Adverse childhood experiences among California student pharmacists.

Introduction: Adverse childhood experiences (ACEs) are associated with higher mental and physical illness and substance use disorders in adulthood. However, little is known about the prevalence of ACEs among student pharmacists and the factors associated with exposure. Our objective was to determine the prevalence of ACEs, resilience, and maladaptive coping strategies among student pharmacists in California. Methods: Student pharmacists from 14 California pharmacy schools completed a 24-item online survey in 2020. This survey instrument comprised the ACEs questionnaire and collected data on the students' demographic characteristics, coping strategies, and resilience. Results: Most respondents were Asian/Pacific Islander (n = 186, 61.0%), female (n = 216, 70.8%), and aged between 25 and 31 years (n = 154, 50.7%). Many (n = 137, 44.9%) students had more than 1 ACE exposure; 66 students (21.6%) had more than 3 ACEs. Many students indicated that they were diagnosed or suspected to be diagnosed with a mental health condition (n = 105, 34.4%) and agreed/strongly agreed that they struggled to manage the workload of pharmacy school (n = 119, 39.9%). Respondents with higher ACE scores (> 3) were more likely to report struggling with managing the workload of pharmacy school, have or suspect having a mental health condition, drink alcohol in the last 12 months, and/or have multiple sexual partners than students with lower ACE scores. Discussion: More than 1 in 5 student pharmacists in this study were exposed to more than 3 ACEs. The student pharmacists' ACE exposure was associated with higher likelihood of mental health conditions and high-risk health behaviors. Further studies are needed to investigate this topic among student pharmacists.

Effectiveness of an analogy-containing video project to reinforce pharmacy students' learning of kidney physiology.

BACKGROUND AND PURPOSE: Kidney physiology is one of the most difficult topics covered in health professions education. This study examined the effectiveness of an analogy-containing video project to reinforce pharmacy students' knowledge of kidney physiology. EDUCATIONAL ACTIVITY AND SETTING: Students were assigned in groups to create a video that used analogy to explain kidney physiology processes. Survey responses, a rubric, and an objective test were used to assess the project's effectiveness. FINDINGS: Students generated various analogies, such as making tea or coffee, cars and roads, and the college application process to explain kidney physiology. Most of the submitted videos successfully met all criteria in the rubric. All students believed that the project was effective, to varying degrees, in reinforcing their knowledge. Weak to moderate positive correlations were found between time spent on the project and perceived effectiveness of use of analogy to accomplish most of the learning objectives investigated. Students reported that the project engaged both lower- and higher-order cognitive skills. Quiz score analysis showed higher average scores of students on physiology-related questions compared to non-physiology items. Notably, this improvement was most marked for bottom-performing students. About 60% of students recommended the use of videos as a class assignment, but only 50% believed that they should be used as an alternative to quizzes. SUMMARY: An analogy-containing video project effectively reinforced student learning of kidney physiology. Further studies are needed to verify the effectiveness of this technique compared to other didactic and learning approaches.

Pharmacy students' perceived barriers to spiritual care: A qualitative study.

Background: Spiritual care (SC) is an important component of whole person care, a goal that many pharmacists embrace. Knowledge about barriers to incorporating SC in pharmacy practice may allow understanding of how to increase its provision. Objectives: The objective of the study was to investigate pharmacy students' perceived personal and professional barriers to incorporating SC in pharmacy practice. Methods: Second-year pharmacy students (n = 62) who attended a required class lecture on SC in healthcare responded to three open-ended questions that explored beliefs about SC in pharmacy practice. Students' responses were thematically analyzed using NVivo. Results: Most (68%) of the students were female; 34% were Asian American. Students identified the following barriers to incorporating SC: limited or lack of time for SC, lack of supervisor and company support for SC, discordant pharmacist-patient spiritual beliefs, discomfort with talking about spirituality, lack of knowledge about spirituality and SC, personal factors, patient refusal of SC, fear of offending patients by discussing spirituality, and pharmacy environment. Conclusion: Major barriers to SC include lack of time for SC, lack of supervisor and company support for SC, and discordant pharmacist-patient spiritual beliefs. Future studies should be conducted to investigate these and other barriers to SC in pharmacy practice.

