Blended learning: Improving the diabetes mellitus counseling skills of German pharmacy students.

INTRODUCTION: Pharmacists have the responsibility to conduct medication therapy management and appropriately counsel patients and physicians on medicines. Blended learning and objective structured clinical examinations (OSCEs) may have the potential to address these skills. This study aimed to assess whether a blended learning program consisting of e-learning and OSCEs could enhance pharmacy students' abilities to conduct pharmaceutical consultations with type 2 diabetes mellitus patients. METHODS: The blended learning program consisted of e-learning, formative OSCEs, and summative OSCEs. The e-learning aimed to bring the students to the same level of diabetes knowledge. The students' baseline consultation skills were measured by a summative pre-training OSCE. After the formative OSCEs, a summative post-training OSCE quantified the change in performance. During the pre- and post-training OSCEs, analytical checklists were used to assess consultation skills and a global rating scale assessed communication skills. Surveys were used to measure students' self-assessment and satisfaction. RESULTS: The study demonstrated significant improvement in students' pharmaceutical knowledge of diabetes mellitus, consultation performances on diabetes mellitus, and self-assessment scores. Most students responded positively on the satisfaction survey. CONCLUSIONS: This study demonstrated that a blended learning approach with e-learning and OSCEs can improve students' diabetes consultations and communication skills. These results support the use of this instructional technique for teaching patient counseling. Further studies should consider a control group to assess whether the improvement of the consultation performance is a result of the training or solely a learning effect due to the repetition of summative OSCEs.

Simulation Training to Improve Informed Consent and Pharmacokinetic/Pharmacodynamic Sampling in Pediatric Trials.

Background: Pediatric trials to add missing data for evidence-based pharmacotherapy are still scarce. A tailored training concept appears to be a promising tool to cope with critical and complex situations before enrolling the very first patient and subsequently to ensure high-quality study conduct. The aim was to facilitate study success by optimizing the preparedness of the study staff shift. Method: An interdisciplinary faculty developed a simulation training focusing on the communication within the informed consent procedure and the conduct of the complex pharmacokinetic/pharmacodynamic (PK/PD) sampling within a simulation facility. Scenarios were video-debriefed by an audio-video system and manikins with artificial blood simulating patients were used. The training was evaluated by participants' self-assessment before and during trial recruitment. Results: The simulation training identified different optimization potentials for improved informed consent process and study conduct. It facilitated the reduction of avoidable errors, especially in the early phase of a clinical study. The knowledge gained through the intervention was used to train the study teams, improve the team composition and optimize the on-ward setting for the FP-7 funded "LENA" project (grant agreement no. 602295). Self-perceived ability to communicate core elements of the trial as well as its correct performance of sample preparation increased significantly (mean, 95% CI, p ≤ 0.0001) from 3 (2.5-3.5) to four points (4.0-4.5), and from 2 (1.5-2.5) to five points (4.0-5.0). Conclusion: An innovative training concept to optimize the informed consent process and study conduct was successfully developed and enabled high-quality conduct of the pediatric trials as of the very first patient visit.

Beating non-communicable diseases in primary health care: The contribution of pharmacists and guidance from FIP to support WHO goals.

According to the World Health Organization (WHO), more than 36 million people die annually from non-communicable diseases (NCDs), representing over 60% of deaths worldwide, 15 million of which occur before the age of 70 years. Prevention and control of NCDs and their risk factors require interventions that are therapeutically cost-effective, affordable by the patient and/or health systems and feasible, based upon local resources. This commentary paper sets a basis of global evidence to advocate, nationally and internationally, for an expanded role for pharmacists in NCD management by compiling best practices and examples. It encourages pharmacists around the world to act upon NCDs, from prevention and screening activities, to patient referral when appropriate, and to pharmacist-led, patient-centred NCD management to improve outcomes and quality of life. Priority NCDs fall into four areas: cardiovascular diseases, diabetes, asthma/chronic obstructive pulmonary disease and cancer. Building on the key roles they already play as primary healthcare professionals in the community, pharmacists can provide focused interventions, specialised counselling and care coordination, improving patient engagement to achieve better outcomes in the global fight against NCDs.

