An EMR-Based Approach to Determine Frequency, Prescribing Pattern, and Characteristics of Patients Receiving Drugs with Pharmacogenomic Guidelines.

(1) Background: This retrospective analysis utilizing electronic medical record (EMR) data from a tertiary integrated health system sought to identify patients and prescribers who would benefit from pharmacogenomic (PGx) testing based on Clinical Pharmacogenetics Implementation Consortium (CPIC) guidelines. (2) Methods: EMR data from a clinical research data warehouse were analyzed from 845,518 patients that had an encounter between 2015 and 2019 at an academic medical center. Data were collected for 42 commercially available drugs with 52 evidence-based PGx guidelines from CPIC. Provider data were obtained through the EMR linked by specialty via national provider identification (NPI) number. (3) Results: A total of 845,518 patients had an encounter in the extraction period with 590,526 medication orders processed. A total of 335,849 (56.9%) patients had medication orders represented by CPIC drugs prescribed by 2803 providers, representing 239 distinct medications. (4) Conclusions: The results from this study show that over half of patients were prescribed a CPIC actionable medication from a variety of prescriber specialties. Understanding the magnitude of patients that may benefit from PGx testing, will enable the development of preemptive testing processes, physician support strategies, and pharmacist workflows to optimize outcomes should a PGx service be implemented.

Survey of Pass/Fail Grading Systems in US Doctor of Pharmacy Degree Programs.

Objective. To understand how US schools and colleges of pharmacy use pass/fail grading systems in Doctor of Pharmacy degree programs.Methods. An electronic survey with 15 selected response items and six open-ended questions was developed to gather qualitative and quantitative data. The convenience survey was distributed in 2020 to the 10 academic pharmacy programs known to use a pass/fail grading system for the majority of their courses.Results. Leaders from eight of the 10 programs identified responded to the survey. Programs varied regarding the types of courses for which they used a pass/fail grading system and whether they shared numerical scores with their students. A variety of grade designations (honors, pass, no pass, fail, satisfactory, etc) were used, and the minimum pass level varied by program, ranging from 70% to 90%. For those institutions that used post-course remediation, the majority of remediation occurred immediately following the academic term or in the summer. The type of information shared with residency program directors (eg, GPA, class rank, overall percentile, qualitative comments) varied between programs.Conclusion. How pass/fail grading systems were used was inconsistent across the cohort. Programs that use a criterion-based grading system might benefit from engaging in conversations with other schools that do the same to determine whether and how consistency in terminology, passing level, percentages, grade point averages, and progression might be achieved. Additional insights on postgraduate training requirements and honorary societies are warranted should the use of pass/fail grading expand as it has in medical education. Further research on this topic is needed.

Personal DNA Testing Increases Pharmacy Students' Confidence and Competence in Pharmacogenomics.

Objective. Pharmacogenomics, a key tool in personalized medicine, and therapeutic drug management is projected to become an integral part of pharmacy practice. This study describes an innovative pedagogy that used several interactive learning methods to increase learners' competence and perceptions in pharmacogenomics.Methods. First-year student pharmacists at the Medical College of Wisconsin participated in lectures, discussions, and patient care laboratory training on the topic of pharmacogenomics. These students were given the opportunity to undergo personal pharmacogenomics testing. Before and after these activities, participants were surveyed about their attitudes towards the use of pharmacogenomics in current and future practice.Results. Forty-five students participated in this voluntary personal pharmacogenomics testing and completed pre-course and post-course surveys. Significant improvements were seen in 22 of the 27 surveys questions responses from the pre-course to the post-course surveys. Student learning outcomes, competencies, and attitudes towards pharmacogenomics improved from a relatively neutral perception of pharmacogenomics to one of more confidence.Conclusion. This study demonstrated that participation in a novel pedagogy that included voluntarily individual pharmacogenomics testing was beneficial to student pharmacists by improving knowledge, interest, and confidence in pharmacogenomics and its incorporation into their future pharmacy practice.

Implementation and evaluation of an interprofessional physical assessment skills workshop for Wisconsin pharmacists.

