Engaging Student Pharmacists in Social Determinants of Health and Health Equity Through Photovoice.

OBJECTIVE: This study aimed to evaluate the impact of an interactive photovoice activity on the perceptions of social determinants of health (SDOH) and health equity among first professional year student pharmacists. METHODS: This study used a mixed-methods exploratory approach at 4 institutions. All students completed a standardized intervention using a prerecorded lecture, active learning using photovoice, and an in-depth debriefing session. The photovoice responses and reflections were analyzed through a deductive approach using content analysis with the applied frameworks of Rolfe's reflection model and the social-ecological model. A presurvey/postsurvey assessed the students' perceptions of SDOH and health equity. Paired sample t tests were conducted to assess the prechange and postchange. RESULTS: A total of 349 students participated; most students reflected at the "what" level (97.7%), whereas 65% reached the "now what" level. Students identified more SDOH factors at the institutional/community level (75.9%) than at the individual/interpersonal level (59.4%) or the society/policy level (28.0%); 191 (55%) students had matchable survey data. A statistically significant improvement was found in the comprehension of health equity concepts (4 items), perceptions of health disparities and system response (4 items), awareness of structural factors impacting equity (3 items), and readiness for inclusivity behavior (3 items). CONCLUSION: A structured teaching and learning activity allowed deeper reflections among student pharmacists. Student perception of the basic terminologies and the impact of beliefs on health care improved after the photovoice assignment. Although students became aware of the SDOH, they had difficulty identifying the structural or upstream factors when addressing SDOH.

Characteristics of Successful International Pharmacy Partnerships.

Recommendations for global pharmacy collaborations are predominately derived from US institutions. This study utilized semi-structured interviews of global collaborators to assess important partnership components. Interviewees stated personal connections and understanding of each other's programs/systems were key components. Additionally, collaborators indicate that mutual benefits between partners can exist without the requirement for bidirectional exchange of learning experiences, and request and value partners and learners who are culturally aware, global citizens. This structured interview approach provided key insight into how to develop mutually beneficial, sustainable partnerships and provides additional confirmation that the five pillars of global engagement align with an international audience.

Financial investment of United States pharmacy schools on international activities.

INTRODUCTION: The primary objective of this study was to determine the financial resources that United States (US) pharmacy schools spend and receive for international activities, as well as the future direction of expenditures and revenue. METHODS: An online survey was sent in April 2019 to the chief financial or administrative officer at each accredited pharmacy school (N = 141) to ask about average annual budget for international activities and areas of expenditure (student travel, partnership development, faculty salary, staff salary, training programs) and revenue (dean's office, university, student tuition and fees, alumni, grants and contracts, other) associated with their budget. Participants were asked whether they anticipated spending or receiving more, the same, or less on the aforementioned expenditure and revenue areas. RESULTS: Sixty-three programs (45%) responded, with 61 (43%) complete responses used for data analysis. Thirty-eight schools (62%) had an annual budget for international activities with an average of $77,327, a median of $18,750, and a range from $2000 to $615,000. Public schools averaged $102,129 compared to $43,225 for private schools. The largest expenditure source was split evenly between student travel and faculty salaries while the largest revenue source was student tuition and fees. The most common response for future trends was to spend or receive the same amount of support. CONCLUSIONS: There is wide variance regarding the amount each US pharmacy school spends on international activities, with most programs anticipating spending or receiving the same amount in the future.

Promoting cultural sensitivity with the ethical and professional use of social media during global pharmacy experiences.

INTRODUCTION: While the use of social media and blogging is an attractive and rapidly growing method to disseminate student reflections and information, the use of digital online methods of learning also require professional and ethical accountability. This commentary describes two approaches to using a checklist to promote the culturally sensitive, professional, and ethical use of social media platforms when students are expected to share their global pharmacy experiential experiences. COMMENTARY: Social media sites and online blogs have the potential to enhance student experiences and promote intercultural competence of participants due to their ease of use and familiarity. If social media applications are used by students as a means of gaining self-awareness of cultural differences or promotion of cultural knowledge and attitudes, a framework for how to approach this process methodically should be employed by educators. E-professionalism criteria, such as self-evaluation of implicit biases, appropriateness of visual images, and timing of online posting can be used to set expectations as part of pre-departure training and to ensure ethical dissemination of online student reflections. IMPLICATIONS: Pharmacy educators can assist students during global experiences abroad by improving their cultural competence when sharing reflections online. To ensure postings are culturally sensitive, ethical, and professional, consideration should be given to the deliberate use of a checklist that can assist with ensuring appropriateness of content and student reflections as part of a formal educational experience.

An ethics-based approach to global health research part 4: Scholarship and publications.