PharmAdhere: training German community pharmacists with Objective Structured Clinical Examinations.

Background Pharmacists who engage in Pharmaceutical Care need skills to optimise responsible medication use and increase medication adherence. Objectives We developed and evaluated a blended-learning programme for German community pharmacists that focused on conducting consultations in chronic diseases. Setting Community pharmacists in Germany. Method Interventional study with pre-post design. We combined e-learning with Objective Standardised Clinical Examinations (OSCEs) for emergency situations, initiation/implementation of medication therapy and detection of symptoms of four chronic diseases. Specific procedures were defined in the Pharmaceutical Action Plan. Skills were measured with a global analytical marking sheet derived from the Medication Related Consultation Framework and scored with the Canadian criticality/relevancy matrix. Time limits matched real practice scenarios. Main outcome measures Changes in knowledge (difference of test results before and after e-learning) and changes in skills (difference in scores of the OSCEs before and after training). Results 22 out of the 26 pharmacists enrolled, completed the study. The number of correctly answered questions increased significantly after the e-learning for all four indications with a mean number of additional correct answers between 3.86 and 4.9 points out of 15 (p < 0.001). The sums of the analytical checklist points in percentages increased significantly in all topics from the baseline summative OSCE to the final summative OSCE between 6.14 and 31.85% (p < 0.001). The maximum duration of consultation per patient was less than 10 min in all OSCEs. Conclusion The use of e-learning and OSCEs was well received by participants and is a successful method to deliver practical Pharmaceutical Care training.

Reporting adverse drug reactions: contribution, knowledge and perception of German pharmacy professionals.

Background The detection, assessment and prevention of adverse drug reactions along the product's life cycle is known as pharmacovigilance. German pharmacists are obliged by law to conduct pharmacovigilance measures, a specific training is not required. Objectives To assess the knowledge, contribution and perception of German pharmacy professionals regarding pharmacovigilance activities, in order to identify their needs to report better on the issue. Setting A semi-quantitative survey among German pharmacy professionals was conducted in November 2017. Method A questionnaire with 20 questions was developed and distributed to pharmacy professionals in four different German regions. Main outcome measures To assess the knowledge the number of right answered questions were examined; for perception a six-point-Likert was used and for contribution, yes or no questions. Results The participation ratio was 64.5% (n = 127). Nearly half of the participants (47.2%, n = 60) stated that they had already reported adverse drug reactions. Regarding the knowledge questions, there was neither a statistically significant difference between the correct answers of pharmacists and pharmacy technical assistents (p = 0.7209), nor between the different regions (p > 0.5054). For better reporting, the participants recommended better training, shorter forms to fill in and/or a contact person to call. Conclusion For the successful integration of pharmacovigilance reporting in daily practice, we suggest the following: (1) A structured, mandatory training of the pharmacy team. (2) The preparation of a standard operating procedure for the pharmacy or its integration into the pharmacy software.

Effective Interventions for Diabetes Patients by Community Pharmacists: A Meta-analysis of Pharmaceutical Care Components.

OBJECTIVE: To evaluate randomized controlled trials (RCTs) that included interventions provided by community pharmacists for patients with type 1 and 2 diabetes, the analysis of each component of the intervention(s), and the description of the training that the pharmacists received. DATA SOURCES: The literature research was conducted in PubMed and in the Cochrane Central Register of Controlled Trials (January 2000 to April 2016) for RCTs with interventions provided by community pharmacists for patients with diabetes. Corresponding authors were contacted about missing data and intervention and training design. STUDY SELECTION AND DATA EXTRACTION: RCTs published in English or German were included if pharmaceutical care or medication therapy management was conducted by community pharmacists with diabetes patients. Basic information, intervention and training design data were extracted. DATA SYNTHESIS: The literature research resulted in 11 eligible studies for further analysis. The corresponding authors of 6 studies responded to our request and sent their raw data. The calculated meta-analytical effect of 640 analyzed patients was a hemoglobin A1C (A1C) difference of -0.66%, with a 95% CI of -0.86% to -0.45%. The analysis revealed that most intervention elements had a significant positive meta-analytical effect on the A1C values. CONCLUSIONS: Our meta-analysis suggests that community pharmacist-led interventions can improve glycemic control in patients with type 1 and 2 diabetes. The most effective intervention components were patient centered and interdisciplinary. Pharmaceutical care interventions should, therefore, include the following components: sending feedback to the physician, setting individual goals, reviewing medication, and assessing patients' health beliefs and medication knowledge.

