Predictors of Stress and Burnout Among Pharmacy Faculty in the United States.

OBJECTIVE: Stress and burnout may impact pharmacy faculty's well-being, quality of life, and productivity. This research study aimed to assess pharmacy faculty's overall burnout and stress levels in the United States and identify the characteristics associated with these two constructs while controlling for faculty characteristics. METHODS: Five thousand two hundred forty-five faculty members were invited to participate in a survey between November 2021 and February 2022. Burnout was assessed using the Oldenburg Burnout Inventory. Stress was assessed using the Perceived Stress Scale. Bivariate analyses were used to identify potential predictors of pharmacy faulty perceived burnout and stress. The relationships between time allocation across different academic responsibilities and faculty's perceived burnout and stress were assessed using linear regression analyses. RESULTS: Out of 5,139 delivered invitations, responses were collected from 774 pharmacy faculty (response rate = 15.1%). Faculty exhibited moderate levels of burnout with an average score of 40.1 on a scale from 16 to 64. Additionally, they displayed moderate perceived stress levels with an average score of 18.2 on a scale from 0 to 40. Faculty displayed significantly more burnout and stress if they were unmarried, non-tenured, younger, female, had lower academic rank, or worked in pharmacy practice departments. Higher stress and burnout were associated with spending more time on teaching, whereas lower burnout and stress were associated with spending more time on administration. CONCLUSIONS: This study found that U.S. pharmacy faculty experience moderate levels of stress and burnout. Some demographic factors and time allocation for teaching and administrative tasks influence these levels.

Using the social cognitive theory to examine spontaneous attempts to quit illicit substance use.

Rural areas in the US exhibit high rates of illicit substance use. This study aimed to investigate the Social Cognitive Theory factors associated with spontaneous attempts to quit illicit substance use in a sample of users. A cross-sectional survey was administered through face-to-face interviews. Data was collected from adult (≥ 18 years of age) current illicit substance users who were not receiving professional addiction treatment. Binary logistic regression analyses were utilized to answer the research question. Data from 230 illicit substance users met the eligibility criteria. The mean age was 38 years, whereas the average history of illicit substance use was 14 years. Users with a higher perceived value of quitting illicit substance use were significantly more likely to attempt to quit use spontaneously. Health behavior interventions that incorporate the perceived value of quitting illicit substance use can be effective in encouraging spontaneous attempts to quit illicit substance use.

A retrospective cohort study of the effect of rapid versus delayed-result procalcitonin testing on antibiotic use at a community hospital.

BACKGROUND: Procalcitonin is a serum biomarker used to distinguish bacterial infection from viral or noninfectious syndromes. Primary literature shows mixed data on use of procalcitonin for de-escalation of antimicrobials. Delays in test results of send-out procalcitonin assays may result in prolonged antimicrobial durations. It is unknown whether availability of rapid-result assays may shorten time to antibiotic de-escalation. AIM: This retrospective, cohort study compared antibiotic durations of treatment between groups with rapid-result versus delayed send-out, procalcitonin test modality. This study was exempt from Ethics Committee Approval, as determined by the Institutional Review Board at the study site. METHOD: Adult hospitalized patients were included if they had at least one procalcitonin test performed during the study period. The primary outcome compared mean duration of antimicrobial therapy between groups receiving a rapid-result procalcitonin test and a send-out test. Secondary outcomes included incidence of Clostridiodes difficile infection, mention of procalcitonin testing in the electronic medical record in reference to antimicrobial therapy decision making, and presence of comorbidities which affect procalcitonin levels independent of infection. RESULTS: A total of 350 lab results were analyzed. The duration of antimicrobial treatment between groups was not statistically different with the median duration of treatment in the send-out group being 2.95 days compared to 3.35 in the rapid result group, p = 0.856. Patient comorbidities with potential to lead to a noninfectious elevation or falsely high level of procalcitonin were common. CONCLUSION: Use of a rapid-result procalcitonin assay does not reduce hospital antimicrobial therapy duration as compared with send-out testing.

Exploring the impact of the United States-based accreditation council for pharmacy education certification on pharmacy education outside the United States.

