Getting started writing a personal diversity statement.

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.

Why We Need to Pay Attention to Stereotype Threat.

Although "implicit bias" has been a major focus in diversity, equity, inclusion, and antiracism educational efforts, less attention has been directed to "stereotype threat." This commentary aimed to bring increased awareness to the pharmacy academy about stereotype threat phenomena as well as explore its impact in the areas of education, with a specific focus on health professions education. In addition, potential and practical strategies are discussed to mitigate its occurrence in pharmacy education.

Understanding faculty perceptions and experiences related to climate, diversity, equity, and inclusion at a college of pharmacy: A pilot study.

INTRODUCTION: A climate survey was piloted to obtain an understanding of the perceptions and personal experiences of faculty for intentional planning of future meaningful, effective, and sustainable diversity, equity, and inclusion (DEI) efforts at a college of pharmacy. METHODS: A 48-item, four section, online survey was developed and administered to 69 faculty between October and November 2021. Likert-like five-point scales and free-text items were included to determine an overall assessment of climate, as well as perceptions and/or personal experiences for each domain of DEI, and demographics. RESULTS: Thirty-nine (57%) faculty completed the survey. For climate, every attribute had at least one respondent that observed someone make an insensitive or disparaging remark "rarely," "occasionally," and "frequently." The response pattern was similar for personal experience with insensitive remarks. For participation in diversity activities, "awareness without participation" was selected by 56% of respondents. For perceptions of diversity, "fairly" or "very" was selected by 38% to 54% of respondents. For equity, "attainable for some" to "not attainable" was identified for 15% to 26% of respondents. CONCLUSIONS: These pilot climate survey results inform climate improvement as it relates to DEI and informs survey instrument refinement.

Moral Distress and Moral Injury in Pharmacy and Why the Academy Needs to Care.

Pharmacists and other pharmacy personnel are experiencing job stress and burnout, and in some instances, suicidal ideation and death by suicide. However, the described lived experiences of pharmacists and other pharmacy personnel are not defined by burnout. Thus, consideration of and research about whether pharmacy personnel are possibly experiencing moral distress or moral injury is necessary and urgent. The pharmacy academy is served by considering workplace conditions and lived experiences of pharmacists because of the potential, negative impact on prospective student recruitment, quality of experiential sites and preceptors, sites for clinical faculty placement, and the well-being of alumni. Understanding phenomena occurring for pharmacy personnel and determining how they impact the pharmacy academy can lend itself to the future development of solutions.

Pharmacy Leaders' Reflections on Leadership and Legacy.

OBJECTIVE: To explore the experiences, contributions, and perceived legacy of individuals recognized as leaders in the pharmacy profession and compare these by gender and generational category. METHODS: A total of 54 leaders were interviewed about their journey to leadership and the legacy they leave to the profession. Interviews were transcribed, de-identified, and qualitatively analyzed using an inductive, modified constant comparison approach for open and axial coding. Qualitative responses were quantified to allow for the comparison of themes by gender and generational category. RESULTS: Common leadership themes included: humility, not expecting to be in a leadership role, taking initiative, being passionate about their work, having mentors to guide them, having a network of people around them, being a part of change, serving during a challenging time, seizing opportunities when they presented themselves, and being involved in professional organizations. The individual's clinical work (38.9%), helping to develop pharmacy as a clinical profession (33.3%), publications (29.6%), impact on students (29.6%), building programs (22.2%), involvement in organizations (20.4%), and impactful research (16.7%) were common themes noted in the legacy responses. CONCLUSION: Although there are many advancements still to be made, upcoming leaders would benefit from the journey and perceived legacy of these leaders as they carry the torch to advance the practice of pharmacy.

Improving a Leadership Scale: Applying Rasch Analysis to Student Pharmacists' Attitudes and Beliefs About Leadership.

OBJECTIVE: Leadership development is necessary for student pharmacists to become pharmacist leaders, but no readily usable standard measurement of student attitudes toward and beliefs about leadership exists. To assess the reliability and validity evidence for using the Leadership Attitudes and Beliefs Scale (LABS-III), originally developed and validated in Malaysia, for use with student pharmacists in the United States. METHODS: The 2-unit leadership course was piloted among second- and third-year students in a public college of pharmacy with a 4-year doctor of pharmacy curriculum. The participating students completed the LABS-III during the first and last classes as part of a quality improvement measure for course enhancement. Rasch analysis was then used to assess the reliability and validity evidence for the LABS-III. RESULTS: A total of 24 students participated in the pilot course. The pre and postcourse surveys had 100% and 92% response rates, respectively. After Rasch analysis model fit was achieved, the item separation for the 14 nonextreme items was 2.19 with an item reliability of 0.83. The person separation index was 2.16 with a person reliability of 0.82. CONCLUSION: The Rasch analysis revealed that the number of LABS-III items should be decreased and that the 3-point response scale should be used to improve functionality and use in classroom settings for PharmD students in the United States. Further research is needed to augment the reliability and validity evidence of the modified instrument for use at other United States colleges of pharmacy.

