Development and Assessment of a Rubric for Teaching Portfolios Developed by Teaching and Learning Curriculum (TLC) Program Participants.

OBJECTIVE: To describe the validation and reliability assessment of a rubric designed to assess participants' teaching portfolios and to identify teaching excellence among teaching and learning curriculum (TLC) program participants. METHODS: Following focus groups with program leadership at a single TLC program, an initial rubric was developed, consisting of criteria mapped to five domains, to be rated on a 4-point scale. The rubric was then re-distributed to the TLC program leadership and external stakeholders for evaluation of face and content validity. The rubric was piloted using teaching portfolios from three cycles of the program. Cronbach's alpha was used to measure internal consistency and a two-way random-effects model was used to assess inter-rater reliability. RESULTS: Eighteen portfolios were independently evaluated by four raters. The overall mean Cronbach's alpha for internal consistency was 0.90 and ranged from 0.65 to 0.84 by domain. The overall mean intraclass correlation coefficient for inter-rater reliability was 0.95 and ranged from 0.57 to 0.91 by domain. CONCLUSION: The rubric evaluates characteristics of teaching portfolios important to internal and external stakeholders and had good to excellent internal consistency and inter-rater reliability. It can be adapted and applied by TLC programs to identify teaching excellence.

Global collaboration to deliver a live pharmacy teaching and learning curriculum.

BACKGROUND AND PURPOSE: The Indiana Pharmacy Teaching Certificate Program (IPTeC) offered a live, two-day conference to pharmacy residents, fellows, and preceptors in Indiana, while simultaneously live-streaming to participants in Doha, Qatar. Participants engaged in longitudinal activities for a one-year period. The purpose is to evaluate this pilot extension of a teaching and learning curriculum (TLC) to experienced preceptors in a global partnership and determine whether global and local participants perceive similar quality of programming. EDUCATIONAL ACTIVITY AND SETTING: Upon completion of the two-day conference, all pharmacists from two years of the program were encouraged to complete the standard course evaluations, consisting of nine items, in order to obtain continuing education (CE) credit. Evaluations of the program were analyzed by location cohort. FINDINGS: A total of 206 eligible pharmacists attended the program, with 154 completing the course evaluations (response rate 75%). "Good" or "outstanding" median ratings were given to each learning objective by both location cohorts, with domestic participants more likely to give "outstanding" ratings (6/9 items versus 0/9 items). SUMMARY: This pilot extension was successful in providing educational content satisfying learning objectives from the perspective of domestic participants and remote participants in Qatar. This type of global collaboration can meet the needs of trainees and experienced preceptors to advance pharmacy education and training.

Perceived Value of Teaching and Learning Curriculum Programs Among Pharmacy Practice Department Chairs.

Objective. To determine the perceived value that pharmacy practice department chairs ascribe to pharmacy faculty candidates having completed a teaching and learning curriculum (TLC) program and related activities.Methods. An 18-item survey instrument was created that was intended to capture the overall impressions of pharmacy practice chairs regarding the value of TLC programs, relative importance compared to other accomplishments (eg, residency completion, board certification), and importance of specific activities. Following pilot testing and establishment of intra-rater reliability, invitations to complete the electronic survey instrument were sent to pharmacy practice chairs (or their equivalent) at accredited Doctor of Pharmacy (PharmD) programs in the United States.Results. Of the 127 pharmacy practice chairs invited, 53 completed the survey (response rate of 41.7%). The majority of respondents held a PharmD degree (90.6%), had been in their role of chair for zero to five years (60.4%), and represented a private institution (54.7%). The majority of respondents who answered the question (32 of 49) felt it was very important or important (16.3% and 49.0%, respectively) that teaching experiences be completed within a formal teaching and learning curriculum program. These programs were believed to be most important for candidates with less than five years of professional experience. Teaching and learning curriculum programs were not deemed to be more important than other accomplishments by most responders. The perceived most important TLC program activities were instruction on didactic and experiential teaching strategies, and experience developing learning objectives, developing examination items, evaluating examination results, and facilitating case conferences or practice laboratory activities.Conclusion. Teaching and learning curriculum programs may provide the foundational experiences needed for pharmacy graduates to stand out among other candidates, although department chairs' perceptions of the value of teaching and learning curriculum experiences varied.

Resident physicians' perceptions of ambulatory care pharmacy.

