Evaluation of a Well-being Promotion (WelPro) Program on Advanced Pharmacy Practice Experience (APPE) Student Burnout.

OBJECTIVE: The objective of this study is to evaluate the Well-being Promotion (WelPro) program and its effect on burnout in Advanced Pharmacy Practice Experience (APPE) students at the University of California, San Francisco. METHODS: A longitudinal cohort study evaluating the WelPro program was conducted in the class of 2021 (Transformation, a 3-year all-year-round curriculum, and Pathway (P), a 4-year traditional curriculum) APPE students. The primary and secondary aims were to evaluate changes in emotional exhaustion (EE) scores from the beginning of year (BOY) to end of year (EOY) for the class of 2021 students and compare EOY EE scores between the classes of 2021 (P) and 2020 (P) students using the Maslach Burnout Inventory-Human Services Survey for Medical Personnel (MBI-HSS [MP]) survey. Independent and paired t tests were used to evaluate EE scores; Wilcoxon signed-rank test and Wilcoxon Mann-Whitney rank sum test were used to evaluate ordinal data. RESULTS: Evaluable survey response rates were 69.6% BOY and 57.7% EOY for the class of 2021 students and 78.7% EOY for the class of 2020 (P) students. No differences in EE scores were observed for the matched class of 2021 from BOY to EOY and between classes of 2021 (P) and 2020 (P) students. CONCLUSION: WelPro did not change EE scores for class of 2021 APPE students. Given multiple confounding factors in the study, additional studies are warranted to determine the effectiveness of such a program on APPE student burnout.

Assessment of Areas of Worklife Among Pharmacy Educators.

Objective. To assess in pharmacy academicians the six domains of worklife (community, control, fairness, reward, workload, values) that have been associated with burnout and poor job satisfaction.Methods. We aimed to assess the Areas of Worklife Survey (AWS) among a sample of pharmacy academicians attending a national meeting to evaluate personal, environmental, or workplace factors that may influence the worklife environment. Data were analyzed using SPSS, descriptive statistics were identified, and Kruskal-Wallis and Pearson correlations were performed.Results. The participant response rate was 40% (n=49/121 attendees). Eighty-eight percent of participants reported working more than 40 hours per week. Mean AWS scores ranged from 2.7 to 3.9 (whereby 1 indicated a strong mismatch between person and work environment and 5 indicated a strong match). The workload and fairness domains had the lowest reported scores, whereas control had the highest. Higher mean scores were reported for control and reward in those with a mentor and for fairness in those having a hobby.Conclusion. Participants gave the lowest ratings to two worklife areas, workload and fairness. Developing targeted interventions, such as in mentorship, hobbies, and transparency in the work setting, may be important for preventing burnout in pharmacy academicians. Further studies in a larger population may help to determine factors associated with the areas of worklife that received low ratings.

Impact of a Well-being Promotion Training Program on Advanced Pharmacy Practice Experience Conference Leaders.

Objective. The objective of this pilot study was to evaluate the attitudes and self-efficacy of advanced pharmacy practice experience (APPE) conference leaders after completing the Well-being Promotion (WelPro) training program developed at the University of California, San Francisco (UCSF) School of Pharmacy.Methods. The WelPro training program was developed to equip participants with the knowledge and tools to assist APPE students in distress and promote student wellness. After completing the WelPro training program, a 20-item survey was administered to 10 conference leaders via a web-based survey tool to assess their attitudes about burnout and self-efficacy in assisting students in distress. Descriptive statistics were used to characterize attitudes and self-efficacy.Results. Ten conference leaders participated in the training program. Of these, nine reported experiencing burnout in their careers, and all believed burnout within the pharmacy profession could be avoided. After the WelPro training program, confidence levels of the conference leaders significantly improved in the following areas: identification of students in distress, identification of resources for students, and recognition of when and how to refer students in distress.Conclusion. Increased self-efficacy of conference leaders to identify and assist students in distress could be translated into their improved ability to support students' overall well-being. The WelPro training program can serve as a model for similar wellness training programs that directors and preceptors in experiential education can implement at their institutions.