Introduction: The Accreditation Council for Pharmacy Education (ACPE) offers certification for interested pharmacy programs outside the United States. This study aimed to explore the reported impact of this certification on the quality of pharmacy education among ACPE-certified pharmacy programs outside the US. Methods: This cross-sectional study was based on highly structured, standardized interviews. A predetermined questionnaire was designed to include both quantitative and qualitative items, which assessed participants' thoughts on the impact of ACPE certification on the quality of pharmacy education as well as programmatic and student learning outcomes. A total of 15 pharmacy colleges and schools outside the US have received the ACPE certification as of July 2020. After IRB approval, these programs were invited to participate in online live interviews, which were scheduled from May to July 2020 via Zoom®, and lasted approximately 45 min each. Results: Administrators from 13 programs participated in this study (87% respondent rate). The majority of these international pharmacy programs reported that the ACPE certification had promoted the quality of pharmacy education at their institutions. However, there were different views on how the ACPE certification has affected the operation of these international pharmacy programs. There was little or no impact of the certification on financial resources, such as salaries and development funds. Conclusion: Despite being confined to little or no change in certain areas of their programs, all the interviewees believed the ACPE certification had an overall positive impact on the quality of their programs, particularly in the area of assessment, preceptor quality and development, improving teaching and learning methods in both didactic and experiential curricula, and developing an inclusive feedback system to receive input from various stakeholders.

Identifying areas of improvement for cultural competence in pharmacy curricula: A multi-school study using the self-assessment of perceived level of cultural competence (SAPLCC) questionnaire.

INTRODUCTION: The implementation of culturally competent healthcare services has been considered a key strategy for the provision of patient-centered care; however, a need remains to address the requirements of teaching cultural competence, including identifying gaps, designing and evaluating curricula, and assessing students' progress toward program objectives. The objective of this study was to explore the applicability of the Self-Assessment of Perceived Level of Cultural Competence (SAPLCC) questionnaire in the identification of improvement areas in cultural competence content in pharmacy curricula. METHODS: This study used previously-collected SAPLCC data from student pharmacists at eight United States pharmacy schools. Total and factor-specific SAPLCC scores were calculated based on the 14 factors published previously and grouped into six domains (knowledge, skills, attitudes, encounters, abilities, and awareness). Differences in overall scores by domain and factors across various student characteristics were examined using analysis of variance. RESULTS: The overall mean total SAPLCC score was classified as moderate. Third-year students had significantly higher SAPLCC mean scores than first-year students, and African American students scored significantly higher than their counterparts. At the factor-level, students scored higher in the Attitudes and Awareness domains and scored lower in the Knowledge, Skills, and Encounters domains. CONCLUSIONS: The application of the SAPLCC in schools participating in this preliminary study allowed for the identification of content areas that may benefit from revision. The SAPLCC may be a useful tool for mapping cultural competence curricular content by each specific domain and identifying areas of potential improvement regarding cultural competence training within pharmacy curricula.

Ultra high-performance liquid chromatography method development for separation of formoterol, budesonide, and related substances using an analytical quality by design approach.

The application of the Quality by Design (QbD) principles in developing a new ultra high performance liquid chromatography method for the analysis of formoterol/budesonide and related substances using Fusion QbD® software is explored. The effect of various chromatographic parameters including, column stationary phase, pH, temperature, flow rate, and gradient time on separations were systematically investigated. Results show that optimal separations of these compounds in a standard solution can be achieved using a BEH C18 column (2.1 × 1.7 µm × 10 cm) applying a pH of 8.2, a temperature of 35 °C, a flow rate of 0.35 mL min-1 and a gradient time of 25 min. Furthermore, the results show that the main parameters affecting the performance of the method were the mobile phase pH, gradient time, and the temperature. For example, the most important factor for peak tailing was the pH of the mobile phase and the critical factors affecting resolution of the analytes were the gradient time and the temperature. As an application, the method was further used to analyze budesonide and formoterol in a sample obtained from a Symbicort® metered dose inhaler and it was found to provide similar separations to those obtained with the standard solution. These findings indicate that applying the QbD principles in analytical method development can be very advantageous not only in obtaining deep understanding of the effect of input parameters but also potential regulatory flexibility.