BACKGROUND: Physicians' acceptance of clinical pharmacy services is dependent on exposure to those services, with use increasing as resident physicians progress through their training. Resident physicians train within environments that have a multidisciplinary teaching and clinical care approach, working closely with other healthcare professionals. Ambulatory care pharmacists are increasingly working with resident physicians in clinic settings as part of the multidisciplinary team, and identification of resident physicians' perceptions may influence future collaboration. OBJECTIVE: The objective of this research is to evaluate the perception of ambulatory care clinical pharmacy services from the perspective of resident physicians. METHODS: A statewide network of ambulatory care pharmacists was identified and received an electronic questionnaire. Pharmacists working within clinics that serve as training sites for resident physicians then completed and distributed questionnaires to the resident physicians within their clinical site. Items related to demographics and perception of involvement and interactions with clinical pharmacists. RESULTS: Forty-five resident physicians responded from four unique clinical sites (response rate = 42%). They agreed or strongly agreed that pharmacists help patients obtain their therapeutic goals (97.8%), are able to educate patients effectively (95.6%), provide high quality care (97.8%), and do a good job helping co-manage patients (91.1%). Previous exposure to pharmacists was limited primarily to the drugstore (48.9%) and hospital (51.1%) settings. Resident physicians in the third year of training and those reporting a friend was a pharmacist, were more likely to have a positive perception of the pharmacist's role as a resident educator (p=0.048 and p=0.044, respectively). CONCLUSIONS: Resident physicians with a longer duration of exposure and personal friendship with a pharmacist are more likely to express positive perceptions. Areas for further enhancements in this interprofessional relationship related to perceptions about pharmacist autonomy and patient relationships were identified.

Resident physicians' perceptions of ambulatory care pharmacy

Background: Physicians' acceptance of clinical pharmacy services is dependent on exposure to those services, with use increasing as resident physicians progress through their training. Resident physicians train within environments that have a multidisciplinary teaching and clinical care approach, working closely with other healthcare professionals. Ambulatory care pharmacists are increasingly working with resident physicians in clinic settings as part of the multidisciplinary team, and identification of resident physicians' perceptions may influence future collaboration. Objective: The objective of this research is to evaluate the perception of ambulatory care clinical pharmacy services from the perspective of resident physicians. Methods: A statewide network of ambulatory care pharmacists was identified and received an electronic questionnaire. Pharmacists working within clinics that serve as training sites for resident physicians then completed and distributed questionnaires to the resident physicians within their clinical site. Items related to demographics and perception of involvement and interactions with clinical pharmacists. Results: Forty-five resident physicians responded from four unique clinical sites (response rate = 42%). They agreed or strongly agreed that pharmacists help patients obtain their therapeutic goals (97.8%), are able to educate patients effectively (95.6%), provide high quality care (97.8%), and do a good job helping co-manage patients (91.1%). Previous exposure to pharmacists was limited primarily to the drugstore (48.9%) and hospital (51.1%) settings. Resident physicians in the third year of training and those reporting a friend was a pharmacist, were more likely to have a positive perception of the pharmacist's role as a resident educator (p=0.048 and p=0.044, respectively). Conclusions: Resident physicians with a longer duration of exposure and personal friendship with a pharmacist are more likely to express positive perceptions. Areas for further enhancements in this interprofessional relationship related to perceptions about pharmacist autonomy and patient relationships were identified

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Factors associated with mentor satisfaction among teaching and learning curriculum program participants.

OBJECTIVES: To evaluate participants' satisfaction with their teaching mentor relationship in a teaching and learning curriculum (TLC) and determine characteristics that are associated with high mentee satisfaction. METHODS: A 31-item survey instrument was administered to all 2015-2016 participants of the Teaching Certificate Program. RESULTS: Seventy percent of program participants (n = 60/86) responded to the survey. Overall, 80% of program participants were satisfied or very satisfied with their mentor relationship. Characteristics associated with participants reporting that they were very satisfied with their teaching mentor relationship included mentor availability for face-to-face contact and affiliation with the same institution. Mentor actions associated with high mentee satisfaction included reviewing lecture slides, providing midpoint feedback, providing career advice, and attending mentee lectures. CONCLUSIONS: Teaching certificate program participants perceive increased mentor accessibility and frequent interaction as key factors to a satisfying mentor-mentee relationship. Optimizing and standardizing mentorship programs are essential to the success of postgraduate teaching curriculums.

Teaching Certificate Program Participants' Perceptions of Mentor-Mentee Relationships.

