Curricular Considerations for Preparing Student Pharmacists to Prescribe Hormonal Contraception.

In 2014, the pharmacist's role in the United States expanded to include prescribing hormonal contraception, and this practice is currently addressed by policy in 14 states and the District of Columbia. Training and education requirements for this expanded scope of practice vary between states and are changing rapidly. The objective of this review is to examine how student pharmacists are taught to provide contraceptive care, specifically for prescribing ongoing hormonal contraception and emergency contraception, and to identify potential gaps in the United States pharmacy curricula related to contraception. Despite steady adoption into community pharmacy practice, there is sparse literature assessing educational methods used to teach contraceptive care. This review offers recommendations to promote consistent and comprehensive student pharmacist education in providing contraceptive care across institutions, regardless of state policy status.

Pharmacist contraception services: All about access.

As increasing numbers of U.S. states and jurisdictions grant pharmacists the authority to prescribe contraception, it is essential that pharmacists understand reproductive justice principles. Many structural barriers exist surrounding pharmacist contraception services that limit patient access to and ability to use these services. Pharmacists should offer comprehensive and all-inclusive reproductive health care services and referrals as part of their role as contraception providers.

Life After the Women's Health Initiative: Where Do We Stand?

When the results of the Women's Health Initiative were first published, use of hormone replacement therapy (HRT) in the management of menopausal symptoms dropped drastically. As a result, many women were left with untreated symptoms that cause significant impact on their quality of life. This article will summarize the benefits and risks of HRT, review leading organizational position statements, and highlight ways to support patients in shared decision making to determine if HRT is appropriate to help manage their menopausal symptoms.

PAs' attitudes about adolescent suicide screening: The Theory of Planned Behavior.

OBJECTIVE: Suicide is an increasing public health problem for adolescents and young adults. The purpose of this study was to identify the frequency of physician assistants' (PAs') self-reported adolescent suicide risk assessments and to elicit salient beliefs regarding behavioral attitudes, norm referents, control factors, and intention to conduct suicide risk assessment with adolescents. METHODS: A convenience sample of PAs completed an anonymous cross-sectional questionnaire. Relationships were assessed using bivariate analyses and qualitative theme analysis. RESULTS: Forty-three PAs completed the questionnaire. Many PAs supported suicide risk assessment screening as a strategy to identify adolescents who are suicidal at an earlier stage of their illness; lack of time during the visit and problematic parental involvement were identified as barriers. CONCLUSIONS: PAs recognized that screening adolescents for suicide ideation may help prevent suicides. Their practice behaviors, however, did not correspond to this belief.

Impact of a Simulated Legislative Visit on Student Pharmacists' Political Skill Inventory Scores.

Objective. To assess the impact of a simulated legislative visit on the Political Skill Inventory (PSI) scores of Doctor of Pharmacy (PharmD) students and assess their perceptions of their role as an advocate.Methods. Anonymous pre- and post-intervention surveys were administered online to third year student pharmacists at one school of pharmacy in North Carolina. Measures included gender, age, previous pharmacy experience, engagement in pharmacy organizations, legislative awareness and engagement, political skill inventory, and perceptions of the simulated legislative visit. Data are presented as medians or proportions, where appropriate. Paired t tests and Cohen d were used to analyze the data.Results. Thirty student pharmacists provided complete and matchable results for the pre- and post-intervention surveys (analysis response rate=36%). The mean PSI score was 5.4 before the intervention and increased to 5.7 after the intervention. The networking ability and interpersonal influence subscales showed significant and medium-to-large increases in effect size whereas the social astuteness and apparent sincerity subscales showed low-to-medium increases in effect size. Student pharmacists' agreement with advocacy skills or responsibilities increased overall from pre-to post-intervention.Conclusion. The political skill inventory scores of student pharmacists significantly improved following participation in a simulated legislative visit and listening to a corresponding advocacy lecture. Determining the effectiveness of educational interventions to develop advocacy skills in student pharmacists is essential to ensure efficacy and potential for PharmD students and graduates to make real-world impacts.

Depression Part 3: Medication Related Problems.