Ethical Issues in Consenting Older Adults: Academic Researchers and Community Perspectives.

OBJECTIVES: Obtaining informed consents from older adults is surrounded by many ethical and practical challenges. The objective of this study was to evaluate ethical issues and strategies in consenting older adults in Jordan as perceived by academic researchers and older adults. METHODS: An anonymous questionnaire was distributed to academic researchers in the Jordanian health sciences colleges, and a sample of older adults. The study survey included items eliciting demographics, professional characteristics, and perceptions regarding the consenting process in older adults, consent-related skills in elderly, and strategies to improve the consenting process in older adults. The survey was then modified to assess the consent-related ethical issues and challenges as viewed by a sample of older adults after explaining the concept of the consenting process to them. KEY FINDINGS: A total of 250 academic researchers and 233 older adults participated in the study. Both researchers and older adults reported that having to sign the written forms and the impact of age-related physical impairments were the most challenging obstacles when consenting older adults. Lack of consistency and repeating questions were the most frequently encountered obstacles by researchers in consenting older adults. Ensuring privacy (anonymity/confidentiality), dedicating more time for the consenting process, treating older adults as autonomous individuals and respecting their cultural beliefs were the most helpful strategies recommended by both academic researchers and older adults. CONCLUSIONS: Obtaining informed consents from older adults is a challenging process. Researchers should be aware of the special needs and strategies to achieve realistic and ethical informed consents from older adults.

Effect of mobile text messages on antiretroviral medication adherence and patient retention in early HIV care: an open-label, randomized, single center study in south Florida.

BACKGROUND: People with HIV (PHIV) with limited access to health services often experience suboptimal antiretroviral therapy (ART) adherence. We investigated whether a daily text messaging intervention improves ART adherence and retention in early HIV care in PHIV in a south Florida hospital-based clinic. METHODS: ART-naïve PHIV receiving care through the clinic's Ryan White HIV/AIDS Program were enrolled and randomly assigned to the intervention or control groups with a 1:1 ratio. The intervention group received a 1-way text message daily and the control group received standard care without receiving text message reminders for 6 months. HIV RNA and CD4 cell count were measured at baseline and post-intervention. Adherence to ART was defined as a visual analog scale of ≥ 90%. Retention in care was defined as continued engagement at study end. RESULTS: 94 ART-naïve patients were randomized and 83 (85.6%) completed the study, of which 44 were in the intervention group and 39 were in the control group. At the end of the 6-month study period, adherence to ART was 84.4% in the intervention group versus 73.5% in the control group (OR, 1.9; 95% CI 0.7-5.0; p = 0.194). Retention in care significantly improved in the intervention group compared to the control group with the odds of retention increasing by 20% (OR, 1.2; 95% CI 1.1-1.5; p = 0.006). Undetectable HIV RNA (< 50 copies/mL) was 86.7% in the intervention group versus 73.5% in the control group (OR, 2.3; 95% CI 0.8-6.9; p = 0.112). A significant increase in CD4 cell count and a decrease in HIV RNA were found at study end, with no differences between the two groups. CONCLUSIONS: In this pilot study, a one-way daily text messaging intervention did not improve ART adherence over a 6-month study period, but significantly enhanced patient retention in early HIV care. Implementation of interventions to improve adherence in this population is required.

Impact of Cognitive and Social Factors on Smoking Cessation Attempts among US Adult Muslim Smokers.

