Characteristics of postgraduate year 2 ambulatory care pharmacy residency programs in the United States.

PURPOSE: A survey was conducted to evaluate the characteristics and structures of postgraduate year 2 (PGY2) ambulatory care pharmacy residency programs in the United States. The survey results can serve as a guide for current and newly emerging programs. METHODS: A 24-question survey was sent to 138 US PGY2 residency program directors (RPDs) in February 2017 to identify key program characteristics, including program type (single-site or multisite), primary practice site, number of residents, length and type of rotations, staffing requirements, additional residency activities, precepting and teaching opportunities, RPD training and credentials, and number and qualifications of preceptors. Descriptive statistics were used to analyze the findings. RESULTS: A 40.6% response rate was achieved. Well over half (57%) of programs had been established within the preceding 5 years. A majority of RPDs reported that their program had 1 (53%) or 2 residents (31%) and/or was a single-site program (80%). Overall, 44 different types of rotations or experiences were offered by the programs. All surveyed programs offered additional teaching opportunities. There were no formal staffing duties in 29% of programs; professional organization membership and conference attendance were highly encouraged but typically not required of residents. Qualifications of the RPD and preceptors closely mirrored those delineated in residency accreditation standards. CONCLUSION: There is an increased need for specialized training in ambulatory care in order to prepare pharmacists for the changing landscape in healthcare. The profession is adapting to this need, as evidenced by the rapid growth of PGY2 ambulatory care residency programs. Understanding characteristics can benefit continued growth to meet the needs of the profession.

Health care insecurity in the underserved: Effect of a charitable pharmacy model.

OBJECTIVES: The objectives of this study were to assess how a charitable pharmacy model affects patient perception of health care insecurity, physical and emotional functioning, and medication access in an underserved population. METHODS: New patients presenting for medication at their initial pharmacy visit at Charitable Pharmacy of Central Ohio were screened for eligibility during a 12-week enrollment period. Participants completed a baseline survey containing the Health Care Insecurity Measure (HCIM), Veterans RAND 12-Item Health Survey (VR-12), and medication access questions. The follow-up survey, which contained the HCIM and VR-12 only, was administered during a pharmacy visit at least 14 days after the patient's initial visit. Survey data were analyzed with the use of descriptive statistics. RESULTS: A total of 105 patients met eligibility criteria, and 17 patients declined to participate. Of the 88 remaining participants, 33 (38%) completed the study (both baseline and follow-up survey). Of the 33 participants who completed the study, there was a statistically significant decrease from the baseline health care insecurity score (23.2 ± 11.1) to the follow-up score (17.9 ± 8.5; P = 0.0031). CONCLUSION: This study demonstrated that pharmacists working in a charitable pharmacy can have a positive impact on the sense of security patients feel about their health care and can better understand their medication-related needs.

Implementation and use of an electronic health record in a charitable community pharmacy.

OBJECTIVES: To describe the implementation of enhanced health information technology (HIT), specifically an electronic health record (EHR), into the workflow of a charitable community pharmacy and to highlight the impact of the EHR on clinical service advancement, student and resident learning, research, and grant support for the pharmacy. SETTING: The Charitable Pharmacy of Central Ohio (CPCO) is a nonprofit community pharmacy that provides medications and pharmacy services for uninsured and underinsured patients. PRACTICE DESCRIPTION: CPCO has adopted a practice model in which patients discuss their medications and health conditions in a private counseling area with a pharmacist or pharmacy student. Counseling sessions incorporate point-of-care testing, medication therapy management, and community program referrals, with documentation of the visit in the patient's chart. PRACTICE INNOVATION: This article describes the implementation of a cloud-based EHR in a charitable community pharmacy. EVALUATION: The decision-making process for converting from a paper-based chart to an EHR is described. Feedback from stakeholders, discussions at staff meetings, and a quality improvement project led by 2 pharmacy residents helped to inform and improve the process. RESULTS: Implementation of an EHR has allowed CPCO to improve documentation of patient encounters and communicate more effectively and efficiently with other health care professionals. Student and resident learning has been enhanced, and reporting tools have facilitated additional opportunities for successful funding and more robust research. CONCLUSION: The use of an EHR at CPCO has provided opportunities to enhance patient care and improve other areas of practice. Community pharmacies should consider the utilization of HIT and EHRs to demonstrate the impact on patient care, elevate the standard of practice, and offer support for provider status.

Managerial skills of new practitioner pharmacists within community practice.

