Transitioning From Points-Based Grading to a Modified Pass/Fail Grading Approach in a Simulated Patient Program.

OBJECTIVE: To determine the impact of transitioning from points-based grading to a modified pass/fail grading approach in a simulated patient (SP) program on first year pharmacy (P1) student performance in a PharmD curriculum. METHODS: Course-level data from the 2021-2022 and 2022-2023 academic years were collected to assess the impact of transitioning to a modified pass/fail grading approach on P1 student performance. During the 2021-2022 academic year, points-based grading was used. In 2022-2023, a modified pass/fail grading approach was implemented: communication assessment used pass/fail grading and clinical assessment used points-based grading; each assessment was worth 50% of the total SP activity grade. Chi-square tests were used to compare the percentage of students who passed each assessment (≥70%) with those who failed. RESULTS: Across both academic years, students completed 9 formative (18 rubrics) and 6 summative (12 rubrics) SP activities. Each activity included separate communication and clinical assessment rubrics. There were no significant differences in performance on 27 of 30 rubrics. There were two formative SP activities where the percentage of students who passed the communication assessment using pass/fail grading (2022-2023 academic year) was different than points-based grading (2021-2022 academic year). In one fall semester activity, the cohort with the modified pass/fail grading approach had lower pass rates, but the opposite trend was observed in the winter semester. CONCLUSION: Our program was able to successfully move to a pass/fail approach for communication assessments of SP activities while maintaining points-based grading for clinical assessments in our P1 curriculum with minimal impact on student performance.

Pharmacotherapy for Type 2 Diabetes Mellitus: What's Up and Coming in the Glucagon-Like Peptide-1 (GLP-1) Pipeline?

Glucagon-like peptide-1 (GLP-1), an incretin hormone, is known to lower glucose levels, suppress glucagon secretion, and slow gastric emptying. These properties make GLP-1 an ideal target in treating type 2 diabetes mellitus (T2DM). There are many FDA-approved GLP-1 agonists on the market today, several of which have demonstrated benefit beyond improving glycemic control. Given the beneficial effects of GLP-1 agonists in patients with T2DM, new drugs are in development that combine the mechanism of action of GLP-1 receptor agonism with novel mechanisms and with drugs that promote GLP-1 secretion. These agents are designed to improve glycemic control and target greater body weight reduction. This article discusses new GLP-1 drugs in the pipeline for the treatment of T2DM.

Evaluation of Curricula Content on Kidney Disease in US Doctor of Pharmacy Programs.

Objective. Although pharmacists improve outcomes in the care of patients with kidney diseases and current guidelines advocate multidisciplinary care, pharmacist nephrology training is not well described. This study seeks to characterize required and elective coursework within US Doctor of Pharmacy curricula. This information will be valuable in identification and evaluation of educational gaps for pharmacists as best practices in the education and care of kidney diseases for pharmacists are established.Methods. This prospective, cross-sectional, descriptive study assessed current practices and trends in education on kidney diseases within Doctor of Pharmacy curricula at accredited programs in the United States through an electronic survey.Results. Forty-three percent (N=61) of all ACPE-accredited pharmacy institutions were represented in the survey. Content on kidney diseases was found to be taught in both required and elective coursework, and one-third of responding institutions offered advanced pharmacy practice experiences focused on kidney diseases. Variation was found in the amount of time allotted for the teaching of kidney diseases topics in pharmacy curricula and the types of experiential training offered. Six respondents reported offering postgraduate education that focused on kidney diseases. Most respondents were clinical faculty who had completed residency training and board certification.Conclusion. Given the complex interplay between kidney diseases and other health conditions, the increasing incidence and prevalence of kidney diseases, and the potential expansion of pharmacists' roles in the care of patients with kidney diseases, a review of current Doctor of Pharmacy curricula is necessary to guide any future optimization efforts to ensure practice-ready pharmacists.

The Impact of an Early Clinical Experience on Pharmacy Student Learning About Ambulatory Care Practice.

Objective. To determine whether student confidence in their knowledge of ambulatory care pharmacy and ability to contribute to patient care in this setting increased after participating in an ambulatory care introductory pharmacy practice experience (IPPE), and whether it changed student interest in pursuing a career in ambulatory care pharmacy.Methods. Second-year pharmacy students (n=86) completed a required ambulatory care experience which included four hours of didactic work and 13.5 hours of clinic experience with an ambulatory care pharmacist. Before and after the experience, students completed an eight-question survey in which they rated their confidence in their knowledge of ambulatory care practice and in providing patient care in this setting, as well as their interest in a career in ambulatory care. A five-point Likert scale was used to assess student confidence (1=not at all confident, 5=very confident) and interest in ambulatory care (1=not at all interested, 5=extremely interested). The Wilcoxon signed rank test was used to compare pre-post survey responses.Results. Eighty-five pharmacy students completed both the pre- and post-survey. Median scores on the post-intervention test increased from 3 to 4 in seven of the domains assessed. Student interest in a career in ambulatory care remained unchanged.Conclusion. An ambulatory care IPPE increased student confidence in their understanding of ambulatory care pharmacy practice and caring for patients in this setting.

