Comparing Medication History Capture Rates In-Person Versus Hybrid: A Multisite Pilot Study.

Purpose: Medication history is the method many organizations use to adhere to The Joint Commission's (TJC) National Patient Safety Goal (NPSG) to communicate accurate patient medication information. Literature is sparse comparing the number of medication histories completed in-person versus virtually. Methods: This is a single system, multi-site, retrospective observational study. Patients included were admitted through the Emergency Department during October 2022. The primary aim of this study compared the percent capture rates of medication history between 2 hybrid sites to an in-person site within a health-system. Our secondary objective compared the differences in the 'medication history acuity score' (MHAS), defined as the total number of edits, additions, and deletions made during a medication history. Results: The medication history capture rate at the in-person site was 74% and at the hybrid sites were 91% and 80%. There were no differences in total medications on each medication history between in-person and hybrid (11 [5-16] vs 11 [6-16]; P = .252). There were no differences in changes made on medication histories between in-person and hybrid (4 [1-7] vs 3 [1-7]; P = .595). Conclusions: Our study demonstrates that medication history capture rates and MHAS are comparable in both in-person and hybrid environments. This similarity suggests the feasibility of implementing hybrid models for medication history services in diverse healthcare settings, potentially enhancing the capacity of health systems to meet TJC NPSG. These findings indicate that hybrid models could be an effective strategy for healthcare systems to optimize their medication history services, especially in settings with varied patient volumes and site specialties.

Pharmacy technician development: Insight into training, preparedness, and career-path perceptions.

BACKGROUND: Although opportunities for pharmacy technicians may be expanding, an increasing number of technicians have transitioned out of their roles. It is important to consider what could be done within education and training to promote the retention of pharmacy technicians. OBJECTIVES: The purpose of this study was to survey pharmacy technicians in the state of Ohio to identify key components of professional development. METHODS: A survey was distributed through REDCap to 24,444 pharmacy technicians with active pharmacy technician licenses in the state of Ohio. Inclusion criteria required survey respondents to be at least 18 years old and currently working as a pharmacy technician. RESULTS: A total of 1386 surveys were fully completed (approximately 6% response rate). Professional development opportunities provided by employers varied across most practice sites, but continuing education was the most reported opportunity. Attending conferences, taking specialized training courses, and tuition reimbursement were less common. The top 3 barriers to professional development participation included additional cost, time, and perceived value. Guidance and mentorship from peers, achieving national certification, and formal on-the-job training were the most helpful in job preparation and training. The main reasons to achieve certification included increased pay, development opportunity, or employer requirement. When considering preparation for new roles, 57% of pharmacy technicians felt prepared or very prepared for the job after 90 days. As technicians continued throughout their careers, the training transitioned from formal hands-on training to self-guided training. CONCLUSION: Pharmacy technicians have a desire to remain in their roles, but participation in professional development opportunities was lacking owing to availability of options and barriers. Pharmacy practice sites interested in retaining technicians should invest in offering and encouraging pharmacy technicians to participate in development opportunities. To continue to develop pharmacy technicians, ongoing education and training tied to increased compensation may improve retention and foster an improved learning environment.

Impact of asynchronous virtual learning on student well-being and success.

INTRODUCTION: As the world has rapidly changed during the COVID-19 pandemic, doctor of pharmacy (PharmD) students' overall well-being has been prioritized. This study aimed to evaluate PharmD students' well-being and perceived academic engagement when moved involuntarily to a majority asynchronous and virtual curriculum during the 2020-2021 academic year in response to the COVID-19 pandemic. Additionally, this study aimed to assess demographic predictors relating student well-being and academic engagement. METHODS: A survey administered via Qualtrics (SAP) was sent to three cohorts of professional students (Classes of 2022 to 2024) enrolled in the PharmD program at The Ohio State University College of Pharmacy. These cohorts were engaged in a primarily asynchronous and virtual curriculum due to COVID-19. RESULTS: Although students displayed mixed results on how asynchronous learning affected their well-being, students replied that they would want to continue learning via a hybrid model (53.3%) or completely asynchronous (24%), while 17.3% wanted primarily synchronous and 5.3% did not reply. CONCLUSIONS: Our results indicated that aspects of the majority asynchronous and virtual learning environment were favored by students. Through student responses, our faculty and staff can take into consideration students' opinions when making future changes to the curriculum. We provided this data for others to consider when evaluating well-being and engagement with a virtual and asynchronous curriculum.

