Descriptive analysis of the legal ramifications of medication diversion by pharmacy employees.

BACKGROUND: Medication diversion, the act of illegally redirecting prescription drugs from their intended path, is a growing problem in the United States, with significant implications for patient safety and the integrity of the health care system. OBJECTIVE: The objective of this study was to link reported diversion cases from state boards of pharmacy to state court docket records to describe the legal ramifications of medication diversion. METHODS: A retrospective analysis of state board of pharmacy records and state court docket records from six states between 2016 and 2021 was completed. RESULTS: A total of 207 medication diversion cases were identified and 61 of these cases were able to be linked to state court cases. The study found that pharmacy technicians were involved in the majority of cases (77.3%). The study found that medication diversion frequently occurred in community pharmacies (59.2%), involving controlled medications (87.4%). The primary reasons for medication diversion were personal use (43.7%) and undetermined motives (48.5%). Of the 61 cases linked to court cases, prevalent disciplinary actions included "misdemeanor or felony charges" (21.4%) and "jail time, suspended" (9.2%). The findings underscore the need for robust systems and protocols within health care facilities to prevent medication diversion, particularly in pharmacy settings. Measures such as implementing physical and electronic controls, addressing flaws in operations, and conducting thorough background checks during the hiring process are crucial for minimizing the risk of diversion. Furthermore, the study reveals inconsistencies in the disciplinary actions taken by state boards of pharmacy and state legal systems, indicating the need for more standardized and consistent processes for prosecuting medication diversion cases. Future research should aim to include a broader sample size and develop standardized data collection methods to further explore medication diversion and its legal implications. CONCLUSION: In conclusion, addressing medication diversion requires a collaborative effort between health care facilities and regulatory bodies. By prioritizing prevention strategies and aligning disciplinary actions, the health care system can ensure patient safety, uphold professional integrity, and effectively combat medication diversion.

Implementation of a pharmacist-led spirometry clinic.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is one of the most common chronic conditions, with spirometry serving as the gold standard for diagnosis. However, a lack of available resources, providers, and time limits appropriate diagnosis of COPD and disease staging. These factors culminate in suboptimal therapeutic management of the disease and often pharmacotherapy regimens that are not supported by Global Initiative for Chronic Obstructive Lung Disease guidelines. OBJECTIVES: The primary objective of the study was to develop and implement a pharmacist-led spirometry clinic to assess the confirmation of COPD diagnosis and pharmacotherapy management. PRACTICE DESCRIPTION: Two federally qualified health centers (FQHCs) in Ohio: Family Health Services of Darke County (FHS) and Rocking Horse Community Health Center (RHCHC). Both FQHCs have clinical pharmacists on staff who provide disease state management services for chronic disease states through a collaborative practice agreement. PRACTICE INNOVATION: At each FQHC, a pharmacist-led COPD and spirometry management service was implemented. This service consisted of disease state education, therapy modifications, and spirometry services for annual and confirmation of diagnosis for COPD patients. EVALUATION METHODS: A retrospective chart review was conducted. Data collection occurred from December 2021 to May 2022. Patients included were 18 years and older with a confirmed diagnosis of COPD. Therapies before spirometry services, COPD assessment test scores, age, gender, and history of exacerbations within the last 12 months were collected. RESULTS: Eight patients at FHS and 1 patient at RHCHC were included in the data analysis. Two patients had their disease state confirmed after postbronchodilator spirometry. Five pharmacotherapy modifications were made for patients evaluated in the analysis. CONCLUSION: Pharmacists in FQHC's are crucial resources to design, implement, and lead spirometry services for the management of COPD within the primary care setting, therefore increasing adherence to guideline recommendations.

Food as medicine? Exploring the impact of providing healthy foods on adherence and clinical and economic outcomes.

