Institutional factors associated with global health education across US pharmacy schools.

INTRODUCTION: The objective of this study is to explore the relationship between institutional factors and offerings of global health education opportunities in pharmacy schools. METHODS: Data for this project came from a review of international advanced pharmacy practice experiences (APPEs) and global course offerings for US pharmacy schools conducted between February 1 and March 31, 2014. These data were merged with data on institutional factors which may influence a school's offering of APPEs or courses. Institutional factors included tuition, class size, academic medical center affiliation, year established, and others. Multivariable regression models were used to evaluate the relationship between individual institutional factors and APPEs and global courses. RESULTS: In multivariable adjusted models, older and more established schools had a larger percent of the graduating class with an international APPE (9.5% vs. 2.6%, p < 0.01) and a larger number of international APPEs (3.8 vs. 1.4, p < 0.01) than schools founded after 1980. Schools with higher tuition (>$25,000/year) had, on average, a larger percent of their graduating class with an international APPE (7.9% vs. 3.1%, p < 0.05), a larger number of international APPEs (3.7 vs. 1.5, p < 0.01), and more interprofessional international APPEs (3.1 vs. 0.7, p < 0.001). There were more course offerings at older schools (1.1 vs. 0.4, p < 0.05) and those with higher tuition (1.3 vs. 0.4, p < 0.01). CONCLUSIONS: More established schools and those with higher tuition appeared to have more robust global offerings. Schools can consider local opportunities to provide global experiential and didactic experiences, which may reduce the financial burden of global programs.

Influencing the future of rural-focused pharmacy education: Identifying factors pertinent to pharmacy practice in rural health environments.

INTRODUCTION: To identify themes regarding the skills used on a regular basis by pharmacists practicing in rural areas. METHODS: A cross-sectional qualitative survey was administered to pharmacists working in a non-clinical capacity in rural community and hospital practice. Pharmacists were identified in conjunction with departments of experiential education, boards of pharmacy, and other rural health experts. Contacts were interviewed using a semi-structured approach with thematic saturation determining the number of interviews. Themes were identified by reviewing interview notes and transcripts for repeated phrases, concepts, and ideas then compared with the literature. RESULTS: Fifteen pharmacists practicing in rural areas were interviewed. Themes related to practice environment, patient population, skills used by rural pharmacists, preparation of students, and continuing education needs were identified. Many of the identified themes are corroborated by published literature. One pharmacy-specific theme not corroborated was "pharmacy specialization is not helpful". DISCUSSION AND CONCLUSIONS: The results of this study coupled with data from rural medical education may be useful for educators developing rural-focused coursework via reverse design.

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.

Professional Organizations for Pharmacy Students on Satellite Campuses.

Objective. To evaluate the structure and impact of student organizations on pharmacy school satellite campuses. Methods. Primary administrators from satellite campuses received a 20-question electronic survey. Quantitative data analysis was conducted on survey responses. Results. The most common student organizations on satellite campuses were the American Pharmacists Association (APhA) (93.1%), American Society of Health-System Pharmacists (ASHP) (89.7%), Christian Pharmacists Fellowship International (CPFI) (60.0%), state organizations (51.7%), and local organizations (58.6%). Perceived benefits of satellite campus organizations included opportunities for professional development, student engagement, and service. Barriers to success included small enrollment, communication between campuses, finances, and travel. Conclusion. Student organizations were an important component of the educational experience on pharmacy satellite campuses and allowed students to develop professionally and engage with communities. Challenges included campus size, distance between campuses, and communication.

Global Experiential and Didactic Education Opportunities at US Colleges and Schools of Pharmacy.

OBJECTIVE: To assess the characteristics of global experiential and didactic education offerings in the pharmacy curricula. METHODS: A 2-stage web-based review of US colleges and schools of pharmacy identified country locations of international advanced pharmacy practice experiences (APPE), globally focused didactic courses, and whether these offerings were interprofessional. Schools were contacted to confirm their offerings and were asked about student participation and demand. RESULTS: Sixty-four percent of responding schools confirmed an international APPE offering in 67 different countries with an average graduating class participation of 6.1%. Forty-seven percent of responding schools confirmed a globally focused course offering with an average graduating class participation of 13.1%. Almost two thirds of international APPEs and a majority of courses were designated as interprofessional. Student demand did not outweigh supply for either. CONCLUSION: Colleges and schools of pharmacy in the United States are continuing to develop global education opportunities for students in the classroom and throughout the world.

Exploring the role of the pharmacist in global health.

