Predictors of Student Failure or Poor Performance on Advanced Pharmacy Practice Experiences.

Objective. To determine factors predictive of student failure or poor performance on advanced pharmacy practice experiences (APPEs) at a single pharmacy program. Methods. This retrospective cohort evaluated students entering the Doctor of Pharmacy (PharmD) program from 2012-2014 at St. Louis College of Pharmacy. Students who received a grade of F for one or more APPEs (failure group) were compared to all other students (non-failure group). A secondary evaluation compared students with a C or F on one or more APPEs (poor performers) to all other students (non-poor performers). Data were collected on didactic and experiential performance, identifiable professionalism issues from introductory pharmacy practice experiences (IPPEs), and academic honor code violations. Univariable and multivariable logistic regressions were performed to determine factors associated with APPE failure and poor performance. Results. A total of 669 students were analyzed. Twenty-eight students (4.2%) failed one or more APPEs and 81 students (12.1%) were identified as poor performers (grade of C or F). For the primary outcome, professional grade point average (GPA) of less than 2.7, practicum failure, IPPE professionalism issue(s), and pharmacotherapy course failure were identified for inclusion in the multivariable analysis. The IPPE professionalism issue(s) (HR 4.8 [95% CI 1.9-12.4]) and pharmacotherapy course failure (HR 4.2 [95% CI, 1.6-11.1]) were associated with APPE failure on multivariable regression. On the secondary analysis, the same variables were identified for multivariable regression, with professional GPA of less than 2.7 (HR 2.7 [95% CI 1.5-5]), IPPE professionalism issue(s) (HR 3.9 [95% CI 2.2-6.9]), and pharmacotherapy course failure (HR 2.0 [95% CI 1.1-3.7]) associated with poor performance. Conclusion. Poor academic performance and/or identified unprofessional behavior while completing IPPEs are associated with APPE failure and poor performance. Interventions should be aimed at identifying at-risk students and addressing risk factors prior to APPEs.

Implementation of a Discharge Education Program to Improve Transitions of Care for Patients at High Risk of Medication Errors.

Background: Transitions of care (TOC) points are those where patient outcomes can be affected, especially patients at high risk for medication errors. Pharmacist-led postdischarge telephone counseling positively affects patient outcomes, though challenges exist relating to successful patient contact. Objective: The objective of this study was to develop and evaluate a discharge education service bridging the inpatient and outpatient setting to increase successful patient contact points during the TOC process from hospital to home. Methods: This prospective, single-centered observational study examined the impact of a discharge medication education program on successful telephone follow-up contact. The primary outcome was the percentage of high-risk patients educated at hospital discharge who were successfully reached via follow-up telephone contact within 2 business days of discharge. Secondary end points included hospital readmission rates and patient survey responses. Results: A total of 50 patients were included in the initial evaluation of this service; 78% of patients were successfully contacted within 2 business days after discharge, an increase from a 20% success rate prior to service implementation. At follow-up telephone calls, patients reported taking an average of 16 medications. The 30-day readmission rate was 10% for patients receiving this service, compared with 19% prior to implementation. When asked if they understood the medication component of their care and if they found the TOC service to be satisfactory, 100% and 96% of patients strongly agreed or agreed with these statements, respectively, and none disagreed. Conclusion and Relevance: This service demonstrates how pharmacists can interact with a high-risk population and increase contact points to optimize care at crucial health care transition points.

Design and Validation of Patient-Centered Communication Tools (PaCT) to Measure Students' Communication Skills.

Objective. To develop a comprehensive instrument specific to student pharmacist-patient communication skills, and to determine face, content, construct, concurrent, and predictive validity and reliability of the instrument. Methods. A multi-step approach was used to create and validate an instrument, including the use of external experts for face and content validity, students for construct validity, comparisons to other rubrics for concurrent validity, comparisons to other coursework for predictive validity, and extensive reliability and inter-rater reliability testing with trained faculty assessors. Results. Patient-centered Communication Tools (PaCT) achieved face and content validity and performed well with multiple correlation tests with significant findings for reliability testing and when compared to an alternate rubric. Conclusion. PaCT is a useful instrument for assessing student pharmacist communication skills with patients.