Background: Chronic disease prevalence is increasing. Adherence to dietary guidelines is low (<50%) despite positive impacts in disease progression, clinical outcomes, and medical costs. It is important to summarize the impact of providing medically-tailored meals to patients on adherence rates, clinical outcomes, and potential economic outcomes. Methods: A systematic review was conducted to identify, extract, and appraise food-provision studies from January 1, 2013-May 1, 2018 for heart disease, diabetes (DM), and chronic kidney disease (CKD). The key findings related to adherence and clinical outcomes were compiled. Published literature was utilized to determine the economic impact of key clinical outcomes. Results: Across diseases, 100 articles (N = 43,175 patients) were included. Dietary adherence was considered "compliant" or ≥ 90% consistently. Significant (p < 0.05) clinical outcomes included 5-10% LDL reduction, 4-11 mmHg SBP reduction, 30% reduction in metabolic syndrome prevalence, 3-5% weight reduction, 56% lower CKD mortality rates, and increased dialysis-free time (2 years:50%, 5 years:25%, calculated cost savings of 80.6-94.3%). Literature review showed these outcomes would result in decreased: cardiovascular (CV) event risk (20-30% reduction: $5-11 billion annually), hospitalization costs ($1-8 billion), and dialysis rates (25-50% reduction: $14-29 billion annually). For heart failure patients, results include: 16% fewer readmissions (saving $234,096 per 100 patients) and a 38-day shorter length of stay (saving $79,425 per hospitalization). Conclusion: Providing medically-tailored meals significantly increases dietary adherence above 90% and allows patients to realize significantly better chronic disease control. Through this, patients could experience fewer complications (CV events, hospital readmissions and dialysis), resulting in significant annual US healthcare cost reduction of $27-48 billion.

Establishing Validity Evidence for Parallel Patient-Provider Empathy Scales to Drive Self-reflection.

Objective. Student pharmacists must cultivate self-awareness to ensure that they can assess their skill development and abilities, including affective domain skills such as empathy. External feedback can augment development, but validated assessments are needed for accuracy. Thus, the objectives of this study were to establish validity evidence for the revised version of the Kiersma-Chen Empathy Scale (KCES-R), compare student self-perceptions and simulated patient perceptions of student empathy using a parallel patient scale (KCES-PV), and evaluate student reflections on the encounter.Methods. Student pharmacists completed an assessment of their self-perceptions of empathy (KCES-R) before and after the patient encounter. Simulated patients completed the KCES-PV regarding the student pharmacists' empathy immediately after the encounter. Student pharmacists also watched their encounter videos and completed a self-reflection on their use of empathy. Responses were analyzed using statistical tests, whereas students' reflections were examined using thematic analysis.Results. Results showed that the KCES-R contains two factors with high internal consistency and can detect changes in empathy. Student pharmacists' self-perceptions of their empathy abilities appeared higher than when their empathy abilities were evaluated by simulated patients. Student pharmacists had a strong belief in the importance of expressing empathy during patient encounters and indicated a need for further development.Conclusion. This study provides validity evidence for the use of the KCES-R and presents a parallel scale that may be used by simulated patients. Validated parallel scales along with reflective practice could be a potential avenue to grow self-awareness and empathy by allowing students to receive feedback and then reflect on their perceived versus actual demonstration of the skill.

Correlation Between Pharmacy Students' Implicit Bias Scores, Explicit Bias Scores, and Responses to Clinical Cases.

Objective. The purpose of this study was to identify the extent of implicit and explicit bias in a sample of pharmacy students and to determine whether there is an association between implicit bias, explicit bias, and responses to clinical cases.Methods. Investigators sent links to two online surveys to students at six US schools and colleges of pharmacy. In the first survey, students responded to two clinical cases. Students were presented with a picture of a White or Black patient with each clinical case. On the second survey, students indicated their level of racial implicit bias as assessed by the Harvard Implicit Association Test and their level of racial explicit bias. Pearson's correlation was used to determine the correlation between bias and responses to the clinical cases.Results. Three hundred fifty-seven first, second, and third year pharmacy students responded to both surveys (response rate 52%). The students who were presented with the picture of a Black patient rated the patient's pain and the reliability of the patient's family as higher than students presented with the picture of a White patient. Students had more negative implicit and explicit bias towards Black patients. Neither implicit nor explicit bias correlated with student responses to the clinical cases.Conclusion. Evidence of slight to moderate negative implicit bias and slight negative explicit bias towards Black patients was identified in this group of pharmacy students. Future studies that include a more representative population and heighten the stakes of the clinical scenario should be done to investigate a possible correlation between bias and clinical behaviors.

Implementation and assessment patient cases using the SBAR method to teach patient quality of life issues.

