Characterization of doctor of pharmacy/health informatics dual degrees in the United States.

INTRODUCTION: Health care is trending towards an increasing reliance on data management, technology, analytics, and automation which is also reflected in pharmacy education. This study aimed to identify and characterize doctor of pharmacy (PharmD)/master of science in health informatics (MSHI) dual-degree offerings at pharmacy institutions within the United States (US). METHODS: A list of PharmD/MSHI programs was obtained from the American Association of Colleges of Pharmacy and the Pharmacy College Application Service. Furthermore, websites of the 143 accredited schools and colleges of pharmacy in the US were inspected to identify additional PharmD/MSHI dual degrees not identified with the previous sources and to verify that the dual degree was being actively offered at each institution. A 26-item questionnaire focusing on program structure, admissions, and output was developed and administered to program representatives via phone interview. Descriptive statistics were calculated. RESULTS: Thirteen schools offering a PharmD/MSHI dual degree were identified, of which 10 participated (response rate = 77%). All programs were created within the last 10 years. Programs were similar in terms of admission requirements such as grade point average thresholds and standardized testing. Variances existed in program structure and output, such as accreditation status and number of enrollees/graduates. CONCLUSIONS: Although health informatics has become more prominent in health care, health informatics education is not yet as pervasive in the pharmacy field. The information collected may be useful for schools considering implementing or modifying their own dual degree program or for students who are interested in health informatics-specialized educational opportunities.

Pharmacy students' personal and professional use of social media.

INTRODUCTION: Current literature does not describe behaviors or the overarching opinion of pharmacy students on the use of different types of social media for personal and professional purposes. The objectives of this study were to identify predominant beliefs among pharmacy students regarding use of social media for professional and personal purposes, characterize pharmacy students' opinions on the effects of social media on their professional career, and determine pharmacy students' perceptions of using social media as tools for learning and discovery. METHODS: A self-administered questionnaire was administered to pharmacy students at Auburn University (N = 450) and Lipscomb University (N = 212). Linear regression was performed to predict students' perceptions of the importance of social media to their future professional life. RESULTS: The leading platforms commonly used by students for personal reasons were Facebook (92.5%), Instagram (70.5%), and Snapchat (70.5%). The most popular platforms used for professional reasons included LinkedIn (40.4%), Facebook (35.4%), and YouTube (29.2%). About 50% of respondents perceived social media to be important to their future professional life as pharmacists. Most students used YouTube and Wikipedia while studying or learning. The regression model predicting students' perceptions of the importance of social media to their future professional life was significant. CONCLUSIONS: Pharmacy students most commonly use Facebook, Instagram, and Snapchat for personal reasons, and LinkedIn, Facebook, and YouTube for professional reasons. Educators may leverage YouTube and wikis to support the education of pharmacy students. Pharmacy students appear to be more aware and active with security settings than previously reported.

Effect of mobile text messages on antiretroviral medication adherence and patient retention in early HIV care: an open-label, randomized, single center study in south Florida.

BACKGROUND: People with HIV (PHIV) with limited access to health services often experience suboptimal antiretroviral therapy (ART) adherence. We investigated whether a daily text messaging intervention improves ART adherence and retention in early HIV care in PHIV in a south Florida hospital-based clinic. METHODS: ART-naïve PHIV receiving care through the clinic's Ryan White HIV/AIDS Program were enrolled and randomly assigned to the intervention or control groups with a 1:1 ratio. The intervention group received a 1-way text message daily and the control group received standard care without receiving text message reminders for 6 months. HIV RNA and CD4 cell count were measured at baseline and post-intervention. Adherence to ART was defined as a visual analog scale of ≥ 90%. Retention in care was defined as continued engagement at study end. RESULTS: 94 ART-naïve patients were randomized and 83 (85.6%) completed the study, of which 44 were in the intervention group and 39 were in the control group. At the end of the 6-month study period, adherence to ART was 84.4% in the intervention group versus 73.5% in the control group (OR, 1.9; 95% CI 0.7-5.0; p = 0.194). Retention in care significantly improved in the intervention group compared to the control group with the odds of retention increasing by 20% (OR, 1.2; 95% CI 1.1-1.5; p = 0.006). Undetectable HIV RNA (< 50 copies/mL) was 86.7% in the intervention group versus 73.5% in the control group (OR, 2.3; 95% CI 0.8-6.9; p = 0.112). A significant increase in CD4 cell count and a decrease in HIV RNA were found at study end, with no differences between the two groups. CONCLUSIONS: In this pilot study, a one-way daily text messaging intervention did not improve ART adherence over a 6-month study period, but significantly enhanced patient retention in early HIV care. Implementation of interventions to improve adherence in this population is required.