BACKGROUND: Pharmacists have a critical, expanding role in health care delivery. In particular, pharmacists in community pharmacy and ambulatory care settings are important and frequent access points for health care services. OBJECTIVE: We describe the interprofessional development and implementation of an interactive, broadly applicable physical assessment skills-based continuing pharmacy education program to provide an avenue for the attainment of this warranted set of skills for pharmacists who desire to provide advanced patient care services in their respective practices. METHODS: Pharmacists, in collaboration with family medicine and emergency medicine physicians, developed workshop content, design, and flow. The structure of the workshops consisted of didactic training, hands-on practical application, simulated practice, and case-based certification examinations. RESULTS: On a postworkshop survey, all respondents answered "agree" or "strongly agree" when asked if the workshops were useful, advanced their skills, and advanced their confidence. It was also found that more than 50% of the participants used their physical assessment skills monthly and 11% daily. The most common assessment performed was obtaining an accurate manual blood pressure. CONCLUSION: The interprofessional development and implementation of workshops dedicated to physical assessment skills education is feasible and led to the incorporation of these skills into pharmacists' practice, particularly in the community and ambulatory care settings.

Collective Action: The Medical College of Wisconsin COVID-19 Vaccination Program.

The Medical College of Wisconsin (MCW) COVID-19 Vaccination Program facilitated early vaccination efforts in metro Milwaukee, Wisconsin from December, 2020 through April, 2021. Goals of the program were to work with clinical partners to ensure rapid vaccination availability for the institution's frontline workforce, to support state public health agencies in offering a vaccination opportunity for underserved and higher education community members, and to train vaccinators. A key component of the program was the MCW COVID-19 Vaccination Clinic, and 88% of MCW's workforce was fully immunized against COVID-19 with the 2-dose, mRNA vaccine by April 30, 2021. Within the MCW clinic, 219 pharmacy and medical students learned to administer vaccinations, and 12,450 community vaccinations were administered.

Comparison of Attitudes of Wisconsin Health Care Providers and Pharmacists Toward Vaccine Administration and Perceived Barriers.

OBJECTIVE: To measure the attitudes of pharmacists and other health care providers towards vaccine administration, overall acceptance of pharmacists as immunization providers, and perceived immunization barriers in Wisconsin. METHODS: The authors conducted a cross-sectional study utilizing an online survey to assess the attitudes of pharmacists and other health care providers toward their role as immunization providers and perceived barriers to providing immunizations. The survey was distributed between November 2018 and February 2019. RESULTS: Two hundred thirty-six pharmacists and 51 other health care providers completed the survey. Of the pharmacists who responded, 203 (86%) provided immunizations. Most respondents (97.9% of pharmacists and 90.2% of other health care providers) see vaccinations as a shared professional responsibility. Both pharmacists (82.6%) and other health care providers (79.6%) believe pharmacists have adequate training to administer vaccines to patients. Immunizing pharmacists identified 2 primary barriers to providing immunizations: patients refusing vaccines for financial reasons (55%) and patients not having insurance coverage for vaccines received in a pharmacy (55%). In contrast, the primary barrier identified by non-immunizing pharmacists is other responsibilities taking precedence over vaccinating (75%). Other health care providers identified determining whether their patients' insurance will reimburse for a vaccine (52%) as their primary barrier toward providing immunizations. CONCLUSION: These surveys provide a baseline measure of the attitudes of Wisconsin pharmacists and other health care providers toward immunization provision and offer opportunities for comparison. Our findings highlight barriers, such as insurance coverage for immunizations, that may prevent pharmacists from increasing vaccination rates in Wisconsin.

Concept for Embedded Primary Care Pharmacist Practitioners (PCPPs): A Disruptive Value-Proposition.

The work environments and expectations for the daily activities of primary care physicians are daunting and often include spending a significant amount of time related to chronic care management with complex medication regimens, medication reconciliation, and the documentation within the electronic medical record (EMR) of these medication related issues [...].

Immunizations at Wisconsin Pharmacies: Results of a statewide vaccine registry analysis and pharmacist survey.