Objective. To assess teaching certificate program (TCP) participants' perceptions of mentor-mentee relationships. Methods. A 15-item survey instrument was administered to all 2014-2015 participants of the Indiana Pharmacy Teaching Certificate (IPTeC) program. Results. One hundred percent of IPTeC program participants (83/83) responded to the survey. The majority of participants indicated that having a professional mentor was either very important (52%) or important (47%) to their professional development and preferred to choose their own professional mentor (53%). Mentor characteristics rated as highly important by mentees included having similar clinical practice interests (82%), having similar research interests (66%), and being available to meet face-to-face (90%). Age, race, and gender of the mentor were not rated by mentees as important. Conclusion. Teaching certificate program participants place high importance on having a professional mentor. Mentorship of pharmacists completing TCPs should be a priority for current pharmacy faculty members so adequate guidance is available to future pharmacy educators.

Evaluation of pharmacist care for hypertension in the Veterans Affairs patient-centered medical home: a retrospective case-control study.

OBJECTIVE: The study objective was to evaluate a pharmacist hypertension care management program within the patient-centered medical home. METHODS: This was a retrospective case-control study. Cases included all patients with hypertension who were referred to the care management program, and controls included patients with hypertension who were not referred to the program during the same 1-year period. Each case was matched to a maximum of 3 controls on the basis of primary care physician, age ±5 years, gender, diagnoses of diabetes and kidney disease, baseline systolic blood pressure ±10 mm Hg, and number of unique antihypertensive medications. Pharmacists provided a hypertension care management program under an approved scope of practice that allowed pharmacists to meet individually with patients, adjust medications, and provide patient education. Primary outcomes were systolic blood pressure and diastolic blood pressure at 6 and 12 months. Multivariate regression models compared each blood pressure end point between cases and controls adjusting for age, comorbidities, baseline blood pressure, and baseline number of blood pressure medications. RESULTS: A total of 573 patients were referred to the hypertension program; 86% (465/543) had at least 1 matched control and were included as cases in the analyses; 3:1 matching was achieved in 90% (418/465) of cases. At baseline, cases and controls did not differ with respect to age, gender, race, or comorbidity; baseline blood pressure was higher (139.9/80.0 mm Hg vs 136.7/78.2 mm Hg, P ≤ .0002) in the cases compared with controls. Multivariate regression modeling identified significantly lower systolic blood pressure for the cases compared with controls at both 6 and 12 months (6-month risk ratio [RR], 9.7; 95% confidence interval [CI], 2.7-35.3; 12-month RR, 20.3; 95% CI, 4.1-99.2; P < .01 for both comparisons). Diastolic blood pressure was significantly lower at 12 months (RR, 2.9; 95% CI, 1.2-7.1; P < .01) but not at 6 months (RR, 1.0; 95% CI, 0.31-3.4; P = .9) for the cases compared with controls. CONCLUSIONS: Patients who were referred to the pharmacist hypertension care management program had a significant improvement in most blood pressure outcomes. This program may be an effective method of improving blood pressure control among patients in a medical home model of primary care.

Survey of pharmacist-managed primary care clinics using healthcare failure mode and effect analysis.

OBJECTIVE: The primary objective was to expand upon results of a previously piloted patient perception survey with Healthcare Failure Mode and Effect Analysis (HFMEA), to identify areas within pharmacist-managed clinics needing improvement. METHODS: The survey was adapted for use in pharmacist-managed clinics. Patients completed the survey following regularly scheduled pharmacist appointments. Data were analyzed with a method adapted from HFMEA. Product scores could range from five to 25. A product of five indicates that pharmacists are doing a good job on the items that patients place the most value on, while a product score of 25 indicates that pharmacists are doing a poor job. A score greater than or equal to ten was used to identify areas for improvement. RESULTS: Seventy-one patients completed surveys. Thirteen components were assessed and no item achieved a mean product greater than or equal to ten. The survey item with the highest mean product pertained to discussion of potential medication side effects (mean: 7.06; interquartile range: 5-10). Analysis of each survey item found that all survey items had multiple individual responses that provided a product score of greater than or equal to ten. The survey items most frequently listed in the overall population as being most valued were "Told you the name of each of your medicines and what they are used for", "Answered your questions fully," and "Explained what your medicines do". CONCLUSIONS: Educational components provided during pharmacist-managed clinic appointments are aligned with patients' needs and are successfully incorporating the components that patients value highly in a patient-healthcare provider interaction. The HFMEA model can be an important teaching tool to identify specific processes in need of improvement and to help enhance pharmacists' self-efficacy, which may further improve patient care.