OBJECTIVES: To identify managerial skills required in community pharmacy practice, explore new practitioners' previous exposure to these skills, and assess new practitioners' perceived preparedness to take on managerial responsibilities. METHODS: A survey was developed with the use of Qualtrics and distributed by state pharmacy associations using a convenience sample of pharmacists from Iowa, Kentucky, Michigan, Ohio, and Pennsylvania. Pharmacists not practicing in a community pharmacy setting at the time of the study were excluded. New practitioners were defined as pharmacists practicing for no more than 10 years. RESULTS: A total of 168 pharmacists completed the survey. More than one-half (56%) of respondents self-reported being in a managerial position, and 90% of respondents thought that managerial skills were always or very often necessary. At graduation, 15% of respondents rated their managerial skill proficiency to be high to very high, with this increasing to 57% at current point in their career. When comparing managers versus non-managers, 78% of skills assessed showed higher utilization in managers. Interestingly, only 44% of skills showed a higher proficiency in managers. Finally, 88% of respondents thought that their managerial skills could be improved. CONCLUSION: New practitioners in community practice reported a high utilization of managerial skills, as well as improved proficiency throughout their careers. These skills are important in both community pharmacy training and practice. Managers reported higher utilization of managerial skills, but that utilization did not always correlate with proficiency. This highlights the need to further identify and improve managerial skills during pharmacy education and as part of ongoing continuing professional development.

Assessment of self-care and medication adherence in individuals with mental health conditions.

OBJECTIVES: This descriptive study explored whether patients with mental health conditions engage in personal medicine (self-care activities) as part of their treatment regimen. Personal medicine is patient-identified and -initiated activities of self-care that can improve mental health through various means, including physical activity, social engagement, and spiritual connectedness. The purpose of this study was to explore patient engagement in personal medicine within an underserved population and to evaluate the impact self-care might have on self-reported medication use and adherence and patient perception of mental health control. DESIGN: Cross-sectional study design with a face-to-face verbally administered survey assessing medication adherence, engagement in self-care activities, perception of self-care, and mental health control. SETTING: The study site was a nonprofit charitable pharmacy in an urban setting. The pharmacy provides medications and pharmacy services at no charge, including disease state education, point-of-care testing, and medication therapy management. PARTICIPANTS: Study participants included those who fill medications for mental health conditions and who are age 18 years and older. MAIN OUTCOME MEASURES: Main outcomes included engagement in self-care and self-reported medication adherence. Additional measures included stratification of dimensions of self-care, perception of mental health control, and patient knowledge of community resources. RESULTS: Overall, 81.7% of participants engaged in activities of self-care, with 98.3% recognizing self-care as important to improving and maintaining their mental health. Greater self-reported adherence rates and mental health control were seen with patients who participate in self-care. CONCLUSION: Participants who identify and engage in personal medicine recognize its value and are willing to incorporate it into their treatment regimen. As accessible and trusted health care providers, pharmacists can encourage patients to identify and use personal medicine to aid in the improvement of their mental health condition.

Assessing Ohio grocery store patrons' perceptions of a comprehensive medication review.

OBJECTIVE: To assess grocery store patrons' perceptions of a comprehensive medication review (CMR) compared with traditional prescription medication counseling. DESIGN: Self-administered survey. SETTING: Eight central Ohio grocery stores during January through April 2007. PARTICIPANTS: Grocery store patrons. INTERVENTION: Survey events. MAIN OUTCOME MEASURES: Responses to survey items about CMRs and prescription medication counseling indicated (1) who study participants would expect to deliver each program, (2) where they would expect services to be offered, and (3) what they would expect to be included or discussed. RESULTS: Predefined response options were provided for each question. The majority of the 214 study participants associated physicians or pharmacists with a CMR. CMRs were thought to be provided in medical offices or pharmacies. Only 3 of 24 qualifiers were statistically significantly different when comparing CMRs and prescription medication counseling (inclusion of health and wellness screenings [55% vs. 43%, P = 0.015], discussion about any of the patients' medications being the same [45% vs. 56%, P = 0.026] and "other" [6% vs. 12%, P = 0.021]). CONCLUSION: Patients may not recognize pharmacists as primary providers of CMRs and may not see a clear distinction between a CMR and prescription medication counseling. More research is needed in this area to further solidify the results. Pharmacists need to market themselves as willing and capable individuals of providing CMRs. Additionally, pharmacists should highlight key differences between a CMR and prescription medication counseling so that patients understand the value of a CMR.

Partner for Promotion: an innovative advanced community pharmacy practice experience.

OBJECTIVES: To implement the Partner for Promotion (PFP) program which was designed to enhance the skills and confidence of students and community pharmacy preceptors to deliver and expand advanced patient care services in community pharmacies and also to assess the program's impact. DESIGN: A 10-month longitudinal community advanced pharmacy practice experience was implemented that included faculty mentoring of students and preceptors via formal orientation; face-to-face training sessions; online monthly meetings; feedback on service development materials; and a web site offering resources and a discussion board. Pre- and post-APPE surveys of students and preceptors were used to evaluate perceptions of knowledge and skills. ASSESSMENT: The skills survey results for the first 2 years of the PFP program suggest positive changes occurring from pre- to post-APPE survey in most areas for both students and preceptors. Four of the 7 pharmacies in 2005-2006 and 8 of the 14 pharmacies in 2006-2007 were able to develop an advanced patient care service and begin seeing patients prior to the conclusion of the APPE. As a result of the PFP program from 2005-2007, 14 new experiential sites entered into affiliation agreements with The Ohio State University College of Pharmacy. CONCLUSION: The PFP program offers an innovative method for community pharmacy faculty members to work with students and preceptors in community pharmacies in developing patient care services.