BACKGROUND: There is currently limited data in the United States on the proportion of immunization doses given at pharmacies outside the influenza vaccine. This study aims to obtain baseline information on the percentage of vaccine doses administered at pharmacies in Wisconsin and to understand the immunization barriers for Wisconsin pharmacists, to inform interventions to increase immunization access at pharmacies. METHODS: Aggregated data from the Wisconsin Immunization Registry (WIR) was obtained for all vaccines administered at pharmacies to patients over the age of six from July 2017 through June 2018. In addition, a survey on attitudes towards and barriers to vaccination was sent to 2000 Wisconsin pharmacists with 236 respondents yielding a 12% response rate. RESULTS: WIR data demonstrates that zoster and influenza vaccines have the highest proportion of doses administered at pharmacies (39% and 20%, respectively). Human papillomavirus (HPV) vaccines have the lowest proportion of doses at 0.2%. Pharmacy survey shows that 86% provide immunizations. Most stock influenza vaccines (84%), whereas much fewer stock HPV vaccines (21%). The greatest immunization barriers for the pharmacy respondents include billing and reimbursement challenges and competing demands for staff. CONCLUSIONS: Despite the barriers, community pharmacies have significant potential to address vaccination gaps. Physicians, patients, and legislative bodies are generally well-accepting of pharmacists as immunizers. Pharmacists, in order to be fully utilized as immunizers, must engage in active communication with patients and be willing to collaborate with physicians. Legislative policy and health insurance reimbursement reforms are also necessary to facilitate further pharmacist participation in immunization.

The Report of the 2017-2018 Professional Affairs Standing Committee: The Development of the Preceptor Self-Assessment Tool for Entrustable Professional Activities for New Graduates.

The 2017-2018 AACP Professional Affairs Committee addressed the charges of (1) developing a self-reflection/self-assessment tool for pharmacy faculty and preceptors to allow them to assess their capability and confidence with Center for the Advancement of Pharmacy Education (CAPE) Educational Outcomes, the Pharmacists' Patient Care Process (PPCP), and the Entrustable Professional Activities (EPAs) for New Pharmacy Graduates and (2) creation of a plan for AACP to utilize in the development of preceptor continuing education and training programs. This report describes the framework, rationale and process for the development of the Preceptor Self-Assessment Tool for Entrustable Professional Activities for New Pharmacy Graduates (PSAE Tool), the pre-test for the PSAE tool, and the online pilot test and its results for the PSAE Tool. The committee provides recommendations for AACP in the continued development and distribution of the PSAE Tool to the schools of pharmacy. Considerations for AACP and the schools of pharmacy to consider in the continuing professional development (CPD) for all preceptors are also discussed. The committee provides a policy statement, adopted by the AACP House of Delegates, regarding the commitment of AACP regarding the CPD for all preceptors. The committee also provides several recommendations to AACP and suggestions to schools of pharmacy and other stakeholder groups pertaining to the committee charges.

The Report of the 2016-2017 Professional Affairs Standing Committee: Formally Embracing and Engaging Preceptors in the Academy - The Time Has Come.

The 2016-2017 AACP Professional Affairs Committee (PAC) was charged to examine strategies to include adjunct/affiliate preceptors as AACP members and to determine the value proposition of AACP membership for this group of educators. The PAC defined adjunct/affiliate preceptors as preceptors who are neither full-time employees nor have a primary employment commitment (≥50% of the preceptor's work salary) at a school/college of pharmacy. Specific charges to the PAC included: recommend an approach to increase the number of adjunct/affiliate preceptors as AACP members, examine AACP membership from an adjunct/affiliate preceptor value perspective, and prepare a concise summary of available literature describing value-added contributions of student pharmacists and pharmacy preceptors to pharmacy practice models, interprofessional education (IPE) and interprofessional practice (IPP). The summary of the plan developed by the PAC to address the charges is presented in the following report, which includes three sections: the value proposition of AACP membership for adjunct/affiliate preceptors, expansion of the presence of adjunct/affiliate preceptors in AACP, and the value of student pharmacists in experiential education settings. The value proposition of AACP membership for adjunct/affiliate preceptors section describes results of surveys and focus groups conducted by the PAC. The PAC surveyed experiential education directors at schools/colleges of pharmacy, adjunct/affiliate preceptors (from a request via the experiential education directors), and new pharmacy practice faculty members in order to determine current resources available for adjunct/affiliate preceptor development, as well as explore potential resources AACP could provide for adjunct/affiliate preceptor development. Focus groups were held with adjunct/affiliate preceptors and experiential education faculty/staff to explore some of the results and concepts generated from the surveys. The PAC developed three recommendations for AACP as a result of the surveys and focus groups. The report also describes various factors that should be considered by AACP in developing a membership category for adjunct/affiliate preceptors, including potential membership models, establishment of an advisory board, and collaboration with other stakeholder groups. The final section of the report provides an executive summary and detailed table, which summarizes available literature on the value of student pharmacists in experiential education. The brief literature review reinforces that there are many different practice settings where student pharmacists add value to patient care and the practice site. This information is significant for experiential education faculty/staff, as well as adjunct/affiliate preceptors, and serves as an example of best practices which document the value experiential education provides to patient care and practice sites. The final section of the report provides a policy statement that was adopted by the 2017 AACP House of Delegates and one suggestion to schools/colleges of pharmacy. The report concludes with a call to action regarding the formal involvement of adjunct/affiliate preceptors by AACP and the academy.

