Implementation of a research capstone course with expanded flexibility.

BACKGROUND AND PURPOSE: A research-focused capstone course was designed to improve flexibility in the way pharmacy students meet the university's capstone requirement. The requirement aims to integrate knowledge, skills, and attitudes from didactic coursework and to apply them in a scholarly way to improve critical and evidence-based thinking, communication skills, and professionalism. This report describes the capstone course and faculty and student perceptions after the first year of implementation. EDUCATIONAL ACTIVITY AND SETTING: The course allows students to work with a faculty advisor on a four-semester hour research project of mutual interest that can be completed in any one of three semesters. After the first student cohort completed their projects, faculty and student perceptions were captured via electronic survey. FINDINGS: A total of 38 students (36%) and 22 advisors (71%) responded to the survey. Approximately 90% of students and faculty agreed that student groups had achieved course objectives upon completion. Although faculty members felt that participating in the capstone course increased their workload and in some cases reduced their productivity, faculty members felt that the course had a beneficial impact for students. SUMMARY: The new capstone course was well received. The flexibility of the course was both a strength and a limitation as most students wanted more structure in the expectations and grading of the project in the form of a rubric or other standardized assessments.

A simulated hospital pharmacy module using an electronic medical record in a pharmaceutical care skills laboratory course.

OBJECTIVES. To implement and evaluate the effects of a simulated hospital pharmacy module using an electronic medical record on student confidence and abilities to perform hospital pharmacist duties. DESIGN. A module was developed that simulated typical hospital pharmacist tasks. Learning activities were modified based upon student feedback and instructor assessment. ASSESSMENTS. Ninety-seven percent of respondents reported full-time hospital internship experience and 72% had electronic medical record experience prior to completing the module. Mean scores on confidence with performing typical hospital pharmacist tasks significantly increased from the pre-module survey to the post-module survey from 1.5-2.9 (low comfort/confidence) to 2.0-3.4 (moderate comfort/confidence). Course assessments confirmed student achievement of covered competencies. CONCLUSIONS. A simulated hospital pharmacy module improved pharmacy students' hospital practice skills and their perceived comfort and confidence in completing the typical duties of a hospital pharmacist.

Using Facebook to facilitate course-related discussion between students and faculty members.

OBJECTIVES: To use Facebook to facilitate online discussion of the content of a Comprehensive Disease Management course and to evaluate student use and perceptions of this exercise. DESIGN: A Facebook page was created and coordinators encouraged students to "like" the page and to post and view study tips, links, or questions. At the end of the course, students' use and perceptions were evaluated using an anonymous survey tool. ASSESSMENT: At the end of week 1, there were 81 followers, 5 wall posts, and 474 visits to the course Facebook page. At peak use, the page had 117 followers, 18 wall posts, and 1,326 visits. One hundred nineteen students (97% of the class) completed the survey tool. Twenty-six percent of students contributed posts compared to 11% who posted on the course discussion board on Blackboard. Students were more likely to post and be exposed to posts on Facebook than on Blackboard. Students found Facebook helpful and 57% said they would miss Facebook if use was not continued in subsequent courses. CONCLUSIONS: Students in a Comprehensive Disease Management course found the addition of a Facebook page a valuable study tool and thought most posts added to their learning.

Pharmacist recommendations to improve the quality of diabetes care: a randomized controlled trial.

BACKGROUND: Diabetes mellitus continues to result in substantial morbidity and mortality despite receiving much attention from health care providers. Automated clinician reminder systems have been developed to improve adherence to diabetes care guidelines, but these reminder systems do not always provide actionable information and may be unable to detect relevant, subjective patient information that affects clinical decision making. Face-to-face visits with pharmacists, who have knowledge of care guidelines and medication management strategies, may assist in improving diabetes care. It is unknown if the combination of pharmacist chart review and clinician reminders could improve diabetes care without requiring face-to-face visits. OBJECTIVE: To assess the effects of a comprehensive, pharmacistdelivered, primary care, physician-focused intervention in a large hospital based primary care practice to improve the quality of care for patients with diabetes including rates of semiannual hemoglobin A1c testing and other biomarker and process measures. METHODS: This was a prospective, randomized, controlled study conducted in a hospital-based, primary care practice, composed of 37 faculty primary care physicians (PCPs) and 95 internal medicine residents. The initial sample included 346 patients with diabetes and 72 PCPs caring for them. PCPs were randomized to receive either a personalized letter from a practicing pharmacist containing treatment recommendations for patients with upcoming primary care visits (intervention, n = 33) or to usual care without the letters (control, n = 39). The letter included patient-specific recommendations regarding overdue testing as well as drug therapy to achieve diabetes-related treatment targets. The intervention included addition of the letter to the electronic medical record (EMR) and presentation of the letter to the PCP at the time of the index primary care visit that occurred between November 2003 and August 2004. Follow-up chart review was performed after the primary care visit to determine changes in 5 process and 3 biomarker outcome measures of diabetes care within 30 days of the index visit. The primary study outcome was a process measure, change in rates of semiannual A1c testing from baseline to 30-day follow-up. Baseline differences were tested for statistical significance using Pearson chisquare. The statistical significance of the intervention's effect was tested using logistic regression models predicting achievement of each study outcome, with randomization status (intervention vs. control) as the predictor variable of interest, controlling for baseline performance for each measure. RESULTS: 171 patients were in the 4 medical clinic suites with 33 PCPs who received the intervention, and 175 patients were in the 4 suites with 39 PCPs in usual care. 30-day outcomes were analyzed for 301 patients (87.0%) who attended their scheduled index primary care visit. Of these 301 patients, 44.5% were black, 65.8% were female, and the mean age was 63 years. At baseline, there were no significant differences between the intervention group (n = 150) and the usual care (control) group (n = 151) in the 3 biomarker measures (proportion with A1c less than 7%, proportion with low-density lipoprotein cholesterol [LDL-C] less than 100 milligrams per deciliter [mg per dL], or blood pressure less than 130/80 millimeters mercury [mm Hg]). There were no significant baseline differences in 4 of the 5 process measures; however, the rate of annual LDL-C testing was significantly higher for the intervention than for the control group at baseline (86.0% vs. 74.8%, respectively, P = 0.015). In logistic regression analysis, rates of semiannual A1c testing were not significantly different between the intervention and control groups, increasing from baseline to follow-up by 16% in the intervention group and 9% in the control group (P = 0.146). The proportion of patients with A1c less than 7% at follow-up was 43.3% in the intervention group versus 37.7% in the control group (intervention effect P = 0.099). The only statistically significant difference between the 2 groups in the 8 outcome measures was a higher proportion with an annual eye exam at follow-up in the intervention group (60.0%) versus the usual care group (50.3%, intervention effect P = 0.017). CONCLUSIONS: Pharmacist-generated recommendations delivered by letter to PCPs in an academic medical practice were not associated with statistically significant improvements in most quality measures for diabetes care assessed at 30 days following the intervention. Further research is needed with more patients and a longer follow-up time to determine how best to improve the quality of care of patients with diabetes using focused recommendations for therapy changes and reminder notices to clinicians.

