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.

Bridging the gap between primary care and community-based organizations to address complex care needs of older adults.

Supporting older adults in their desire to remain in an independent living environment requires a collaborative, interprofessional approach in which the individual's medical and social needs are coordinated. This approach requires recognizing the difference in the culture of care between primary care and community-based organizations. Identifying how the two cultures differ may be the first step to learning how to work collaboratively and effectively to meet the social and medical needs of older adults. In this paper, we describe the rationale and process for integrated primary and community-based care in a comprehensive restructuring of care for older adults as well as recommendations for implementation.

Geriatric Interprofessional Team Transformation for Primary Care overview.

BACKGROUND: The Geriatric Interprofessional Team Transformation for Primary Care (GITT-PC) is a model developed to deliver optimal care to older adults in primary care. GITT-PC is an expansion of the John A. Hartford Foundation Geriatric Interdisciplinary Team Training (GITT) program developed at New York University and funded from 1995 to 2002 (Fulmer et al., 2004). GITT was designed to create training models that reflect the needs of the changing health care system and the challenge of caring for older adults with complex conditions (Fulmer et al., 2005). The GITT-PC model builds on the lessons learned from GITT and the development of curricula and training materials based on best practices. METHODS: Implementation of GITT-PC is accomplished through systems and practices that meet the needs and preferences of patients and their families and that are implemented by teams of health professionals and community service providers. GITT-PC is focused on four core components of high-quality geriatric care: (1) health promotion and prevention, (2) chronic disease management, (3) advanced care planning, and (4) transitional care management, each component corresponding to a Medicare-reimbursable visit. RESULTS: Implementation of these reimbursable services enables practices to provide evidence-based geriatric care while realizing a potential significant return on investment. CONCLUSIONS: The GITT-PC model has evolved from an academic training program to a financially sustainable model that serves to improve the care of older adults through a systematic team transformation process that makes a clear business case for primary care (Tabbush et al., 2021). The GITT-PC training program can be implemented in primary care practices with a focus on improving or expanding delivery of annual wellness visits (AWVs) and, potentially, registered RN-led AWVs.

Age-friendly health care and the 4Ms in RN-led annual wellness visits.

BACKGROUND: Medicare annual wellness visits (AWVs) are prevention-focused healthcare visits free to Medicare recipients. These visits focus on health maintenance, health risk assessment, prevention of illness, and maintaining independence, all of which are within the scope of registered nurse (RN) practice as well as aligned with what matters, medication, mentation, and mobility - the 4Ms - of age-friendly health care. The objective of this pilot study was to evaluate the implementation of the 4Ms in the context of RN-led Medicare AWVs in a primary care practice. METHODS: In a primary care practice with approximately 2500 patients, including approximately 571 of whom were enrolled in Medicare, RN-led Medicare AWVs were implemented, incorporating the 4Ms framework. During this time, data were collected on the effect of the AWV on access to care-conceptualized here as the number of visits available as well as the type of clinician open to staff these visits. Data collection also included patient responses to the 4Ms question "what matters most?" RESULTS: Overall, the RN-led visits were successful and beneficial to the practice. Each RN-led visit allowed for 2 additional acute or monitoring visits per provider (nurse practitioner, MD) per day, increasing patient access to their primary care providers. Inclusion of the 4Ms questions facilitated discussion around overall mental and emotional well-being, life stressors, quality of life, and goals of care. CONCLUSION: RN-led Medicare AWVs incorporating the 4Ms framework enhances the role of RNs in primary care by focusing on a health promotion role, utilizing RNs to their full scope of practice. RN-led AWVs increase provider availability for acute and chronic care appointments, as well as foster conversations around quality of life, as well as mental and emotional well-being.

Assessing perspectives of a global health area of concentration within the PharmD curriculum.