Pharmacy students' attitudes and beliefs about spirituality and spiritual care in professional education in Zimbabwe.

INTRODUCTION: A majority of Zimbabweans are religious and/or spiritual. Spirituality and spiritual care (SC) are important parts of patient care. The study's objective was to investigate pharmacy students' attitudes/beliefs about spirituality and SC in pharmacy education and practice in Zimbabwe. METHODS: This cross-sectional descriptive nationwide study gathered data from pharmacy students at the University of Zimbabwe (UZ) and Harare Institute of Technology. The 38-item survey measured students' spirituality and SC perspectives and their religious and demographic characteristics. RESULTS: Most respondents were Christian (89%), female (54%), and attended the UZ (63%). Slightly over half agreed/strongly agreed that they "would like to undertake coursework that will make them competent in providing SC to patients" (52%), SC education would improve their clinical performance (51%), and education that promotes spiritual well-being or integration will make them more empathetic and compassionate practitioners (63%). Pharmacy students also believed that more education on spirituality should be given to pharmacy students (48%), SC is an important part of pharmacy practice (74%), "discussing patients' spiritual or religious beliefs can improve the pharmacist-patient relationship" (74%), and anticipated to incorporate spirituality into professional practice upon graduation (50%). CONCLUSIONS: Most pharmacy students in Zimbabwe considered themselves spiritual/religious and had positive perceptions about spirituality and SC in pharmacy education and practice. There was a positive association between students' personal religiosity and their beliefs about SC. Students anticipated that SC would be incorporated into their education and future professional practice and indicated they wanted more education and training to feel competent in SC.

An exploratory qualitative study of pharmacy student perspectives of implicit bias in pharmacy practice.

INTRODUCTION: Implicit biases can contribute to unfair treatment in healthcare and exacerbate healthcare disparities. Little is known about the implicit biases that exist within pharmacy practice and their behavioral manifestations. The purpose of this study was to explore pharmacy student perspectives about implicit bias in pharmacy practice. METHODS: Sixty-two second-year pharmacy students attended a lecture on implicit bias in healthcare and engaged in an assignment designed to explore their thoughts about how implicit bias manifests or may manifest within pharmacy practice. Students' qualitative responses were content analyzed. RESULTS: Students reported several examples in which implicit bias may emerge in pharmacy practice. Various forms of potential bias were identified including bias associated with patients' race, ethnicity, and culture, insurance/financial status, weight, age, religion, physical appearance and language, lesbian, gay, bisexual, transgender, queer/questioning and gender identity, and prescriptions filled. Students identified several potential implications of implicit bias in pharmacy practice including unwelcoming non-verbal behavior on the part of providers, differences in time devoted to interacting with patients, differences in empathy and respect, inadequate counseling, and (un)willingness to provide services. Students also identified factors that could precipitate biased behaviors such as fatigue, stress, burnout, and multiple demands. CONCLUSIONS: Pharmacy students believed that implicit biases manifested in many different ways and were potentially associated with behaviors that resulted in unequal treatment in pharmacy practice. Future studies should explore the effectiveness of implicit bias trainings on reducing the behavioral implications of bias in pharmacy practice.

An online survey to describe pharmacy student spirituality and spiritual care perspectives.

INTRODUCTION: Little is known about student pharmacists' perspectives of spirituality and spiritual care (SC) in pharmacy education and practice. The purpose of this study was to examine student pharmacists' perspectives about spirituality and incorporating SC in pharmacy education and practice. METHODS: Student pharmacists were recruited from two private pharmacy schools in California, one religiously-affiliated and one non-religiously affiliated. A faculty member at each school invited student pharmacists via email or through Zoom (Zoom Video Communications) chat to complete the 37-item online survey through an embedded link. The investigator-designed survey was comprised of 22 items inquiring about spirituality and SC as well as several items assessing demographic and religious characteristics. RESULTS: Participants included 470 student pharmacists (87.2% response rate) who were 28.9 ± 5.7 years old on average. Half of the respondents (50.5%) attended the non-religiously affiliated university. Most of the respondents were female (67%), Christian (67.8%), spiritual (79.2%), and religious (75.2%). They "agreed" or "strongly agreed" that: "understanding patients' spiritual beliefs is an important part of pharmacy practice" (83%), "I would pray with my patients as a pharmacist" (54.8%), "it is appropriate for a pharmacist to have spiritual or religious conversations with patients" (52.9%), and "it is appropriate for a pharmacist to pray with and for patients who request it" (66.9%). These beliefs were positively correlated with self-reported religiosity and spirituality. CONCLUSIONS: Most students considered themselves spiritual and religious and felt that spirituality and learning about SC were important. The respondents' SC perspectives were associated with their religiosity and spirituality.