Designing pharmacy services based on grocery store patron preferences.

OBJECTIVE: To assess preferences of grocery store patrons concerning pharmacy services and identify study participant characteristics that may predict the success of pharmacy services in the community setting. DESIGN: Self-administered survey. SETTING: Central Ohio from December 16, 2005, to January 12, 2006. PARTICIPANTS: 163 grocery store patrons. INTERVENTIONS: Eight grocery store survey events. MAIN OUTCOME MEASURES: Responses to survey items about (1) perceived importance of 28 pharmacy services, (2) identification of the 3 most important services, (3) frequency of grocery store and pharmacy use, (4) preferred methods of advertising pharmacy services, and (5) socioeconomic demographics. Preferred services delineated by various demographics also were analyzed. RESULTS: A total of 163 surveys were returned from study participants. Nine services appeared in both the top 12 overall preferred services and the 12 highest-ranked services. Statistically significant differences were observed among services ranked as important or very important by age, race, employment, income, caregiver status, and prescription drug coverage status. The three advertising tools selected most frequently included: weekly grocery store ads (68.6%), in-store signs (51.0%), and flyers attached to prescription bags (36.0%). CONCLUSION: Grocery store patrons would like a wide range of nontraditional pharmacy services that could be implemented into community pharmacies. Pharmacies in grocery stores need to provide both traditional and expanded pharmacy services to meet the desires and expectations of current and potential patients, and expanded marketing methods should be considered.

Documentation of patient care services in a community pharmacy setting.

OBJECTIVE: To assess the types of patient care documentation systems currently being used by community pharmacists and determine the preferred characteristics of an ideal patient care documentation system. DESIGN: Mailed survey. SETTING: United States. PARTICIPANTS: One pharmacist from each of 125 targeted community pharmacies. INTERVENTION: Survey mailed in February 2003, followed by a second mailing to nonrespondents in March 2003. MAIN OUTCOME MEASURES: Responses to survey items about (1) patient care services provided at the pharmacy, (2) characteristics of the current documentation system, and (3) characteristics of an ideal documentation system. RESULTS: A total of 48 usable responses were received from 106 pharmacies to which surveys were delivered (45.3%). Independent pharmacies accounted for 50% of survey respondents. More than 80% of respondents were providing patient screening or management services associated with a chronic disease such as diabetes, hypertension, or dyslipidemia. Approximately 54% of the pharmacists were using a paper documentation system. However, challenges identified with a paper system included documentation time, retrieval of patient data, tracking patient outcomes, and storage. Respondents indicated that an ideal documentation system would be comprehensive, easy and efficient to use, and affordable. CONCLUSION: Pharmacists recognize the importance of documenting patient care services. While the majority of respondents are using paper charts to document patient care services, computerized systems appear to offer advantages over paper charts. This information offers community pharmacists a summary of previous experiences and a starting point when trying to identify or modify a documentation system that would better meet the pharmacies' needs.

Status and recommendations for self-care instruction in US colleges and schools of pharmacy, 2006.

Teachers of pharmacy self-care courses have met annually since 1998 at the Nonprescription Medicines Academy (NMA) held in Cincinnati, Ohio. During these meetings, self-care faculty members discuss methods of enhancing the teaching of self-care in US colleges and schools of pharmacy. Self-care courses are taught using a variety of methods and content is woven into pharmacy curricula in many different ways. This manuscript sets forth the current state of self-care instruction in pharmacy curricula including the recommended core curriculum, instructional methodologies, course mechanics, existing standards, and assessment and curricular placement, and makes recommendations for the future.

Healthy skin for women: a review of common conditions and therapies.

OBJECTIVE: To review common dermatologic conditions that may be of particular concern to women throughout their lives, including acne, contact dermatitis, skin conditions of pregnancy, dry skin, and sun-related skin damage. DATA SOURCES: Articles identified through a search of MEDLINE and pharmacology and dermatology textbooks using the terms women, dermatology, skin, acne, skin cancer, sunscreens, pregnancy, melanoma, basal cell carcinoma, dermatitis, cosmetic dermatitis, dry skin (xerosis), actinic keratosis, oral contraceptives, and striae. Additional references were identified from the bibliographies of retrieved articles and book chapters. DATA SYNTHESIS: A number of skin conditions may be of particular concern to women throughout their lives. Acne, which may be particularly troublesome during the teenage years and young adulthood, and skin conditions that are common during pregnancy may be influenced by hormonal changes that occur at different life stages. Skin conditions that are influenced by the environment include contact dermatitis, dry skin, and sun-related skin damage, including actinic keratosis, carcinoma, and melanoma. Many of these conditions are amenable to nonpharmacologic therapy and over-the-counter treatments, whereas others require prescription pharmacotherapy. Pharmacists are in an ideal position to advise women about the appropriate management of these conditions and to identify lesions that require additional assessment. CONCLUSION: Pharmacists can make valuable contributions to patients' self-care of the skin by recommending products, educating patients about skin health, and counseling patients about prescription medications. Gaining a greater understanding of skin conditions that are of particular concern to women can prepare pharmacists to make these contributions.