When selecting and managing psychoactive medications in older people, it is equally important to focus on avoidance of toxicity as it is to focus on efficacy. Higher psychoactive medication load is associated with increased rate and risk of all cause hospitalization. The medication classes used to treat depression and related comorbidities include antidepressants, antipsychotics, stimulants, mood stabilizers, lithium, anxiolytics and sedative hypnotics. This discussion will examine considerations to help avoid medication related problems relevant to medications used to treat depression in the antidepressant pharmacological class.

Student pharmacists' perceptions regarding pharmacist-prescribed hormonal contraceptives and their professional responsibility.

BACKGROUND: Currently, 13 U.S. jurisdictions allow for pharmacist-prescribed contraception; however, pharmacists' intention to use and ultimate uptake of this patient care opportunity have been variable. OBJECTIVES: The objectives of this study were to (1) identify student pharmacists' attitudes toward pharmacist-prescribed hormonal contraception (HC), (2) identify student pharmacist perceived barriers regarding pharmacist-prescribed HC, and (3) explore what factors affect student pharmacists' viewpoints. METHODS: An anonymous survey was administered using Qualtrics among third-year student pharmacists in a public health course. The survey was developed using the Theory of Planned Behavior (TPB) and previously published literature. TPB was developed to predict an individuals' intention to engage in a behavior at a specific time and place. All responses were anonymous. Survey responses were summarized using descriptive statistics, and Wilcoxon Mann-Whitney test was used to compare differences based on student pharmacist gender and religion. RESULTS: A total of 67 student pharmacists participated in the survey (response rate 80.7%). Most agreed-strongly agreed (n = 59, 88.1%) that pharmacists are capable of appropriately assessing and selecting HC therapies and believe it should be within a pharmacist's scope of practice (n = 53, 79.1%). Similarly, most agreed-strongly agreed that it is a professional responsibility for pharmacists to provide this service (n = 56, 83.6%). Potential barriers identified included limited access to patient medical records (n = 55, 82.1%), interruption to workflow (n = 51, 76.1%), and concerns for a decrease in well-women examinations (n = 51, 76.1%). Most identified with the Christian faith (n = 45, 67.2%) but said this did not influence their opinions (n = 40, 59.7%). Gender, age, and religion were not found to be associated with student pharmacists' attitudes. However, an increasing number of barriers were negatively associated with their attitudes. CONCLUSION: Student pharmacists believe it is within a pharmacist's scope of practice and a professional responsibly to prescribe HC. Student pharmacists were less supportive of pharmacist-prescribed HC if they reported a greater number of barriers.

Opposition to Pharmacist Contraception Services: Evidence for Rebuttal.

Pharmacist contraception services are growing across the United States. Several states have authorized pharmacists to prescribe contraception, and the interest in other states continues to grow. Opposition to these practices exists and centers on discussions related to safety, training, cost, and fragmentation of care. We review these arguments and provide evidence refuting these concerns. Pharmacist-prescribed contraception increases access to care, and patients express interest in utilizing this service at the pharmacy. Pharmacists follow evidence-based recommendations. Counseling on preventative services and referral to other providers is part of contraception care by pharmacists. Training programs have been developed to equip both pharmacy students and pharmacists with the knowledge, skills, and tools needed to successfully provide these services. This article can serve as a guide for pharmacists and advocates when discussing pharmacist-prescribed contraception with policymakers, patients, and other healthcare professionals.

Student Pharmacists' Attitudes Toward Suicide and the Perceived Role of Community Pharmacists in Suicidal Ideation Assessment.

Objective. To determine first-year Doctor of Pharmacy students' attitudes toward suicide and perceptions of the role of the pharmacist in assessing patients for suicidal ideation, and whether their previous pharmacy work experience influences these attitudes and perceptions. Methods. An anonymous online survey was administered to first-year student pharmacists at one school of pharmacy in North Carolina. Measures included gender, previous community pharmacy work experience, personal contact with suicide, and score on the Attitudes Toward Suicide (ATTS) scale. Results. Seventy-three student pharmacists (75%) completed the survey. The vast majority (92%) agreed or strongly agreed that suicide was a real disease. Similarly, most students (79%) agreed or strongly agreed that pharmacists have a professional responsibility to assess for suicidal ideation. There was not a significant association between ATTS score and previous community pharmacy work experience nor the perceived pharmacist's role in assessing for suicidal ideation. Additionally, there was no association between ATTS score and personal contact with suicide. Conclusion. First-year student pharmacists, while undecided on their personal attitudes toward suicide, overwhelmingly agreed that suicide is a disease and that pharmacists have an important role in assessing patients for suicidal ideation. Pharmacy schools should implement training programs to prepare student pharmacists to identify suicidal ideation, design interventions to address student pharmacists' personal beliefs that may impact their ability to provide patient care, and provide students with adequate support skills to care for patients experiencing mental health crises.