The Florida Mobile Health Adherence Project for People Living With HIV (FL-mAPP): Longitudinal Assessment of Feasibility, Acceptability, and Clinical Outcomes.

BACKGROUND: For people living with HIV (PLWH), antiretroviral therapy (ART) adherence is crucial to attain better health outcomes. Although research has leveraged consumer health information technologies to enhance ART adherence, no study has evaluated feasibility and clinical outcomes associated with the usage of a commercially available, regularly updated mobile health (mHealth) app for improving ART adherence among PLWH. OBJECTIVE: This study aimed to assess the feasibility, acceptability, and clinical outcomes of Care4Today, an existing, free, biprogrammatic mHealth app for improving ART adherence among PLWH. METHODS: The Florida mHealth Application Adherence Project (FL-mAPP) was a 90-day longitudinal pilot study conducted in 3 public HIV clinics in Florida, United States. After obtaining informed consent, 132 participants completed a survey and then were given the option to try an existing mHealth app to help with ART adherence. Of these, 33.3% (44/132) declined, 31.1% (41/132) agreed but never used the app, and 35.6% (47/132) used the app. All were asked to complete follow-up surveys at 30 days and 90 days after enrollment. Usage data were used to assess feasibility. Clinical outcomes of self-reported ART adherence and chart-obtained HIV viral load and CD4+ T-cell counts were compared among those who used the platform (users) versus those who did not (nonusers). Participants and HIV care providers also provided responses to open-ended questions about what they liked and did not like about the app; comments were analyzed using thematic analysis. RESULTS: Of 132 participants, 47 (35.6%) and 85 (64.4%) were categorized as users and nonusers, respectively. Among users, a Kaplan-Meier plot showed that 25 persons (53%) continued using the app after the 90-day follow-up. At 30-day follow-up, 13 (81.3%) of those who used the mHealth app reported ≥95% ART adherence, compared with 17 (58.6%) nonusers (P=.12). Overall, 39 (82%) users liked or somewhat liked using the platform. Participants' favorite features were medication reminders, ability to create custom reminders, and adherence reports. CONCLUSIONS: This longitudinal study found that a commercially available medication adherence mHealth app was a feasible and acceptable intervention to improve ART adherence among PLWH and engaged in clinical care across 3 public HIV clinics in the state of Florida. Overall, participants liked the Care4Today app and thought the medication reminders were their favorite feature. Generally, self-reports of ART adherence were better among users than nonusers, both at 30- and 90-day follow-ups. Further clinical research needs to address user fatigue for improving app usage.

'Fit-for-purpose?' - challenges and opportunities for applications of blockchain technology in the future of healthcare.

Blockchain is a shared distributed digital ledger technology that can better facilitate data management, provenance and security, and has the potential to transform healthcare. Importantly, blockchain represents a data architecture, whose application goes far beyond Bitcoin - the cryptocurrency that relies on blockchain and has popularized the technology. In the health sector, blockchain is being aggressively explored by various stakeholders to optimize business processes, lower costs, improve patient outcomes, enhance compliance, and enable better use of healthcare-related data. However, critical in assessing whether blockchain can fulfill the hype of a technology characterized as 'revolutionary' and 'disruptive', is the need to ensure that blockchain design elements consider actual healthcare needs from the diverse perspectives of consumers, patients, providers, and regulators. In addition, answering the real needs of healthcare stakeholders, blockchain approaches must also be responsive to the unique challenges faced in healthcare compared to other sectors of the economy. In this sense, ensuring that a health blockchain is 'fit-for-purpose' is pivotal. This concept forms the basis for this article, where we share views from a multidisciplinary group of practitioners at the forefront of blockchain conceptualization, development, and deployment.

Updating the Model: The Case for Independent Pharmacy to Embrace Digital Health.