BACKGROUND AND PURPOSE: Quality of life (QoL) preferences are an important consideration with respect to the Pharmacists' Patient Care Process (PPCP) and should be assessed prior to implementing a patient-centered plan. The objectives of this intervention were to determine if the design of a QoL activity impacts student performance, and to discern student perceptions of an innovative, case-based activity. EDUCATIONAL ACTIVITY AND SETTING: Two cohorts of students in their second professional year were asked to present an article that included a QoL consideration. The two student cohorts were asked to complete the activity using a case report and modified SBAR (Situation, Background, Assessment, Recommendation) format. Presentations were graded using a rubric, and scores were assessed retrospectively. An unpaired t-test was used to examine differences. The final cohort of students was also asked to complete a survey to gather their perspectives. Results were described using descriptive statistics; thematic analyses were also performed. FINDINGS: Students who completed the SBAR activity (N = 71) performed significantly better than those who completed the article (N = 98) presentation (95.62 ± 5.47 vs. 86.30 ± 16.54, P < .001). Those who completed the survey (N = 22) felt they made moderate to excellent progress explaining QoL (86%) and that the activity was helpful (68%). Overall, students reported an improved understanding of the patient's perspective. SUMMARY: The PPCP requires that students must consider the patient's QoL in order to develop an optimal patient-centered plan. Activities such as this may improve student understanding of QoL implications.

Training student pharmacists to facilitate human immunodeficiency virus point-of-care testing.

BACKGROUND AND PURPOSE: The advent of HIV point-of-care testing (POCT) has increased ease of access to HIV testing in the outpatient setting. As community pharmacy continues to expand, it is crucial that student pharmacists are exposed to POCT in the classroom so they are prepared for more intensive training as a pharmacist as they could be providing POCT in future practice. Our objective was to train student pharmacists to perform HIV POCT and educate patients on results and implications of testing. Educational activity and setting: Following a didactic HIV lecture, second-year student pharmacists learned to utilize the OraQuick ADVANCE Rapid HIV-½ Antibody Test in a one-hour workshop. Participants were then assessed using a 4-point Likert type scale during an individual, 10-min skills lab on their ability to provide POCT using sample kits and interpret simulated results. Data were analyzed using descriptive statistics. FINDINGS: Forty-one students participated. Students showed competency when performing HIV POCT, as 92.7% of students were able to describe the test, and 97.6% of students were able to interpret the results correctly. Students scored a mean of 46.2 points overall (maximum of 50). SUMMARY: Results suggest training student pharmacists to perform HIV POCT may better prepare them to administer the test and counsel patients on results in an outpatient setting. Future studies should examine the differences in the ability to perform POCT between pharmacists who received training as students and those who did not.

Description of Position Ads for Pharmacy Technicians.

Pharmacy technician roles are evolving alongside the changing role of a pharmacist. There is currently no uniform definition of a pharmacy technician's role in the pharmacy workforce. The objective of this study was to look at the United States-based pharmacy technician advertisement database from Pharmacy Week to find patterns and commonalities in the duties and qualifications of pharmacy technicians. A retrospective analysis was performed on fourteen days of pharmacy technician job listings from Pharmacy Week from the year 2018. Information obtained from the listings included job title, location, setting, type of job, job duties, and job requirements. Job duties and requirements were coded by themes. Fourteen days of data resulted in 21,007 individual position listings. A majority of the job listings were for full-time positions (96.4%) and most were in the retail setting (96.78%). The most common requirements were registration with State Board, high school diploma, ability to perform tasks, communication, and physical. The most common job duties were general office etiquette, performing tasks under the direct supervision of the pharmacist, and professionalism. This study provides a description of the evolving role of pharmacy technicians through the broad variety in expectations for requirements of pharmacy technician applicants and the duties they perform when hired.

Assessing the Effects of a Paired TBL Session and Patient Simulation on Pharmacy Student HIV Treatment Knowledge.

DESCRIPTION OF THE PROBLEM: Pharmacists can play a crucial role in monitoring, counseling, and providing adherence checks across practice pharmacy settings; but they may not gain experience in this area until after graduating from pharmacy school. STATEMENT OF INNOVATION: Students participated in an intentionally aligned team-based learning session followed by completion of an HIV patient treatment worksheet and an HIV patient care simulation. This sequence was assessed using the HIV Treatment Knowledge Scale. DESCRIPTION OF THE INNOVATION: Second-year pharmacy students (N=48, 98% response rate) participated in a baseline knowledge assessment before a four-hour HIV team-based learning (TBL) session, which included the use of an online HIV Patient Management Simulator. Students were administered the scale again post-session. Three days before the simulation, students had access to an HIV patient treatment worksheet that was required to be completed before the simulation. Ten days after the initial assessment, students participated in an HIV patient simulation where they proposed a new antiretroviral plan while also addressing monitoring, barriers, and maximizing adherence for the patient. Post-simulation, students were again administered the scale. Data were analyzed using descriptive statistics, Wilcoxon and paired t-tests, as appropriate. CRITICAL ANALYSIS: A total of 48 second-year pharmacy students participated. HIV knowledge increased significantly post-TBL (p < 0.001). Post-simulation, scores improved, but not significantly (p = 0.291). Knowledge on 15 of the 21 items on the HIV Treatment Knowledge Scale significantly improved from pre-TBL to post-simulation (p ≤ 0.025). NEXT STEPS: Future investigation should focus on the impact that HIV simulation training has on skills, abilities, confidence, and empathy.