BACKGROUND: Muslims in the United States (US) exhibit high rates of cigarette smoking. Guided by the Social Cognitive Theory, the study aimed to investigate the associations between the number of serious cigarette smoking cessation attempts and cognitive as well as environmental factors in adult US Muslim smokers. METHODS: This cross-sectional study was based on a convenience sample of adult (≥ 18 years) US Muslim smokers. After receiving IRB approval, data were collected using an on-line survey. Unadjusted Poisson regression followed by adjusted multivariable Poisson regression analyses were conducted to answer the research question. RESULTS: One hundred thirty-two smokers completed the questionnaire. Smokers reported more serious cigarette smoking cessation attempts if they 1) had more knowledge about the consequences of cigarette smoking cessation, 2) had more positive attitudes regarding quitting, and 3) reported greater religiosity. Additionally, smokers reported fewer serious cigarette smoking cessation attempts if they 1) were employed, 2) affiliated with Sunnah sect, 3) reported better self-assessed health, 4) reported higher perceived value for quitting, and 5) indicated that using tobacco was not allowed inside the home. Only three smokers reported using both prescription medications and counseling to aid with smoking cessation attempts. CONCLUSIONS: Inadequate utilization of pharmaceutical smoking cessation products and provider professional assistance may exacerbate the problems associated with elevated rates of smoking among US Muslim smokers. Knowledge of the consequences, more positive attitudes, and greater religiosity can be influential constructs in future interventions aimed at encouraging smoking cessation attempts in this population.

A Multi-School Validation of a Revised Scale for Assessing Cultural Competence in Pharmacy Students.

Objective. To revise the Self-Assessment of Perceived Level of Cultural Competence (SAPLCC) instrument and validate it within a national sample of pharmacy students. Methods. A cross-sectional study design using a convenience sample of pharmacy schools across the country was used for this study. The target population was Doctor of Pharmacy (PharmD) students enrolled in the participating pharmacy programs. Data were collected using the SAPLCC. Exploratory factor analysis with principal components extraction and varimax rotation was used to identify the factor structure of the SAPLCC instrument. Results. Eight hundred seventy-five students from eight schools of pharmacy completed the survey. Exploratory factor analysis resulted in the selection of 14 factors that explained 76.6% of the total variance and the grouping of 75 of the 86-items in the SAPLCC into six domains: knowledge (16 items), skills (11 items), attitude (15 items), encounters (11 items), abilities (13 items), and awareness (9 items). Using a more diverse, representative sample of pharmacy students resulted in important revisions to the constructs of the SAPLCC and allowed the identification of a new factor: social determinants of health. Conclusion. The 75-item SAPLCC is a reliable instrument covering a full range of domains that can be used to measure pharmacy students' perceived level of cultural competence at baseline and upon completion of the pharmacy program.

Tobacco Use among Adult Muslims in the United States.

BACKGROUND: Compared with the general United States (US) population, Muslims in the US exhibit elevated rates of tobacco use. As a result, they might be at a higher risk for preventive disease and premature death as compared with the general US population. OBJECTIVE: This study investigated the Social Cognitive Theory (SCT) factors that are associated with tobacco use among a sample of adult Muslims in the US. METHODS: Data were collected (November 2016-March 2017) using a cross-sectional, on-line survey from a convenience sample of adult (≥ 18 years) US Muslims. Participants with a lung cancer history were excluded. Associations between SCT factors and tobacco use were investigated with bivariate analyses and multinomial logistic regression models. RESULTS: Eligible participants (n = 271) from 30 states completed the survey; 52.8% reported current tobacco use. A higher rate of current tobacco use was reported by men (62.8%) as compared to women (41.3%), x2(1, N = 271) = 12.49, p < .001. In terms of cognitive factors, individuals who (1) expected more personal consequences for tobacco use on health, and (2) had more confidence regarding ability to abstain from tobacco use, were less likely to report current tobacco use. In terms of environmental factors, individuals whose family members did not use tobacco were less likely to report current tobacco use. CONCLUSION: The study findings suggest that family-oriented interventions emphasizing self-efficacy and personal consequences to prevent tobacco use can potentially be effective in reducing tobacco use rates in the adult US Muslim population.

Patient Perceptions of Text Messaging to Improve Antiretroviral Therapy Adherence: A Qualitative Study of Patients in a Ryan White Clinic.

