Needs assessment and impact of mental health training among doctor of pharmacy students.

INTRODUCTION: Mental illness is extremely prevalent, yet many pharmacy students get little exposure to mental health training. The majority of studies assessing mental health training and Mental Health First Aid (MHFA) are focused on undergraduate programs. This study critically evaluated the impact of MHFA on pharmacy students' knowledge, confidence, and perceptions as they pertain to mental health, as well as the appropriateness of MHFA as a training course for pharmacy students. METHODS: There were two parts to this study: (1) a pre-/post-survey that assessed the impact of MHFA on pharmacy students as well as the appropriateness of MHFA for students at this level of education and training and (2) a college-wide survey that assessed the impact of mental health training of any type on confidence in mental health-related skills and the perceived usefulness of mental health training for pharmacy students. RESULTS: Participants of the MHFA portion of the study demonstrated a statistically significant improvement in knowledge of mental health-related topics and confidence to interact with someone experiencing mental illness (P < .05) after completing the MHFA course. Perceptions of mental illness did not improve significantly following a single training. The college-wide survey (N = 275) revealed a significantly higher confidence level among students who had previously completed any mental health training program compared to those who had not (P < .05). CONCLUSIONS: MHFA training significantly increased students' knowledge and confidence in approaching and interacting with persons experiencing mental illness.

Impact of a pilot elective course to address student pharmacist well-being.

INTRODUCTION: Survey results from 2016 and 2018 at the University of Michigan College of Pharmacy highlighted mental health concerns for the student population, including struggles with depression, anxiety, and academic distress. This led to creation of a pilot well-being elective course for first year doctor of pharmacy students. This article describes how this course was assessed and adapted for the future. METHODS: The well-being elective course used a course-specific survey and the Brief Inventory of Thriving to assess student outcomes. The course-specific survey was based upon the course objectives and the University of Michigan Common Agenda for Well-Being. Both surveys were given pre- and post-course to identify change. RESULTS: Course survey results illustrated an improvement in student well-being over a single semester. Compared with pre-course responses, students who completed the course were significantly more likely to agree with statements indicating they had strong time management skills, resilience to manage the fluctuations of life, were able to make thoughtful choices to reduce harm and promote well-being, and overall rated their well-being as excellent. Additionally, nearly all students felt a sense of strengthened community with peers and faculty within the course, better able to recognize or refer a peer for help, and felt the course contributed to their overall well-being. CONCLUSIONS: Implementation of this well-being elective pilot course provided students the tools and resources to improve upon their overall well-being in an effort to address anxiety, depression, and academic distress.

Career and professional development services for pharmacy students.

INTRODUCTION: As the number of pharmacy programs and graduates continue to rise, pharmacy students are being faced with new challenges in seeking post-graduate positions. A Career Connections program was established as part of the student affairs office to develop, implement, and evaluate career and professional development at the University of Michigan College of Pharmacy. The objective of this paper was to evaluate student perceptions and value of career and professional development services in preparing students for competitive job and residency markets. METHODS: An electronic survey was administered to second-, third-, and fourth-professional year students and 2017 graduates to evaluate all facets of career and professional development services offered by the college of pharmacy. RESULTS: The majority of students (76.8%) were satisfied with their access to career development services. Of all the services and events evaluated, students were most satisfied with the internship panel, fourth-year residency seminars, and third-year professional development elective course. Additional services recommended by students included more networking opportunities with alumni, continued exposure to different careers in pharmacy, and more emphasis on the job searching process. CONCLUSIONS: Career development services were generally perceived favorably. The college has implemented several changes based on feedback from students, including splitting students into career-based tracks in the professional development elective and adding additional job-searching seminars. Future initiatives will include increasing outreach to college alumni. Career and professional development services at pharmacy programs should be continuously evaluated in a rapidly changing post-graduate landscape.

Pharmacy Phamilies as a Component of a Co-Curricular Program for Doctor of Pharmacy Students.

