship is an applicable and relevant educational framework when engaging multiple learners in clinical education environments.

Educational outcomes associated with early immersion of second-year student pharmacists into direct patient care roles in health-system practice.

BACKGROUND AND PURPOSE: To assess the educational impact of engaging second professional year student pharmacists in active, direct patient care experiences in health system practice. EDUCATIONAL ACTIVITY AND SETTING: Student pharmacists in their second professional year completed a redesigned, skill-based four-week introductory pharmacy practice experience in health system practice. The immersion consisted of experiences in both operational and clinical pharmacy environments. Students were assessed with skill development checklist assessments. Pre-post surveys were also collected. Data were analyzed using a mixed methods approach. FINDINGS: Twenty-eight student pharmacists were included; of those, 26 completed both surveys (92.9% response rate). Survey results revealed significant increases in 81.8% of operational and 100% of clinical self-efficacy statements (p<0.05) and positive perceptions of the program overall. Overall, findings suggested that student pharmacists developed skills in health system practice while identifying additional areas for emphasized learning. SUMMARY: Student pharmacists engaged in early, hands-on, direct patient care experiences enhanced their skill development in operational and clinical pharmacy practice.

Accountable Care in Transitions (ACTion): A Team-Based Approach to Reducing Hospital Utilization in a Patient-Centered Medical Home.

BACKGROUND: There is limited data describing the role of the patient-centered medical home (PCMH) in successful transitions programs and more information is needed to determine the transition points where pharmacist involvement is most impactful. METHODS: A family medicine center developed a multidisciplinary outpatient-based transitions program focused on reducing emergency department (ED) and hospital use in medically complex patients. Key team members were a medical provider, clinical pharmacist practitioner (CPP), and care manager. The objective was to evaluate the impact of the program by comparing utilization before and after the intervention and to identify patient and process characteristic predictors of 30-day rehospitalizations. RESULTS: Of the 268 patients included, the mean time to follow-up appointment attended was 11.6 (11.8) days after discharge. The majority of patients (72%) saw their primary care provider at follow-up. Patients experiencing the multidisciplinary intervention had lower 30-day rehospitalizations at 7, 14, and 30 days postdischarge with significance achieved at 14 and 30 days. Compared to before the intervention, reductions in both ED visits and hospitalizations as well as increases in clinic visits were seen at 1, 3, and 6 months. CPP involvement was associated with lower rehospitalizations (7.7% vs 18.8%; P = .04). CONCLUSION: A multidisciplinary outpatient-based transitions program embedded in the PCMH increased access to primary care and reduced hospital and ED utilization. Face-to-face CPP involvement significantly lowered rehospitalizations. This program describes a standardized approach to complex care needs with defined roles, a model that may be generalizable and reproduced in other medical homes.

Intentional Interprofessional Experiential Education.

The experiential component of a doctor of pharmacy curricula is an ideal, yet underutilized vehicle to advance interprofessional education (IPE) initiatives. To date, most experiential-based IPE initiatives occur in a naturally occurring, non-deliberate fashion. The American Association of Colleges of Pharmacy (AACP) Experiential Education Section formed the Task Force on Intentional Interprofessional Education in Experiential Education in academic year 2015-2016 to explore the issue. This commentary describes the work of the task force, including the following elements: defining intentional interprofessional experiential education as "the explicit effort by preceptors and practice sites to create/foster educational opportunities or activities designed specifically to achieve interprofessional educational competencies;" conducting a systematic literature review to identify examples of intentional interprofessional experiential education in the published literature; surveying faculty with oversight of experiential education programs and preceptors within those programs; and generating recommendations to stakeholders including AACP, pharmacy schools, and experiential education administrators.

The Importance of Authentic Leadership to all Generations Represented within Academic Pharmacy.

Academic pharmacy spans several generations including traditionalists, baby boomers, Generation X, and Generation Y, commonly referred to as millennials. It has been suggested that leadership styles must change to accommodate these generational differences in academic pharmacy, yet there are no data of which we are aware, that support this assertion. We contend that leadership styles are derived from one's authentic self and are based on core beliefs and values; therefore, leadership styles must not change to accommodate a specific generation or other subset of academic pharmacy. Instead, effective leaders must change tactics (ie, methods or processes) to reach and influence a specific cohort. This article develops and supports the argument that leadership styles should not change to accommodate generational differences in academic pharmacy.