Diascopy and histopathological evaluation of nonblanching erythematous dermatoses in dogs.

BACKGROUND: Diascopy is a point-of-care diagnostic test used to differentiate skin erythema due to vascular dilation from haemorrhage. In the veterinary literature, only a handful of diseases have been described to be associated with a negative (nonblanching) diascopy result, and histological investigation of haemorrhage has been inconsistent. OBJECTIVES: Retrospective study to undertake a histopathological investigation of canine, nonblanching erythematous dermatoses for the presence or absence of haemorrhage and vascular changes. MATERIALS AND METHODS: Skin biopsies from dogs presented with moderate-to-severe nonblanching erythema were evaluated histologically. Additionally, clinical data about each patient were analysed. RESULTS: Twenty cases were identified with nonblanching erythema. Diagnoses included vasculopathy (n = 6), canine eosinophilic dermatitis (n = 3), cutaneous epitheliotropic T-cell lymphoma (n = 2), and one case each of sterile granuloma and pyogranuloma syndrome, German shepherd dog pyoderma, multiple mast cell tumours, haemangiosarcoma, exfoliative cutaneous lupus erythematosus, canine leishmaniosis with sebaceous adenitis, sebaceous adenitis with concurrent dermatophytosis, calcinosis cutis and canine atopic dermatitis with insect-bite reaction. One or more vascular changes were present in all 20 cases and included perivascular oedema, endothelial swelling and neutrophilic infiltration of vessel walls. Haemorrhage was identified in 17 of 20 cases (85%). Three cases without dermal haemorrhage were calcinosis cutis, sebaceous adenitis with dermatophytosis and canine atopic dermatitis with insect-bite reaction. CONCLUSIONS AND CLINICAL RELEVANCE: Negative diascopy was associated with haemorrhage and vascular pathological findings in the majority of cases, yet not all. Haemorrhage was identified histologically in all diseases previously reported as nonblanching as well as in a few additional diseases.

Expanding pharmacists' roles: Pharmacists' perspectives on barriers and facilitators to collaborative practice.

OBJECTIVE: The pharmacy profession is shifting from transactional dispensing of medication to a more comprehensive, patient-centered model of care. Collaborative practice agreements (CPAs) extend the role of a pharmacist to initiate, monitor, modify, and discontinue drug therapies and provide other clinical services. Although collaborative practice has been shown to improve health system efficiency and patient outcomes, little is known about how pharmacists perceive CPAs. To explore pharmacists' perspectives of CPAs, including barriers and facilitators to CPA implementation. METHODS: Semistructured key informant interviews were used to elicit information from licensed pharmacists practicing in a variety of settings in Arizona. Thematic analysis was used to identify key qualitative themes. RESULTS: Seventeen interviews of pharmacists with (n = 11, 64.7%) and without (n = 6, 35.3%) CPAs were conducted in April-May 2019. The pharmacists saw their role in CPAs as supportive, filling a care gap for overburdened providers. A heightened sense of job satisfaction was reported owing to increased pharmacist autonomy, application of advanced knowledge and clinical skills, and ability to have a positive impact on patients' health. Challenges to the implementation of CPAs included liability and billing issues, logistic concerns, some experiences with provider hesitancy, and lack of information and resources to establish and maintain a CPA. The barriers could be overcome with conscious team-building efforts to establish trust and prove the worth of pharmacists in health care teams; strategic engagement of stakeholders in the development of CPAs, including billing and legal departments; and mentorship in the CPA creation process. CONCLUSIONS: The pharmacists in this study enjoyed practicing collaboratively and had overall positive perceptions of CPAs. As health worker shortages become more dire and pharmacy practice evolves to expand the role of pharmacists in providing direct patient care, CPAs will be an important tool for restructuring care tasks within health systems.

Exploring performance predictors among employees in a pharmacist-led medication management center.