BACKGROUND: Pharmacy student professional growth depends heavily on co-curricular involvement, in addition to classroom learning. Co-curricular programming can be supported by an innovative structure using self-directed learning and a unique mentorship process. INNOVATION: A novel faculty and peer mentorship structure, called Pharmacy Phamilies, is integrated into a credited Lifelong Learning course that spans the 4 years of our PharmD program. This course is comprised of student-chosen activities to meet requirements in six domains, as well as reflections and other assignments. Recent changes include a new Pharmacy Phamily group reflection process and the use of co-curricular logs to document student activities. FINDINGS: Based on a student survey, the majority of respondents were satisfied with their level of engagement with their Pharmacy Phamily (72%) and with their advisor (76%). The majority also reported that the Pharmacy Phamily program is meeting its goals of establishing a sense of community at the college (76%) and enhancing students' professional development (72%). A total of 86% of students preferred the Pharmacy Phamily group reflection over the former six individual reflections and 93% of students agreed the co-curricular log was a useful tool to document involvement in professional activities. CONCLUSION: Pharmacy Phamilies and peer-reviewed, group reflection can provide an inclusive structure of support and social connection for students at the college of pharmacy.

Impact of a Pharmacy Student Organization on the Admissions Experience and Student Professional Development.

Objective. To evaluate the impact of a program which integrated student pharmacists into the admissions process on pharmacy school candidates' perceptions of the program and on participants' professional development. Methods. An anonymous survey regarding the pharmacy school admission process was sent to candidates following their visit to campus and interviews from fall 2014 through spring 2017. A second survey of all student pharmacists enrolled in January 2018 was conducted to assess the impact of a student-led organization, Pharmacy Student Ambassadors (PSA), on their professional development. Results. The response rate for the survey completed by candidates was 66% (335/504) and the response rate for the survey completed by enrolled student pharmacists was 50% (166/330). Almost all of the candidates were satisfied with the admissions process (96%, 322/335). They cited the welcoming and friendly environment and opportunity to interact with student pharmacists as the best aspects of the admissions process. In the survey of enrolled students, the majority of PSA volunteers agreed or strongly agreed with statements regarding their organization's influence on professional development (76%), enhancing communication skills (77%), self-reflection (78%), and feeling respected and valued (73%). Furthermore, the majority of student pharmacists agreed or strongly agreed that participation in the PSA positively impacted their own admissions process (87%), made interviewees more at ease and comfortable (88%), increased their knowledge and understanding of the culture in the program (82% and 75% respectively), and influenced their personal decisions to attend the University of Michigan College of Pharmacy (63%). Conclusion. Student pharmacist involvement in the admissions process was correlated with pharmacy school candidate satisfaction and contributed to enrolled students' positive perceptions regarding their professional development.

Evaluation of peer-led study groups in a PharmD program.

INTRODUCTION: Academic support in the form of formal, peer-led study groups was initiated at a four-year college of pharmacy utilizing paid group facilitators and a student program coordinator under the direction of the Associate Dean for Student Affairs. This study's purpose was to assess the first year of this program from the viewpoints of the student participants, study group facilitators, and faculty. METHODS: Student, study group facilitator, and faculty perceptions of the study group initiative were collected following the first year of operation via cross-sectional surveys and qualitative content analysis. Surveys addressed the perceived value of study groups and their impact on study habits, supportive relationships, and professional growth. A five-point Likert scale was used to note participants' level of agreement with each survey item, while open-ended questions gathered subjective feedback. The mean, standard deviation, and frequency were calculated for each survey item across the three participant groups and qualitative themes from free-responses were identified. RESULTS: Student survey responses overwhelmingly supported the value and continuation of study groups (93% to 100% agreed or strongly agreed), with both participants and facilitators expressing enthusiasm for the program. Facilitators felt adequately trained (85.7%) and that their roles positively influenced their professional development (85.7% to 100%). Faculty respondents agreed that the program was valuable and should be continued. CONCLUSIONS: Overall, students and facilitators perceived study groups to be valuable in supporting the academic success of pharmacy students.

Assessment of mental health in doctor of pharmacy students.