INTRODUCTION: While global health education in pharmacy expands, limited research has described the outcome of completing a global health area of concentration on career decisions, perceptions on cultural sensitivity, health disparity awareness, and global health competencies among pharmacists and students. METHODS: This mixed methods study enrolled 21 graduates and 17 student pharmacists who participated in a global health concentration at one school of pharmacy in the United States. Data sources included graduate interviews and surveys, student pharmacist focus groups, and global health competency self-assessments. RESULTS: Five themes emerged among graduates: (1) skills were applicable to diverse settings, (2) early exposure to underserved care prepared graduates for current practice, (3) participation impacted the lens through which graduates viewed careers, (4) participation influenced patient care in current practice, and (5) graduates gained insight on complex global health issues. Three themes were identified among student pharmacists: (1) the program provided opportunities to personalize education, (2) participants gained insight through hands-on experience, and (3) participants developed new perspectives on approaching underserved care. Many graduates (77.4%) currently practiced in an underserved setting. Graduates and fourth professional year students reported improvement in all seven global health competency domains. CONCLUSIONS: A global health concentration in pharmacy curricula can facilitate skills and global health competencies that are applicable across a wide variety of patient care contexts. This concentrated experience provided opportunities to further develop career interests and personalize education, creating a cadre of pharmacists dedicated towards addressing health disparities and serving the underserved.

Impact of service-learning placement on pharmacy student knowledge, attitudes, and confidence in helping patients navigate Medicare Part D.

INTRODUCTION: Pharmacists are in a prime position to empower patients to navigate Medicare Part D. This study aimed to determine if service-learning has a place in pharmacy student Medicare education. The primary objective of the study was to assess knowledge, attitudes, and confidence of first-year pharmacy students at Medicare focused service-learning sites compared to students at alternative sites. METHODS: First-year pharmacy students at the University of Pittsburgh School of Pharmacy were assessed on their knowledge, attitudes, and confidence of Medicare Part D after a semester of service-learning either at a State Health Insurance Assistance Program (SHIP) or at an alternative site not focused on Medicare (control). All students attended a four-part lecture series on Medicare before starting service-learning. Students were surveyed at baseline and after their service-learning experience. RESULTS: A total of 110 (94.8%) students successfully completed both the pre- and post-survey. Knowledge improved significantly in the SHIP group (P = .01) and did not increase significantly in the control group (P = .06). Attitudes toward Medicare Part D, assessed on a Likert scale, became less favorable in the control group (-0.40, P < .001). Student confidence in the ability to counsel patients on Medicare part D improved in the SHIP group (0.42, P < .001) and decreased in the control group (-0.80, P < .001). CONCLUSIONS: Combining a didactic lecture series on Medicare Part D with service-learning involving Medicare counseling may solidify student knowledge of Medicare as well as students' confidence in helping patients navigate Medicare Part D.

Evaluating Students' COVID-19 Knowledge, Attitudes and Practices (COVKAP) during the COVID-19 Pandemic.

The COVID-19 pandemic led to significant disruption in students' lives through lockdowns, restricted movement, remote instruction, and mixed information. Therefore, this study aimed to capture the knowledge, attitudes, and practices of student pharmacists during 2020-2021. A 43-item COVID-19 Knowledge, Attitudes, and Practices (COVKAP) survey previously developed was administered at four schools of pharmacy across the U.S. during Fall 2020 and Spring 2021. A total of 418 responses were analyzed from graduating classes of 2021-2024. There were no significant differences in correct COVID-19 knowledge responses across the four graduating years. Respondents' attitudes around COVID-19 were homogenous with the exception for their belief in their preparedness to administer COVID-19 vaccines. Respondents reported wearing masks daily (76.8%), infrequently visiting restaurants (82.1%), practicing social distancing daily (45.7%), and referring to medical journals for information (72%). In conclusion, during the pandemic, student pharmacists experienced significant changes in their academic lives. Their knowledge and subsequent attitudes and practices were consistent with the state of evidence during Fall 2020 and Spring 2021. Subsequently, as newer information has emerged, the authors suggest that the COVKAP survey may be modified and administered frequently to address student needs and concerns as the pandemic evolves.