Student Stress Management and Wellness Programs among Colleges of Pharmacy.

OBJECTIVE: To describe the programmatic stress-related interventions that colleges of pharmacy are providing for their students. METHODS: A paper-based questionnaire was distributed to 80 college teams who attended two consecutive offerings of the American Association of Colleges of Pharmacy institute focused on promoting student well-being. The five-part questionnaire consisted of: 1) tracking and assessment of perceived student stress levels, 2) the types and formats of stress-coping interventions that are offered, 3) the measured impacts of any stress-coping interventions, 4) the level of faculty/staff training and involvement in student stress remediation, and 5) institutional demographics. RESULTS: Of the 40 college teams responding to the survey there were similar numbers of private (44%) and public (56%) institutions. More than half (57.5%) reported measuring student stress levels. The most common interventions offered were counseling (95%), academic advising (82%), physical exercise support (77%), and relationship building activities (70%). Topics offered in the curriculum were most often related to handling substance abuse (50%), time-management (45%), and finances (40%). A majority (79.5%) of schools reported they do not offer formal training on student stress and mental health to faculty and staff and do not formally assess the impact of stress and coping interventions. CONCLUSION: Colleges of pharmacy are addressing student stress and well-being, yet variability exists in terms of assessment, interventions, and didactic offerings. Multiple barriers to improvement remain and mediating barriers and determining assessments for coping and interventions may be next steps for Colleges of Pharmacy.

Item analysis of emotional exhaustion in pharmacy practice faculty.

INTRODUCTION: The primary objective of this study was to identify the single question on the Maslach Burnout Inventory - Educator Survey (MBI-ES) that correlated with high emotional exhaustion (EE) among pharmacy practice faculty. METHODS: We analyzed data collected from the electronic administration of the MBI-ES to faculty at United States (US) colleges and schools of pharmacy in 2014. For our primary outcome, we used Spearman's rho correlation (rs) to identify a single question on the MBI-ES that was highly correlated with high EE (one of three subscales of MBI-ES). We calculated likelihood ratio statistics for each level of the item with the largest rs with total EE, then converted those to adjusted predicted probabilities of high EE. De-identified data were collected via Qualtrics version 60949 (Provo, Utah) and analyzed using IBM SPSS Statistics, Version 22.0 (Armonk, NY). RESULTS: The single item, "I feel emotionally drained from my work" (rs = 0.833, p = 0.01), was most correlated with high EE score on the MBI-ES. Faculty who reported "I feel emotionally drained from my work" once per week and few times per week had 62.8% and 93% chance of having high EE, respectively. CONCLUSION: The single item that was most highly correlated with EE may be used for further evaluation of faculty who may be at risk for burnout. Interventions for reducing burnout among pharmacy practice faculty are critically needed for sustaining our pool of faculty.

Assessment of contraceptive curricula in US pharmacy programs.

INTRODUCTION: Pharmacists prescribe contraception in some states following expansions in scope of practice. Adequate education on contraception in pharmacy curricula is crucial to effectively deliver these services. METHODS: A 26-item survey assessing contraception curricula regarding was administered by email to instructors and administrators at 139 pharmacy schools in the United States. The survey assessed teaching methods, hours taught, topic content, and opinion of adequacy of contraceptive education provided by the program. RESULTS: The survey achieved a response rate of 40% (n = 56). All programs that responded offer emergency contraception and hormonal contraception content, 96% offer non-hormonal over-the-counter contraception content, and 91% offer long-acting reversible hormonal contraception content. Average number of hours taught were as follows: non-hormonal over-the-counter contraception 2.0 hours, emergency contraception 0.9 hours, hormonal contraception 3.0 hours, long-acting reversible hormonal contraception 0.8 hours, and non-reversible hormonal contraception 0.5 hours. Patient cases were most used to supplement didactic content in all topics. Standardized patient interviews were used less frequently for both hormonal contraception (25%) and emergency contraception (7%). About 68% of programs agreed or strongly agreed that the contraceptive education provided by the program was adequate. A majority (70%) indicated interest in a standardized contraceptive curriculum. CONCLUSIONS: Contraceptive education is broadly covered in didactic curricula within pharmacy education. Further assessment and development of curricula standards may be warranted to assess quality and adequacy of contraceptive education in pharmacy.