Perspectives about Spiritual Care in Pharmacy Practice: A Community-based Survey.

Background: Addressing religious and spiritual needs are important components of holistic healthcare. Little is known about the general public's perspectives about pharmacists providing spiritual care (SC). Objectives: To explore how community members perceive, experience, and desire pharmacist-provided SC. Method: IRB approval was obtained for this observational, cross-sectional study. Adults receiving COVID-19 vaccinations at an immunization clinic completed an investigator-designed 33-item online survey. The survey measured respondents' perspectives about and experiences with pharmacist-provided SC, as well as demographic characteristics. Results: Of the respondents (n = 261), 57% were female and 46% were Hispanic/Latino. Most (59%) agreed that their religion/spirituality would be important to them if they were ill; 64% also agreed that it would be helpful for a pharmacist to know about patients' religious/spiritual beliefs pertaining to their healthcare, and 60% agreed that pharmacists should provide SC to patients who request it. While 96% indicated that they had never talked to a pharmacist about a spiritual or religious matter related to their health or medication, 96% also indicated that no pharmacist had asked to pray with them. These results are contextualized perhaps by the finding that 76% reported having no professional relationship with a pharmacist. Conclusion: Respondents often reported an openness to receiving SC from pharmacists. Most respondents, however, had not received SC from a pharmacist. Future studies should be conducted to better understand patient preferences for pharmacist-provided SC.

Pharmacy Students' Perception of an Elective Course on Evidence-based Learning Strategies.

Objective. To examine pharmacy students' perceptions of an elective course on evidence-based learning strategies.Methods. Pre- and post-course survey questionnaires were administered to students who enrolled in an elective course, to determine the learning strategies they used prior to course attendance, track their use of evidence-based learning strategies and observance of healthy lifestyle habits, and assess their perception of the course. A written assignment was given that required students to reflect on the learning outcomes that resulted from their application of evidence-based learning strategies. Mean scores on the pre- and post-course survey were analyzed using a general linear model repeated measures test.Results. The 59 students in this study predominantly used less-effective strategies (eg, re-reading and re-writing of notes) prior to taking the course. They reported increased use of evidence-based learning strategies, particularly retrieval practice and elaboration, and practice of healthy lifestyle habits (ie, enough sleep, exercise, good nutrition) after course completion. Students believed that using the above learning strategies improved their learning and memory and performance on graded assessments, among other benefits. Students had a positive perception of the course.Conclusion. The elective course was associated with increased use of effective learning strategies, adoption of healthy lifestyle practices that aid learning, and increased appreciation for evidence-based learning strategies by the students. Future studies are needed to examine actual learning outcomes and barriers to implementation of evidence-based learning techniques.

Pharmacists' perspectives about spiritual care: A state-wide survey.

BACKGROUND: Patients' religious and spiritual beliefs affect their health behaviors, health outcomes, and interactions with health care providers. Incorporating spiritual support in clinical care contributes positively to patient health outcomes. No known studies have explored spiritual care (SC) within the context of pharmacy practice. OBJECTIVE: To examine pharmacist perspectives about SC, the frequency with which SC is incorporated in pharmacy practice, and the ways that pharmacists provide SC. METHODS: Data were collected using a cross-sectional statewide survey. The 57-item questionnaire was mailed to 1000 randomly selected registered pharmacists in California in 2019. Descriptive statistics, Pearson correlation, independent samples t test, and chi-square tests were used to analyze the data. RESULTS: Most of the 215 respondents were female (57.5%); the average length of work experience was 23.3 years (SD = 14.4). Just over half practiced in an urban setting (51.1%); similarly, half worked with terminally ill patients (50.2%). Most of the respondents were "somewhat" to "very spiritual" (77.8%) and "somewhat" to "very religious" (64.3%). Most pharmacists agreed that pharmacists should know about patients' spiritual concerns that may relate to their health (60.5%), that they should practice in a spiritually sensitive manner (73.4%), and that addressing patients' spiritual concerns improved their mental and physical health (76.7%). Respondents "rarely" to "very often or always" prayed privately for a patient (63.8%) and talked to patients about a spiritual and/or religious topic (51.2%), encouraged a patient to pray (49.3%), referred patients to their clergy or religious leader (39.5%), and prayed with a patient (33.5%). The frequency of spiritual services provided by pharmacists differed by their own spirituality, religiosity, and perception of institutional support (P < 0.05). CONCLUSION: Most of the respondents were spiritual and religious and believed that spirituality is important for their patients. Thus, some provided SC to their patients. Future research is warranted to examine ethically appropriate strategies for pharmacists to provide SC.

