Evaluating the Need for Competency-Based Pharmacy Education (CBPE): The Report of the 2023-2024 Academic Affairs Standing Committee.

The 2023-2024 Academic Affairs Committee was charged to create a sense of urgency around the concept of Competency-Based Pharmacy Education and develop a "readiness for change" instrument that is based on the 5 essential elements that make up the definition of Competency-Based Pharmacy Education. This report describes the process undertaken by the committee to determine the societal needs of pharmacists and current state of pharmacy practice and pharmacy education. The practice gaps in pharmacy education and the key drivers needed to close these gaps are evaluated. To complete the charges, the committee conducted evidence-based literature reviews and completed a series of focus groups with stakeholders and thought leaders with experience in competency-based education.

The Need for Competency-Based Education.

OBJECTIVES: While pharmacy education updates learning as new information arises, changes to learning experiences can trail behind current practices and technology. There have been multiple calls for radical changes in how health professions education is delivered to ensure patients are receiving high-quality care. Competency-based education has been one way discussed in the literature for how to handle this need to develop students who have a willingness to learn and can problem-solve. The goal of this review is to examine whether competency-based education is needed to drive the profession of pharmacy forward. FINDINGS: To address, we collaboratively identified stakeholder perspectives to evaluate the need. The following stakeholders achieved consensus among the committee members: patients/society, learners, workplace/profession, and academic institutions. SUMMARY: Based on those perspectives, needs, and gaps to address those needs were identified and are presented in this review.

Enabling Factors for the Implementation of Competency-Based Curricula in Colleges and Schools of Pharmacy.

OBJECTIVES: To review the implementation drivers of competency-based pharmacy education (CBPE) and provide recommendations for enablers. FINDINGS: Competency-based education is an emerging model in the health professions, focusing on time-variable competency development and achievement compared with a time-bound, course-based, traditional model. CBPE is an outcomes-based organized framework of competencies enabling pharmacists to meet health care and societal needs. However, challenges need to be recognized and overcome for the successful implementation of CBPE. Competency drivers include defining the competencies and roles of stakeholders, developing transparent learning trajectories and aligned assessments, and establishing lifetime development programs for stakeholders. Organization drivers include developing support systems for stakeholders; facilitating connections between all educational experiences; and having transparent assessment plans, policies, and procedures that align with core CBPE precepts, including the sustainability of time-variability. Leadership drivers include establishing growth mindset and facilitating a culture of connection between workplace and educational environments, program advocacy by institutional leaders, accepting failures as part of the process, shifting the organizational culture away from learner differentiation toward competence, and maintaining sufficient administrative capability to support CBPE. SUMMARY: The successful implementation of CBPE involves enabling the competency, organization, and leadership drivers that will lead to program success. More research is needed in the areas of creation, implementation, and assessment of CBPE to determine success in this model. We have reviewed and provided recommendations to enable the drivers of successful implementation of CBPE.

Competency-based pharmacy education definition: What components need to be defined to implement it?

OBJECTIVES: This study aimed to define the essential elements in the proposed competency-based pharmacy education (CBPE) definition, provide the key defining components of each essential element on the basis of educational theory and evidence, and define how the essential elements meet the identified needs for CBPE. METHODS: best-practice integrative review was conducted as part of the work of the American Association of Colleges of Pharmacy CBPE Task Force to define the essential elements in the CBPE definition and how these elements fit with the need for CBPE. The definition was compared with other published competency-based education definitions across K-12, higher education, medical education, and veterinary education. Task Force members then met to develop a consensus on the core components of the 5 essential elements in the definition. Next, the Task Force evaluated the fit of CBPE by matching the identified needs, discussed in detail elsewhere, across each of the stakeholder perspectives with the core components of the 5 essential elements in the derived definition of CBPE. FINDINGS: Upon review of the proposed CBPE definition, the Task Force identified 5 essential elements. These elements include the following: meeting health care and societal needs, outcomes-based curricular model, de-emphasized time, learner-centered culture, and authentic teaching and learning strategies aligned to assessments. SUMMARY: This article helps to establish a common language for CBPE by defining the essential elements of the core components of the definition, and provides a starting point for further exploration of CBPE.

Recommendations and Next Steps For Competency-Based Pharmacy Education.