Consideration of Aggressive and Strategic Approaches to Address Declining Enrollment in US Pharmacy Schools.

Members from Cohort 13 of the Academic Leadership Fellows Program (ALFP) 2016-2017 were challenged to present a debate on the topic: "In Turbulent Times, Pharmacy Education Leaders Must Take Aggressive Action to Prevent Further Declines in Enrollment" at the American Association of Colleges of Pharmacy INfluence 2017 meeting in Rio Grande, Puerto Rico. This paper is the result of thoughtful insights emerging from this debate. We present a discussion of the question of whether pharmacy education leaders must take aggressive action or strategic approaches to prevent further declines in enrollment. There are many thoughts regarding current declines in enrollment. Some educators contend that a more aggressive approach is needed while others argue that, while aggressive actions might lead to short-term gains, a more viable approach involves strategic actions targeting the underlying causes for decreasing enrollment. This paper explores themes of enrollment challenges, current and future workforce needs, and financial issues for both pharmacy programs and students. In summation, both aggressive actions and a strategic, sustainable approach are urgently needed to address declining enrollment.

Implementation and evaluation of a women's reproductive health pharmacy elective.

BACKGROUND AND PURPOSE: To create, implement and evaluate an elective course for pharmacy students focusing on women's reproductive health topics. EDUCATIONAL ACTIVITY AND SETTING: A course was developed that included lectures discussing contraception, infertility, preconception care, pregnancy, and postpartum health. Active learning provided in the forms of journal article review and review of drug information resources for medication use in pregnancy were utilized. Workshops provided hands-on experiences with prescription contraceptives and over-the-counter fertility products. Knowledge and skills were assessed with in-class quizzes, journal article presentations, class participation, patient cases, and a final exam. A 46-item survey was administered to students pre- and post-course to assess self-perceived knowledge and confidence in women's reproductive health. FINDINGS: A total of 33 students were enrolled in the course. The response rate for the pre-course survey was 100% (n = 33) and for the post-course survey was 91% (n = 30). Students' confidence in counseling on women's reproductive health topics significantly increased after the course (mean scores 2.62 pre-course and 3.75 post-course, p < 0.0001). Similar results were seen in students' self-perceptions of their overall knowledge in women's health (mean scores 2.63 pre-course and 3.92 post-course, p < 0.0001). Preferred methods of learning included product workshops, and journal club presentations were the least preferred learning method. DISCUSSION AND SUMMARY: A women's reproductive health course was well received by students and increased their self-perceived knowledge and confidence in the areas of prescription contraceptives and over-the-counter fertility products.

Guide for Drug Selection During Pregnancy and Lactation: What Pharmacists Need to Know for Current Practice.

OBJECTIVE: To provide guidance for clinicians on risk assessment of medication use during pregnancy and lactation. DATA SOURCES: Authors completed PubMed searches to identify articles focused on the use of medications in pregnancy, including fetal development, drug transfer across the placenta, trimester exposure, chronic conditions in pregnancy, medications in lactation, and lactation and chronic disease. STUDY SELECTION AND DATA EXTRACTION: Articles were reviewed to provide overall guidance to medication selection during pregnancy. The following information was reviewed: medication use in pregnancy, including fetal development, drug transfer across the placenta, trimester exposure, chronic conditions in pregnancy, medications in lactation, and lactation and chronic disease. DATA SYNTHESIS: This article will provide an overview of medication safety considerations during pregnancy and lactation. Information was interpreted to help clinicians predict the potential risk and benefit in each patient to make an evidence-based decision. The article concludes with guidance on risk assessment and how pharmacists may support fellow health care providers and their patients when considering medication use. CONCLUSIONS: Information about the effects of medication use during reproductive periods is limited. With the removal of the Food and Drug Administration pregnancy categories, clinicians will be relying on pharmacists to aid in the appropriate selection of therapies for patients. It is critical that pharmacists keep abreast of resources available and be able to assess data to help prescribers and their patients.

