Vaccine administration by pharmacy technicians: Impact on vaccination volume, pharmacy workflow and job satisfaction.

Background: Immunizing pharmacy technicians (IPTs) have become more prevalent in recent years, but their impact on community pharmacy practice has yet to be determined. Objectives: Determine the impact of implementing IPTs on vaccination volume in a community pharmacy chain and assess pharmacy staff's perspectives on the clinical abilities of IPTs and their impact on pharmacy workflow and job satisfaction. Methods: Retrospective data analysis comparing the number of vaccines administered in a supermarket pharmacy chain from September to March 2019-2020 and 2020-2021 in pharmacies with IPT(s) versus those without IPT(s). For the secondary objective, investigators developed and deployed two role-based mixed quantitative/qualitative surveys among pharmacy staff. Results: Pharmacies with IPT(s) observed a greater mean increase in vaccination volume from 2019-2020 to 2020-2021 versus those without IPTs (+159.35 vs. +104.57, p = 0.011). Among IPT survey respondents, 50/75 (66.7%) felt more satisfied with their job after receiving immunization training. Among pharmacist respondents, 80/119 (67.3%) felt that IPTs positively impacted their job satisfaction and 61.7% felt that pharmacist clinical services were either somewhat positively affected, or positively affected. Conclusion: Implementing IPTs can increase the volume of vaccines administered in a chain pharmacy and may positively affect job satisfaction and pharmacy workflow.

Comparison of student pharmacists' performance on in-person vs. virtual OSCEs in a pre-APPE capstone course.

INTRODUCTION: Objective structured clinical examinations (OSCEs,) provided in-person or virtually, assess student pharmacist readiness for advanced pharmacy practice experiences (APPEs). During the COVID-19 pandemic in 2020, it was necessary for many educators to design and implement virtual OSCEs (vOSCEs). Impact on student performance utilizing in-person vs. vOSCE has not been well evaluated. The objective of this study was to determine if a difference existed in student performance when comparing in-person vs. vOSCE in a third year (P3) pharmacy pre-APPE capstone course. METHODS: In winter 2019, four in-person OSCE stations were designed and implemented in a pre-APPE P3 capstone course. In winter 2021, the same four stations were transitioned into vOSCE stations. Assessment (summative) data from similar student cohorts from OSCE 2019 were compared vOSCE 2021 stations using Mann-Whitney U test. RESULTS: There was no meaningful difference found when comparing student performance on in-person OSCE vs. vOSCE. There was no significant difference for the number of students offered remediation. For most stations, performance improved from formative to summative assessments. CONCLUSIONS: Providing vOSCEs to assess students' skills in a pre-APPE P3 capstone course is a reasonable alternative to in-person OSCEs.

Using community pharmacies and team observed structured clinical encounters (TOSCEs) for interprofessional education and training.

INTRODUCTION: Collaborative practice improves patient outcomes and is a needed student skill. An interprofessional education and collaborative practice (IPECP) program was developed using community pharmacies, clinics, and emergency departments. This study's purpose was to assess student pharmacists' team attitudes and skill development after the IPECP using team observed structured clinical encounters (TOSCEs). METHODS: Nineteen pairs of fourth-year pharmacy and second-year physician assistant students practiced together in a community pharmacy (two days) and clinic or emergency department (two days). They completed TeamSTEPPS training and two team modules. Assessments included TOSCEs and pre/post attitude surveys. RESULTS: Students significantly increased all TOSCE domain skills with pre- to post-mean score (SD) of: team communications 3.0 (0.5) to 4.1 (0.5), collaboration 2.8 (0.6) to 4.0 (0.5), roles and responsibilities 2.4 (0.4) to 3.8 (0.5), patient-centered care 2.8 (0.5) to 4.1 (0.6), conflict management 2.8 (0.5) to 4.1 (0.6), team functioning 2.7 (0.6) to 3.9 (0.6), and global performance 2.8 (0.6) to 4.0 (0.5). Afterwards, students reported positive attitudes about team-based patient care. All students stated the experience increased patient and healthcare professional communication skills and understanding of patient problems, and decreased errors. Most students (84%) agreed team care increased interventions compared to individually provided care. Most students (84%) thought the experience was worthwhile, and 68% agreed the IPECP program should be continued. CONCLUSIONS: This study supports that IPECP can be conducted in a community pharmacy and clinic or emergency department to improve student team skills as evidenced by documented team skills development during TOSCEs.

Bone health assessments by student pharmacists during interprofessional education.