Collagenase and the Treatment of Dupuytren Contracture: Efficacy of Treatment and Patient Satisfaction.

Background: Collagenase clostridium histolyticum has become a widely used treatment in the management of Dupuytren disease. The aims of this study are to assess the immediate success of treatment of Dupuytren contracture with collagenase injection, to measure long-term patient-rated outcomes, to determine whether the risk factors for the disease impacted outcomes and to report complications of collagenase treatment. Methods: A prospective study was performed in a tertiary referral centre. Measurements were recorded pre-treatment, day 1 and day 90. Patient-rated outcome scores were measured using Disability of the Arm, Shoulder and Hand questionnaire (DASH) and the Michigan Hand Questionnaire (MHQ) at minimum 36 months post-injection. Results: The study included 45 patients with 53 hands with a mean age of 65.7 years. The treatment was successful in 62% of patients with the greatest improvement in the metacarpal-phalangeal joint of the little finger. Diabetes, epilepsy, gender, alcohol intake and positive family history had no statistically significant predictive value on successful outcomes. Patient satisfaction at 41 months was high with mean MHQ score of 97.3. Conclusions: Collagenase is effective in the treatment of Dupuytren contracture, with disease involving the little finger showing the greatest benefit. Risk factors for development of Dupuytren disease had no effect on successful outcome and long-term satisfaction rates are high. Level of Evidence: Level III (Therapeutic).

Quo vadis? Short-term medical missions in a globalized world and the role of pharmacy.

Short-term medical missions (STMMs) have evolved in the past few decades to provide non-emergent care including routine and follow-up primary care for acute and chronic conditions, along with treatment of neglected tropical diseases. Many STMMs operate outside the local health care infrastructure and may have limited local partnerships. STMM outcomes in improving local population health are often inferred but not well documented. Concerns such as ethical conduct, provider bias, and lack of adequate training and preparation continue to be raised. When disruptions occur (e.g., the COVID-19 pandemic), STMMs need to develop and prepare for challenges such as the inability to travel and provide care. Pharmacists as health professionals play a unique role when volunteering in STMMs. However, pharmacists' roles in STMMs need further development along with a framework to guide STMM work. Often driven by a few dynamic individuals, STMMs need to be aware of local geo-socio-political issues and develop local partnerships toward a meaningful legacy of building sustaining, long-lasting systems that will continue to serve others beyond the life of the STMMs and their founders.

Impact of an International Service Trip on Pharmacy and Medical Learners' Attitudes Toward Interprofessional Collaboration.

Objective. The purpose of this study was to evaluate the impact of an interprofessional medical service trip to rural Honduras on pharmacy and medical learners' attitudes toward interprofessional learning.Methods. In this mixed-methods research, 19 participating students and residents from medicine and pharmacy completed the Readiness for Interprofessional Learning Scale (RIPLS) before and after the service trip in fall 2017 and spring 2018. Individual semi-structured interviews were conducted with participants following each trip to better understand which aspects of the experience shaped their interprofessional learning.Results. Following the service trip, a significant improvement was found for the Teamwork & Collaboration subscale and the Negative Professional Identity subscale of the RIPLS. Several themes emerged from interviews, including that face-to-face interaction promotes collaboration; limited resources encourage team-based problem-solving; time together outside of work strengthens interprofessional connections; participating in another profession's patient care activities fosters appreciation of individual roles; interprofessional care takes time; and participants felt a greater desire to pursue interprofessional practice in the future.Conclusion. Interprofessional learning during a medical service trip improved participants' attitudes toward collaboration. This study highlights which aspects of this experience contributed most to interprofessional learning, and our results may guide future efforts to design effective interprofessional education experiences.