Emergency Contraception Algorithm and Guide for Clinicians.

There are currently three forms of emergency contraception: oral levonorgestrel, oral ulipristal acetate, and the copper intrauterine device. The copper intrauterine device is the most effective, followed by ulipristal acetate and levonorgestrel, respectively. Although levonorgestrel is the least effective method, studies show that more prescribers are familiar with it and that is the most frequently used method. Clinicians should consider several factors when helping women make informed medical decisions regarding emergency contraception, including access to the products, a woman's individual preference, timing since unprotected intercourse, body mass index or weight, and initiation or resumption of routine contraception. This article explains and summarizes these considerations and provides an algorithm to guide clinicians.

Assessment of Burnout and Associated Risk Factors Among Pharmacy Practice Faculty in the United States.

Objectives. To measure the level of burnout among pharmacy practice faculty members at US colleges and schools of pharmacy and to identify factors associated with burnout. Methods. Using a cross-sectional, electronic, anonymous survey-design, we measured faculty burnout (n=2318) at US colleges and schools of pharmacy using the Maslach Burnout Inventory-Educators Survey (MBI-ES), which measures burnout dimensions: emotional exhaustion, depersonalization, and personal accomplishment. We assessed MBI-ES scores, demographics and possible predictors of burnout. Results. The response rate was 32.7% (n=758). Emotional exhaustion was identified in 41.3% and was higher in women, assistant professors, and those without a hobby. Participants without a mentor had higher scores of depersonalization. Those with children ages 1-12 years had higher emotional exhaustion and depersonalization compared to those with older children. Conclusion. Pharmacy practice faculty members at US colleges and schools of pharmacy are suffering from burnout, exhibited mainly through emotional exhaustion.

Role of the community pharmacist in emergency contraception counseling and delivery in the United States: current trends and future prospects.

Women and couples continue to experience unintended pregnancies at high rates. In the US, 45% of all pregnancies are either mistimed or unwanted. Mishaps with contraceptives, such as condom breakage, missed pills, incorrect timing of patch or vaginal ring application, contraceptive nonuse, forced intercourse, and other circumstances, place women at risk of unintended pregnancy. There is a critical role for emergency contraception (EC) in preventing those pregnancies. There are currently three methods of EC available in the US. Levonorgestrel EC pills have been available with a prescription for over 15 years and over-the-counter since 2013. In 2010, ulipristal acetate EC pills became available with a prescription. Finally, the copper intrauterine device remains the most effective form of EC. Use of EC is increasing over time, due to wider availability and accessibility of EC methods. One strategy to expand access for both prescription and nonprescription EC products is to include pharmacies as a point of access and allow pharmacist prescribing. In eight states, pharmacists are able to prescribe and provide EC directly to women: levonorgestrel EC in eight states and ulipristal acetate in seven states. In addition to access with a prescription written by a pharmacist or other health care provider, levonorgestrel EC is available over-the-counter in pharmacies and grocery stores. Pharmacists play a critical role in access to EC in community pharmacies by ensuring product availability in the inventory, up-to-date knowledge, and comprehensive patient counseling. Looking to the future, there are opportunities to expand access to EC in pharmacies further by implementing legislation expanding the pharmacist scope of practice, ensuring third-party reimbursement for clinical services delivered by pharmacists, and including EC in pharmacy education and training.

The pharmacist's role in promoting preconception health.

OBJECTIVE: To review the pharmacist's role in preconception health. DATA SOURCES: PubMed search using the terms preconception, immunizations, epilepsy, diabetes, depression, tobacco, asthma, hypertension, anticoagulation, pharmacist, pregnancy, and current national guidelines. DATA SYNTHESIS: Preconception health has become recognized as an important public health focus to improve pregnancy outcomes. Pharmacists have a unique role as accessible health care providers to optimize preconception health by screening women for tobacco use, appropriate immunizations, and current medication use. Counseling patients on preconception risk factors and adequate folic acid supplementation as well as providing recommendations for safe and effective management of chronic conditions are also critical and within the scope of practice for pharmacists. CONCLUSION: Pharmacists play an important role in medication screening, chronic disease state management, and preconception planning to aid women in preparing for healthy pregnancies.

