How Pharmacist Preceptors Foster Students' Therapeutic Reasoning Using the One-Minute Preceptor Method.

Objective. To compare whether preceptors trained in the One-Minute Preceptor (OMP) method versus preceptors not trained in the OMP method use OMP methods, and whether their students demonstrate more frequent expression of therapeutic reasoning processes during case presentations. Methods. A pilot quasi-experimental study was conducted. In 2015, four preceptors attended an OMP training session. The OMP preceptors and three preceptors not trained in OMP were asked to collect audio recordings of their students presenting patient cases. The audio recordings were coded for preceptors' use of OMP methods and students' expression of therapeutic reasoning processes. Results. In total, we collected 42 audio recordings from 27 students presenting a patient case to one of seven preceptors. Preceptors trained in OMP more frequently asked students to commit to a therapeutic assessment and plan, probed for their supporting reasoning, and reinforced what was done well. However, non-OMP preceptors' students more frequently articulated assessments and treatment plans in their case presentations. The non-OMP students also more frequently initiated discussion about the reasoning behind their assessments and plans without prompting from their preceptor. Conclusion. Implementing OMP workshops for preceptors to elicit students' therapeutic reasoning processes requires further consideration. Future research is needed on pragmatic and effective precepting methods.

Clinical Inquiries: What are the benefits and risks of daily low-dose aspirin for primary prevention of CV events?

One nonfatal myocardial infarction (MI) will be avoided for every 126 to 138 adults who take daily aspirin for 10 years (strength of recommendation [SOR]: A, systematic reviews and meta-analyses of multiple randomized controlled trials [RCTs]). Taking low-dose aspirin for primary prevention shows no clear mortality benefit. A benefit for primary prevention of stroke is less certain. Although no evidence establishes increased risk of hemorrhagic stroke from daily low-dose aspirin, one gastrointestinal hemorrhage will occur for every 72 to 357 adults who take aspirin for longer than 10 years (SOR: A, systematic reviews and meta-analyses of multiple RCTs and cohort studies).

Creating a new rural pharmacy workforce: Development and implementation of the Rural Pharmacy Health Initiative.

PURPOSE: An innovative certificate program aimed at expanding the rural pharmacy workforce, increasing the number of pharmacists with expertise in rural practice, and improving healthcare outcomes in rural North Carolina is described. SUMMARY: Predicted shortages of primary care physicians and closures of critical access hospitals are expected to worsen existing health disparities. Experiential education in schools and colleges of pharmacy primarily takes place in academic medical centers and, unlike experiential education in medical schools, rarely emphasizes the provision of patient care in rural U.S. communities, where chronic diseases are prevalent and many residents struggle with poverty and poor access to healthcare. To help address these issues, UNC Eshelman School of Pharmacy developed the 3-year Rural Pharmacy Health Certificate program. The program curriculum includes 4 seminar courses, interprofessional education and interaction with medical students, embedding of each pharmacy student into a specific rural community for the duration of training, longitudinal ambulatory care practice experiences, community engagement initiatives, leadership training, development and implementation of a population health project, and 5 pharmacy practice experiences in rural settings. CONCLUSION: The Rural Pharmacy Health Certificate program at UNC Eshelman School of Pharmacy seeks to transform rural pharmacy practice by creating a pipeline of rural pharmacy leaders and teaching a unique skillset that will be beneficial to healthcare systems, communities, and patients.

Improved Utilization of Preventive Services Among Patients Following Team-Based Annual Wellness Visits.

BACKGROUND The Annual Wellness Visit was designed to enhance preventive services utilization among Medicare beneficiaries; Annual Wellness Visits are underutilized with sparse documented effectiveness. Patients of 3 community-based and 2 retirement community outpatient clinics in western North Carolina had team-based Annual Wellness Visits over a 20-month program, with the goal of improving the uptake and delivery of the Annual Wellness Visit. A clinical pharmacist saw high-complexity patients (≥5 medications) and a licensed practical nurse saw low-complexity patients. We examined the effectiveness of team-based Annual Wellness Visits on patients' use of preventive services.METHOD We conducted a retrospective chart review on a random sample of 500 patients for 12 months post-Annual Wellness Visit. Change over time in use of preventive services was assessed using McNemar's test. Adjusted relative risks of use within 6 months were calculated using generalized linear models with the Poisson loglinear function.RESULTS Overall, utilization of Annual Wellness Visit increased from 14% at baseline to 44% after the 20-month program. The percentage of patients up-to-date with all recommended services increased from 17.4% at the Annual Wellness Visit to 42% within 6 months. Age-appropriate preventive screens and vaccines demonstrated the most improvement (55.8% to 75.4% and 36% to 52.2%, respectively). Community-based patients were less likely to obtain recommended services (RR = 0.618; 95% confidence interval [CI], 0.442-0.865), while patients with supplemental insurance (RR = 1.484; 95% CI, 1.023-2.153), patients seen in subsequent Annual Wellness Visits (RR = 1.405; 95% CI, 1.062-1.858), and patients who were men (RR = 1.422; 95% CI, 1.053-2.041) were more likely to obtain recommended services.LIMITATIONS Generalization is limited by the pre-/post design of one organizational model.CONCLUSION Team-based Annual Wellness Visits with a clinical pharmacist or an LPN, who were supervised by physicians, were associated with significantly improved utilization of preventive services. Use will likely continue to improve as more patients access team-based Annual Wellness Visits yearly.