An EHR-based method to structure, standardize, and automate clinical documentation tasks for pharmacists to generate extractable outcomes.

As the recognition of team-based care grows and pharmacists increase in patient care interventions, it is important that tools to track clinical services are easily accessible and well-integrated into workflow for all providers. We describe and discuss feasibility and implementation of data tools in an electronic health record to evaluate a pragmatic clinical pharmacy intervention focused on deprescribing in aged adults delivered at multiple clinical sites in a large academic health system. Of the data tools utilized, we were able to demonstrate clear documentation frequency of certain phrases during the intervention period for 574 patients receiving opioids and 537 patients receiving benzodiazepines. Although clinical decision support and documentation tools exist, they are underutilized or cumbersome to integrate into primary health care and strategies, such as employed, are a solution. This communication incorporates the importance of clinical pharmacy information systems in research design.

An interprofessional experience preparing a collaborative workforce to care for older adults.

The development and evaluation of an interprofessional education (IPE) pre-professional geriatrics experience involving learners from 10 different health discipline programs is described. The experience provided learners with opportunities to use small-group collaborative approaches in two 3-hour interprofessional sessions. Learners gained exposure to geriatric principles and awareness of the needs of older adults and their families using case studies developed by experienced interprofessional faculty. Learners completed pre- and post-experience surveys and worksheets on their confidence to function in interprofessional teams, knowledge of other disciplines, perceptions of importance of each discipline in providing older adult care, and the qualities considered for a successful team. Data were collected over three offerings of the experience (2016, 2017, 2018) and analyzed using paired sample t-tests and ANOVA. A total of 562 learners participated with outcome measures indicating increased knowledge of older adult services different health professionals provide and increased confidence in knowing when to complete care referrals. Mean increase in learners' confidence to function in interprofessional teams was significant, suggesting the experience was effective in facilitating confidence in functioning and improving views of other disciplines' roles. This experience demonstrated that learners gained exposure to apply geriatric principle skills and critical thinking as interprofessional team members.

Pharmacist interventions to deprescribe opioids and benzodiazepines in older adults: A rapid review.

BACKGROUND: Many older adults are prescribed opioids and benzodiazepines (BZDs), despite increased susceptibility to adverse events. Challenges of deprescribing include fragmented care and lack of knowledge or time. Pharmacists are well-positioned to overcome these challenges and facilitate deprescribing of these medications. OBJECTIVES: We sought to evaluate interventions utilizing pharmacists to deprescribe opioids and BZDs in older adults. METHODS: We conducted a rapid review following a comprehensive literature search to identify interventions with pharmacist involvement for deprescribing opioids and BZDs in older adults. Studies were included based on: (1) inclusion of patients ≥ 65 years old receiving BZDs and/or opioids, (2) evaluation of feasibility or outcomes following deprescribing (3) pharmacists as part of the intervention. We included randomized, observational, cohort, and pilot studies. Studies that did not report specific results for BZD or opioids were excluded. RESULTS: We screened 687 abstracts and included 17 studies. Most (n = 13) focused on BZD deprescribing. Few studies focused on opioids (n = 2) or co-prescribing of opioids and BZDs (n = 2). The most common intervention was educational brochures (n = 8), majority being the EMPOWER brochure for deprescribing BZDs. Other interventions included chart review with electronic notes (n = 4), pharmacist-led programs/services (n = 2), and multifactorial interventions (n = 3). Many studies were underpowered or lacked suitable control groups. Generally speaking, interventions utilizing educational materials and those in which pharmacists engaged with patients and providers were more effective. Interventions relying on electronic communication by pharmacists were less successful, due to low acceptance or acknowledgement. CONCLUSIONS: We identified a number of feasible interventions to reduce BZD use, but fewer interventions to reduce opioid use in older adults. An optimal approach for deprescribing likely requires pharmacists to engage directly with patients and providers. Larger well-designed studies are needed to evaluate the effectiveness of deprescribing interventions beyond feasibility.

Promoting Whole Health in the Dental Setting: Steps Toward an Integrated Interprofessional Clinical Learning Environment Involving Pharmacy, Social Work, and Nursing.

INTRODUCTION: Dental settings have not traditionally functioned as access points to the health care system, however they can serve patients who may not otherwise seek routine health care. Millions of Americans annually visit either a dental or primary care provider, but not always both as recommended, even though multiple health co-morbidities can manifest in and impact oral health. Offering multidisciplinary health services in a dental setting has potential to reach unserved populations. DESCRIPTION: Innovative partnerships between schools of dentistry, pharmacy, social work, and nursing were designed to promote integrated service delivery in the emerging workforce and the purposeful inclusion of oral health in integrated care settings. DISCUSSION: Oral complications of systemic disease and systemic complications of oral disease impose significant burdens on populations and the public health infrastructure in terms of economic cost, disability, and mortality. Exacerbated by the lack of integrated services, intersecting social, economic, and health issues perpetuate disparities and negative health outcomes. Care is often focused on reactive rather than preventive measures therefore addressing only the acute issue instead of the underlying, causative problem(s). CONCLUSION: We describe steps for integrated, whole-health services and lessons learned for other academic health institutions and interprofessional settings considering integrated clinical models.