A nontraditional faculty development initiative using a social media platform.

OBJECTIVE: To assess the outcomes from an 11-year nontraditional professional development activity implemented by female faculty members at several colleges and schools of pharmacy. DESIGN: Within the context of an online fantasy football league, faculty members practiced community-based faculty development strategies, including peer mentoring, skills development, constructive feedback and other supportive behaviors. ASSESSMENT: Data were extracted from curriculum vitae to characterize the academic progress of participants and to quantify scholarly work collaborations among league members. Analyses were limited to members who had participated in the league for 10 or more consecutive years. Seventy-one collaborative scholarly works occurred among team managers, including presentation of 20 posters and 2 oral presentations at national or international meetings, publication of 29 peer-reviewed articles and 15 book chapters, and funding of 5 research projects. CONCLUSION: Social media platforms can foster nontraditional faculty development and mentoring by enhancing connectivity between pharmacy educators who share similar interests.

Characteristics of the ideal postgraduate year 1 pharmacy practice residency candidate: a survey of residency program directors.

OBJECTIVE: Assess pharmacy postgraduate year 1 (PGY1) residency application statistics and identify the qualities most desired in the ideal pharmacy residency candidate. METHODS: A list of PGY1 residency program directors across the United States (n = 750) was acquired, and a validated electronic survey was created. The survey contained 25 questions pertaining to program demographics, application statistics, and candidate characteristics. RESULTS: A total of 252 programs completed the survey. The average number of positions per program was 3.4 ± 2.6. The average ratio of applicants to available positions was 15:1. The highest scored quality was familiarity with an applicant's college of pharmacy (7.7 ± 2.5). Holding a leadership position within the college/university scored 6.5 ± 2, while poster presentations and publications were rated lower (4.1 ± 2.5 and 3.1 ± 2.3, respectively). When asked to rank modifiable characteristics, strong letters of recommendation, letters of intent, and prior experience with the applicant were ranked the highest. CONCLUSIONS: Strong letters of recommendation and intent along with prior experience with an applicant are highly valued. Although leadership positions and scholarship are not ranked as highly, they may distinguish applicants if the preceding criteria are met. Applicants should strive to build relationships with preceptors and obtain work experience or experiential rotations at potential residency locations.

A pilot study evaluating genetic and environmental factors for postpartum depression.

OBJECTIVE: To assess the influence of genetic and environmental risk factors upon postpartum depression. DESIGN: Case-control, prospective study. SETTING: The University of California at San Francisco Obstetric and Gynecology Clinic. PARTICIPANTS: Mothers screened for postpartum depression six weeks after delivery with the Edinburgh Postnatal Depression Scale and recruited as cases and controls. MEASUREMENTS: Eligible subjects completed a series of assessments and a structured clinical interview to confirm diagnosis of depression. Deoxyribonucleic acid was obtained for genotyping of 81 single nucleotide polymorphisms in 12 genes hypothesized to be postpartum depression-related. RESULTS: Twenty-four cases and 24 controls were eligible for analysis. Three single necleotide polymorphisms in the serotonin 2A receptor (HTR2A) gene were associated with postpartum depression. The strongest association at a functional promoter polymorphism (rs6311), a functional promoter single nucleotide polymorphisms (p=0.002, odds ratio 0.25, 95% confidence interval:0.10-0.63), was a finding robust to population stratification. Gene-wide association was significant for HTR2A (permuted p=0.008), but not when corrected for all 12 genes. Analysis of demographic and psychosocial risk factors identified distressed relationship, unplanned pregnancy, and a previous history of depression as significant predictive variables (p≤0.05). CONCLUSIONS: This pilot data suggests deoxyribonucleic acid variations in HTR2A may be associated with postpartum depression. Psychosocial variables were also identified as risk factors. The relative influence of these variables on the manifestation of postpartum depression is yet to be determined.

Proton Pump Inhibitors and the Risk for Hospital-Acquired Clostridium difficile Infection.