Impact of Dosing Conversion From Basal Insulin to Follow-On Insulin Glargine.

BACKGROUND: Several basal insulins have recently come to market including follow-on insulin glargine (Basaglar®). Currently, there is no real-world data published on the implications of conversion to Basaglar on dosing or glycemic control. OBJECTIVE: To identify differences in basal insulin dosing requirements, hemoglobin A1c (HbA1c), and incidence of hypoglycemia or weight gain when converting a patient to Basaglar from another basal insulin. METHODS: Single-center, retrospective chart review at an academic medical center. All patients prescribed Basaglar between December 15, 2016, and August 31, 2017 were included for review if converted from another basal insulin. PRIMARY OUTCOME: Difference in basal insulin requirements in both units/d and units/kilogram (kg)/d after conversion to Basaglar. SECONDARY OUTCOME: Change in HbA1c and weight. RESULTS: Mean basal insulin dose was 38.4 ± 26.3 units/d pre-conversion and 40.5 ± 29.8 units/d post-conversion (P = .031). Results were significant for patients with type 2 diabetes mellitus (T2DM; pre-conversion basal dose 34.6 ± 24.3 units/d; post-conversion basal dose 37.6± 29.0 units/d; P = .009). Weight-based dosing changed from 0.37 ± 0.25 units/kg/d pre-conversion to 0.39 ± 0.29 units/kg/d post-conversion (P = .056) and was significant for patients with T2DM (P = .040). A nonsignificant decrease in HbA1c was seen (-0.14% ± 1.24%; P = .142). There was no difference seen in weight (111.6 ± 46.3 kg vs 111.7 ± 46.9 kg; P = .662). CONCLUSION: Patients with diabetes require similar basal insulin doses upon conversion to Basaglar. Clinicians should monitor blood glucose closely during basal insulin transition.

Pharmacists providing care in statewide physician organizations: findings from the Michigan Pharmacists Transforming Care and Quality Collaborative.

BACKGROUND: Clinical services provided by pharmacists embedded in practices can improve patient outcomes within the primary care setting. Little is known about whether physician organizations (POs) will retain the services of clinical pharmacists after outside funding for a statewide implementation program is ended. OBJECTIVE: To evaluate a statewide program, Michigan Pharmacists Transforming Care and Quality (MPTCQ), that incorporated pharmacists within 17 POs. METHODS: A descriptive study was conducted using data collected from June 2016 to September 2018 from primary care clinical pharmacist encounters in POs participating in MPTCQ. Process outcomes included the number of participating POs, patient encounters, and average visits per patient. Analyses at the encounter level were stratified by 2 encounter types: disease state management (DSM) or comprehensive medication review (CMR). Separately by encounter type, pharmacist effect was described by the number, type, and reasons for medication changes, as well as medication adherence and cost barriers found and addressed. Clinical outcomes included hemoglobin A1c and blood pressure change. Sustainability and patient satisfaction of pharmacists providing clinical services are reported. RESULTS: Across 17 POs, 27 pharmacists participated in the MPTCQ program. Pharmacists completed 24,523 patient encounters for DSM with 5,942 patients, with an average of 5 visits per patient with diabetes and 2 visits for hypertension. Pharmacists made 15,153 therapeutic medication changes during visits for diabetes and hypertension, with approximately 70% related to efficacy. Pharmacists completed 4,203 CMR visits for 3,092 patients. During CMR visits, 1,296 therapeutic medication changes were recommended. Problems with medication cost were identified in 13% of CMR visits. Blood pressure and A1c levels decreased in patients managed by pharmacists. In 157 patients surveyed, 87% rated their pharmacists' care as excellent. Sixteen POs retained their pharmacists at the end of funding. CONCLUSIONS: A statewide provider-payer partnership successfully integrated and retained primary care pharmacists within POs. Pharmacists in the MPTCQ program contributed to improvements in disease control by changing medications to improve patient clinical outcomes. DISCLOSURES: Support for MPTCQ was provided by Blue Cross and Blue Shield of Michigan (BCBSM) as part of the BCBSM Value Partnerships program. Coe was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under award number KL2TR002241. Although BCBSM and MPTCQ work collaboratively, the opinions, beliefs, and viewpoints expressed by the authors do not necessarily reflect the opinions, beliefs, and viewpoints of BCBSM or any of its employees. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The authors have no conflicts of interest to report.

Approaches to Medication Management in Patients with Kidney Failure Opting for Conservative Management.