Pharmacists' spiritual care perspectives and experiences: Qualitative findings from a statewide survey.

OBJECTIVE: Pharmacists are encouraged to provide whole-person care. Because holistic care is conceptualized as including spiritual care (SC), this study investigated the experiences and perspectives of pharmacists regarding SC in pharmacy practice. METHODS: Data for this cross-sectional, qualitative study were collected from a survey mailed to 1000 randomly selected registered pharmacists in California in 2019. The data reported here are the responses to open-ended questions eliciting information about the last time the pharmacists provided SC to a patient, indicators that a patient needs spiritual assistance, and religious beliefs thought to be harmful. The data were content-analyzed by 2 investigators. RESULTS: Although 215 pharmacists responded to the survey, only 141 responded to the open-ended questions. Most of the respondents were women (58%), Christian (70%), religious (73%), attended religious services (78%), and practiced in an urban setting (56%). The themes observed indicated that these pharmacists prayed with, and for, patients; talked to patients about God and religion; referred patients to spiritual services; were sensitive to patients' spiritual or religious beliefs; and listened to patients' expressions of spirituality. Some respondents, however, avoided religious conversations and requests; some also reported unwillingness to provide SC to patients. The pharmacists had limited education, knowledge, and awareness about SC. CONCLUSIONS: The pharmacists in this sample reported diverse perspectives about SC that ranged from acceptance to rejection of SC in patient care. Pharmacists are not fully engaged in providing SC because of several challenges, including limited education and training on SC. Scholarly inquiry is needed to examine how pharmacists can best provide SC in pharmacy practice.

Factors influencing implementation of personalized prevention plans among annual wellness visit patients using the theory of planned behavior: A quantitative study.

BACKGROUND: The Affordable Care Act provides Medicare Part B beneficiaries access to cost-free Annual Wellness Visits (AWVs). Patients receive health behavior recommendations from a Personalized Prevention Plan (PPP) during AWV encounters. AIMS: To identify factors clinical pharmacists can use to influence adoption of PPPs in primary care practices. METHOD: Utilizing a cross-sectional design, 77 Medicare patients (mean age 74.05 ±â€¯8.04 years) presenting for subsequent AWV completed a theory of planned behavior (TPB) based questionnaire at two primary care practices. RESULTS: 66.2% reported they were in the process of implementing PPPs and 51.9% reported implementing recommendations in the previous 12 months. TPB constructs accounted for 35.8% (p < .001) of the variation in intention, with subjective norm (SN) (ß = 0.359, p = 0.004) as the strongest determinant, followed by attitude (ß = 0.195, p = 0.093), and perceived behavioral control (PBC) (ß = 0.103, p = 0.384). Intention accounted for 27.1% of the variance for implementing PPPs and was not a significant determinant (ß = 0.047, p = 0.917). Addition of past behavior with TPB constructs significantly improved the predictability of the TPB model, accounted for 55% of the variation in intention (p < .001), and demonstrated a significant positive influence (ß = 0.636, p < 0.001) on future PPP implementations. DISCUSSION: This study demonstrates utility of the TPB in predicting implementation of PPPs. CONCLUSIONS: Clinical pharmacists positioned as providers of AWVs can strengthen intention to adopt PPPs by integrating referents into AWV processes, and evaluating past behavior trends to improve future PPP implementation.