Student Pharmacists during the Pandemic: Development of a COVID-19 Knowledge, Attitudes, and Practices (COVKAP) Survey.

BACKGROUND: The COVID-19 pandemic has caused innumerable changes to all aspects of human life and behavior, including academic life. This study describes the development of a COVID-19 Knowledge, Attitudes, and Practices (COVKAP) Survey among U.S. student pharmacists. The survey was administered at Doctor of Pharmacy programs in three states-Tennessee, Ohio, and Pennsylvania. METHODS: The COVKAP survey-an online cross-sectional survey-was distributed to U.S. student pharmacists enrolled in three different colleges of pharmacy in three states during the fall semester of 2020. The survey was developed using literature review and Dillman's recommendations for survey design. The COVKAP survey consisted of 23 closed and Likert-scale questions, and three open-ended questions. The research team conducted descriptive and inductive thematic analyses on the quantitative and qualitative data, respectively using SPSS (v27) and Dedoose® software. RESULTS: A total of 421 responses were received. Respondents were predominantly female (72%) and White (79%). The average age of respondents was 23.4 years. The qualitative analysis revealed three themes: (1) Wellbeing and mental health struggles; (2) Being part of the decision-making process; (3) Necessity of adequate protection measures. CONCLUSIONS: Preliminary study findings indicate that student pharmacists' concerns and the challenges that they face in their academic pursuits are largely similar across the three states in this study and inform about the importance of recognizing and mitigating the impact of widespread disruption in education. This disruption provides an opportunity for pharmacy academia to examine practices and methods that can be improved upon to help students become successful practitioners.

Collaborative Assessment Of Collective Reach And Impact Among INBRE Supported Summer Undergraduate Research Programs Across The United States.

The motivational outcome of undergraduate research experiences is an increasingly common component of STEM education practices. Student benefits associated with these experiences include increased interest and retention in STEM and/or research fields. Across the country, many institutional research activities in twenty-three states and Puerto Rico are supported through the National Institutes of Health's Institutional Development Award (IDeA) Networks of Biomedical Research Excellence (INBRE) Program. INBREs are statewide collaborations of research intensive and primarily undergraduate institutions that are designed to support the biomedical research pipeline as well as faculty research. Most INBREs offer summer undergraduate research experiences to meet their program goals. While the structure and focus of these programs are tailored to state-specific needs, they typically include 10-15 week sessions and many emphasize participation from underrepresented student populations. In summer 2019, eleven INBREs collaborated to explore the collective reach and impact of their summer undergraduate research programs (SURPs). A common set of survey items were identified and added to pre- and/or post-program surveys. These items focused on the reach of the programs (e.g. demographics of participating students) and the impact of the programs on educational goals for students. In total, data from 461 students across 11 states were included in the project. One third of participating students were from underrepresented racial/ethnic groups; 28% were first-generation college students and 34% were Pell grant eligible. After the program, 72% of participants reported that they hoped to earn a doctoral-level degree. Our results suggest that INBRE-supported SURPs are successfully reaching underrepresented students and that INBRE-supported students widely anticipate pursuing graduate level study in STEM fields.

Impact of Knowledge and Risk Perceptions on Older Adults' Intention for Surveillance Colonoscopy.