Evidence on the use of short message service (SMS) to improve medication adherence in people living with HIV (PLHIV) is mounting, yet qualitative research on patient perceptions regarding SMS content and utility for HIV/AIDS remains nascent. To explore the experience of receiving medication reminders via SMS among PLHIV, 45 uninsured and underinsured PLHIV nested within the intervention arm of a larger study received daily, 1-way SMS adherence reminders. Qualitative data were collected by face-to-face, structured interview and were analyzed using conventional content analysis methods. Three main themes emerged from the data: (1) reminders helping with adherence, (2) concerns about delivery modes, and (3) the need for confidentiality. Study findings offer enhanced focus on an emerging strategy in patient-centered HIV care: Equipped with greater context on the experiences of PLHIV using SMS adherence reminders, health-care providers can offer more targeted support and thereby maximize the benefits of this popular and powerful technology.

Review of National and International Accreditation of Pharmacy Programs in the Gulf Cooperation Council Countries.

Objective. To compare the different philosophies, emphases and processes of national and international accreditation paths available to pharmacy programs in Gulf Cooperation Council (GCC) countries. To identify engagement of GCC pharmacy programs with International Pharmacy Accreditation or Certification (IPAC) and the outcome advantages of IPAC compared to other national accreditation standards. Findings. National quality standards across the GCC countries are similarly structured but in different stages of development. Pharmacy specific standards are absent. Of the 44 institutions identified offering pharmacy degrees, only three out of 28 of those in the Kingdom of Saudi Arabia (KSA) and all but two out of 15 elsewhere in the GCC, have national program-level accreditation. Nine of the institutions have IPAC via either the Accreditation Council for Pharmacy Education-International Services Program (ACPE-ISP), the Canadian Council for Accreditation of Pharmacy Programs (CCAPP) or the German Accreditation Agency in Health and Social Sciences (AHPGS). None of the institutions have sought accreditation from the Australian Pharmacy Council (APC). IPAC may serve as a tool to provide specific recognition of the quality of pharmacy programs and to enhance the quality of pharmacy education in the region. Summary. In the absence of national bodies to accredit pharmacy initial training degrees, IPAC has become increasingly popular in the GCC countries. There are distinct regional differences in uptake and choice of IPAC. IPAC may serve as a tool to provide specific recognition of the quality of pharmacy programs and to enhance the quality of pharmacy education in the region in the absence of an unmet for pharmacy-specific national accreditation.

Assessment of Texan pharmacists' attitudes, behaviors, and preferences related to continuing pharmacy education.

BACKGROUND: Whether the available Continuing Education (CE) programs meet pharmacists' continuously increasing needs and preferences is open to question. OBJECTIVES: to investigate pharmacists' perceptions and attitudes concerning available CE programs, evaluate the pharmacists' choices with regard to selecting among different CE programs, and investigate the factors that are associated with preference to utilize online CE programs. METHOD: A 17-question survey was developed and mailed to a random sample of 600 Texan pharmacists. In addition to collecting basic demographic information, the survey investigated pharmacists' choices with regard to delivery and content of CE programs, motivations to participation in CE programs, and pharmacists' preferences for future CE programs. RESULTS: A total of 161 pharmacists completed the survey and mailed back their responses. Excluding the 75 undeliverable surveys, the response rate was 31%. Approximately 83% of respondents found that currently available CE programs met their educational needs. The most important factors influencing pharmacists' choices with regard to CE programs were the scope programs, the location where programs are held, and the cost associated with enrolling in such programs. Online CE was the most preferred mode of CE among participants. The factors that were associated with pharmacists' preferences to complete 50% or more of required CE through online programs were previous use of online CE programs, preference to limit the duration of CE programs to 1 or 2 hour-long, and perceived ability to find adequate CE programs among currently available CE programs. CONCLUSION: The findings suggest modalities for CE programs providers on how to improve CE programs in the future in order to meet the preferences of local pharmacists.

Reliability assessment of a peer evaluation instrument in a team-based learning course.

OBJECTIVE: To evaluate the reliability of a peer evaluation instrument in a longitudinal team-based learning setting. METHODS: Student pharmacists were instructed to evaluate the contributions of their peers. Evaluations were analyzed for the variance of the scores by identifying low, medium, and high scores. Agreement between performance ratings within each group of students was assessed via intra-class correlation coefficient (ICC). RESULTS: We found little variation in the standard deviation (SD) based on the score means among the high, medium, and low scores within each group. The lack of variation in SD of results between groups suggests that the peer evaluation instrument produces precise results. The ICC showed strong concordance among raters. CONCLUSIONS: Findings suggest that our student peer evaluation instrument provides a reliable method for peer assessment in team-based learning settings.