OBJECTIVE: The objective of this commentary is to explore the potential role of the pharmacist in the field of global health by understanding the definition of global health and how it can be applied to the profession of pharmacy. SUMMARY: While the role of the pharmacist in public health has been defined, the literature is limited with respect to the role of the pharmacist in global health. It is suggested that the "global" in global health should refer to the scope of a problem and not necessarily the geographic location. Through this lens, pharmacists have the opportunity to play an important role in both public health and global health. In particular, pharmacists can look at the varied global health careers established in medicine and use this as a framework to understand the potential role of the pharmacist within global health practice and program delivery, research, and policy. CONCLUSIONS: To further define the role of the pharmacist in global health, pharmacists may have to change their perception of what services they can provide and where these services can be applied.

Rural health in pharmacy curricula.

The 2010 Patient Protection and Affordable Care Act proposes strategies to address the workforce shortages of primary care practitioners in rural America. This review addresses the question, "What specialized education and training are colleges and schools of pharmacy providing for graduates who wish to enter pharmacy practice in rural health?" All colleges and schools accredited by the Accreditation Council for Pharmacy Education or those in precandidate status as of December 2011 were included in an Internet-based review of Web sites. A wide scope of curricular offerings were found, ranging from no description of courses or experiences in a rural setting to formally developed programs in rural pharmacy. Although the number of pharmacy colleges and schools providing either elective or required courses in rural health is encouraging, more education and training with this focus are needed to help overcome the unmet need for quality pharmacy care for rural populations.

Development of a course review process.

OBJECTIVE: To describe and assess a course review process designed to enhance course quality. DESIGN: A course review process led by the curriculum and assessment committees was designed for all required courses in the doctor of pharmacy (PharmD) program at a school of pharmacy. A rubric was used by the review team to address 5 areas: course layout and integration, learning outcomes, assessment, resources and materials, and learner interaction. ASSESSMENT: One hundred percent of targeted courses, or 97% of all required courses, were reviewed from January to August 2010 (n=30). Approximately 3.5 recommendations per course were made, resulting in improvement in course evaluation items related to learning outcomes. Ninety-five percent of reviewers and 85% of course directors agreed that the process was objective and the course review process was important. CONCLUSION: The course review process was objective and effective in improving course quality. Future work will explore the effectiveness of an integrated, continual course review process in improving the quality of pharmacy education.

Prospective student pharmacist interest in a rural pharmacy curriculum.

OBJECTIVE: To determine prospective student pharmacists' interest in a rural pharmacy health curriculum. METHODS: All applicants who were selected to interview for fall 2011 enrollment at the UNC Eshelman School of Pharmacy were invited to participate in a Web-based survey. Questions addressed participants' willingness to participate in a rural health pharmacy curriculum, interest in practicing in a rural area, and beliefs regarding patient access to healthcare in rural areas. RESULTS: Of the 250 prospective student pharmacists invited to participate, 91% completed the survey instrument. Respondents agreed that populations living in rural areas may have different health needs, and students were generally interested in a rural pharmacy health curriculum. CONCLUSIONS: An online survey of prospective student pharmacists was an effective way to assess their interest in a rural pharmacy program being considered by the study institution. Location of the rural program at a satellite campus and availability of housing were identified as factors that could limit enrollment.

Practice settings, job responsibilities, and job satisfaction of nontraditional PharmD and BS pharmacy graduates.

OBJECTIVES: To assess differences in the practice of pharmacy and in job satisfaction between graduates of a nontraditional doctor of pharmacy (PharmD) program and a bachelor of science (BS) in pharmacy program. METHODS: Two separate survey instruments were mailed to 293 PharmD graduates and 293 BS graduates. RESULTS: Two hundred fourteen (73.0%) of the 293 nontraditional PharmD graduates and 189 (64.5%) of the 293 BS graduates completed the survey instruments. Nontraditional PharmD graduates expressed greater satisfaction, both in their current position and with pharmacy as a career, compared to BS graduates. Nontraditional PharmD graduates were more likely than BS graduates to practice in a hospital and have more clinical responsibilities. CONCLUSIONS: Nontraditional PharmD graduates are more likely to have greater satisfaction with their job and with pharmacy as a career compared to BS-trained pharmacists.

Roles of innovation in education delivery.

This paper reviews trends in higher education, characterizing both the current learning environments in pharmacy education as well as a vision for future learning environments, and outlines a strategy for successful implementation of innovations in educational delivery. The following 3 areas of focus are addressed: (1) rejecting the use of the majority of classroom time for the simple transmission of factual information to students; (2) challenging students to think critically, communicate lucidly, and synthesize broadly in order to solve problems; and (3) adopting a philosophy of "evidence-based education" as a core construct of instructional innovation and reform.