After consideration of risks and benefits, some patients with kidney failure choose conservative management. Conservative management of kidney failure (CM-KF) does not include dialysis or transplant and utilizes primarily pharmacologic strategies for symptom management, which can be challenging due to the number and complexity of symptoms. Additionally, there are safety concerns regarding altered pharmacokinetics and the adverse effects induced by some of the therapies that may be selected to treat symptoms. This review describes common kidney failure symptoms and provides recommendations for pharmacologic management in CM-KF. Selection of medication should be individualized to the patient and comorbidities, drug interactions, cost, and adverse effects should be carefully considered. Additional studies specifically focused on CM-KF are needed.

Implementation and barriers to uptake of interactive voice response technology aimed to improve blood pressure control at a large academic medical center.

OBJECTIVES: Blood pressure control among patients with hypertension is a widely recognized quality metric, but many large health systems fail to reach targets set by the Healthcare Effectiveness Data and Information Set. We developed an interactive voice response (IVR) system called the "Mobile You Blood Pressure Program" at a large academic medical center and linked it to the health system's electronic health record (EHR). The goal of the program was to capture home blood pressure readings in the EHR and to alert ambulatory care clinical pharmacists automatically of readings below or above clinical thresholds through direct messaging in the EHR. The goal of this report is to describe implementation of IVR, initial patient participation rates, and pharmacist-identified barriers to patient enrollment. SETTING: Ambulatory care clinical pharmacist specialists' practice in 14 clinics in family medicine and internal medicine at Michigan Medicine, an academic health system serving more than 24,000 patients with a diagnosis of hypertension. PRACTICE DESCRIPTION: This study describes implementation and initial patient enrollment in IVR linked to the EHR for home blood pressure monitoring. EVALUATION: We tracked the number of hypertensive patients enrolled and IVR call completion rates between September 2017 and February 2018. We also assessed pharmacist-identified barriers to patient enrollment during 2 separate 2-week intervals in January and February 2018. RESULTS: Between September 1, 2017, and February 28, 2018, a total of 71 patients were enrolled from 14 clinics. Patients were scheduled for 1-3 IVR calls per week focusing on medication adherence and blood pressure control. A total of 936 IVR phone calls were made, with 488 (52%) calls completed. Access to a validated home blood pressure monitor was the largest pharmacist-identified barrier to patient enrollment. CONCLUSIONS: The IVR Mobile You Blood Pressure Program represents a new application of digital technology within our health system. Pharmacist-identified barriers to patient participation included access to a validated home blood pressure monitor.

The Importance of Research and Scholarly Activity in Pharmacy Training.

Regardless of practice setting, it is imperative that pharmacists be able to either participate in generating new knowledge or use the ever-expanding body of literature to guide patient care. However, competing priorities in Pharm.D. curricula and residency training programs have resulted in limited emphasis on acquiring research and scholarly skills. Factors likely contributing to this reduced focus include the lack of curricular and postgraduate training standards emphasizing the development of research skills, time to commit to scholarly activity, and accessibility to experienced mentors. Strategies for increasing scholarly activity for pharmacy students and residents should therefore continue to be a focus of professional degree and residency training programs. Several resources are available for academic planners, program directors, and institutions to augment scholarly experience for pharmacy trainees and clinicians. This commentary highlights the importance of providing research opportunities for students and residents, describes the potential barriers to these activities, and provides recommendations on how to increase the instruction and mentoring of trainees to generate and use research.

Three-dimensional culture conditions lead to decreased radiation induced cytotoxicity in human mammary epithelial cells.

For both targeted and non-targeted exposures, the cellular responses to ionizing radiation have predominantly been measured in two-dimensional monolayer cultures. Although convenient for biochemical analysis, the true interactions in vivo depend upon complex interactions between cells themselves and the surrounding extracellular matrix. This study directly compares the influence of culture conditions on radiation induced cytotoxicity following exposure to low-LET ionizing radiation. Using a three-dimensional (3D) human mammary epithelial tissue model, we have found a protective effect of 3D cell culture on cell survival after irradiation. The initial state of the cells (i.e., 2D versus 3D culture) at the time of irradiation does not alter survival, nor does the presence of extracellular matrix during and after exposure to dose, but long term culture in 3D which offers significant reduction in cytotoxicity at a given dose (e.g. approximately 4-fold increased survival at 5Gy). The cell cycle delay induced following exposure to 2 and 5Gy was almost identical between 2D and 3D culture conditions and cannot account for the observed differences in radiation responses. However the amount of apoptosis following radiation exposure is significantly decreased in 3D culture relative to the 2D monolayer after the same dose. A likely mechanism of the cytoprotective effect afforded by 3D culture conditions is the down regulation of radiation induced apoptosis in 3D structures.