GOALS: The authors aimed to characterize older adults' intentions for future surveillance colonoscopy, knowledge of polyps, and predictors of colonoscopy plans. BACKGROUND: Guidelines recommend that the decision to continue or stop surveillance colonoscopy in older adults with colon polyps be "individualized." Although older adults want to be included in decision making, how knowledge regarding polyps influences decisions is unknown. STUDY: In collaboration with a rural family medicine practice, the authors invited adults aged 65 years and older with a history of colon adenomas to complete a 14-item survey regarding intention for colonoscopy and knowledge of colon polyps. RESULTS: Sixty-seven of 105 (63%) patients completed the survey. The mean age was 72 years. Regarding future surveillance, 53% planned to return, 25% were unsure, and 22% did not plan to return. There were no significant differences in baseline characteristics on the basis of the intention for future colonoscopy. Regarding polyp knowledge, 73% had correct knowledge around how common polyps are; 50% thought that more than half of untreated polyps would become cancerous-an inaccurately elevated perception by 10 folds. Respondents who perceived polyps to have a high malignant potential were more likely to report plans for surveillance colonoscopy (68% vs. 39%; P=0.03). CONCLUSIONS: In this survey of older adults with a history of polyps, many had a falsely elevated perception of polyps' potential for cancer that was associated with a higher intention for future colonoscopy. Ensuring older adults have an understanding of the risks of polyps is an essential step toward improving decision making around surveillance colonoscopy.

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.

A qualitative assessment of diabetes care access and disease management in Central America.

BACKGROUND: Diabetes is a growing concern in low-and middle-income countries. Medical missions play a role in increasing access to care and medicines, but often ignore non-communicable disease prevention and advanced management. Increased knowledge of local community needs and resources can lead to the development and implementation of pharmacist-supported interventions to improve diabetes management in rural areas. OBJECTIVES: The purpose of this study was to 1) understand the availability of monitoring for diabetes locally; and 2) describe knowledge and health beliefs regarding diabetes management for those with diabetes, and prevention among those at high risk of developing diabetes. METHODS: This qualitative evaluation used semi-structured interviews with key informants in a community in rural Honduras. Participants included those with diabetes, those at-risk for developing diabetes, and community leaders. Data was analyzed using thematic content analysis through an iterative process of coding and theme development. RESULTS: A total of 35 interviews were conducted with five resulting themes: 1) participants identified multiple barriers to diabetes management including access to monitoring, access to certain medications, and access to advanced levels of care; 2) participants acknowledge the relationship between lifestyle choices and diabetes control, but struggled with adherence to a healthy lifestyle; 3) participants identify that they have limited knowledge of diabetes pathophysiology, diabetes management, and strategies to prevent diabetes; 4) participants felt that opportunities existed within the community to support diabetes education and prevention, and 5) providers should integrate culture, societal norms, and religion in diabetes management. CONCLUSION: This research identifies challenges and resulting opportunities for managing diabetes in rural Honduras. Health care providers including pharmacy personnel should consider strategies to engage communities around self-care and diabetes education. Further, strategies are needed to enhance access to resources and essential medicines for diabetes management. These themes can guide clinicians in supporting communities to enhance diabetes care.

An Ethics-based approach to Global Health Research Part 3: Emphasis on Partnership Funding.

Acquiring funding for global health research within pharmacy can be challenging, particularly for new investigators who may have a strong interest in resolving global dilemmas related to health. Moreover, there can be inherent imbalances and ethical issues when navigating the funding process for global partnerships. There exists a lack of literature providing ethical guidance for mitigating dilemmas that may arise. This commentary discusses current funding streams for investigators interested in global pharmacy research, as well as specific recommendations for the funding process. These recommendations include managing award funds, ethical considerations for funding research partnerships, and balancing power between low to middle income countries and high-income countries. Lastly, case examples of funding partnerships involving pharmacy are highlighted, emphasizing important lessons learned. This commentary addresses the critical need for providing global health researchers with both important considerations and experience-based recommendations for navigating global funding partnerships using an ethical approach.

Older Adult Perspectives Toward Surveillance Colonoscopy: A Qualitative Study.