Survey of pharmacist-managed primary care clinics using healthcare failure mode and effect analysis / Estudio de consultas de atención primaria gestionadas por farmacéuticos usando el análisis de modos y efectos de fallos en salud

OBJECTIVES: The primary objective was to expand upon results of a previously piloted patient perception survey with Healthcare Failure Mode and Effect Analysis (HFMEA), to identify areas within pharmacist-managed clinics needing improvement. METHODS: The survey was adapted for use in pharmacist-managed clinics. Patients completed the survey following regularly scheduled pharmacist appointments. Data were analyzed with a method adapted from HFMEA. Product scores could range from five to 25. A product of five indicates that pharmacists are doing a good job on the items that patients place the most value on, while a product score of 25 indicates that pharmacists are doing a poor job. A score greater than or equal to ten was used to identify areas for improvement. RESULTS: Seventy-one patients completed surveys. Thirteen components were assessed and no item achieved a mean product greater than or equal to ten. The survey item with the highest mean product pertained to discussion of potential medication side effects (mean: 7.06; interquartile range: 5-10). Analysis of each survey item found that all survey items had multiple individual responses that provided a product score of greater than or equal to ten. The survey items most frequently listed in the overall population as being most valued were "Told you the name of each of your medicines and what they are used for", "Answered your questions fully," and "Explained what your medicines do". CONCLUSIONS: Educational components provided during pharmacist-managed clinic appointments are aligned with patients' needs and are successfully incorporating the components that patients value highly in a patient-healthcare provider interaction. The HFMEA model can be an important teaching tool to identify specific processes in need of improvement and to help enhance pharmacists' self-efficacy, which may further improve patient care (AU)

OBJETIVOS: El objetivo primario fue profundizar sobre los resultados de un cuestionario pre-pilotado de percepciones de los pacientes con el análisis de modos y efectos de fallos en salud (HFMEA) para identificar áreas en las que las consultas de farmacéuticas necesitan mejorar. MÉTODOS: El cuestionario fue adaptado para su uso en consultas farmacéuticas. Los pacientes cubrieron el cuestionario después de las citas farmacéuticas acordadas. Los datos se analizaron usando un método adaptado del HFMEA. Las puntuaciones de producto podían oscilar de 5 a 25. Un producto de 5 indicaba que el farmacéutico estaba realizando un buen trabajo en los ítems que el paciente valorizaba más, mientras que una puntuación de 25 indicaba que el farmacéutico estaba haciendo un mal trabajo. Se utilizaron las puntuaciones de 10 o más para identificar áreas de mejoría. RESULTADOS: 71 pacientes completaron cuestionarios. Se evaluaron 33 componentes y ningún ítem alcanzó un producto medio mayor o igual a 10. El punto de la encuesta que alcanzó la media más alta trataba de la discusión de los potenciales efectos secundarios de la medicación (media: 7.06; rango intercuartilico: 5-10). El análisis de cada ítem del cuestionario encontró que todos los ítems tenían varias respuestas individuales que proporcionaban una puntuación igual o mayor de 10. Los ítems más frecuentemente considerados por la población total como siendo los más valorados fueron "le dijo el nombre de todos sus medicamentos y para que se usan", "respondió completamente sus preguntas" y "explico lo que hacen los medicamentos". CONCLUSIONES: Los componentes educativos proporcionados en las visitas a las consultas farmacéuticas se alinean con las necesidades de los pacientes e incorporan con éxito los componentes que los pacientes valoran más en la interacción paciente-profesional de la salud. El modelo HFMEA puede ser una importante herramienta educativa para identificar procesos específicos que necesitan mejorar y para ayudar a aumentar la autoeficacia de los farmacéuticos, lo que podrá en el futuro mejorar la atención a pacientes (AU)

Redesign of a statewide teaching certificate program for pharmacy residents.

OBJECTIVES: To identify and assess changes made to the Indiana Pharmacy Resident Teaching Certificate program over 10 years to adapt to the growing number and changing needs of pharmacy educators in the next generation. DESIGN: In 2011, all resident program participants and directors were sent an electronic survey instrument designed to assess the perceived value of each program component. ASSESSMENT: Since 2003, the number of program participants has tripled, and the program has expanded to include additional core requirements and continuing education. Participants generally agreed that the speakers, seminar topics, seminar video recordings, and seminar offerings during the fall semester were program strengths. The program redesign included availability of online registration; a 2-day conference format; retention of those seminars perceived to be most important, according to survey results; implementation of a registration fee; electronic teaching portfolio submission; and establishment of teaching mentors. CONCLUSION: With the growing number of residents and residency programs, pharmacy teaching certificate programs must accommodate more participants while continuing to provide quality instruction, faculty mentorship, and opportunities for classroom presentations and student precepting. The Indiana Pharmacy Resident Teaching Certificate program has successfully evolved over the last 10 years to meet these challenges by implementing successful programmatic changes in response to residency program director and past program participant feedback.