Psychosocial factors associated with pharmacists' end-of-life medication counseling and dispensing.

OBJECTIVE: In 2015, California legalized physician-assisted suicide through passing the End of Life Option Act (ELOA). This study aimed to identify and describe the psychosocial factors associated with pharmacists' intention to counsel and dispense end-of-life medications. METHODS: Data were collected using a 51-item questionnaire that was mailed to 2,000 registered community pharmacists in California. The study collected data on TPB constructs (attitude, subjective norm [SN], and perceived behavioral control [PBC]), behavioral and control beliefs, perceived obligation, and demographic and practice characteristics. Hierarchical linear regression was used to identify the factors associated with the pharmacists' intention. RESULTS: A total of 353 responses (19.4% response rate) were received from respondents with an average age of 50.4 ± 14.8 years. Most of the respondents were women (53.1%) and religious (56.4%). Most pharmacies did not currently stock ELOA medications (n = 197, 56.1%), and most pharmacists had never been presented with an ELOA prescription in their practice (n = 319, 90.4%). The pharmacists had a positive intention (mean = 8.24 ± 4.6, range: 2-14), attitude (mean = 17.15 ± 6.9, range: 4-28), SN (mean = 1.1 ± 4.5; range: -9 to 9), and PBC (mean = 1.85 ± 3.5; range: -6 to 6) to dispense ELOA medications. Attitude (ß = 0.570, P < 0.001), SN (ß = 0.238, P < 0.001), and perceived obligation were statistically significant predictors of the pharmacists' intention to dispense ELOA medications for patients with a valid prescription but PBC (ß = 0.022, P = 0.531) was not. CONCLUSION: Interventions to promote pharmacists' counseling and dispensing of ELOA medications should focus on developing strong intention. Improving pharmacists' attitude, SN, and perceived obligation is critical to increasing their willingness to dispense ELOA medications.

Assessing Medicare Patients' Salient Beliefs to Improve Annual Wellness Visit Health Outcomes.

OBJECTIVE: To identify key beliefs that influence behavior, regarding Medicare's Annual Wellness Visit (AWV) and older patients' willingness to implement personalized prevention plans.
DESIGN: Cross-sectional. In-depth semi-structured focus group sessions with Medicare patients in July 2018.
SETTING: Two primary care physician-based practices.
INTERVENTION: A trained moderator facilitated two focus group sessions, and used open-ended questions based on the theory of planned behavior to elicit behavioral, normative, and control beliefs associated with implementing personalized prevention plans.
MAIN OUTCOME MEASURE: Content analysis of the focus groups' transcribed data was used to identify modal salient beliefs. Transcribed focus group sessions were analyzed utilizing grounded-theory methods for emergent themes.
RESULTS: A total of 13 older patients participated in the focus group sessions. Prevalent behavioral beliefs among participants influenced by patient-centered care outcomes included improvement in physical activity, adopting a healthy balanced diet, and weight loss.
Interpersonal and environmental disparities influenced commonly reported control factors such as lack of support at home and affordable fitness facilities. Macro-level influences such as physicians and social marketing by insurance providers, and health partners and spousal support were identified as important normative factors.
CONCLUSION: Identified salient beliefs were congruent to social determinants of health in Medicare patients. Results of the study demonstrate perceived enablers and barriers of elderly patients regarding implementing health-promoting advice. AWV pharmacists should address perceived barriers to improve attitudes and self-efficacy; and incorporate enabling beliefs into adherence strategies to improve adoption of health recommendations.

California Dentists' Opinions of the Interface Between Oral and Overall Health.

This cross-sectional study investigated California dentists' knowledge and opinion of the interface between oral and overall health. A questionnaire and cover letter explaining the purpose of the study were mailed to 1,100 randomly selected California licensed general dentists. The survey measured dentists' knowledge and opinions of the interface between oral and overall health as well as their recommendations for strengthening this interface. Dentists believed that there was minimal interface between oral and overall health care.

Attitudes of Nursing Facilities' Staff Toward Pharmacy Students' Interaction with its Residents.