Gap analysis of pharmacist communication with community-based oral health care providers.

BACKGROUND: Current communication techniques among different types of health professionals are often inefficient and ineffective, leading to provider frustration and suboptimal patient care that can have community-wide implications. Oral health care providers (OHCPs) in the United States prescribe high numbers of antibiotics and immediate-release opioids and have practice sites that are physically isolated from those of other health professionals, making communication more challenging. OBJECTIVE: This study was conducted to identify barriers to effective communication between community pharmacists and OHCPs to inform the processes for improving provider education and the methods for training future pharmacists. METHODS: A mixed-methods approach was used. Community pharmacists with an active license were eligible to participate and were recruited via e-mail. The participants received an electronic survey that assessed current communication methods, obstacles to optimal communication, and comparisons of OHCPs with other prescribers. The survey participants were asked to self-identify their interest in telephone interviews, which were analyzed using thematic coding to assess the role of the pharmacist in combating public health issues such as opioid abuse through interprofessional collaboration. RESULTS: There were 125 participants (response rate 9%) for the survey and 7 participants for the interviews. The most common reasons for which the pharmacists contacted OHCPs were to address incomplete prescriptions (40%) and medication-related problems (35%), with the most common medication-related problems being adverse drug reactions (35%) or cost issues (25%). The most challenging obstacles to communication included lack of time and lack of professional relationships. The pharmacists' impressions of OHCPs were largely positive. CONCLUSION: Possible strategies to address the identified communication barriers include creation of a universal communication system and establishment of networks between pharmacists and community providers. This study lays the groundwork for future efforts in the field of interprofessional education research and practice, which can be used to improve delivery of community-based care.

Incorporating Oral Health Considerations for Medication Management in Care Transitions.

Transitions of care involve multifaceted considerations for patients, which can pose significant challenges if factors like oral health are overlooked when evaluating medication management. This article examines how oral health factors should be considered in medication management of patients who may be at risk for hospital readmission. This article also explores successes and challenges of a pharmacy consult service integrated into a dental clinic practice, and the opportunities within that setting to improve overall patient outcomes including those related to care transitions.

Let's Work Together: Interprofessional Training of Health Professionals in North Carolina.

Implementation of interprofessional education efforts at Duke University Health System and the University of North Carolina have enhanced teamwork, education, and mentoring for health professional learners and faculty. The IPE initiatives address the critical need for enhanced collaboration among all team members in the evolving health care arena.

Educational outcomes associated with early immersion of second-year student pharmacists into direct patient care roles in health-system practice.

BACKGROUND AND PURPOSE: To assess the educational impact of engaging second professional year student pharmacists in active, direct patient care experiences in health system practice. EDUCATIONAL ACTIVITY AND SETTING: Student pharmacists in their second professional year completed a redesigned, skill-based four-week introductory pharmacy practice experience in health system practice. The immersion consisted of experiences in both operational and clinical pharmacy environments. Students were assessed with skill development checklist assessments. Pre-post surveys were also collected. Data were analyzed using a mixed methods approach. FINDINGS: Twenty-eight student pharmacists were included; of those, 26 completed both surveys (92.9% response rate). Survey results revealed significant increases in 81.8% of operational and 100% of clinical self-efficacy statements (p<0.05) and positive perceptions of the program overall. Overall, findings suggested that student pharmacists developed skills in health system practice while identifying additional areas for emphasized learning. SUMMARY: Student pharmacists engaged in early, hands-on, direct patient care experiences enhanced their skill development in operational and clinical pharmacy practice.

Hotspotting: Development of an Interprofessional Education and Service Learning Program for Care Management in Home Care Patients.

The purpose of this article is to describe a service learning opportunity where interprofessional teams of students worked together to address patients' social determinants of health through home visits. This article describes this process, known as "hotspotting," and presents the development of this project, including collaboration with a local home health agency, recruiting of students, and weekly team meetings for debriefing. Evaluation data, barriers with implementation, and next steps for sustainability are also discussed.

Post-Hospital Discharge Care: A Retrospective Cohort Study Exploring the Value of Pharmacist-Enhanced Care and Describing Medication-Related Problems.