Pharmacy Leaders' Advice to Students Pursuing Leadership: A Qualitative Study.

INTRODUCTION: Leadership development is important both from a curricular standpoint and for continued advancement of the profession. Advice from current leaders in the profession may serve as a powerful motivator to students desiring to be leaders. The purpose of this qualitative study was to provide advice from experienced pharmacy leaders. METHODS: Fifty-four pharmacy leaders were identified based on pre-determined, specific criteria and by using a snowball sampling method. Interviews with leaders were conducted via Zoom to learn about their leadership journey, their legacy, and advice they would give students. The interviews were transcribed, de-identified and analyzed using the inductive, modified constant comparison approach for open and axial coding. Advice themes were compared by gender and generational category. RESULTS: The majority of the interviewees were male (69%), belonged to the Baby Boomer Generation (1946-1964, 59.3%), and held leadership positions in education (78%) and health systems (48%). Thirty-seven leadership advice themes were present. The topmost advice to students was to keep an open mind (35%) and to get involved in organizations (32%). Pieces of advice shared by both men and women leaders included: being open minded, getting involved in organizations, taking initiative, trying new or difficult things, and finding your passion. Keeping an open mind, and taking initiative were common across the three generations. CONCLUSION: Pharmacy leaders have insightful information for students aspiring to be future leaders. Leadership advice was similar by gender and generational category. Students would benefit in developing their leadership based on advice from the lived experience of pharmacy leaders. Future studies could examine students' perspectives on leadership advice.

Pharmacy Workplace Wellbeing and Resilience: Themes Identified from a Hermeneutic Phenomenological Analysis with Future Recommendations.

This study applied a hermeneutic phenomenological approach to better understand pharmacy workplace wellbeing and resilience using respondents' written comments along with a blend of the researchers' understanding of the phenomenon and the published literature. Our goal was to apply this understanding to recommendations for the pharmacy workforce and corresponding future research. Data were obtained from the 2021 APhA/NASPA National State-Based Pharmacy Workplace Survey, launched in the United States in April 2021. Promotion of the online survey to pharmacy personnel was accomplished through social media, email, and online periodicals. Responses continued to be received through the end of 2021. A data file containing 6973 responses was downloaded on 7 January 2022 for analysis. Usable responses were from those who wrote an in-depth comment detailing stories and experiences related to pharmacy workplace and resilience. There were 614 respondents who wrote such comments. The findings revealed that business models driven by mechanized assembly line processes, business metrics that supersede patient outcomes, and reduction of pharmacy personnel's professional judgement have contributed to the decline in the experience of providing patient care in today's health systems. The portrait of respondents' lived experiences regarding pharmacy workplace wellbeing and resilience was beyond the individual level and revealed the need for systems change. We propose several areas for expanded inquiry in this domain: (1) shared trauma, (2) professional responsibility and autonomy, (3) learned subjection, (4) moral injury and moral distress, (5) sociocultural effects, and (6) health systems change.

Improving the Experience of Providing Care in Community-Based Pharmacies.

This study applied a human factors and ergonomics approach to describe community-based pharmacy personnel perspectives regarding how work environment characteristics affect the ability to perform the duties necessary for optimal patient care and how contributors to stress affect the ability to ensure patient safety. Data were obtained from the 2021 APhA/NASPA National State-Based Pharmacy Workplace Survey, launched in the United States in April 2021. Promotion of the online survey to pharmacists and pharmacy technicians was accomplished through social media, email, and online periodicals. Responses continued to be received through the end of 2021. A data file containing 6973 responses was downloaded on 7 January 2022 for analysis. Qualitative thematic analysis was applied for developing operational definitions and coding guidelines for content analysis of the data. The patterns of responses for the dependent variables were compared among community-based practice setting types (chain, supermarket/mass merchandiser, and independent) and work positions (manager, staff pharmacist, technician/clerk, and owner). Chi-square analysis was used for determining statistically significant differences. The findings showed that personnel working in community-based pharmacies reported undesirable work environments and work stress that affected their ability to perform assigned duties for optimal patient care and ensure patient safety. Four work system elements were identified that were both facilitators and barriers to the ability to perform duties and ensure patient safety: (1) people, (2) tasks, (3) technology/tools, and (4) organizational context. Acknowledging local contexts of workplaces, giving adequate control, applying adaptive thinking, enhancing connectivity, building on existing mechanisms, and dynamic continuous learning are key elements for applying the HFE (human factors ergonomics) approach to improving the experience of providing care in community-based pharmacies.

Assessing the Association of Hispanic Ethnicity and Other Personal Characteristics with Pharmacy School Admissions.