OBJECTIVE: To examine the relationship between proton pump inhibitor (PPI) usage and nosocomial Clostridium difficile infection (CDI) and determine the duration of therapy at which CDI risk increases. PATIENTS AND METHODS: This retrospective case-control study included consecutive adult patients in whom nosocomial CDI developed after hospitalization for 3 or more days at one of 2 affiliated hospitals between June 1, 2010, and October 31, 2011. These patients were matched to patients hospitalized within 6 months who did not have CDI development in a 1:2 ratio using age, sex, and antibiotic usage. Potential risk factors for CDI, including PPI use and duration, were evaluated. Multivariate analysis was performed to control for confounding variables and identify risk factors. RESULTS: A total of 201 patients were evaluated, 67 with CDI and 134 matched controls. Patients in whom CDI developed were more likely to have received a PPI (76% vs 39%; P<.001) and had a longer duration of PPI therapy (median [range], 5 [0-20] days vs 0 [0-11] days; P<.001) than those who did not have CDI development. After controlling for prior hospital admission, intensive care unit admission, admission from a skilled nursing facility, immunosuppression, number of antibiotics received, PPI duration, and time to event via multivariate analysis, PPI duration was found to be a risk factor for CDI (odds ratio, 1.14; 95% CI, 1.02-1.27; P=.018). The probability for CDI was higher when PPI use exceeded 2 days in patients without a prior hospital admission and 1 day in patients with a prior admission. CONCLUSION: The duration of PPI therapy is significantly associated with CDI. Clinicians should strongly consider restricting PPI use given the short exposure time associated with this increased risk.

Immunizations and pregnancy: an update for pharmacists.

OBJECTIVE: To review the safety of immunizations in pregnancy. DATA SOURCES: PubMed search using the terms vaccine, immunizations, and pregnancy, as well as current national guidelines. DATA SYNTHESIS: Immunizations for women of childbearing age are an integral component of pregnancy planning. Some vaccines are compatible with pregnancy, whereas others, in particular live-attenuated vaccines, are contraindicated because of the theoretical risk to the fetus. The immunizing pharmacist must be aware of updated guidelines regarding the safe and appropriate use of vaccines during pregnancy. Certain routine adult vaccines are contraindicated during pregnancy, including the live-attenuated intranasal influenza, measles-mumps-rubella, varicella, zoster, and human papillomavirus vaccines. The trivalent inactivated influenza vaccine is specifically recommended for all women who are pregnant during influenza season. The hepatitis B, tetanus-diphtheria-acellular pertussis, and several other routine adult and travel vaccines may be administered safely in pregnancy if the patient meets certain risk criteria. Breast-feeding is compatible with all routine adult vaccines. Vaccinia (smallpox) and yellow fever vaccines are cautioned against use except in certain circumstances. CONCLUSION: Pharmacists can play an important role in recommending safe and appropriate vaccines before and during pregnancy.

Student pharmacist perspectives on providing pharmacy-access hormonal contraception services.

OBJECTIVE: To assess student pharmacists' interest and opinions in providing reproductive health services, particularly hormonal contraception (HC), in their future practices. METHODS: This descriptive, nonexperimental, cross-sectional study was conducted in California between February and May 2007. Surveys were distributed to 790 second- and third-year student pharmacists to measure interest, opinions, and perceived barriers in providing HC services. RESULTS: 502 survey responses (63.5% response rate) were received. Student pharmacists reported interest in providing HC services (96.2%) to both minors and adults (53.3%), adults (40.6%), or minors (6.2%). Students felt that patients would benefit from improved access and advice (94.0%). Inadequate pharmacist time was deemed an extremely important barrier in determining whether pharmacists could efficiently and effectively provide HC services, followed by lack of private counseling area in the pharmacy, inadequate patient health information, and lack of appropriate incentive structure. Students were interested in providing other reproductive health services, specifically preventive measures against sexually transmitted infections (STIs; 89.2%) and STI treatment for the partners of patients presenting with valid STI prescriptions (88.4%). CONCLUSION: Student pharmacists were very interested in providing pharmacy access to HC and related reproductive health services as future practitioners. The willingness of student pharmacists to provide this support indicates that pharmacy access to HC could be a viable service.