A tool for measuring active learning in the classroom.

OBJECTIVES: To develop a valid and reliable active-learning inventory tool for use in large classrooms and compare faculty perceptions of active-learning using the Active-Learning Inventory Tool. METHODS: The Active-Learning Inventory Tool was developed using published literature and validated by national experts in educational research. Reliability was established by trained faculty members who used the Active-Learning Inventory Tool to observe 9 pharmacy lectures. Instructors were then interviewed to elicit perceptions regarding active learning and asked to share their perceptions. RESULTS: Per lecture, 13 (range: 4-34) episodes of active learning encompassing 3 (range: 2-5) different types of active learning occurred over 2.2 minutes (0.6-16) per episode. Both interobserver (> or = 87%) and observer-instructor agreement (> or = 68%) were high for these outcomes. CONCLUSIONS: The Active-Learning Inventory Tool is a valid and reliable tool to measure active learning in the classroom. Future studies are needed to determine the impact of the Active-Learning Inventory Tool on teaching and its usefulness in other disciplines.

Role of pharmacist counseling in preventing adverse drug events after hospitalization.

BACKGROUND: Hospitalization and subsequent discharge home often involve discontinuity of care, multiple changes in medication regimens, and inadequate patient education, which can lead to adverse drug events (ADEs) and avoidable health care utilization. Our objectives were to identify drug-related problems during and after hospitalization and to determine the effect of patient counseling and follow-up by pharmacists on preventable ADEs. METHODS: We conducted a randomized trial of 178 patients being discharged home from the general medicine service at a large teaching hospital. Patients in the intervention group received pharmacist counseling at discharge and a follow-up telephone call 3 to 5 days later. Interventions focused on clarifying medication regimens; reviewing indications, directions, and potential side effects of medications; screening for barriers to adherence and early side effects; and providing patient counseling and/or physician feedback when appropriate. The primary outcome was rate of preventable ADEs. RESULTS: Pharmacists observed the following drug-related problems in the intervention group: unexplained discrepancies between patients' preadmission medication regimens and discharge medication orders in 49% of patients, unexplained discrepancies between discharge medication lists and postdischarge regimens in 29% of patients, and medication nonadherence in 23%. Comparing trial outcomes 30 days after discharge, preventable ADEs were detected in 11% of patients in the control group and 1% of patients in the intervention group (P = .01). No differences were found between groups in total ADEs or total health care utilization. CONCLUSIONS: Pharmacist medication review, patient counseling, and telephone follow-up were associated with a lower rate of preventable ADEs 30 days after hospital discharge. Medication discrepancies before and after discharge were common targets of intervention.

Duloxetine: a dual serotonin-norepinephrine reuptake inhibitor for treatment of major depressive disorder.

The burden of mental illness has been underestimated worldwide. Depression was the fourth leading cause of disease burden in the world in 1990 and is projected to be the second leading cause of disability by 2020. It is a leading cause of morbidity and mortality in the United States, costing billions of dollars annually in direct and indirect medical costs and losses in productivity. Patients with major depressive disorder (MDD) may experience both psychological and medical complaints, including somatic sensations or pain. Some antidepressants have been shown to treat chronic pain syndromes, but despite the variety of antidepressants available in the United States, only 65-70% of patients respond to initial antidepressant treatment. Treatments are limited by delayed onset of antidepressant effects, side effects, partial response, and treatment resistance. Duloxetine, approved by the U.S. Food and Drug Administration for the treatment of MDD, is a reuptake inhibitor at serotonergic and noradrenergic neurons and appears to have low affinity for other neurotransmitter systems. In clinical trials, duloxetine was effective for the treatment of MDD and was well tolerated. Further study is needed to compare its efficacy with that of other antidepressants, to clarify effects on somatic symptoms, and to assess potential adverse cardiovascular and sexual side effects. Duloxetine is also approved for the management of diabetic peripheral neuropathic pain and is under investigation for the treatment of stress urinary incontinence in women.