In July 2021, the chairs of the American Association of Colleges of Pharmacy Council of Deans, Council of Faculties, and Council of Sections developed a task force to discuss potential ways to improve pharmacy education. The Competency-Based Education (CBE) Joint Task Force was created to explore the pros and cons of advancing a competency-based approach to pharmacy education (CBPE) and to determine ways to create more flexibility within pharmacy curricula to enable CBE. To achieve these goals, the Task Force systematically reviewed available resources and outlined the pros and cons of CBPE, best practices for implementation, strategies to minimize barriers, and recommendations on whether CBE should be implemented in pharmacy education. This commentary summarizes the Task Force's findings regarding whether CBPE is a suitable approach for pharmacy education and the next steps if implemented.

Pharmacists' Impact on Older Adults Transitioning To and From Patient Care Centers: A Scoping Review.

Objective: Expand upon previous reviews conducted on transitions of care (TOC) services with a focus on pharmacist interventions for older adults specifically transitioning to and from long-term care, acute rehabilitation, residential care facilities, care homes, skilled nursing, or assisted living facilities, collectively termed patient care centers (PCC). Data Sources: A PubMed and Ovid MEDLINE search was conducted including citations between 1974 and July 14, 2022. Bibliographies were also reviewed for additional citations. Methods: Articles included described pharmacist interventions during TOC for patients transitioning to and from PCC, were written in English, and reported outcomes pertaining to TOC services. Of 873 citations reviewed, 22 articles met the inclusion criteria. Results: Most studies were prospective in design with small sample sizes, of limited duration, and with varying interventions and reported outcomes. Most explored the transition from hospital to PCC and included a pharmacist intervention involving the identification of medication errors and discrepancies during the TOC. Few studies reported cost savings or 30- and 60-day reductions in readmission rates or mortality. Conclusions: This scoping review revealed a lack of robust clinical trials to assess the effectiveness of specific interventions performed by pharmacists for patients transitioning to and from PCC. Of the available data, pharmacist involvement within an interprofessional team can be an effective intervention to resolve medication discrepancies, reduce readmissions, and medication-related adverse events. An opportunity exists for future studies to explore ways to improve outcomes during TOC within PCC.

Enhancing advanced pharmacy practice experiences through the use of Web 2.0 technologies.

BACKGROUND AND PURPOSE: Web 2.0 technologies have been leveraged to enhance learning experiences. However, limited data exists about implementing Web 2.0 into pharmacy education and within experiential learning. EDUCATIONAL ACTIVITY AND SETTING: Two adult internal medicine advanced pharmacy practice experiences (APPEs) applied Web 2.0 technologies including Google (Alphabet, Inc.), Dropbox (Dropbox, Inc.), Facebook (Facebook, Inc.), WordPress (WordPress Foundation), and ClassDojo (ClassDojo, Inc.) with the primary purpose of enhancing student learning, with specific purposes for each technology including improvements in writing, reflection, and time-management skills. An analysis of the use of Web 2.0 technologies included comparing student and preceptor evaluations, mapping learning outcomes to assessments, and evaluating student engagement with the technologies, blog statistics, survey data, and application utilization. FINDINGS: From 2017 to 2019, 40 students were engaged with Web 2.0 technologies as a component of their APPE. Student and preceptor evaluations remained relatively unchanged compared to evaluations before using Web 2.0. Students maintained high levels of engagement across applications including 2928 Facebook comments, 4016 "likes", 280 blog posts, and 158 blog comments. Survey results revealed that students perceived that Facebook and blogging helped improve overall learning and communication skills meeting important learning outcomes. SUMMARY: The integration of two APPEs with Web 2.0 technologies enhanced learning and achieved learning outcomes for students on their adult acute care rotation.

COViD-19 "Long-Haulers": Caring for Older People in the Aftermath of a Global Pandemic.

The coronavirus pandemic raised many questions about how to optimally care for older people as evidenced by the vulnerability of this population to the virus over the past eighteen months. Not only are older people at a higher risk for contracting the disease but also for experiencing the severest forms of COVID-19. Unfortunately, many have succumbed to this relentless and devastating virus. Those who survive may encounter added challenges including the long-term sequelae of COVID-19. In the aftermath of this pandemic, how can healthcare professionals effectively care for older people experiencing long-term complications of this disease?

Evaluating Prescribing Practices of Apixaban in the Elderly.