Disseminating research findings from global health collaborations is essential to advancing science. However, there are a number of ethical considerations and potential challenges to address to ensure thoughtful and non-exploitative reporting. The factors include the benefits and risks to publication, authorship criteria or values, and the accessibility of forums or journals in which to pursue publication. This paper provides commentary related to planning for writing, communicating intentions to publish, obtaining permissions to publish, risks in internationally collaborative work, authorship principles, and journal selection. Authors' and editors' knowledge of experienced individuals from both pharmacy literature, medical fields, and general publications is incorporated to provide an assessment of risks and benefits of publication of international global health research.

An ethics-based approach to global health research part 1: Building partnerships in global health.

Global health partnerships (GHPs) can be the cornerstone for advancing research and public health. The steps to build a global research partnership focus on sharing a common research agenda, identifying key partners in the community, and establishing goals and expectations for partnerships. Moreover, upholding important values, such as communication, trust, and transparency is essential for building successful partnerships. Ethical dilemmas can propose challenges to researchers in global health. These challenges can be overcome by creating a shared vision for a research agenda, maintaining communication, and providing bidirectional training.

Cultural Sensitivity and Global Pharmacy Engagement in the Caribbean: Dominica, Jamaica, Puerto Rico, and St. Kitts.

Sustainable and reciprocal partnerships in pharmacy education and practice exist between schools and colleges of pharmacy in the United States and Caribbean countries and territories. This paper discusses the cultural considerations for such partnerships to flourish. First, general information on Caribbean countries and territories is covered. Next, the paper transitions into how to ensure culturally sensitive engagements when traveling to or hosting visitors from the Caribbean. This paper is intended to assist practitioners with integrating culturally sensitive considerations into the development of partnerships in this region.

An Introduction to Cultural Sensitivity and Global Pharmacy Engagement.

Global engagement between schools and colleges of pharmacy in the United States and many regions of the world is increasing. For an enriching and fruitful interaction, sensitivity toward the cultural, ethical, educational, religious, historical, political, regulatory, and practice issues is critical. Lack of sensitivity may negatively impact engagement among students, professionals and other people from different regions of the world. In this special issue, eight papers will introduce general information about five regions of the world that have established and increased global engagements with institutions in the United States: Africa, the Arab world, Asia, the Caribbean, and Latin America. In addition, the special issue will include a paper with key information related to global engagement within the United States. For each paper, the specifics provided about the selected countries include: demographics, culture, climate, pharmacy education, and health care systems, as well as common stereotypes and misconceptions held by and about the people of the country. Further, recommendations for pharmacists and other health care professionals on culturally sensitive engagement will be emphasized. Finally, recommendations for culturally sensitive engagement when US schools are hosting students and faculty members from those regions will be summarized. The papers are based on literature reviews of databases from 2000 to 2018 and internet searches with specific keywords or terms, such as cultural sensitivity, global, pharmacy, stereotypes, and ethics. Additional keywords are identified in individual papers on specific regions. Authors for each paper consist of practitioners with experience in travelling to and hosting students and professionals from the regions; practitioners with local work experience, and professionals from each region. The special issue is intended to serve as a resource for US schools and colleges of pharmacy currently engaged in or considering future outreach opportunities in these regions, and for those seeking opportunities in the United States. The special issue will provide key information to facilitate culturally sensitive engagement in existing or future relationships.

Current Practices in Global/International Advanced Pharmacy Practice Experiences: Preceptor and Student Considerations.

The objective of this article is to describe the key areas of consideration for global/international advanced pharmacy practice experience (G/I APPE) preceptors, students and learning objectives. At the 2013 Annual Meeting of the American Association of Colleges of Pharmacy (AACP), the GPE SIG prepared and presented an initial report on the G/IAPPE initiatives. Round table discussions were conducted at the 2014 AACP Annual Meeting to document GPE SIG member input on key areas in the report. Literature search of PubMed, Google Scholar and EMBASE with keywords was conducted to expand this report. In this paper, considerations related to preceptors and students and learning outcomes are described. Preceptors for G/I APPEs may vary based on the learning outcomes of the experience. Student learning outcomes for G/I APPEs may vary based on the type of experiential site. Recommendations and future directions for development of G/IAPPEs are presented. Development of a successful G/I APPE requires significant planning and consideration of appropriate qualifications for preceptors and students.

Current Practices in Global/International Advanced Pharmacy Practice Experiences: Home/Host Country or Site/Institution Considerations.