Patient and prescriber perceptions of depression screening within a community pharmacy setting.

OBJECTIVES: To determine patient and prescriber perceptions of depression screening within the community pharmacy setting and to assess the best strategies for patient engagement and care coordination. DESIGN: Qualitative semistructured key informant interviews using the Consolidated Framework for Implementation Research as a theoretical framework. SETTING AND PARTICIPANTS: A community pharmacy in the metropolitan Piedmont region of North Carolina from February 2019 to May 2019. Prescriber and patient interviews were audio recorded, transcribed, and independently coded by 2 investigators. A qualitative analysis was completed, with a selection of supporting quotations for each theme. OUTCOME MEASURES: Qualitative analysis of prescriber and patient perceptions of depression screening provided in community pharmacies, strategies for patient engagement, and coordination of care for depression screenings. RESULTS: Twelve patients and 4 prescribers participated in the study. The patient perceptions were categorized into 3 key themes: (1) private and confidential screenings; (2) disparate views regarding the potential interventions that pharmacists could offer; and (3) mental health stigma concerns. The prescriber perceptions were categorized into 3 key themes: (1) support for expanded access to depression screenings provided in community pharmacies; (2) necessity of referral algorithms for transitions of care; and (3) communication of full screening results for positive and negative screens. A mutual theme was identified among patients and prescribers: the view that mental health care provided at a community pharmacy was influenced by an established relationship with a community pharmacist. CONCLUSION: This study describes patient and provider perceptions of depression screening within the community pharmacy setting. Prescribers were supportive of community pharmacists' ability to close the gaps in access to care for patients with mental health conditions, whereas patients had mixed feelings that may have been influenced by concerns of privacy, confidentiality, and stigma. This deeper understanding of prescriber and patient perceptions of how community pharmacies could expand access to depression screening may provide a roadmap for offering these interventions in community pharmacies.

North Carolina community pharmacists' attitudes about suicide and willingness to conduct suicidal ideation assessment: A cross-sectional survey study.

BACKGROUND: Suicide is a major and growing public health problem. Pharmacists are one of the most accessible members of the health care team. Due to their unique place in the health care system, pharmacists may be an ideal resource for monitoring patients at risk of suicide. The objectives of this study were to: (1) investigate community pharmacists' attitudes toward suicide; (2) identify pharmacist-reported barriers to suicidal ideation assessment; and (3) evaluate facilitators and barriers to pharmacists conducting suicidal ideation assessment. METHODS: An anonymous questionnaire was distributed to North Carolina (NC) community pharmacists. Measures included contact with suicide, perceived role in suicidal ideation assessment, Attitudes Towards Suicide (ATTS), and barriers in suicidal ideation assessment. Multivariable logistic regression was used to analyze the data. RESULTS: There were usable and complete data for 225 participants (3.52% response rate). The median ATTS score was 70 (IQR = 7). Community pharmacists were significantly more likely to perform a suicidal ideation assessment at least sometimes when (s)he reported a lower number of barriers (OR = 0.70, 99.5% CI = 0.51-0.98) and when (s)he agreed or strongly agreed that they knew how to help someone who was suicidal (OR = 6.63, 99.5% CI = 1.74, 25.23). The most common barrier to suicidal ideation assessment was lack of education in mental health screening (n = 176). CONCLUSIONS: Suicide prevention education programs for pharmacists may need to address reducing barriers, increasing knowledge about suicide, and improving self-efficacy. Targeting these areas may lead more pharmacists conducting these assessments.

Predictors of performance on the North Carolina Multistate Pharmacy Jurisprudence Examination.