GOALS AND BACKGROUND: Surveillance colonoscopy is the most common indication for colonoscopy in older adults, yet factors involved in patient decision-making are poorly defined. We sought to understand general perspectives of older adults toward surveillance colonoscopy. STUDY: We conducted 2 in-person, 90-minute semistructured focus groups at a rural, tertiary care, academic facility with a total of 20 English-speaking participants with a history of colon polyps. We also obtained baseline characteristics including information to calculate life expectancy using the Schonberg Index, a validated measure of 5-year and 9-year mortality. RESULTS: Participant ages ranged from 75 to 89, 67% were female, and 61% had a life expectancy of ≤9 years. Major common themes included reasons for and against getting a surveillance colonoscopy, and preferences and opinions surrounding discontinuing surveillance. Fear of cancer, trust in the colonoscopy procedure, and provider advice played prominent roles in patient decisions to return for surveillance. Most felt they should make screening decisions with input from providers, and that providers should engage them in these decisions and base recommendations on their patients' personal history and health, not on how old they are or on actuarial data. CONCLUSIONS: This small, qualitative study suggests that older adults familiar with surveillance colonoscopy prefer patient-centered decision-making on when to discontinue testing and want support and information from providers when making choices. The evidence also suggests that participants value provider communication and trust their advice. Future work will use this information to create a larger patient survey on attitudes and beliefs toward surveillance colonoscopy.

Free Clinic Patients' Perceptions and Barriers to Applying for Health Insurance After Implementation of the Affordable Care Act.

Despite implementation of the Affordable Care Act (ACA), many Americans remain uninsured and receive care in free clinics. It is unknown what free clinic attendees in Pennsylvania know about health insurance expansion or what they perceive as barriers in enrolling in health insurance. The objective of this study was to assess the perceptions and experiences of free clinic patients from southwestern Pennsylvania when applying for health insurance after implementation of the ACA. We designed and implemented a survey of patients at three free clinics within Allegheny County, Pennsylvania from September 2016 to February 2017. Our survey included 22-items, 7 sociodemographic questions and 15 questions regarding the patient's health status and their perspectives related to obtaining health insurance. Data was obtained from 203 patient surveys; 110 (55.3%) of the respondents were men and 99 (48.8%) were African American. There were 48 respondents (24.1%) who did not report any income at the time of the study, and of those that did report an income, 92 (46.2%) respondents reported an income below 133% of the federal poverty level. The main barriers patients faced when applying for health insurance were: (1) lack of knowledge about health insurance (n = 127, 58.1%), (2) cost of health coverage (n = 85, 41.9%), (3) lack of resources (n = 83, 40.4%), and (4) lack of enrollment documentation (n = 43, 23.8%). Significant work is needed to better educate patients about their eligibility and options for health insurance. Free clinics can play a key role in eliminating barriers to health insurance enrollment.

Student Pharmacists' Perspectives on Service-Learning Experiences in Free Clinics.

Objective. To explore student pharmacists' perspectives on the value of pharmacy-related service-learning experiences focused on caring for underserved populations. Methods. Student pharmacists were required to complete a three-hour volunteer experience at a free clinic in western Pennsylvania. Reflective essays from all second- and third-year student pharmacists who participated in the required service-learning experience were deidentified. Essays were thematically analyzed to formulate a list of codes that represent dominant conceptual categories. Two independent coders read and coded all essays submitted from September 2015 to May 2017 using qualitative data analysis. Codes were evaluated for intercoder variability and discrepancies were mediated through discussion. Results. Four hundred twenty-two students submitted reflective essays: 222 essays were submitted by second-year students and 200 by third-year students. The prevailing themes reflected the professional obligation students felt to provide care to the underserved, empathy for underserved patients, perspectives on equitable health resource distribution, the value of service-learning experiences, growth in interprofessional awareness, and self-reported empowerment from the experience. Themes were consistent in the reflective essays of both second-year and third-year students. Third-year students' essays reflected a greater sense of self-assurance and confidence in their role at the free clinics. Students made connections between their didactic learning and experiential education. Conclusion. Student pharmacists valued their experiences working in underserved settings. Free clinics provide opportunities for student pharmacists to develop hands-on training as well as gain a broader perspective on underserved populations, health resource distribution, and the role of pharmacists.