Capacity of hospitals to partner with academia to meet experiential education requirements for pharmacy students.

PURPOSE: Current hospital and health-system participation in and the future capacity for experiential education for pharmacy students was investigated. METHODS: An online survey of ASHP members identified as U.S. pharmacy directors was conducted to assess their current and future involvement in partnering with colleges and schools to meet the experiential education requirements for doctor of pharmacy students and the current status of the student learning experiences. Questionnaire items examined the factors on which expanded involvement in experiential education would depend, the nature of support provided by colleges and schools, the types of experiences available for students, respondents' perceptions of factors influencing the quality of experiential education, the value of experiential education to the sites, respondents' challenges and concerns about experiential education, and respondents' current capacity and projections for introductory and advanced experiences through 2012. RESULTS: Data from 549 respondents were analyzed. Most respondents indicated that they had conducted advanced experiences for their 2007 graduates and anticipated that they would continue to do so. Among the top challenges identified regarding advanced experiences were concerns about time to serve and be trained as preceptors and a lack of standardization and coordination among colleges and schools. Hospitals forecasting their future capacity to accommodate students indicated that their projections were highly dependent on the number of pharmacists at their hospitals. Many respondents noted that their capacity projections were tied to their ability to expand clinical services at their hospitals. CONCLUSION: A survey of pharmacy directors suggested an ability of U.S. hospitals to conduct advanced experiential education opportunities for pharmacy students through 2012 and to expand introductory experiences.

Efficacy, tolerability, and parent reported outcomes for cefdinir vs. high-dose amoxicillin/clavulanate oral suspension for acute otitis media in young children.

OBJECTIVES: To compare efficacy, tolerability, and parental satisfaction of cefdinir and high-dose amoxicillin/clavulanate oral suspensions given to young children with non-refractory acute otitis media (AOM) based on clinical endpoints and outcomes measures. RESEARCH DESIGN AND METHODS: This was an investigator-blinded, multicenter study in which 318 children 6 months through 6 years of age with a clinical diagnosis of AOM were randomized to receive 10 days of either cefdinir (14 mg/kg divided BID) or high-dose amoxicillin/clavulanate (90/6.4 mg/kg divided BID). MAIN OUTCOME MEASURES: Investigators evaluated clinical response at an end-of-therapy (EOT) office visit conducted on day 12-15. Outcomes of satisfaction, tolerability, and adherence were also assessed at that visit using an Otitis Parent Questionnaire. RESULTS: The treatment groups were similar at baseline with respect to patient demographics. At the EOT visit, for cefdinir and amoxicillin/clavulanate, respectively, intent-to-treat (ITT) clinical cure rates were 82% (129/158) and 85% (134/158) (p = 0.547; 95% confidence interval [CI] -11.7 to 5.4) and per-protocol cure rates were 82% (123/150) and 90% (129/143) (p = 0.045; 95% CI -16.4 to 0.0). This difference was driven primarily by reduced cefdinir response in patients with recurrent AOM (p = 0.010) and those younger than 24 months (p = 0.039). Comparing cefdinir with amoxicillin/clavulanate, parents more often reported significantly better ease of use (89% vs. 57%; p < 0.0001), better taste (85% vs. 39%; p < 0.0001), and better adherence (at least 95% of doses) (82% vs. 61%; p < 0.0001). Diarrhea/loose stools were more common in the amoxicillin/clavulanate group than in the cefdinir group (28% vs. 18%, respectively; p = 0.0341). One patient in the cefdinir group and eight patients in the amoxicillin/clavulanate group withdrew from the study prematurely due to at least one adverse event (p = 0.0364). Study limitations included assessment of clinical recurrence by telephone call rather than office visit, exclusion of children with refractory AOM, and no assessment of middle ear microbiology. CONCLUSIONS: Among young children with non-refractory AOM, cefdinir was as efficacious as high-dose amoxicillin/clavulanate in the ITT group, but somewhat less effective in per-protocol analysis. From the parental perspective, cefdinir was easier to administer, had a better taste, caused less diarrhea, and resulted in higher treatment adherence than high-dose amoxicillin clavulanate.