OBJECTIVES: To advocate for independent pharmacy to embrace digital health as a means to improve patient outcomes and compete more strongly in an increasingly competitive business environment. SUMMARY: Independent pharmacies are positioned to be at the forefront of adopting digital health tools for a variety of reasons. They often can make changes to their business model faster than a major retail chain, are often in rural locations where few other providers are located, and are already starting to offer the types of clinical services that can be greatly aided by digital health. This commentary presents the case for a change in the current model of pharmacy practice to one which embraces digital health. The role of the pharmacist would grow beyond exclusively medication management to incorporate tools such as wearable health trackers and mobile phone applications. By utilizing digital health, the pharmacist can obtain a greater amount of patient health data via an asynchronous electronic uploading process, and then use that data to further improve their ability to offer clinical services. CONCLUSION: Digital health is a powerful tool that should be embraced by independent pharmacy. By leveraging digital health, pharmacies can improve both accessibility and quality of care, thus providing a competitive advantage in the retail marketplace.

A Progress Report on the State of Pharmacy Informatics Education in US Pharmacy Schools and Colleges.

Objective. To characterize informatics education opportunities in US colleges and schools of pharmacy curricula. Methods. Informatics curricular information online was catalogued via publicly available websites. Website content was searched via domain-specific keywords. Online course descriptions were reviewed. Website searches were also conducted for informatics-related opportunities. Results. Of 132 pharmacy curricula found online, 47 (36%) included an informatics course. Of those, 64% (n=30) were required while 47% (n=22) were elective courses. Additionally, 20% (n=26) provided informatics advanced and/or introductory pharmacy practice experiences, 20% (n=27) offered an informatics residency, and 17% (n=22) listed certificate and/or graduate degree programs in informatics. Conclusion. Over the past 10 years, little observable progress has been made in pharmacy school curricula in response to the increasing importance of informatics to the profession. Pharmacy programs can address this educational gap by internal (eg, course development) and external (eg, open source curriculum) solutions.

Geospatial blockchain: promises, challenges, and scenarios in health and healthcare.

A PubMed query run in June 2018 using the keyword 'blockchain' retrieved 40 indexed papers, a reflection of the growing interest in blockchain among the medical and healthcare research and practice communities. Blockchain's foundations of decentralisation, cryptographic security and immutability make it a strong contender in reshaping the healthcare landscape worldwide. Blockchain solutions are currently being explored for: (1) securing patient and provider identities; (2) managing pharmaceutical and medical device supply chains; (3) clinical research and data monetisation; (4) medical fraud detection; (5) public health surveillance; (6) enabling truly public and open geo-tagged data; (7) powering many Internet of Things-connected autonomous devices, wearables, drones and vehicles, via the distributed peer-to-peer apps they run, to deliver the full vision of smart healthy cities and regions; and (8) blockchain-enabled augmented reality in crisis mapping and recovery scenarios, including mechanisms for validating, crediting and rewarding crowdsourced geo-tagged data, among other emerging use cases. Geospatially-enabled blockchain solutions exist today that use a crypto-spatial coordinate system to add an immutable spatial context that regular blockchains lack. These geospatial blockchains do not just record an entry's specific time, but also require and validate its associated proof of location, allowing accurate spatiotemporal mapping of physical world events. Blockchain and distributed ledger technology face similar challenges as any other technology threatening to disintermediate legacy processes and commercial interests, namely the challenges of blockchain interoperability, security and privacy, as well as the need to find suitable and sustainable business models of implementation. Nevertheless, we expect blockchain technologies to get increasingly powerful and robust, as they become coupled with artificial intelligence (AI) in various real-word healthcare solutions involving AI-mediated data exchange on blockchains.

Non-modifiable determinants of pharmacy residency match rates.

OBJECTIVE: The purpose of this study was to examine non-modifiable pharmacy program characteristics on residency match rates. METHODS: American Society of Health-System Pharmacists match and non-match lists were de-identified and evaluated for students graduating in 2015. Variables analysed included length of program, type of institution and didactic grading scheme. KEY FINDINGS: Students from 4-year programs, attending a public institution, or using a grade point average had greater odds of matching. Logistic regression model indicated a good model fit (χ2 (2) of 4.44, P = 0.108). CONCLUSIONS: Students considering residency training may benefit from awareness of such factors when choosing a pharmacy program.

Patient Participation at Health Care Conferences: Engaged Patients Increase Information Flow, Expand Propagation, and Deepen Engagement in the Conversation of Tweets Compared to Physicians or Researchers.