OBJECTIVE: The aim of this study was to evaluate prescribing practices for elderly patients started on apixaban in multiple practice settings.
DESIGN: Retrospective, chart review.
SETTING: One outpatient and three inpatient settings in Arizona and Massachusetts.
PATIENT, PARTICIPANTS: Patients who received a new order for apixaban between July 1, 2015, and December 31, 2016. Inclusion criteria included adults 65 years of age and older who were receiving apixaban for atrial fibrillation or venous thromboembolism (VTE) at a current treatment dose.
There were 1,045 patients included, the average age was 78 years, 52% were male, and 90% had atrial fibrillation.
MAIN OUTCOME MEASURE: Appropriate prescribing of apixaban based on Food and Drug Administration (FDA)-labeling (age, weight, serum creatinine).
RESULTS: Six patients who were on hemodialysis were excluded from the analysis, leaving 1,039 patients to be analyzed. 16.2% (168/1,039) of patients had an incorrect dose of apixaban prescribed based on their indication. Of those, 75% (126/168) were taking the medication for atrial fibrillation and 25% (42/168) for VTE. For those with atrial fibrillation (n = 126), the majority of inappropriate orders resulted from doses that were lower than indicated (113/126).
CONCLUSION: This research suggests that elderly patients may receive inappropriately lower doses of apixaban than indicated, which may decrease the effectiveness of the medication. This research supports the fact that pharmacists can play a vital role in anticoagulation stewardship by verifying apixaban doses for accuracy.

Evaluation of a transitional care pharmacist intervention in a high-risk cardiovascular patient population.

PURPOSE: The utility of a transitions-of-care (TOC) pharmacist intervention focused on improving the quality and safety of the medication process for high-risk cardiovascular patients was evaluated. METHODS: A quality-improvement initiative was developed for patients with heart failure or acute coronary syndrome followed longitudinally at a hospital's outpatient cardiovascular clinic. The TOC pharmacist intervention occurred either before a patient's outpatient cardiovascular clinic appointment or during a hospitalization. The major outcome analyzed was the number of unplanned hospital readmissions within 30 days. Additional endpoints evaluated included the time to healthcare utilization, number of medication discrepancies identified, percentage of therapeutic recommendations accepted by a provider, number of medication access issues resolved, patient cost savings, patient satisfaction, and mean time spent on an intervention by the pharmacist per patient encounter. RESULTS: A total of 118 patients received the TOC pharmacist intervention. A total of 516 medication discrepancies were identified and corrected, with 55.6% of discrepancies involving cardiovascular medications. A total of 244 recommendations for therapeutic optimization were provided, with an 81% provider acceptance rate and a 100% patient satisfaction rate. Fifty-five patients were provided with medication cost savings, and medication-access issues were resolved for 8 patients. A TOC pharmacist spent means of 98 and 73 minutes on patient education and coordination of care during inpatient and ambulatory encounters, respectively. The 30-day hospital readmission rate for patients with heart failure was reduced by 20%. CONCLUSION: A TOC pharmacist intervention improved the quality and safety of care across both inpatient and ambulatory settings for high-risk cardiovascular patients at our institution.

Concerns for Bleeding in the Elderly with the Use of Direct Oral Anticoagulants.

Since Food and Drug Administration approval of dabigatran in 2010, direct oral anticoagulants (DOACs) have been alternatives to warfarin for patients who are at risk for cardioembolic complications of nonvalvular atrial fibrillation. Unfortunately, there are limited safety data available on the use of these newer agents in older adults, particularly risks of gastrointestinal, intracranial, and major bleeding (as defined by the International Society on Thrombosis and Haemostasis) in those 75 years of age and older. The purpose of this manuscript is to provide a review of available literature regarding the risk of bleeding in older adults for each DOAC based on available retrospective cohort, secondary, and subgroup analyses, and to highlight the need for additional safety information in this population.

Clinical Research That Matters: Designing Outcome-Based Research for Older Adults to Qualify for Systematic Reviews and Meta-Analyses.

Though older adults are more sensitive to the effects of medications than their younger counterparts, they are often excluded from manufacturer-based clinical studies. Practice-based research is a practical method to identify medication-related effects in older patients. This research also highlights the role of a pharmacist in improving care in this population. A single study rarely has strong enough evidence to change geriatric practice, unless it is a large-scale, multisite, randomized controlled trial that specifically targets older adults. It is important to design studies that may be used in systematic reviews or meta-analyses that build a stronger evidence base. Recent literature has documented a gap in advanced pharmacist training pertaining to research skills. In this paper, we hope to fill some of the educational gaps related to research in older adults. We define best practices when deciding on the type of study, inclusion and exclusion criteria, design of the intervention, how outcomes are measured, and how results are reported. Well-designed studies increase the pool of available data to further document the important role that pharmacists have in optimizing care of older patients.