OBJECTIVE: All Appalachian College of Pharmacy second-year students undertake the longitudinal geriatric early pharmacy practice experiences (EPPE) 2 course, which involves interacting with geriatric residents in two nursing facilities over two semesters. The study investigated the nursing staff's perceptions about the rotation and the pharmacy students' interaction with nursing facility residents. STUDY DESIGN: Cross-sectional study. SETTING: Academic setting. PARTICIPANTS: 63 nursing facility staff. INTERVENTIONS: A 10-item attitude survey administered to nursing staff. MAIN OUTCOME MEASURES: Nursing staff attitude toward pharmacy students' interaction with geriatric residents during the course. RESULTS: Sixty-three responses were received (84% response rate). Most respondents were female (95.2%), who occasionally interacted with pharmacy students (54.8%) and had worked at the facilities for an average of 6.8 years (standard deviation [SD] = 6.7) years. Staff reported that pharmacy students practiced interacting with geriatric residents and nursing facility staff, learned about different medications taken by residents as well as their life as a nursing facility resident. In addition, the student visits improved the mood of residents and staff's understanding of medicines, among others. Staff suggested that students spend more time with their residents in the facility as well as ask more questions of staff. CONCLUSION: The nursing facility staff generally had favorable attitudes about pharmacy students' visits in their nursing facility. Nursing facility staff noted that the geriatric rotation was a great learning experience for the pharmacy students.

A Cost-Benefit Analysis of a Family Systems Intervention for Managing Pediatric Chronic Illness.

Despite recent increases of psychosocial programs for pediatric chronic illness, few studies have explored their economic benefits. This study investigated the costs-benefits of a family systems-based, psychosocial intervention for pediatric chronic illness (MEND: Mastering Each New Direction). A quasi-prospective study compared the 12-month pre-post direct and indirect costs of 20 families. The total cost for program was estimated to $5,320. Families incurred $15,249 less in direct and $15,627 less in indirect costs after MEND. On average, medical expenses reduced by 86% in direct and indirect costs, for a cost-benefit ratio of 0.17. Therefore, for every dollar spent on the program, families and their third payers saved approximately $5.74. Implications for healthcare policy and reimbursements are discussed.

Measuring achievement goal orientations of pharmacy students.

OBJECTIVES: To measure the achievement goal orientations of pharmacy students attending a 3-year (accelerated) doctor of pharmacy (PharmD) program. METHODS: A 16-item survey based on the Achievement Goal Questionnaire (AGQ) was administered to first-year (P1) and second-year (P2) pharmacy students at the Appalachian College of Pharmacy (ACP). Students were instructed to indicate to what degree each statement was true for them using a 7-point Likert scale (1=not true of me, 7=very true of me). RESULTS: One hundred twenty of the 155 students (77%) completed the survey. Most students had mastery-approach, mastery-avoidance, performance-approach, and/or performance-avoidance goal orientations; few had work-avoidance goal orientations. Second-year students and male students had higher work-avoidance mean scores than did P1 students and female students (p<0.05). CONCLUSION: Pharmacy students were mastery- and performance-oriented learners, and most did not have work-avoidance goal orientations. Male students and P2 students had higher work-avoidance than did female students and P1 students, respectively. More longitudinal studies are needed to confirm these findings.

Examination of the use of complementary and alternative medicine in Central Appalachia, USA.

INTRODUCTION: A growing number of people in the USA and worldwide use complementary and alternative medicine (CAM). CAM usage has been reported to differ by region. Little is known about the usage of CAM, especially among the Appalachian region population. The aim of this study is to evaluate the usage of CAM among adults in Central Appalachia. METHODS: A 23-question survey was distributed to 250 participants seeking free medical care at remote area medical events held in Wise County, Virginia in July 2012 and in Buchanan County, Virginia in October 2012. The questions on the survey addressed various aspects concerning CAM: forms of treatment used, frequency of use, main reasons for using CAM, and where they obtained their CAM therapies. The survey also collected demographic characteristics of the respondents. Subjects were asked to complete a two-page survey while waiting for service. RESULTS: A total of 192 (76.8%) responses were useful and complete. About 56% of the CAM users were female and 55% had an annual gross income of less than $20,000. About 49% had used CAM therapies in the past, of which 58% used CAM therapies at least once a month. Respondents used CAM because it worked well (n=52; 27%), had less side effects (n=45; 23%), and was affordable (n=43; 22%). CAM therapies were used mainly to address back pain (n=23; 15.6%), general health and wellbeing (n=22; 14.9%), depression and anxiety (n=11; 7.5%), and general pain (n=11; 7.5%), among others. Having a primary care provider, current level of education, and gross annual income were significantly associated with CAM use (p<0.001). Most respondents (n=94; 85%) were comfortable telling their doctor or other medical personnel about their use of CAM therapies. CONCLUSION: The prevalence of CAM usage among people in the Central Appalachia region was high, and higher than the national average. Most respondents were comfortable sharing their CAM usage information with their healthcare providers. More research is needed to further understand the factors underpinning CAM usage by the Central Appalachia population.