Patient-perceived content and formatting expectations for prescription container labeling.

OBJECTIVES: The objectives of the study were to identify patient expectations for prescription label content and formatting and to explore how United States Pharmacopeia Chapter 17 Standards for prescription container labeling meet patient expectations. DESIGN: Focus group. SETTING: St. Louis, Missouri, in July and August 2014. PARTICIPANTS: Patients 18 years and older who were taking at least 2 chronic prescription medications and managing their medications independently. MAIN OUTCOME MEASURE: Qualitative themes. INTERVENTION: Not applicable. METHODS: Five focus groups (17 total participants) were conducted in St. Louis in 2014. Focus groups were audio-recorded and consent was obtained from the participants. The audio files were professionally transcribed. Atlas.ti software (version 7.5.3) was used to analyze the transcript data, which were then coded to identify key themes. To ensure consistency of interpretation, a constant comparative analytic framework approach was used. RESULTS: Analysis produced 6 themes related to patient perceptions and expectations of prescription label content and formatting: importance of drug name, dose, and directions; lack of side effects on the label; improved organization and larger font size; using the color red; lack of familiarity with auxiliary labels; and the importance of pharmacy information. Themes focused on how patients use prescription labels and the relative value of different aspects of prescription container labeling. CONCLUSIONS: Patient-perceived prescription content and formatting expectations for prescription container labeling were generally consistent with published USP Chapter 17 guidelines. The importance of pharmacy phone numbers, white space, and highlighting were noteworthy.

Student use of health literacy tools to improve patient understanding and medication adherence.

OBJECTIVE: Evaluate curricular changes related to health literacy and determine impact on independent-living senior residents as part of an introductory pharmacy practice experience for third-year student pharmacists. DESIGN: Students were randomly assigned a resident whom they visited multiple times to conduct assessments and provide various services using three methods: Ask Me 3™ Four Habits Model, and Teach-back. SETTING: The study was conducted at independent-living apartments within a 24-mile radius from the St. Louis College of Pharmacy, St. Louis, Missouri. PATIENTS, PARTICIPANTS: Participants (n = 147 to 173, across all three years) were volunteer, elderly residents, living at a facility that collaborated with the research. INTERVENTIONS: Within one academic year, students collected medical and medication histories, conducted household safety checks, performed screening assessments, assessed adherence, and provided general recommendations to a resident. MAIN OUTCOME MEASURE(S): Outcomes included resident satisfaction, student satisfaction, and correlations between student use of health literacy tools and resident satisfaction. RESULTS: Exit surveys indicated resident overall satisfaction with the program, increased understanding of health-related information, increased confidence in asking health care professionals questions about their health, and greater commitment to medication adherence as a result of the experience. Students were highly satisfied with the program. Analyses reveal some correlations between a previously determined performance level of student communication and resident satisfaction. CONCLUSIONS: Students' use of health literacy communication tools during encounters with independent-living senior residents can result in greater patient understanding and empowerment, which may in turn help improve medication adherence.

Comparison of patient simulation methods used in a physical assessment course.

OBJECTIVE: To determine whether there is a difference in student pharmacists' learning or satisfaction when standardized patients or manikins are used to teach physical assessment. DESIGN: Third-year student pharmacists were randomized to learn physical assessment (cardiac and pulmonary examinations) using either a standardized patient or a manikin. ASSESSMENT: Performance scores on the final examination and satisfaction with the learning method were compared between groups. Eighty and 74 student pharmacists completed the cardiac and pulmonary examinations, respectively. There was no difference in performance scores between student pharmacists who were trained using manikins vs standardized patients (93.8% vs. 93.5%, p=0.81). Student pharmacists who were trained using manikins indicated that they would have probably learned to perform cardiac and pulmonary examinations better had they been taught using standardized patients (p<0.001) and that they were less satisfied with their method of learning (p=0.04). CONCLUSIONS: Training using standardized patients and manikins are equally effective methods of learning physical assessment, but student pharmacists preferred using standardized patients.