BACKGROUND: Health care conferences present a unique opportunity to network, spark innovation, and disseminate novel information to a large audience, but the dissemination of information typically stays within very specific networks. Social network analysis can be adopted to understand the flow of information between virtual social communities and the role of patients within the network. OBJECTIVE: The purpose of this study is to examine the impact engaged patients bring to health care conference social media information flow and how they expand dissemination and distribution of tweets compared to other health care conference stakeholders such as physicians and researchers. METHODS: From January 2014 through December 2016, 7,644,549 tweets were analyzed from 1672 health care conferences with at least 1000 tweets who had registered in Symplur's Health Care Hashtag Project from 2014 to 2016. The tweet content was analyzed to create a list of the top 100 influencers by mention from each conference, who were then subsequently categorized by stakeholder group. Multivariate linear regression models were created using stepwise function building to identify factors explaining variability as predictor variables for the model in which conference tweets were taken as the dependent variable. RESULTS: Inclusion of engaged patients in health care conference social media was low compared to that of physicians and has not significantly changed over the last 3 years. When engaged patient voices are included in health care conferences, they greatly increase information flow as measured by total tweet volume (beta=301.6) compared to physicians (beta=137.3, P<.001), expand propagation of information tweeted during a conference as measured by social media impressions created (beta=1,700,000) compared to physicians (beta=270,000, P<.001), and deepen engagement in the tweet conversation as measured by replies to their tweets (beta=24.4) compared to physicians (beta=5.5, P<.001). Social network analysis of hubs and authorities revealed that patients had statistically significant higher hub scores (mean 8.26×10-4, SD 2.96×10-4) compared to other stakeholder groups' Twitter accounts (mean 7.19×10-4, SD 3.81×10-4; t273.84=4.302, P<.001). CONCLUSIONS: Although engaged patients are powerful accelerators of information flow, expanders of tweet propagation, and greatly deepen engagement in conversation of tweets on social media of health care conferences compared to physicians, they represent only 1.4% of the stakeholder mix of the top 100 influencers in the conversation. Health care conferences that fail to engage patients in their proceedings may risk limiting their engagement with the public, disseminating scientific information to a narrow community and slowing flow of information across social media channels.

An Approach for All in Pharmacy Informatics Education.

Computerization is transforming health care. All clinicians are users of health information technology (HIT). Understanding fundamental principles of informatics, the field focused on information needs and uses, is essential if HIT is going to support improved patient outcomes. Informatics education for clinicians is a national priority. Additionally, some informatics experts are needed to bring about innovations in HIT. A common approach to pharmacy informatics education has been slow to develop. Meanwhile, accreditation standards for informatics in pharmacy education continue to evolve. A gap remains in the implementation of informatics education for all pharmacy students and it is unclear what expert informatics training should cover. In this article, we propose the first of two complementary approaches to informatics education in pharmacy: to incorporate fundamental informatics education into pharmacy curricula for all students. The second approach, to train those students interested in becoming informatics experts to design, develop, implement, and evaluate HIT, will be presented in a subsequent issue of the Journal.

Role of Residency Interview Preparatory Activities as a Determinant on Pharmacy Residency Match Rates.

PURPOSE: Different strategies have been implemented to assist students in securing residency positions. The purpose of this study was to explore the impact of student participation in residency preparation activities on match rates. METHODS: A retrospective observational study was conducted to explore the effect of participation in residency preparation activities and grade point average (GPA) on residency match rate. Match rates for students participating in the Residency Interview Preparation Seminar (RIPS) or mock interviews (ie, intervention group) were compared with students who participated in neither activity (ie, control group). RESULTS: A total of 118 individuals were included in the comparison. Forty-eight students participated in RIPS (n = 29) or mock interviews (n = 19), while 70 students were in the control group. The intervention group had a statistically larger proportion of students securing residency than the control group (81% vs 57%; P = .009). Match rates between students enrolled in RIPS versus those in the mock interview group were not significant. No statistically significant differences were observed based on GPA. CONCLUSION: Students receiving additional preparation prior to interviews when seeking postdoctoral training were significantly more likely to obtain a residency position. In academic settings with limited resources, mock interviews may be preferred over comprehensive preparatory courses.

An Approach for Some in Advanced Pharmacy Informatics Education.