The structured interview and interviewer training in the admissions process.

OBJECTIVES: To determine the extent to which the structured interview is used in the PharmD admissions process in US colleges and schools of pharmacy, and the prevalence and content of interviewer training. METHODS: A survey instrument consisting of 7 questions regarding interviews and interviewer training was sent to 92 colleges and schools of pharmacy in the United States that were accredited or seeking accreditation. RESULTS: Sixty survey instruments (65% response rate) were returned. The majority of the schools that responded (80%) used interviews as part of the PharmD admissions process. Of the schools that used an interview as part of the admissions process, 86% provided some type of interviewer training and 13% used a set of predefined questions in admissions interviews. CONCLUSIONS: Most colleges and schools of pharmacy use some components of the structured interview in the PharmD admissions process; however, training for interviewers varies widely among colleges and schools of pharmacy.

Community-based weight management in long-term heart transplant recipients: a pilot study.

BACKGROUND: Heart transplant recipients often suffer from obesity, dyslipidemia, and hypertension thought to be related to triple-drug immunosuppression and poor adherence to diet and exercise. A lifestyle intervention that allows recipients to attend a community-based weight management program may improve health outcomes. OBJECTIVE: To determine (1) the effects of attending a community-based weight management program on weight, systolic and diastolic blood pressure, and the lipid profile; and (2) the feasibility of a community-based program for weight management. METHODS: Twenty-one patients (81% male; age 57 years, 99.7 months since transplantation) participated in a randomized clinical trial and received either weight management counseling (control) or a 6-month scholarship to a structured commercial program (treatment). Using simple analysis of covariance models, group differences were assessed and reported as marginal means. RESULTS: At baseline, there were no demographic differences between groups. There were no differences in outcome variables except weight (control, 102.1 kg vs treatment, 98.3 kg; P= .05). After 6 months, significant differences were found in weight (control, 100.5 kg vs treatment, 95.6 kg; P= .047) and high-density lipoprotein cholesterol (control, 40.6 mg/dL vs treatment, 49.1 mg/dL; P= .044). A marginally significant difference was found in systolic blood pressure (control, 138 mm Hg vs treatment, 121 mm Hg; P= .07). A decrease in diastolic blood pressure (6 mm Hg) was attributed to treatment effect (P = .16). No differences were noted in total cholesterol, triglycerides, or low-density lipoprotein cholesterol. CONCLUSIONS: The structured commercial program appears to be an effective, feasible alternative to usual care. Findings need to be confirmed in future research with a larger sample.

Lifestyle and health status differ over time in long-term heart transplant recipients.

OBJECTIVE: To describe differences in lifestyle and health status across 5 post-transplant periods. METHODS: The sample consisted of 126 heart transplant recipients (87% men) grouped by time after transplantation: group 1, 12 to 24 months (n= 13); group 2, 25 to 48 months (n= 19); group 3, 49 to 72 months (n=24); group 4, 72 to 96 months (n=27); and group 5, > or =97 months (n=43). Data were obtained using demographic and health status evaluation forms and the Lifestyle Profile-II, which measures physical activity, nutrition, health responsibility, interpersonal relationships, stress management, and spiritual growth. RESULTS: Most often reported lifestyle attributes were spiritual growth and interpersonal relationships. Least often reported was physical activity. Pairwise comparisons revealed that groups 3 (chi2 = 16.4; SD = 4.8; P = .03) and 4 (chi2 = 16.6; SD= 5.8; P = .04) had lower physical activity than group 2 (chi2 = 21.3; SD = 5.2). Health status evaluation revealed that there were no group differences in systolic (P = .46) or diastolic (P = .77) blood pressure. Although creatinine was elevated, there were no group differences (P = .86). High-density lipoprotein was higher than 42 mg/dL in all groups, but there were differences across groups in low-density lipoprotein (P = .003). Groups 1 (chi2 = 139.2; SD = 38.5) and 2 (chi2 = 141.0; SD = 47.8) were different than group 5 (chi2 = 112.9; SD = 36.1; P = .05). There were group differences in cholesterol (P = .002), with lower levels in groups 4 (chi2 = 190.5; SD= 38.6) and 5 (chi2 = 186.3; SD = 37.7) as compared to group 2 (chi2 = 230.8; SD = 66.5). CONCLUSIONS: Identifying posttransplant periods in which healthy behaviors and health status may be vulnerable to decline is important for providing ongoing education and psychological support to transplant recipients who manage a complex regimen.