INTRODUCTION: Pharmacy student mental health is of increasing concern to faculty, administrators, and students. The objectives of this study were to investigate the mental health of doctor of pharmacy (PharmD) students at a four-year college of pharmacy (COP), compare components of mental health of PharmD students to the general university campus students, and examine the relationship between academic distress and specific components of mental health. METHODS: The mental health status of PharmD students was measured using the Counseling Center Assessment of Psychological Symptoms (CCAPS-62), a validated survey tool assessing eight subscales of mental health. Comparisons were made within the PharmD student population and to the general campus population at the same university, who were surveyed during the same time period. Statistical analysis included a series of univariate regressions and chi square testing. RESULTS: Fifty-eight percent of PharmD students (193/332) voluntarily participated in the study. Over 25% of PharmD students scored in the high severity range for depression, generalized anxiety, academic distress, and eating concerns. Academic distress scores were significantly worse for second-year PharmD students, while hostility scores were significantly worse for third-year PharmD students. Correlations were identified between academic distress and depression, generalized anxiety, and social anxiety. PharmD scores in several subscales were significantly worse than the general campus population. CONCLUSION: High academic stress levels and poor mental health outcomes were observed in PharmD students. Identification and implementation of methods to reduce the psychological distress of PharmD students are needed.

Analysis of Medications Returned During a Medication Take-Back Event.

A medication take-back event was held in Lansing, MI, USA, for four hours in September 2013. The objective was to quantify medication waste by determining the ratio of medication units remaining versus dispensed and to identify therapeutic classes with greater ratios of remaining medication units. Drug name, strength, quantity remaining, quantity dispensed, dispensary source, and brand or generic were recorded from the label of each medication container returned. Out of the over 3600 medication containers collected, this study analyzed 2459 containers, which included 304 controlled substances. On average, 66 percent of the medications dispensed in these containers were unused, and therefore wasted. Immunologic medications had the lowest quantity of waste at 54%, while geriatrics/miscellaneous therapeutic class yielded the highest quantity of waste at 79%. The most common therapeutic classes collected were pain/spasm, cardiovascular, and mental health. Greater emphasis on patient education regarding medication adherence and health care professionals' judicious prescribing habits is warranted to reduce the frequency of unused medications. The increased accessibility to medication return sites may alleviate the prevalence of medication accumulation, environmental damage, and medication misuse.

Polypharmacy and medication-related complications in the chronic kidney disease patient.

PURPOSE OF REVIEW: Medication-related problems are very common in patients with chronic kidney disease (CKD). Identification, prevention and management of these problems require a comprehensive, interdisciplinary approach. This article reviews the recent literature regarding medication-related problems in CKD and proposes initiatives for addressing these problems through a structured review process and use of patient-centered adherence-promoting strategies. RECENT FINDINGS: Pharmacist-conducted medication review and intervention programs are successful at identifying and resolving medication-related problems in CKD patients. These programs are associated with a reduction in the number of medications and frequency of hospitalization, and are associated with maintenance of quality of life. However, adherence continues to be a major medication-related problem in CKD care. SUMMARY: Structured medication review and assessment of adherence assist in identification and resolution of medication-related problems in CKD. More research is needed on successful methods to improve medication adherence and related health outcomes.

An advanced pharmacy practice experience in transitional care.

OBJECTIVES: To implement and assess a 4-week advanced pharmacy practice experience in transitional care. DESIGN: Students participated in the transitional care planning of patients being discharged from 4 general medicine services. Students interviewed patients; assessed discharge medications; reconciled preadmission and discharge medications; provided medication counseling; and conducted postdischarge follow-up by phone to assist patients with medication-related problems and identify additional concerns. ASSESSMENT: Student involvement increased the number of patients who could be assessed and interviewed by the pharmacist preceptor from 10 patients/day to 15 to 20 patients/day. Students strengthened their provider-patient and provider-provider communication skills and developed skills in identifying and resolving barriers to medication adherence. CONCLUSION: This transitional care APPE provided students an opportunity to gain experience and self-confidence in the application of pharmaceutical care skills in a transitional care setting, while also providing valuable patient care services to the hospital.

Strategies for reducing polypharmacy and other medication-related problems in chronic kidney disease.