BACKGROUND Medication-related problems occur at high rates during care transitions. Evidence suggests that pharmacists are well-suited to identify and resolve medication-related problems during hospital admission and at discharge. Additional evidence is needed to understand the impact of face-to-face pharmacist visits in primary care after discharge. The purpose of the study was to describe medication-related problems found during face-to-face pharmacist visits in a medical home after hospital discharge.METHODS A retrospective cohort study was conducted within an academic primary care center staffed by family medicine trained physicians that evaluated patients who attended a hospital follow-up visit with pharmacist-enhanced care (N = 86) versus usual care (N = 86). The primary objective was to describe medication-related problems identified by pharmacists using a modified individualized Medication Assessment and Planning tool for patients receiving pharmacist-enhanced care. Secondary analyses were also conducted to compare 30-day and 60-day hospital readmission and emergency department visit rates in those exposed to pharmacist-enhanced care versus those who were not.RESULTS At baseline, the mean hospitalizations in the prior year were 1.1 ± 1.7 (pharmacist-enhanced care) and 0.76 ± 1.2 (usual care), indicating a low initial readmission risk. Of patients receiving pharmacist-enhanced care, 97.7% were found to have at least 1 medication-related problem, with an average of 4.36 medication-related problems per patient. The 30-day readmission rate was lower, but not significantly different between groups (8.1% for pharmacist-enhanced care versus 12.8% for usual care; adjusted odds ratio (OR), 0.47; 95% confidence interval (CI), 0.16-1.36).LIMITATIONS Limitations include the retrospective cohort study design and small sample size. Medication-related problems were identified and collected prospectively during pharmacist visits.CONCLUSION Medication-related problems are ubiquitous after hospital discharge. Larger prospective studies will be needed to understand the potential value of pharmacist-enhanced care during hospital follow-up visits on readmission rates in low-risk patient populations receiving care within a primary care medical home.

Improving Dental Students' Long-Term Retention of Pharmacy Knowledge with "Medication Minutes".

A major challenge in foundational science courses in dental curricula is the application of information from the classroom to a clinical setting. To bridge this gap, the aim of this study was to increase students' learning in a foundational pharmacology course through increasing clinical relevance and using formative assessment. Second-year dental students in an introductory pharmacology course were presented material in a traditional basic science lecture format and in brief examples of pharmacy-generated clinical content (Medication Minutes). Short-term retention was assessed with a series of five post-class session, non-graded quizzes, each containing four questions: two knowledge-based (one from basic science material and one Medication Minute) and two application-based (one from basic science material and one Medication Minute). Ten knowledge-based (basic science material) questions and ten application-based (Medication Minutes) questions were included on exams throughout the semester. The primary outcome was to measure long-term retention using performance on these questions on an assessment the following semester. Additionally, the impact of student engagement on examination performance was evaluated based on the number of quizzes each student completed. Students who completed three or more quizzes (n=43, 53%) were designated as "highly engaged," while students who completed less than three quizzes (n=36, 44%) were defined as "less engaged." Two students (3%) were excluded for not completing the long-term assessment or not consenting to the study. On short-term retention measures, the students performed better on the Medication Minute (M=0.76) than basic science (M=0.58) (p<0.001) material; however, on the in-semester examinations, there was no difference in performance. On long-term retention measures, the students performed better on Medication Minute material (M=0.64) than basic science material (M=0.33) (p<0.001); this was true for both highly engaged and less-engaged students. These results suggest that teaching pharmacology in a clinical context yielded better long-term retention than teaching with a non-clinical focus.

Organizational readiness for change: Preceptor perceptions regarding early immersion of student pharmacists in health-system practice.

PURPOSE: To examine preceptors' perceptions regarding readiness for change pre- and post-implementation of a pilot early immersion program engaging student pharmacists in direct patient care. METHODS: Student pharmacists enrolled in the second professional year of a Doctor of Pharmacy degree program completed a four-week health-system introductory pharmacy practice experience (IPPE) which was modified to include direct patient care roles in operational (drug preparation and dispensing) and clinical (comprehensive medication management) pharmacy environments. Pharmacy preceptors with direct oversight for program implementation completed a pre/post Organizational Readiness for Implementing Change (ORIC) survey and a 50-min interview or focus group post-experience. The ORIC survey evaluates two dimensions of organizational readiness for change - change commitment and change efficacy. Additional items assessed included implementation needs, support, and perceived value of the change. ORIC survey constructs were compared before and after the experience. Interviews and focus groups were audio recorded, transcribed, and evaluated by constant comparative analysis. A mixed methods approach was used to triangulate findings and develop greater understanding of the ORIC survey results. RESULTS: Twenty pharmacy preceptors (37 ± 8 years of age, 60% female, 65% clinical pharmacist position, 70% prior preceptor experience) participated in the study. There were no significant changes in pre/post survey constructs, except for a decline in the perception of organizational change commitment (p < 0.001). Sub-analyses indicated the decline was associated with items assessing individual dedication and individual commitment to the change (p < 0.05 for both). Primary emerging themes from interviews included concerns about implementation requirements, contextual factors of the experience that affected implementation, and varying perceptions about the value of early immersion across preceptor roles. CONCLUSION: As pharmacy curricula immerse student pharmacists in practice earlier in their education, pharmacy departments can utilize the ORIC survey to identify preceptors' commitment and concerns to support the necessary changes for student pharmacist engagement.