Computerization is transforming health care while the quantity and complexity of biomedical knowledge rapidly grows. Today, all clinicians use health information technology (HIT), but only some pharmacists need to be cross-trained in "all" that advanced informatics entails so they can devise new and better information systems to support the pharmacy practice of the future. We propose a dual approach to informatics education in pharmacy: incorporate fundamental informatics education into pharmacy curricula for all students; and train some students interested in becoming informatics experts to design, develop, implement, and evaluate novel HIT for pharmacy. This commentary focuses specifically on the latter. It discusses the advanced pharmacy informatics training needed by some pharmacists to support innovation of HIT and to enable a shift to a more fully system-supported pharmacy practice.

Development and implementation of a multitiered health informatics curriculum in a college of pharmacy.

Standards requiring education in informatics in pharmacy curricula were introduced in the last 10 years by the Accreditation Council for Pharmacy Education. Mirroring difficulties faced by other health professions educators, implementation of these requirements remains fragmented and somewhat limited across colleges of pharmacy in the US. Clinical practice and workforce metrics underline a pronounced need for clinicians with varying competencies in health informatics. In response to these challenges, a multitiered health informatics curriculum was developed and implemented at a college of pharmacy in the Southeast. The multitiered approach is structured to ensure that graduating pharmacists possess core competencies in health informatics, while providing specialized and advanced training opportunities for pharmacy students, health professions students, and working professionals interested in a career path in informatics. The approach described herein offers institutions, administrators, faculty, residents, and students an adaptable model for selected or comprehensive adoption and integration of a multitiered health informatics curriculum.

Cognitive and Performance Enhancing Medication Use to Improve Performance in Poker.

Use of neuroenhancers has been studied in groups ranging from students to surgeons; however, use of cognitive and performance enhancing medications (CPEMs) to improve performance in poker has remained largely overlooked. To assess the use of CPEMs to improve poker performance, a survey of poker players was conducted. Participants were recruited via Internet poker forums; 198 completed the online survey. Approximately 28 % of respondents used prescription CPEMs, with the most commonly used including: amphetamine/dextroamphetamine (62 %), benzodiazepines (20 %), and methylphenidate (20 %). CPEMs were used in poker to focus (73 %), calm nerves (11 %), and stay awake (11 %). Caffeine (71 %), as well as conventionally counter-intuitive substances like marijuana (35 %) and alcohol (30 %) were also reported to enhance poker performance. Non-users of CPEMs were dissuaded from use due to not knowing where to get them (29 %), apprehension about trying them (26 %), and legal or ethical concerns (16 %). Respondents most frequently acquired CPEMs via friends/fellow poker players (52 %), or prescription from physician (38 %). Additionally, greater use of CPEMs was associated with living outside the United States (p = 0.042), prior use of prescription medications for improving non-poker related performance (p < 0.001), and amateur and semi-professional player status (p = 0.035). Unmonitored use of pharmacologically active agents and their methods of acquisition highlight safety concerns in this cohort of poker players, especially among non-professional players. The current state of guidance from national organizations on CPEM use in healthy individuals could impact prescribing patterns.

Associations of gender and age groups on the knowledge and use of drug information resources by American pharmacists.

OBJECTIVE: To explore knowledge and use of drug information resources by pharmacists and identify patterns influenced by gender and age-group classification. METHODS: A survey questionnaire was mailed nationwide to 1,000 practitioners working in community (n = 500) and hospital (n = 500) settings who answer drug information questions as part of their expected job responsibilities. Responses pertaining to drug information resource use and knowledge of different types of drug-related queries, resource media preferences, and perceived adequacy of resources maintained in the pharmacy were analyzed by gender and age group. The t statistic was used to test for significant differences of means and percentages between genders and between age groups. Descriptive statistics were used to characterize other findings. RESULTS: Gender and age group classification influenced patterns of knowledge and use of drug information resources by pharmacists. They also affected pharmacists' perceptions of the most common types of questions prompting them to consult a drug information reference, as well as the resources consulted. Micromedex, exclusively available in electronic format, was the most commonly consulted resource overall by pharmacists. Lexi-Comp Online was the leading choice by women, preferred over Micromedex, but was not one of the top two resources selected by men. CONCLUSIONS: This study successfully identified the influence of gender and age-group classification in assessing drug information resource knowledge and use of general and specific types of drug-related queries.