Health literacy: use of the Four Habits Model to improve student pharmacists' communication.

OBJECTIVE: To assess whether student pharmacists' communication skills improved using the Four Habits Model (FHM) at the St. Louis College of Pharmacy. METHODS: During the Fall of 2009 and 2010, student pharmacists in the third professional year learned and practiced the FHM. They were given feedback by faculty on three of the four Habits, used the FHM for self and peer assessment, and were formally evaluated on all four Habits during a standardized patient encounter. RESULTS: Student pharmacist performance significantly improved from baseline during both Fall 2009 and Fall 2010 in the majority of the Habits assessed. CONCLUSION: Use of the FHM in pharmacy education can improve a student pharmacists' ability to display the four Habits of communicating and developing relationships with patients. Tailoring of the FHM to pharmacy encounters will further enhance the utility of this communication framework. PRACTICE IMPLICATIONS: Use of the FHM enhances the measurement and assessment of the relational aspects of student pharmacist-patient communication skills. Consistent use of the FHM over time is likely necessary to fully develop and retain communication skills. The overall goal is to improve patient's health literacy and appropriate medication use by improving communication and the pharmacist-patient relationship.

Professional technical standards in colleges and schools of pharmacy.

OBJECTIVE: To determine the prevalence, characteristics, and use of professional technical standards among colleges and schools of pharmacy accredited by the Accreditation Council for Pharmacy Education (ACPE). METHODS: The Web site of every college and school of pharmacy accredited by ACPE was searched to identify information regarding the availability, content, and use of technical standards and to obtain demographic information. RESULTS: Information was obtained from all of the 114 colleges and schools of pharmacy and 67 (59%) had technical standards in place. Common themes for technical standards were: observation; communication; motor; intellectual, conceptual, integrative and quantitative abilities; and behavioral and social attributes. Of those colleges and schools with technical standards, 61 (91%) had standards that addressed all 5 of these themes and 34 (51%) specified that the technical standards were used in their admission, progression, and graduation procedures. CONCLUSION: More than half of the colleges and schools of pharmacy examined in this study have technical standards; however, 41% have yet to develop and implement them. Colleges and schools of pharmacy looking for guidance in technical standards development could use the technical standards themes identified in this study.

Asthma friendly pharmacies: a model to improve communication and collaboration among pharmacists, patients, and healthcare providers.

Pharmacists, with expertise in optimizing drug therapy outcomes, are valuable components of the healthcare team and are becoming increasingly involved in public health efforts. Pharmacists and pharmacy technicians in diverse community pharmacy settings can implement a variety of asthma interventions when they are brief, supported by appropriate tools, and integrated into the workflow. The Asthma Friendly Pharmacy (AFP) model addresses the challenges of providing patient-focused care in a community pharmacy setting by offering education to pharmacists and pharmacy technicians on asthma-related pharmaceutical care services, such as identifying or resolving medication-related problems; educating patients about asthma and medication-related concepts; improving communication and strengthening relationships between pharmacists, patients, and other healthcare providers; and establishing higher expectations for the pharmacist's role in patient care and public health efforts. This article describes the feasibility of the model in an urban community pharmacy setting and documents the interventions and communication activities promoted through the AFP model.

Independent community pharmacists' perspectives on compounding in contemporary pharmacy education.