International outreach by schools and colleges of pharmacy is increasing. In this paper, we provide current practice guidelines to establish and maintain successful global/international advanced pharmacy practice experiences (G/I APPEs) with specific recommendations for home/host country and host site/institution. The paper is based on a literature review (2000-2014) in databases and Internet searches with specific keywords or terms. Educational documents such as syllabi and memoranda of understanding (MoUs) from pharmacy programs were also examined. In addition, a preliminary draft was developed and the findings and recommendations were reviewed in a 90-minute roundtable discussion at the 2014 American Association of Colleges of Pharmacy Annual Meeting. Recommendations for the host country include travel considerations (eg, passport, visa, air travel), safety, housing, transportation, travel alerts and warnings, health issues, and financial considerations. For the home country, considerations for establishment of G/I APPE site (eg, vetting process, MoU, site expectations) are described. The paper is a resource for development of new G/I APPEs and provides guidance for continuous quality improvement of partnerships focusing on G/I pharmacy education.

Defining the pharmacist role in the pandemic outbreak of novel H1N1 influenza.

OBJECTIVES: To assess patient knowledge about H1N1 influenza pandemic and vaccine availability, evaluate the effectiveness of student pharmacist education about H1N1 influenza, assess patient comfort with pharmacists as immunization providers, and identify patients preferred location for H1N1 vaccination. DESIGN: Descriptive, nonexperimental, cross-sectional study. SETTING: 18 community pharmacy advanced pharmacy practice experience (CP-APPE) sites located across New York State, from September 2009 to February 2010. PARTICIPANTS: Convenience sample of adult (≥18 years of age) patients of CP-APPE sites. INTERVENTION: Student pharmacists delivered an education intervention to patients and patients completed anonymous surveys. MAIN OUTCOME MEASURES: Patient knowledge and comfort with pharmacists as immunizers. RESULTS: 19 student pharmacists at 18 CP-APPE sites engaged in 215 interventions. The majority of respondents were women (60.9%) who were older than 60 years (43.7%) and white (83.7%). Patient knowledge and comfort with pharmacists as immunizers improved significantly. Compared with baseline, student pharmacist education interventions significantly increased the number of patients who were comfortable receiving the H1N1 influenza vaccination from a pharmacist (from 69.3% to 81.4%, P = 0.012). CONCLUSION: Student pharmacists served as an effective education resource for patients regarding the H1N1 pandemic. Patient comfort with pharmacist provision of the H1N1 vaccination can enable pharmacists to serve as frontline health professionals in the time of a pandemic outbreak.

Patient-centered medical homes: primer for pharmacists.

OBJECTIVE: To provide a patient-centered medical home (PCMH) primer for pharmacists, including basic background information, key terminology, and examples of success stories. DATA SOURCES: PCMH literature and resources obtained through search strategies by authors including but not limited to PubMed and Google Scholar. SUMMARY: PCMHs are a potential means of achieving cost reduction in health care and providing collaborative and comprehensive care, and they represent a promising option for achieving health care reform. Medication therapy management and collaborative drug therapy management are possible means for pharmacists to fulfill the goals of PCMHs. CONCLUSION: Pharmacists must become knowledgeable of standards of PCMH and their abilities to fulfill these standards. Advocacy at local, state, and national levels is needed to achieve recognition of the value of pharmacists in PCMHs.

Encouraging safe medication disposal through student pharmacist intervention.

OBJECTIVES: To (1) determine the public's current method of medication disposal, (2) identify the public's knowledge of the environmental impact of inappropriate medication disposal, (3) determine whether student-facilitated education improves the public's awareness of safe medication disposal, and (4) determine whether the public recognizes student pharmacists as a public health information resource for issues such as safe disposal of medications. DESIGN: Cross sectional. SETTING: Albany, NY, pharmacies during August and September 2009. PARTICIPANTS: 242 patrons at 13 Albany College of Pharmacy and Health Sciences Community Pharmacy Advanced Pharmacy Practice Experience (CPAPPE) sites (2 mass merchandiser, 5 community chain, and 6 grocery store pharmacies). INTERVENTION: Nine-question baseline and five-question postintervention anonymous surveys were administered to a convenience sample of store patrons 18 years of age or older. MAIN OUTCOME MEASURES: Medication disposal practices before and after education, beliefs on the environmental importance of inappropriate disposal practices, and perceptions of student pharmacists as sources of information. RESULTS: Students from CPAPPE sites completed 242 educational interventions. Respondents were primarily women (72%). At baseline, 12.8% of patients disposed of medication appropriately. Respondents frequently flushed medications down the toilet (27.2%) or incorrectly dumped medications in the trash (34.6%). Only 30.9% had received previous advice on safe medication disposal. Posteducation survey results indicated that 80.1% of respondents were willing to change their disposal methods. Increased numbers of respondents viewed inappropriate medication disposal as a moderate to substantial problem (from 57.2% preeducation to 83.9% posteducation). Of participants, 59.7% strongly agreed that student pharmacists were a good resource for information on safe medication disposal. CONCLUSION: Additional public education on safe medication disposal is needed. Student pharmacists produced positive outcomes toward reducing this environmental and potential public health risk.