INTRODUCTION: To evaluate an expanded set of variables and determine their association with Wingate University School of Pharmacy (WUSOP) graduates' scores on the North Carolina (NC) Multistate Pharmacy Jurisprudence Examination (MPJE). METHODS: Demographic, pre-admission, pharmacy school, and licensing preparation variables were collected for WUSOP graduates who attempted the NC MPJE for the first time in 2017. Bivariate correlations between student-pharmacist characteristics and the MPJE score were performed. RESULTS: Several variables were found to have a statistically significant association with the NC MPJE score, including prerequisite grade point average, pharmacy coursework, Pharmacy Curriculum Outcomes Assessment performance, and completion of MPJE practice questions. There were no significant associations between NC MPJE scores and demographic characteristics, previous paid pharmacy employment, receipt of undergraduate degree, or Pharmacy College Admission Test scores. CONCLUSION: This exploratory analysis identified characteristics of WUSOP graduates that were associated with performance on the NC MPJE. The results of this study will be communicated with future graduates to enhance their success on the jurisprudence examination.

Papers don't write themselves: Creating a system to support writing productivity.

INTRODUCTION: To be a successful academic writer, we need a strong awareness of the circumstances that support our writing productivity. COMMENTARY: First and foremost, writing requires time-on-task. To obtain focused, effective writing time, we may need to increase our accountability related to writing. In addition, each writer needs a writing system - a set of processes that helps them to reliably complete their writing work. To build an effective writing system, we advocate for observation, reflection, and experimentation related to our writing processes. In particular, examination of the what, where, when, and how of writing is critical. Strategies for optimizing productivity during writing sessions are also needed. IMPLICATIONS: Strengthening writing productivity requires mechanisms for accountability, awareness of our writing process, and strategies to enhance the effectiveness of each writing session.

Drug updates and approvals: 2019 in review.

In 2019, the FDA approved several new drugs for use in primary care. This article highlights the following new drugs: risankizumab-rzaa (Skyrizi); halobetasol and tazarotene (Duobrii); dolutegravir and lamivudine (Dovato); romosozumab-aqqg (Evenity); brexanolone (Zulresso); solriamfetol (Sunosi); aclidinium and formoterol (Duaklir Pressair); and siponimod (Mayzent).

Inviting manuscripts to Leadership Experience and Development Reports (LEADeR).

The Journal announces a new section called "Leadership Experience and Development Reports" within our Short Communications manuscript category. Manuscripts in this section seek to share scholarly activities and experiences within the area of leadership development that are rooted in a leadership framework, model, or theory. Submissions can include work related to student pharmacists, pharmacy residents, fellows, graduate students and faculty/staff development.

Explaining Pharmacy Students' Dispensing Intentions in Substance Abuse-Related Gray Areas Using the Theory of Planned Behavior.

Objective. To examine the extent to which theory of planned behavior (TPB) constructs and demographic characteristics explain pharmacy students' dispensing intentions in ethically or legally gray areas involving potential substance misuse or abuse. Methods. Two cohorts of third-year Doctor of Pharmacy (PharmD) students (n=159) were provided with five written cases describing common "gray area" dispensing scenarios in community practice involving medications and devices with potential for misuse or abuse (eg, long-term buprenorphine maintenance prescription without evidence of tapering, early refill of a narcotic for an out-of-town patient, non-prescription sale of pseudoephedrine). Students completed a 12-item survey instrument for each case. Items assessed whether the student would dispense the medication or device in the given scenario, how many times in 10 similar scenarios the student would dispense the medication or device, attitudes regarding dispensing, and subjective norm and perceived behavioral control beliefs. Results. Wide variation in the percentages of students who would dispense the medications or devices was noted across the five scenarios (14% in the buprenorphine scenario to 61% in the pseudoephedrine scenario). Attitude scores significantly predicted dispensing decisions in all scenarios (p<.001), whereas subjective norm and perceived behavioral control beliefs were significant predictors of dispensing only in select case scenarios. Gender and community pharmacy work experience did not consistently predict dispensing intentions. Conclusion. Student attitudes consistently predicted intent to dispense across five gray practice scenarios. These findings can be used to inform development of educational interventions that influence students' attitudes and self-awareness in community practice decision-making scenarios involving potential substance misuse or abuse.