INTRODUCTION: Bone-healthy lifestyle is a cornerstone of osteoporosis prevention and treatment. Student pharmacists are ideally suited to perform bone health assessments during interprofessional education (IPE) programs. In this article, we describe the outcomes of bone health assessments performed by second-year student pharmacists (P2s) as part of a novel IPE activity. METHODS: Bone health assessments provided by P2s to older adults during an interprofessional team home visit were evaluated. Three health profession students (pharmacy, medicine, physician assistant, nursing, physical therapy, occupational therapy, and/or social work) worked as collaborative teams, with each student completing discipline-specific patient assessments. Data collected included bone density scan status, Fracture Risk Assessment Tool (FRAX) score, and calcium and vitamin D intakes. P2s' recommendations for bone density testing and adjustments to dietary intakes based on patient-specific factors were also evaluated. RESULTS: All P2s (n = 98) completed a bone health assessment with their older adult. Almost all older adults (85.6%) met risk criteria for bone density scanning. In addition, 51.5% and 27.8% reported taking less than their age and sex-specific recommended dietary allowance of calcium and vitamin D, respectively. P2s recommended changes in calcium and vitamin D dietary intake, supplement use, or both for 64.3% of the older adults. CONCLUSIONS: In a novel IPE home-visit program, P2s were successfully utilized to assess bone health and provide recommendations for bone density scanning and calcium and vitamin D intakes to volunteer older adult patients.

Emerging Topics in Vaccine Therapeutics for Adolescents and Adults: An Update for Immunizing Pharmacists.

Vaccine therapeutics and the practice of immunization provision are ever-changing. As pharmacy-based immunization services continue to flourish in the United States, more and more patients are requesting both routine and travel vaccines in community pharmacies. However, vaccine recommendations from the Centers for Disease Control and Prevention/Advisory Committee on Immunization Practices (CDC/ACIP) can sometimes differ from product-specific US Food and Drug Administration (FDA)-indicated uses. In addition, changes in vaccine schedules, product availability, and disease outbreaks can present immunizing pharmacists with scenarios requiring a high level of clinical judgment. Thus, it is of paramount importance that all immunizing pharmacists maintain competency in the most recent evidence in vaccine therapeutics, as well as practice standards for vaccine provision and administration. This review provides an update of the most recent literature surrounding emerging topics in adolescent and adult immunizations-highlighting influential studies and recent developments in the prevention of herpes zoster, human papillomavirus (HPV), measles, mumps, rubella (MMR), meningococcal disease, tetanus, diphtheria, and pertussis. Key concepts discussed include the emergence of the new recombinant zoster vaccine (RZV), meningococcal vaccine product selection, MMR revaccination during disease outbreaks, tetanus vaccine product selection, and duration of pertussis immunity with vaccination.

A Community-Based Survey to Assess Knowledge, Attitudes, Beliefs and Practices Regarding Herpes Zoster in an Urban Setting.

INTRODUCTION: In the USA, nearly one in three people will experience herpes zoster (HZ) in their lifetime. Underserved communities may be at even higher risk due to several factors, including access to healthcare, education, and co-morbid conditions. The purpose of this study was to investigate current knowledge, attitudes, beliefs and practices (KABP) relative to HZ and HZ vaccines in a large urban city. METHODS: A cross-sectional KABP survey was conducted via in-person interview among 381 participants aged ≥ 50 years in Detroit, MI, USA, from June to August 2018. Survey results were stratified into two groups [< 60 and ≥ 60 years of age (YO)] for comparison. RESULTS: Of the 381 participants, 373 reported their age (110 < 60 YO and 263 ≥ 60 YO). Overall, the majority of participants reported having heard of HZ and HZ vaccines. In addition, receiving a recommendation from a healthcare provider (37.5%) followed by gaining a better understanding of HZ vaccine (36.7%) and of HZ (29.9%) were leading factors that influenced participants' willingness to receive the vaccine. Of note, 65.5% of participants < 60 YO reported the belief that HZ is preventable versus only 53.2% in those ≥ 60 YO (p = 0.001). CONCLUSION: Our findings underscore the need to educate patients in underserved communities about HZ as well as new HZ vaccine recommendations to improve vaccination rates and reduce the incidence of HZ and its associated sequelae.

Student Perspectives Regarding Specialty Pharmacy Within Doctor of Pharmacy Curricula.