OBJECTIVE: Health care companies are increasingly interested in developing and maintaining employee motivation. However, this can be challenging with different professions working together in delivering telephonic medication therapy management services. The purpose of the study is to assess employees' perceptions of performance metrics, strategies to achieve those metrics, motivational work factors, and barriers to achievement at a medication management center (MMC). DESIGN: Focus group using purposive sampling. SETTING: Six in-person focus groups were conducted with the MMC employees. PARTICIPANTS: Separate focus groups were conducted for pharmacists, student pharmacist interns, and pharmacy technicians. Each group consisted of approximately 5 participants, lasted roughly 1 hour, and was facilitated by trained qualitative researchers. OUTCOME MEASURES: The semistructured sessions involved participants responding to open-ended, predetermined questions introduced by a facilitator. The sessions were audio-recorded and transcribed for analysis. Two independent reviewers analyzed the transcripts; a third independent reviewer facilitated a consensus to resolve discrepancies. RESULTS: Thirty MMC employees, with an average age of 32.1 ± 10.5 years, participated; most of them (73.3%) were women and had worked at the MMC for an average of 2.8 ± 2.2 years. Six themes were identified: (1) awareness and understanding of performance measures; (2) perceptions of performance measures; (3) suggested changes to make the performance measures more reflective of their roles; (4) motivating factors to improve performance; (5) performance barriers; and (6) strategies to achieve performance goals. The intrinsic motivational factors included providing patient care, helping change patients' lives, and meeting work goals. The extrinsic motivational factors included remuneration, management, teamwork, work environment, and feedback. The performance barriers were unrealistic goals, lack of feedback, ineffective communication, and inconsistent operational procedures. CONCLUSIONS: These study findings contribute to a growing body of research surrounding employee motivation within organizations with diverse workforces. Future work is warranted to investigate employee motivation in similar pharmacy-related settings.

Pharmacists' perceptions of the pharmacists' patient care process and performance in a simulated patient interaction.

OBJECTIVES: To (1) evaluate the use of the pharmacists' patient care process (PPCP) by licensed pharmacists through a simulated patient activity and (2) describe pharmacists' awareness and perceptions of the PPCP in the state of Arizona. DESIGN: Interviews were conducted to elicit pharmacists' perceptions and awareness of the PPCP. A simulated patient activity involved a role-play pharmacist-patient interaction in a community pharmacy setting. The PPCP was employed as the evaluative framework to assess pharmacist behavior. SETTING AND PARTICIPANTS: Pharmacists licensed in the state of Arizona practicing in various pharmacy settings were recruited through e-mail list serves and snowball recruitment. Data were collected in person, by telephone, and via video chat. OUTCOME MEASURES: Emergent qualitative themes from interviews were used to describe pharmacists' awareness and perceptions of the PPCP. The presence or absence of PPCP elements were assessed during the simulations. RESULTS: A total of 17 pharmacists were interviewed; 16 participated in the simulated activity. Of these, 7 (41.2%) participants recalled specific details regarding the PPCP process. Participants felt that the PPCP accurately reflected their daily workflow. Accordingly, a mean of 15.8 of the 19 PPCP elements was observed in simulated pharmacist-patient interactions, still allowing room for improvement in pharmacist-led care planning. Participants indicated perceived value in a shared patient care process that facilitates collaboration with myriad health professionals and as an aid to leverage pharmacists' role on health care teams. CONCLUSION: In this study, pharmacists practicing in Arizona in various settings expressed an awareness of the PPCP, felt it accurately reflected the work they do, and expressed that the tool potentially added value to their work.

An Academic-Community Collaboration to Deliver Medication Therapy Management (MTM) Services to Patients Living in Rural Counties of a Southwestern State in the United States.

BACKGROUND: Patients living in rural communities often experience pronounced health disparities, have a higher prevalence of diabetes and hypertension, and poorer access to care compared to urban areas. To address these unmet healthcare service needs, an established, academic-based MTM provider created a novel, collaborative program to provide comprehensive, telephonic services to patients living in rural Arizona counties. OBJECTIVE: This study assessed the program effectiveness and described differences in health process and outcome measures (e.g., clinical outcomes, gaps in care for prescribed medications, medication-related problems) between individuals residing in different rural-urban commuting area (RUCA) groups (urban, micropolitan, and small town) in rural Arizona counties. METHODS: Subjects eligible for inclusion were 18 years or older with diabetes and/or hypertension, living in rural Arizona counties. Data were collected on: demographic characteristics, medical conditions, clinical values, gaps in care, medication-related problems (MRPs), and health promotion guidance. Subjects were analyzed using 3 intra-county RUCA levels (i.e., urban, micropolitan, and small town). RESULTS: A total of 384 patients were included from: urban (36.7%), micropolitan (19.3%) and small town (44.0%) areas. Positive trends were observed for clinical values, gaps in care, and MRPs between initial and follow-up consultations. Urban dwellers had significantly lower average SBP values at follow-up than those from small towns (p < 0.05). A total of 192 MRPs were identified; 75.0% were resolved immediately or referred to providers and 16.7% were accepted by prescribers. CONCLUSION: This academic-community partnership highlights the benefits of innovative collaborative programs, such as this, for individuals living in underserved, rural areas.

Corrigendum to "Impact evaluation of a four-year academic-community partnership in provision of medication management and tertiary prevention services for rural patients with diabetes and/or hypertension" preventive medicine reports 17 (2020): 101,038.