Medication-related problems are very common in patients with chronic kidney disease (CKD). These problems are often avoidable and can result in detrimental patient consequences and high financial costs. Despite these risks, it is often medically necessary to prescribe multiple medications to treat the comorbid conditions that accompany CKD. In addition, patients' use of nonprescription medications and changes in pharmacokinetic and pharmacodynamic parameters may further contribute to medication-related problems in CKD, including drug interactions and the need for dosage adjustments. A structured medication assessment process is one approach to reducing the risks associated with medication-related problems. This multifaceted process involves a comprehensive medication history interview, structured therapy assessment, and open communication between members of the medical team. A detailed description of this process is provided to aid healthcare providers in addressing this important issue.

Safety and tolerability of intravenous ferric carboxymaltose in patients with iron deficiency anemia.

There is limited safety information about ferric carboxymaltose (FCM), a new intravenous iron preparation. This randomized, crossover study compared the safety and tolerability of double-blinded intravenous doses of FCM or placebo in patients with iron deficiency anemia. Subjects (559) with iron deficiency anemia received a dose of either FCM (15 mg/kg, maximum 1000 mg) over 15 minutes or placebo on day 0. On day 7, subjects received the other agent. Safety evaluations were performed on days 7 and 14. The primary endpoint was the incidence of treatment-emergent adverse events during each 7-day study period. During the first 24 hours and during the 7-day treatment period, at least one treatment-emergent adverse event was experienced by 15.0% and 29.3% of subjects after FCM and 11.4% and 19.7% after placebo, respectively. Most were classified as Grade 1 or 2. Six subjects had Grade 3 treatment-emergent adverse events after FCM and 9 subjects after placebo. One subject had a Grade 4, and 1 subject had a Grade 5 treatment-emergent adverse event, but neither was considered study drug-related. During the first 24 hours of the treatment period, drug-related adverse events were reported in 9.3% of subjects receiving FCM and 4.8% receiving placebo. Of drug-related Grade 3 events, 4 subjects received FCM and 5 subjects received placebo. Administration of FCM (15 mg/kg, maximum of 1000 mg) over 15 minutes was well tolerated and associated with minimal risk of adverse reactions in patients with iron deficiency anemia.

Prescription of antihypertensive agents to haemodialysis patients: time trends and associations with patient characteristics, country and survival in the DOPPS.

BACKGROUND: Haemodialysis patients were studied in 12 countries to identify practice patterns of prescription of antihypertensive agents (AHA) associated with survival. METHODS: The sample included 28 513 patients enrolled in DOPPS I and II. The classes of AHA studied were beta blocker (BB), angiotensin-converting enzyme inhibitor (ACEI), angiotensin receptor blocker (ARB), peripheral blocker, central antagonist, vasodilator, long-acting dihydropyridine calcium channel blocker (CCB), short-acting dihydropyridine CCB and non-dihydropyridine CCB. To reduce bias due to unmeasured confounders, the associations with mortality were assessed by separate Cox models based on patient-level prescription and facility prescription practice. RESULTS: An increase in prescription of ARBs (9.5%) and BBs (9.1%) was observed from DOPPS I to II. Prescription of AHA classes varied significantly by country, ranging for BBs from 9.7% in Japan to 52.7% in Sweden and for ARBs from 5.5% in Italy to 21.3% in Japan in DOPPS II. Facilities that treated 10% more patients with ARBs had, on average, 7% lower all-cause mortality, independent of patient characteristics and the prescription patterns of other antihypertensive medications (P = 0.05). Significant and independent associations with reduction in cardiovascular mortality were observed for ARBs (RR = 0.79; P = 0.005) and BBs (RR = 0.87, P = 0.004) in analyses of patient-level prescriptions. These associations in the facility-level model followed the same direction. CONCLUSIONS: DOPPS data show large variations across countries in AHA prescription for haemodialysis patients. The data suggest an association between ARB use and reduction in all-cause mortality, as well as with the use of BBs and reduction in cardiovascular mortality among haemodialysis patients.

Diuretic use, residual renal function, and mortality among hemodialysis patients in the Dialysis Outcomes and Practice Pattern Study (DOPPS).