Description and comparison of medication diversion in pharmacies by pharmacists, interns, and pharmacy technicians.

OBJECTIVES: 1) To describe reported medication diversion within the practice of pharmacy; and 2) to compare diversion by employee type. DESIGN: Retrospective study. SETTING: A sample of state board of pharmacy records was examined from 9 states. Disciplinary actions were obtained from the records for the time period of May 2008 to May 2013. PARTICIPANTS: Pharmacy employees (pharmacist, technician, interns). INTERVENTION: Not applicable. MAIN OUTCOME MEASURES: When a diversion case was identified, the following items were obtained for each case of medication diversion: 1) category of pharmacy employee (pharmacist, technician, intern); 2) type of substance (control, noncontrol, both); 3) use of diverted substance (sale, personal use, both, undetermined); and 4) action taken by the board. RESULTS: A total of 811 medication diversion cases in 9 states were identified. Most cases involved a pharmacy technician (71.4%), controlled substances only (94.2%), and diversion for personal use (46.6%) and resulted in license or registration revocation or surrender (62.5%). When examining medication diversion use by purpose for diversion, there were significant differences by pharmacy employee type (sale use: P = 0.003; personal use: P = 0.032; unknown use: P < 0.001). CONCLUSION: Medication diversion is a pressing problem. There were 811 cases examined by 9 state boards, and many cases may be unreported. Technicians represent nearly three-fourths of diversions. It is essential that the practice of pharmacy identifies and assesses strategies to reduce medication diversion.

Impact of Student vs Faculty Facilitators on Motivational Interviewing Student Outcomes.

Objective. To determine the impact of student or faculty facilitation on student self-assessed attitudes, confidence, and competence in motivational interviewing (MI) skills; actual competence; and evaluation of facilitator performance. Methods. Second-year pharmacy (P2) students were randomly assigned to a student or faculty facilitator for a four-hour, small-group practice of MI skills. MI skills were assessed in a simulated patient encounter with the mMITI (modified Motivational Interviewing Treatment Integrity) tool. Students completed a pre-post, 6-point, Likert-type assessment addressing the research objectives. Differences were assessed using a Mann-Whitney U test. Results. Student (N=44) post-test attitudes, confidence, perceived or actual competence, and evaluations of facilitator performance were not different for faculty- and student-facilitated groups. Conclusion. Using pharmacy students as small-group facilitators did not affect student performance and were viewed as equally favorable. Using pharmacy students as facilitators can lessen faculty workload and provide an outlet for students to develop communication and facilitation skills that will be needed in future practice.

Description and comparison of pharmacy technician training programs in the United States.

OBJECTIVE: To describe pharmacy technician training programs in the United States and to compare pharmacy technician program characteristics between programs with and without a pharmacist on faculty and between programs with different accreditation status. DESIGN: Descriptive, cross-sectional study. SETTING: Not applicable. PARTICIPANTS: United States pharmacy technician programs. INTERVENTION: Not applicable. MAIN OUTCOME MEASURES: Student class size, faculty credentials, coursework components, program length, tuition rates, and admission criteria. RESULTS: Currently, there are more than 698 pharmacy technician programs across 1114 campuses, with complete data available for 216 programs. Programs varied widely in terms of class sizes, faculty credentials, and admission criteria. Programs with pharmacists on faculty were significantly less expensive than were those without pharmacists (P = 0.009). Accreditation had no impact on tuition prices. CONCLUSION: This is the first study of its kind to describe and characterize pharmacy technician training programs. There is relatively little control of technician training by the profession of pharmacy. The quality of these programs in terms of student outcomes is unknown, and it should be explored. Rigorous debate and discussion is needed regarding the future of pharmacy technician roles and the training required for those roles.