[This corrects the article DOI: 10.1016/j.pmedr.2019.101038.].

Pilot study of focus groups exploring student pharmacists' perceptions of a medication management center internship.

INTRODUCTION: Student pharmacists are expected to participate in real-life, patient-centered experiences to help develop clinical knowledge and professional skills. This study explored student pharmacist intern perceptions of work experience at a medication management center (MMC). We also examined how working at the MMC helped fulfill curricular requirements, helped develop leadership skills, and provided professional development opportunities. METHODS: Two focus groups were conducted with first-, second-, and third-year student pharmacist interns at the MMC in April 2019. The focus groups were audio recorded for verification purposes, transcribed, and analyzed thematically by two independent reviewers. RESULTS: A total of five student pharmacist interns participated. Four main themes were identified: (1) knowledge; (2) communication; (3) time management; and (4) leadership, mentorship, and networking. Participants had opportunities to acquire new knowledge and skills outside the classroom, providing them an academic advantage while recognizing areas of deficiency. Students practiced communication skills that helped improve language skills and manage difficult patients, although telephonic consultations were challenging. Students learned to prioritize time with patients but reported difficulty managing their work schedules. Leadership, mentorship, and networking opportunities facilitated learning and improved their self-confidence. CONCLUSIONS: This qualitative analysis identified four key themes, highlighting the many benefits available for student pharmacist interns working at an academic-based MMC. Further research is needed to address challenges reported in this study and should include a larger sample of student pharmacists for more generalizable results.

Impact evaluation of a four-year academic-community partnership in provision of medication management and tertiary prevention services for rural patients with diabetes and/or hypertension.

Medication therapy management (MTM) services, including targeted, pharmacist-delivered, tertiary prevention interventions, were provided to rural patients with chronic diseases via an academic-community partnership. The purpose of this investigation was to evaluate the overall program and pre/post patient outcomes from this four-year, multi-site collaboration. Five community health sites collaborated with a university-based MTM provider to deliver services in Arizona (2012-16). Eligible patients: were 18 or older (median 65 years); had a diagnosis of diabetes and/or hypertension; and resided in a rural community. Participants received an initial telephone consultation with the MTM pharmacist; follow-up consultations were conducted after 30 or 90 days for high- and low-risk patients, respectively. Community partner staff collected clinical data and addressed pharmacists' recommendations. Descriptive analysis and bivariate analyses of pre- and post-intervention results were conducted. Most (n = 410, 70%) of the 577 participants receiving an initial and follow-up consultation with the MTM pharmacist had both diabetes and hypertension. These individuals showed statistically significant improvements in fasting blood glucose (p < 0.0001), hemoglobin A1C (p = 0.0082) and systolic blood pressure (p = 0.009) while those with only one condition did not demonstrate significant changes. While the pre/post changes in chronic disease control indicators were statistically significant, the clinical significance was low to moderate. Patients with both comorbid diabetes and hypertension experienced benefit from collaborative, targeted MTM pharmacist-delivered, tertiary prevention interventions in tandem with community-based pharmacy resources. This multi-site MTM program showed promise in increasing patients' use of these services, yet effective strategies are needed to expand recruitment of eligible patients in the future.

Implementation of an Interprofessional Medication Therapy Management Experience.

Objective. To measure the impact of an interprofessional experience (IPE) in medication therapy management (MTM) on students' attitudes and skills regarding interprofessional collaboration (IPC). Methods. This interprofessional MTM experience spanned three weeks, with health science students (medicine, nursing, nutrition, and pharmacy) meeting once weekly. The IPE facilitated interprofessional student collaboration via small-group sessions to conduct MTM consultations for patients with complex chronic conditions. Student learning and attitudinal changes were evaluated by comparing pre- and post-IPE survey responses and a qualitative summary of the students' clinical recommendations. Efficacy of student groups was measured via patient satisfaction surveys and was reported by frequency of response. Results. Twenty-seven students participated in the program and 22 completed both pre- and post-IPE surveys (81% response rate). The survey included open-ended and Likert-type items assessing students' attitudes and skills regarding the IPE as well as their reactions to the experience. Significant changes were observed for two attitudinal items regarding interprofessional teams: maintaining enthusiasm/interest and responsiveness to patients' emotional and financial needs. Patient-reported satisfaction and students' complex clinical recommendations provided further evidence of student learning. Conclusion. This novel IPE in MTM promoted interprofessional collaboration and education in this unique patient care area. Students' attitudes toward and skills in interprofessional collaboration improved, and the patients who received care reported positive experiences. Many health professions programs face challenges in meeting IPE requirements. The results of our study may provide the impetus for other institutions to develop similar programs to meet this urgent need.