BACKGROUND: Information about residual renal function (RRF) and outcomes associated with practices of diuretic use in patients with end-stage renal disease is not available worldwide. METHODS: Diuretic use was investigated in 16,420 hemodialysis patients from the Dialysis Outcomes and Practice Patterns Study, a prospective observational study of hemodialysis patients selected from nationally representative facilities on 3 continents. Logistic regressions were used to investigate associations between diuretic use and patient characteristics. Outcomes of interdialytic weight gain, increased serum potassium and phosphorus levels, and odds of retaining RRF after 1 year were investigated. Cox regression was used to analyze the association between mortality and diuretic use. RESULTS: Facility diuretic use varied substantially from 0% to 83.9% of patients. Diuretic use decreased sharply after the start of dialysis therapy. Loop diuretic use ranged from 9.2% in the United States to 21.3% in Europe, whereas use within 90 days of starting dialysis therapy ranged from 25.0% in the United States to 47.6% in Japan. Diuretic use was associated with lower interdialytic weight gain and lower odds of hyperkalemia (potassium > 6.0 mmol/L). Patients with RRF on diuretic therapy had almost twice the odds of retaining RRF after 1 year in the study versus patients not on diuretic therapy. Patients administered diuretics had a 7% lower all-cause mortality risk (P = 0.12) and 14% lower cardiac-specific mortality risk (P = 0.03) versus patients not administered diuretics. CONCLUSION: Variation exists in facility practices of diuretic use. In patients with RRF, there may be benefit associated with continuing diuretic use rather than automatically discontinuing diuretic therapy at dialysis initiation.

Sexual dysfunction in dialysis patients treated with antihypertensive or antidepressive medications: results from the DOPPS.

BACKGROUND: The relationship between medication prescription and sexual dysfunction (SD) in dialysis patients is unclear. METHODS: We studied antihypertensive and antidepressive agents prescribed for 7346 patients in the Dialysis Outcomes and Practice Patterns Study phase 1 (DOPPS I) and 8891 patients in DOPPS II. At baseline, DOPPS I patients completed a quality of life survey, including four questions about sexual functioning, from which we created a composite SD scale. DOPPS II patients were asked only one question about SD. We examined predictors of SD with logistic regression, using numerous patient characteristics, comorbid conditions and additional variables. RESULTS: Reported SD ranged from 66.4% (France) to 84.5% (Spain). The mean composite SD score ranged from 6.4 (Spain) to 7.9 (Germany) (on a 3-15 scale). Peripheral alpha-blockers increased odds of DOPPS I patients having their sex life bothered by end-stage renal disease (ESRD) (OR=1.18), and there were elevated odds of arousal problems with central antagonists, loop diuretics and peripheral alpha-blockers (OR=1.19, 1.24 and 1.29, respectively). Selective serotonin reuptake inhibitors (SSRIs) and benzodiazepines increased odds of problems with enjoyment (OR=1.59 and 1.26, respectively) and arousal (OR=1.70 and 1.24, respectively), and having sex life bothered by ESRD (DOPPS I: OR=1.36 and 1.24; DOPPS II: 1.30 and 1.31, respectively). Vasodilators reduced the odds of sexual enjoyment problems (OR=0.75). Composite SD scores worsened with peripheral alpha-blockers (+0.41), tricyclics (+0.78), SSRIs (+0.80) and benzodiazepines (+0.50), but not with vasodilators (-0.57). CONCLUSIONS: Awareness of associations between SD and prescribed medications may offer opportunities for intervention.

Large variations in prescriptions of gastrointestinal medications in hemodialysis patients on three continents: the Dialysis Outcomes and Practice Patterns Study (DOPPS).

Little is known about proton pump inhibitor (PPI) or H(2) receptor antagonist (HA) prescription patterns or regarding use of predictors in hemodialysis patients. Proton pump inhibitor and HA prescribing patterns were investigated in 8628 hemodialysis patients from seven countries enrolled in the prospective, observational Dialysis Outcomes and Practice Patterns Study. Logistic regression examined predictors associated with PPI and HA use, adjusting for age, sex, country, time with end-stage renal disease, medications, 14 comorbid conditions, and the association between the number of comorbid conditions and the prescription of gastrointestinal (GI) medications. In a cross-section from February 1, 2000, 3.4% to 36.9% of patients received an HA and 0.8% to 26.9% took a PPI, depending upon the country. From 1996 to 2001, the prescription of HAs declined while PPI use increased. Facility use of HAs and PPIs ranged from 0% to 94% of patients. H2 receptor antagonist or PPI use was significantly and independently associated with age, narcotic use, corticosteroids, acetaminophen, nonsteroidal anti-inflammatory drugs, tricyclic antidepressants, selective serotonin reuptake inhibitors, coronary artery disease history, cardiovascular diseases other than hypertension or congestive heart failure, peripheral vascular disease, pulmonary disease, and GI bleed. Proton pump inhibitors or HAs were more likely to be prescribed in Italy, Spain, and the United Kingdom than in the United States. The odds of PPI prescription increased if serum phosphorus <5.5 mEq/L or serum albumin <3.5 g/dL. Prescription of GI medications was associated with many comorbidities and use of several medications. Extreme variability of prescription patterns suggests that there is no standard approach in treatment practices.