[PHARMAGRIPS: structured pharmaceutical counseling in the self-medication of the common cold. A randomised controlled study (RCT)]. / PHARMAGRIPS: Pharmazeutische Beratung in der Selbstmedikation des grippalen Infekts. Eine randomisierte kontrollierte Studie (RCT).

Many minor ailments are treated in Germany by self-medication. Most drugs dispensed by pharmacy staff are those for the common cold, general pain and gastrointestinal disorders. Whilst pharmacists express their need for further training in counseling on side effects, interactions and contraindications, they tend to receive feedback from patients to the effect that the drugs used have not worked. From July to October 2013 we carried out a prospective, single-blind, quasi-randomised controlled study on the effect of training on structured pharmaceutical advice in self-medication of the common cold (PHARMAGRIPS Study). Using a controlled, interventional study design we investigated whether it is possible to improve the pharmaceutical counseling in self-medication within a short time, by using an appropriate teaching method. The counseling should be made in a systematic way and refer to evidence-based content in order to avoid incorrect advice. We enrolled 86 pharmacists and assigned them randomly into the study protocol. Of those, 56 completed the study as planned and were analysed. In this study, we reviewed the structure of the average pharmaceutical consultation and added evidence-based content from the Cochrane Reviews on common cold. We then integrated this structured consultation in a methodical modem training program consisting of e-learning and live classes which we evaluated scientifically. For this purpose, we conducted telephone interviews with the participating pharmacists by using standardized case report forms. The case report forms contained the questions that the participants were supposed to ask. For every question asked, the participant received a certain amount of points, 18 in total. The training was stated to be successful at the primary endpoint when an improvement of at least 3.5 out of 18 points was achieved on average. The secondary endpoints were related to various aspects of the interview process (medical history, limits of self-medication, evidence-based drug selection and integration of customer input in the consultation interaction). The training group improved in the primary endpoint by an average of 5.93 points (p < 0.001) and compared to the control group significantly in all secondary endpoints, with one participant managing to achieve the full score. The participants recognized the importance and practical relevance of the exercise in a short time and were able to implement even integrate complex content in their consultations and to give the customer appropriate advice.

[Pharmacist's requirements for evidence-based self-medication guidelines]. / Bedarf von Pharmazeuten an evidenzbasierten Leitlinien für die Selbstmedikation.

Due to the removal of many pharmaceuticals from the prescription requirement, self-medication implies an increasing responsibility for pharmacists towards their patients. The application of evidence-based guidelines could be a responsible basis for consulting in pharmacies. Evidence-based guidelines represent the systematically accumulated and evaluated facts (the evidence) of desired and undesired effects of pharmaceuticals in the population. We wanted to find out which interest pharmaceutical professionals have in evidence-based guidelines and which are the exact requirements on their content, deducted from public pharmacies everyday demands. With this purpose, three surveys were conducted between March and August 2012, in which 365, 350, and 486 pharmaceutical professionals participated respectively. The results show that pharmacy staff is very interested in evidence based guidelines. Furthermore, they suggest that the pharmacy staff feel safe with the self-diagnosis of the customer, with the consideration of limits of self-medication, as well as with the selection of the--according to own assessment--appropriate active substance. For the selection of the correct active substance, the following criteria are named: self-security in the counselling, first-hand experiences as well as the wish of the customer. At the same time, it is striking that the most frequent critique the pharmacy staff gets from pharmacy customers is the lack of effectiveness of the selected medication. With that in mind, it is possible that not the appropriate medication was selected, and the chosen criteria as selection method should be replaced by an evidence-based decision. Secondly, the results show that in up to 52% of the cases, depending on the indications, the participating consultants felt less certain to uncertain with regards to possible interactions or contraindications. Also in this context, it is desirable to prepare the existing data in such a practical way, that the pharmacies are able to apply them directly.