Primary care monitoring of long-term opioid therapy among veterans with chronic pain.

OBJECTIVE: To characterize long-term opioid prescribing and monitoring practices in primary care. DESIGN: Retrospective medical record review. SETTING: Primary care clinics associated with a large Veterans Affairs (VA) medical center. PATIENTS: Adult patients who filled ≥6 prescriptions for opioid medications from the outpatient VA pharmacy between May 1, 2006 and April 30, 2007. OUTCOME MEASURES: Indicators of potential opioid misuse, documentation of guideline-recommended opioid-monitoring processes. RESULTS: Ninety-six patients (57%) received a long-acting opioid, 122 (72%) received a short-acting opioid, and 50 (30%) received two different opioids. Indicators of some form of potential opioid misuse were present in the medical records of 55 (33%) patients. Of the seven guideline-recommended opioid-monitoring practices we examined, the mean number documented within 6 months was 1.7 (standard deviation [SD] 1.5). Pain reassessment was the most frequently documented process (N = 105, 52%), and use of an opioid treatment agreement was the least frequent (N = 19, 11%). Patients with indicators of potential opioid misuse had more documented opioid-monitoring processes than those without potential misuse indicators (2.4 vs 1.3, P < 0.001). After adjustment, potential opioid misuse was positively associated with the number of documented guideline-recommended processes (mean = 1.0 additional process, 95% confidence interval [CI] 0.4, 1.5). CONCLUSIONS: Guideline-recommended opioid management practices were infrequently documented overall but were documented more often for higher risk patients who had indicators of potential opioid misuse. The relationship between guideline-concordant opioid management and high-quality care has not been established, so our findings should not be interpreted as evidence of poor quality opioid management. Research is needed to determine optimal methods of monitoring opioid therapy in primary care.

Effectiveness of a hypertension care management program provided by clinical pharmacists for veterans.

STUDY OBJECTIVE: To evaluate the effectiveness of a hypertension care management program provided by clinical pharmacists. DESIGN: Pre- and postintervention design with retrospective medical record review. SETTING: Tertiary care Veterans Affairs medical center and affiliated primary care clinics. PATIENTS: Five hundred seventy-three veterans with hypertension who were referred to the program between June 1, 2007, and May 31, 2008. INTERVENTION: Participation in the hypertension care management program provided by clinical pharmacists who met individually with patients, orchestrated drug therapy, and provided patient counseling. MEASUREMENTS AND MAIN RESULTS: The following data were collected from patients' medical records: demographics, date of program referral, dates of pharmacist visits, blood pressure at each visit, concurrent antihypertensive drugs and their dosages, drug changes at each visit, as well as patient education topics discussed during a visit. To ensure a minimum of 6 months of follow-up data for all patients, data collection continued through November 30, 2008, for a total study duration of 18 months. The primary study outcome was the difference between systolic and diastolic blood pressure measurements at the final pharmacist care management visit and those measurements at the initial pharmacist visit. Systolic blood pressure decreased from a mean ± SD of 141.3 ± 18.5 mm Hg at the initial pharmacist visit to 130.1 ± 13.8 mm Hg at the final pharmacist visit, and diastolic blood pressure decreased from 79.1 ± 12.2 to 74.5 ± 10.3 mm Hg (p<0.001 for both comparisons). The secondary outcome was the proportion of patients reaching blood pressure treatment goals at the final visit compared with the initial pharmacist visit. Of the 573 patients, 431 (75.2%) reached blood pressure treatment goals at the final visit (p ≤ 0.001) compared with 221 (38.6%) at the initial visit. The study patients had several comorbid diseases, including diabetes mellitus (196 patients [34.2%]) and chronic kidney disease (43 patients [7.5%]). Both study outcomes were also assessed for these subgroups. CONCLUSION: Patients referred to the hypertension care management program had a significant reduction in blood pressure, and most met their blood pressure treatment goals. This pharmacist-managed program may be an efficient method of care delivery to improve patient outcomes.