OBJECTIVES: To identify compounding practices of independent community pharmacy practitioners in order to make recommendations for the development of curricular objectives for doctor of pharmacy (PharmD) programs. METHODS: Independent community practitioners were asked about compounding regarding their motivations, common activities, educational exposures, and recommendations for PharmD education. RESULTS: Most respondents (69%) accepted compounding as a component of pharmaceutical care and compounded dermatological preparations for local effects, oral solutions, and suspensions at least once a week. Ninety-five percent were exposed to compounding in required pharmacy school courses and most (98%) who identified compounding as a professional service offered in their pharmacy sought additional postgraduate compounding education. Regardless of the extent of compounding emphasis in the practices surveyed, 84% stated that PharmD curricula should include compounding. CONCLUSIONS: Pharmacy schools should define compounding curricular objectives and develop compounding abilities in a required laboratory course to prepare graduates for pharmaceutical care practice.

A Pharmacy Faculty Academy to foster professional growth and long-term retention of junior faculty members.

OBJECTIVES: Implement a Pharmacy Faculty Academy designed to foster professional growth of new faculty members in an outcomes-oriented, "frames"-based manner and to evaluate the impact on faculty satisfaction and retention rates. DESIGN: A Faculty Academy was designed based on critical themes relevant to junior faculty members and important symbolic, structural, human resource, and political considerations. The year-long program included concentrated sessions during the first 4 weeks of employment followed by longitudinal activities requiring an advancing level of faculty performance. ASSESSMENT: Qualitative and quantitative metrics for engagement and professional growth improved dramatically during the implementation period. The 21 faculty members who completed the program from 2005-2007 provided positive feedback. CONCLUSION: An individualized, systematic approach to faculty development resulted in more highly engaged and productive faculty members who were more likely to remain long term within the College.

Developing a business-practice model for pharmacy services in ambulatory settings.

A business-practice model is a guide, or toolkit, to assist managers and clinical pharmacy practitioners in the exploration, proposal, development and implementation of new clinical pharmacy services and/or the enhancement of existing services. This document was developed by the American College of Clinical Pharmacy Task Force on Ambulatory Practice to assist clinical pharmacy practitioners and administrators in the development of business-practice models for new and existing clinical pharmacy services in ambulatory settings. This document provides detailed instructions, examples, and resources on conducting a market assessment and a needs assessment, types of clinical services, operations, legal and regulatory issues, marketing and promotion, service development and exit plan, evaluation of service outcomes, and financial considerations in the development of a clinical pharmacy service in the ambulatory environment. Available literature is summarized, and an appendix provides valuable citations and resources. As ambulatory care practices continue to evolve, there will be increased knowledge of how to initiate and expand the services. This document is intended to serve as an essential resource to assist in the growth and development of clinical pharmacy services in the ambulatory environment.

Prevalence of compounding in independent community pharmacy practice.

OBJECTIVES: To determine the extent of prescription compounding in independent community pharmacies and identify factors that influence the decision of independent pharmacists whether to provide compounding services. DESIGN: Cross-sectional survey. SETTING: Illinois, Missouri, Kansas, and Iowa. PARTICIPANTS: 370 pharmacists in charge. INTERVENTION: Anonymous questionnaire mailed in January 2005. MAIN OUTCOME MEASURES: Percentage of pharmacies that provide compounding; percentage of dispensed prescriptions that require compounding; factors contributing to decisions whether to provide compounding service. RESULTS: Overall, 94% of respondent pharmacies provided compounding services at the time of this survey. Prescriptions that required compounding represented less than 1% of total prescriptions for the majority (58.3%) of respondents. The main reasons for the decision to provide compounding service were wanting to provide full pharmaceutical care to patients (73.8% of compounders) and responding to requests by prescribers (48.7%). Pharmacies that did not provide compounding service cited the main reason as not receiving prescriptions that required compounding (63.6% of noncompounders). CONCLUSION: Compounding remains a component of pharmacy practice in the independent community setting. Prescriptions that required compounding represented 2.3% of all prescriptions dispensed by compounding pharmacies.