Parental attitudes affecting compliance with the recommendation for two doses of 2009 pandemic influenza A (H1N1) vaccine in children less than 10 years of age in West Virginia.

OBJECTIVE: It is unclear why parents would decline the second dose of an influenza vaccine for their children during a declared global pandemic. Therefore our objective was to examine parental attitudes behind parents foregoing the second dose of 2009 pandemic influenza A (H1N1) vaccine for their children in Kanawha County, WV. METHOD: A survey tool addressing barriers to receiving second dose was developed and validated with a randomly generated parent focus group. The West Virginia's Statewide Immunization Information System (WVSIIS) database listed 1,925 parents who have one child or more who received the first but not the second dose of vaccine within the recommended time period. The surveys and letters were sent to all the 1,925 parents. Participants were offered the choice of completing a paper version of the survey sent through the mail or an online version at a password-protected website. RESULTS: A total of 381 surveys were received (345 hardcopy surveys and 36 online surveys) and were included in the analyses (response rate 22.0%). Of these 381 respondents 249 did not meet the inclusion criteria. Thus our effective response rate was 132/1525, or 8.66%. The major reasons for respondents being unable to have their child(ren) receive the second dose were related to access limitations. A perception of low urgency and safety of vaccine were other concerns. However, the majority of respondents (80%) did not cite safety concern as a reason for not accepting the second dose. CONCLUSION: Our findings suggest that rather than safety concerns, parents often faced access challenges in having their children fully vaccinated which were perhaps not widely recognized.

Patient attitudes toward community pharmacist attire.

The white coat has symbolized professionalism, while representing provider-patient fiduciary relationship. Although well described in the literature for physicians, few studies examine the impact of pharmacist attire on patients' opinions regarding professionalism and trust. Therefore, understanding patient perceptions regarding pharmacist's attire and its influence on comfort, confidence, trust, and professionalism may provide guidance on ways to enhance the quality of the provider-patient relationship. A 43-item Likert-type questionnaire was administered to 347 adults in a community pharmacy setting to determine preferences about the pharmacist's attire, accessories, and body art incorporating 8 photographs depicting a male pharmacist in various degrees of dress formality (ie, casual to professional). Descriptive and inferential statistics were used to summarize and analyze the data. Survey respondents reported it was desirable/strongly desirable that pharmacists be dressed in a shirt and tie, dress shoes, white coat, and name tag (mean 4.21-4.72), whereas they should not be dressed in jeans, casual shoes, or have visible body art (mean 2.17-2.78). Over 86% of the respondents felt that a pharmacist with a white coat instilled feelings of comfort, confidence, trust, and professionalism. In a community pharmacy setting, a pharmacist wearing a white coat appears to be the mainstay in displaying professionalism and inspiring trust in adult patients.

Availability and perceived value of masters of business administration degree programs in pharmaceutical marketing and management.

OBJECTIVES: To examine pharmacist-targeted master of business administration (MBA) degree programs and investigate pharmacists' perceptions regarding them. METHODS: Specialized MBA programs in pharmaceutical marketing and management offered at US colleges and schools of pharmacy were identified in the literature and compared. Pharmacists' perceptions of MBA programs were evaluated through a survey of clinical preceptors affiliated with a school of pharmacy. RESULTS: Seven US universities that offer an MBA program in pharmaceutical marketing and management were identified. Thirty-three percent of the 57 pharmacist preceptors who responded to the survey reported plans to pursue an MBA degree program. Respondents preferred MBA programs related to healthcare or pharmacy (66%) over general MBA programs (33%). CONCLUSION: An MBA in pharmaceutical marketing and management could provide pharmacists with advanced knowledge of the operational and strategic business aspects of pharmacy practice and give pharmacy graduates an advantage in an increasingly competitive job market.