BACKGROUND: The rapid growth of the specialty pharmacy industry will require many pharmacists with experience and/or training in specialty pharmacy practice (SPP). Unfortunately, there is no standard requirement set forth by the Accreditation Council for Pharmacy Education (ACPE) for specialty pharmacy education among pharmacy schools, which has resulted in graduates with doctor of pharmacy degrees (PharmD) having little to no didactic or experiential training in SPP. OBJECTIVES: To (a) assess PharmD student perspectives on coverage of specialty pharmacy in their respective curricula and (b) identify whether attitudes and perspectives towards SPP vary based on student work experience. METHODS: Study investigators created a 16-item web-based survey that assessed student work experience in pharmacy practice, presence of learning experiences that cover SPP in PharmD curricula, and familiarity with, exposure to, and interest in SPP, SPP learning experiences, and SPP careers. The survey was made available to students at ACPE-accredited colleges of pharmacy from January to April 2018. RESULTS: 643 students from 20 different colleges of pharmacy completed the survey. Over half of the surveys (63.3%) originated from schools in the Midwest region of the United States. Just over one third (37.7%) of students reported that their curricula offered a learning experience specifically dedicated to SPP, whereas 17.6% reported that SPP was integrated into other pharmacy coursework. 28% reported that SPP was covered using a mixture of dedicated courses and class integration. Students with current or previous work experience in SPP or managed care were more likely to report willingness to take an experiential rotation in SPP and pursue a career in SPP than students with no or other pharmacy-related work experience. These students were also more likely to report that their curriculum performed poorly in preparing students to pursue a career in SPP. CONCLUSIONS: In a convenience sample survey of pharmacy students at ACPE-accredited colleges of pharmacy, perspectives on SPP, curricular coverage of SPP, and SPP careers varied significantly based on student work experience. DISCLOSURES: This study received funding support from the Wayne State University Department of Pharmacy Practice Research & Development Fund. The authors do not have any conflicts of interest or financial disclosures to declare.

Dosing challenges with direct oral anticoagulants in the elderly: a retrospective analysis.

BACKGROUND: Direct oral anticoagulants (DOACs) provide patients with attractive options for anticoagulation in atrial fibrillation (AF). However, dosing these agents in the elderly can be challenging due to factors such as drug interactions, reduced renal function, and less frequent monitoring. This study addressed this challenge by reviewing the dosing of three commonly used DOACs (i.e. apixaban, dabigatran, and rivaroxaban) in elderly patients managed at a pharmacist-run anticoagulation clinic. METHODS: This was a single-center, retrospective cohort study. A total of 98 cases of DOAC therapy in patients with AF aged 75 years or older receiving care at a large urban healthcare center were identified via chart review. Dosing of each DOAC was assessed at therapy initiation and throughout treatment whenever a serum creatinine was reported, using the Cockcroft-Gault equation to estimate creatinine clearance (CrCl). Dose excursions (defined as instances where patients were exposed to non-Food and Drug Administration (FDA)-approved doses) were documented in each case. Rationales for dose excursions were determined by study investigators via review of progress notes and categorized using clinical judgement. RESULTS: Upon therapy initiation apixaban was dosed in accordance with FDA recommendations in 92.9% of patient cases, dabigatran in 91.2% of cases, and rivaroxaban in 86.1% of cases (p = 0.70). FDA-recommended dosing was maintained throughout treatment at the highest rates with dabigatran (88.2% versus 78.6% with apixaban and 58.3% with rivaroxaban; p = 0.01, p = 0.005 for dabigatran versus rivaroxaban). The most common rationales for dose excursion were fluctuation in estimated CrCl near the dosing cutoff, and recommendations from nonpharmacist providers co-managing the patient. CONCLUSIONS: Prescribing and maintaining FDA-recommended doses of DOAC agents in the elderly is more challenging than initially perceived. Fluctuations in renal function, comorbidities, and concomitant antiplatelet use may necessitate more individualized dosing strategies with these agents.

Adolescent human papillomavirus vaccination in the United States: Opportunities for integrating pharmacies into the immunization neighborhood.

Human Papillomavirus (HPV) vaccination faces several barriers, including a social stigma which carries religious and philosophical implications among parents of adolescents as well as young adults. Hundreds of immunization interventions and programs have been developed to address these factors and boost HPV vaccination rates in the United States. We sought to review the existing literature highlighting barriers to HPV immunization, as well as programs targeting increased HPV vaccine uptake in effort to develop novel vaccination initiatives. The most impactful barriers identified were parental stigma and low quality of provider recommendations for the vaccine. Despite the implementation of many HPV initiatives, outcomes of these programs are largely limited to modest improvements in vaccine uptake in small, homogeneous populations. We describe pharmacies as distinctly advantageous but underutilized resources within the immunization neighborhood and propose a novel concept to improve vaccination rates as well as reduce HPV-related disease burden in all demographics.