Access to healthcare services for underrepresented minority populations can be improved by having a diverse profession that reflects the diversity of the patient population being served. The criteria used for pharmacy school admissions may inhibit or strengthen the opportunities that URM students have to be accepted into the University of Arizona R. Ken Coit College of Pharmacy (COP) program. It is currently unclear how personal characteristics are associated with pharmacy school admissions at the COP. This study evaluates whether Hispanic ethnicity was associated with pharmacy school admission status, and secondarily, determines other characteristics associated with admissions. This retrospective database study used admissions data from 2005 to 2018. Completed applications were included in the analysis. The outcome variable was admitted versus not admitted to the pharmacy program. A multivariable logistic regression model was used to identify variables associated with admission status using an a priori alpha level of 0.05. A total of 2096 applicants were included in the analysis (mean age 25.1 ± 5.2 years, 59.9% female, 13.0% Hispanic). Hispanic ethnicity was not associated with admission status. Characteristics significantly associated with admission to pharmacy school were age, gender, high school attended, previous application to the college, and Pharmacy College Admission Test (PCAT) biology and chemistry scores. Although bias was not seen in the admissions process, this study highlights the need for intervention to ensure future cohorts better reflect the diversity of the region.

Opioid prescribing practices in chronic pain management: guidelines do not sufficiently influence clinical practice.

UNLABELLED: To examine the use of extended-release (ER) opioids relative to immediate-release (IR) opioids in chronic opioid prescription episodes, pharmacy claim data from a national health plan database were analyzed. Enrollees having at least 1 pharmacy claim for an opioid formulation between June 2003 and May 2006, and at least 1 year of continuous enrollment after their first observed pharmacy claim were included. Opioid prescription episodes were created by combining contiguous days of therapy, allowing for a maximum of 7 days between refills (>or=8 d = new episode). Outcomes are reported in the form of probabilities and odds ratios (ORs). A total of 3,993,011 opioid prescription episodes were derived from 1,967,898 enrollees. Overall, prescription episodes involving IR preparations (97.7%) were more prevalent than episodes using ER preparations (2.3%). The odds of an ER preparation being prescribed chronically (>or=60 d) were approximately 11 times that of an IR preparation (OR = 10.7); however, the majority of chronic prescription episodes used IR formulations (84.8%). When stratified by prescriber type (specialist vs nonspecialists), the probability of a specialist prescribing ER opioids in these chronic prescription episodes was 19.1% versus 13.7% for nonspecialists. Specialists were about 50% more likely to prescribe ER opioids relative to nonspecialists (OR = 1.49). PERSPECTIVE: This analysis suggests that the availability of pain-treatment guidelines, recommendations, and education alone may not be enough to influence opioid-prescribing practices in the treatment of chronic pain.

Safety and tolerability of the lidocaine patch 5%, a targeted peripheral analgesic: a review of the literature.

The safety, tolerability, and efficacy of the lidocaine patch 5% (Lidoderm), a targeted peripheral analgesic with an FDA-approved indication for the treatment of postherpetic neuralgia, has been well established. Recent case reports and studies have suggested potential efficacy in other neuropathic and nonneuropathic pain conditions. Several pharmacokinetic studies have demonstrated minimal systemic absorption with 12-, 18-, and 24-hour/day dosing. Mean maximum plasma concentrations have shown the lidocaine patch to possess a minimal risk for systemic toxicities or drug-drug interactions. The most common adverse events generally involve mild skin reactions. There have been no drug-drug interactions noted in clinical trials. Recent evidence suggests that extended application does not result in A-beta-mediated sensory loss at the application site, which is particularly important in patients who already have a degree of sensory loss due to their underlying condition. The lidocaine patch provides a treatment option that carries a relatively low systemic adverse event and drug-drug interaction risk burden, even with continuous application of up to four patches per day.

Pharmacokinetics and safety of continuously applied lidocaine patches 5%.

The pharmacokinetics, safety, and tolerability of four topical lidocaine patches 5% continuously applied for 72 hours and changed every 12 or 24 hours were examined. In this randomized, prospective, multiple-dose, open-label pharmacokinetic study, lidocaine patches were applied to healthy men and women for three consecutive days. Ten subjects received four lidocaine patches every 24 hours (group 1), and 10 subjects received four patches every 12 hours (group 2). Serial samples of venous blood were obtained to determine pharmacokinetic data. Overall tolerability and safety were assessed, and skin sensory testing was conducted to determine whether local anesthetic activity was produced. The mean maximum plasma lidocaine concentrations at steady state with lidocaine patches applied in groups 1 and 2 were 186 and 225 ng/mL, respectively, compared with the reported mean maximum plasma concentration of 130 ng/ml. with the labeled dosage (12 hr/day). The area under the concentration-time curve for one dosage interval at steady state was 3550 and 4506 ng.hr/mL for groups 1 and 2, respectively. No loss in sensation at the application site was reported. No patient had edema, and most cases of erythema were very slight. No systemic adverse events were judged to be related to the patches. Continuous application for 72 hours of four lidocaine patches 5%, changed every 12 or 24 hours, produced plasma lidocaine concentrations that remained well below those that typically produce antiarrhythmic effects or toxicity. Mild application-site erythema occurred in most patients, but no systemic adverse reactions were judged to be related to the patches. No loss in sensation at the application site was reported.