HMG-coenzyme a reductase inhibitor use is associated with mortality reduction in hemodialysis patients.

BACKGROUND: Cardiovascular disease is the most common cause of mortality in patients with end-stage renal disease. Cardiovascular benefits of 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) have been clearly established in the general population, but not in dialysis patients. This study examined statin prescription patterns and assessed the relationship between statin prescription and clinical outcomes in hemodialysis (HD) patients. METHODS: Data were analyzed from the Dialysis Outcomes and Practice Patterns Study, a prospective observational study of HD patients randomly selected from representative dialysis facilities in France, Germany, Italy, Spain, the United Kingdom, Japan, and the United States. Predictors of statin prescription were investigated by means of logistic regression. Cox regression models tested the association between statin prescription and risk for mortality and cardiac events, with adjustments for common demographic factors and comorbid conditions. RESULTS: Statins were prescribed for 11.8% of HD patients overall. Most facilities (81.2%) prescribed statins to less than 20% of their patients. Patients prescribed statins had a 31% lower relative risk for death compared with those not prescribed statins (P < 0.0001). Statins were associated with a 23% lower cardiac mortality risk (P = 0.03) and a 44% lower noncardiac mortality risk (P < 0.0001). At a facility level, prescribing statins was associated with lower overall mortality rate, with a 5% lower risk for every 10% increase in number of patients prescribed statins within the facility (P = 0.02). CONCLUSION: Statin prescription is associated with reduced mortality in HD patients, providing additional support for the value of statin therapy in this patient group.

Screening for depression in hemodialysis patients: associations with diagnosis, treatment, and outcomes in the DOPPS.

BACKGROUND: Depressive symptoms and depression are the most frequent psychologic problems reported by hemodialysis patients. We assessed the prevalence of depressive symptoms and physician-diagnosed depression, their variations by country, and associations with treatment by antidepressants among hemodialysis patients. We also assessed whether depressive symptoms were independently associated with mortality, hospitalization, and dialysis withdrawal. METHODS: The sample was represented by 9382 hemodialysis patients randomly selected from dialysis centers of 12 countries enrolled in the Dialysis Outcomes and Practice Patterns Study (DOPPS II). Depressive symptoms were assessed by the short version of the Center for Epidemiological Studies Depression Screening Index (CES-D), using > or =10 CES-D score as the cut-off value. RESULTS: Overall prevalence of physician-diagnosed depression was 13.9%, and percentage of CES-D score > or =10 43.0%. While the smallest prevalence of physician-diagnosed depression was observed in Japan (2.0%) and France (10.6%), the percentage of CES-D score > or =10 in these counties was similar to the whole sample. Patients on antidepressants also varied by country, 34.9% and 17.3% among those with physician-diagnosed depression and CES-D scores > or =10, respectively. In Cox models adjusted for several comorbidities, CES-D scores > or =10 were associated with significantly higher relative risks (RR) of death (RR = 1.42; 95% CI = 1.29 to 1.57), hospitalization (RR = 1.12; 95% CI = 1.03 to 1.22), and dialysis withdrawal (RR = 1.55; 95% CI = 1.29 to 1.85). CONCLUSION: The data suggest that depression is underdiagnosed and undertreated among hemodialysis patients. CES-D can help identify hemodialysis patients who are at higher risk of death and hospitalization. Interventions should target these patients with the goal to improve survival and reduce hospitalizations.