Examination of psychosocial predictors of Virginia pharmacists' intention to utilize a prescription drug monitoring program using the theory of planned behavior.

BACKGROUND: Little is known about the main drivers of pharmacists' intention to utilize prescription drug monitoring programs (PDMPs) when making care decisions and the actual contribution of these factors in explaining intention and behavior. OBJECTIVES: This study examined what theory of planned behavior (TPB) model constructs (i.e., attitude, subjective norm [SN], perceived behavioral control [PBC]), past utilization behavior (PUB) and perceived moral obligation (PMO) were significant predictors of Virginia community pharmacists' intention to utilize a PDMP. METHODS: A cover letter with a link to a 28-item online survey was e-mailed to 600 members of the Virginia Pharmacists Association. Multiple regression analyses were used to determine the association between pharmacists' intention to utilize the PDMP database and attitude, SN, PBC, PUB and PMO. RESULTS: Ninety-seven usable responses were received, for a response rate of 16.2%. A majority of the respondents were Caucasian (96.4%), female (50.5%), working in independent community pharmacies (60.4%) with an average age of 49.5 ± 13.4 years. Overall, pharmacists intended to utilize a PDMP (mean = 5.3 ± 4.6; possible range: -9 to 9), had a positive attitude toward utilizing PDMP (mean = 6.3 ± 5.3; possible range: -12 to 12), perceived that others wanted them to utilize a PDMP (SN score = 3.7 ± 2.4; range: -6 to 6), and believed that they had control over utilization behavior (PBC score = 4.5 ± 4.0; range: -9 to 9). Attitude (ß = 0.723, P < 0.001), SN (ß = 0.230, P = 0.014) and PBC (ß = -0.215, P = 0.026) significantly predicted pharmacists' intent, accounting for 56.7% of the variance in intention to utilize the PDMP database (P < 0.001). The addition of PMO (P < 0.001) significantly contributed to explaining the variance in intention but PUB did not. CONCLUSIONS: Members of the Virginia Pharmacists Association who responded to the survey showed a strong positive intent to utilize PDMP database. Pharmacists' attitudes, subjective norm, perceived behavioral control and perceived moral obligation were significant predictors of intention but past utilization behavior was not. The TPB is a useful theoretical framework when predicting PDMP utilization behavior of community pharmacists, accounting for 56.7% of the variance in intention.

Investigating pharmacy students' attitudes toward nursing facility patients after a geriatric rotation.

OBJECTIVE: To investigate pharmacy students' attitudes toward nursing facility patients and nursing facilities after completing a geriatric rotation. DESIGN: A cross-sectional post-test 20-item survey. SETTING: An academic institution and two nursing facilities. PARTICIPANTS: Nursing facility patients and second-year Appalachian College of Pharmacy students. INTERVENTIONS: Students in Early Pharmacy Practice Experience 2 geriatric course. OUTCOME MEASURES: Students' attitudes toward nursing facility patients and nursing facilities (14 items). RESULTS: Of 138 students, 91.4% completed the survey following their geriatric rotation. Most students had positive attitudes toward nursing facility patients and nursing facilities on all 14 items. For example, students thought, "most older people are pleasant to be with" (mean = 3.88 ± 1.1). About 98% of students had adequate knowledge of geriatrics. Age, gender, marital status, and relationship with grandparents were not associated with students' attitudes (P ≯ 0.05). CONCLUSION: Pharmacy students had positive attitudes toward elderly patients and nursing facilities and adequate knowledge of geriatrics after completing the geriatric rotation.