Assessment of pharmacy technician learning preferences and implications for training.

PURPOSE: To assess pharmacy technician learning preferences using the VARK tool and through self-identification. METHODS: The VARK (visual, aural, read/write, kinesthetic) questionnaire was incorporated into a larger survey, which was distributed during live staff meetings and a continuing education session held by the Ohio Pharmacists Association attended by 204 pharmacy technicians across various practice settings. RESULTS: A 90% response rate was achieved. Most respondents (78.8%) self-identified a single predominant learning preference, with 60.3% indicating a preference for kinesthetic learning methods. In contrast, after assessment with the VARK questionnaire 37.9% of survey participants were categorized as having a quadmodal learning style incorporating all VARK modalities. With regard to the Pharmacy Technician Certification Exam, a large majority of participants (96.2% of those providing a response) indicated that they had taken the exam in the past, with 17 participants (9.3% of those providing a response) indicating more than 1 attempt to pass the exam. Furthermore, experiential (on-the-job) training was identified by a large majority of survey respondents (79.3%) as the preferred way to learn new information. CONCLUSION: Learning preferences of pharmacy technicians vary amongst individuals, with many found to have multiple learning preferences through VARK questionnaire assessment. Incorporating experiential training and establishing learning preferences of pharmacy technicians may aid in development of accredited training programs that cater to the needs of pharmacy technicians.

A naloxone and harm reduction educational program across four years of a doctor of pharmacy program.

BACKGROUND AND PURPOSE: Naloxone distribution is an increasing service provided by pharmacists as more states enact laws enabling pharmacists to dispense naloxone without a prescription or per protocol to individuals in the wake of an opioid overdose epidemic. Education and training programs are necessary to ensure students and practicing pharmacists are able to effectively provide the service. EDUCATIONAL ACTIVITY AND SETTING: All first, second, and third year students in the doctor of pharmacy (PharmD) program at The Ohio State University College of Pharmacy (OSUCOP) participated in a pilot naloxone and harm reduction educational program. The program consisted of a three-part recorded lecture and a hands-on interactive workshop. Fourth-year students had the opportunity to participate. Students completed a ten-question assessment based on the content of the recorded lecture. Following the workshop, self-reflection and feedback were solicited. FINDINGS: Qualitative data indicated students felt the naloxone educational program was beneficial. Inclusion of harm reduction strategies, a mock counseling session, hands-on practice with naloxone delivery devices, and patient case discussions were valued. DISCUSSION AND SUMMARY: OSUCOP was able to develop and deliver a naloxone and harm reduction educational program across all four years of the PharmD curriculum within one year of passage of laws increasing pharmacist dispensing of naloxone.

A structured patient identification model for medication therapy management services in a community pharmacy.

OBJECTIVES: To describe the development and implementation of a structured patient identification model for medication therapy management (MTM) services within traditional dispensing activities of a community pharmacy to facilitate pharmacist-provided completion of MTM services. DESIGN: A daily clinical opportunity report was developed as a structured model to identify MTM opportunities daily for all MTM-eligible patients expecting to pick up a prescription. Pharmacy staff was trained and the standardized model was implemented at study sites. SETTING AND PARTICIPANTS: One hundred nineteen grocery store-based community pharmacies throughout Ohio, West Virginia, and Michigan. OUTCOME MEASURES: A structured patient identification model in a community pharmacy consists of reviewing a clinical opportunity report, identifying interventions for MTM-eligible patients, and possibly collaborating with an interdisciplinary team. This model allows pharmacists to increase MTM cases performed by providing a structured process for identifying MTM-eligible patients and completing MTM services. RESULTS: The development and implementation of a structured patient identification model in the community pharmacy was completed and consists of pharmacists reviewing a clinical opportunity report to identify MTM opportunities and perform clinical interventions for patients. In a 3-month pre- and post-implementation comparison, there was a 49% increase in the number of MTM services provided by pharmacists (P < 0.001). CONCLUSION: A structured patient identification model in the community pharmacy was associated with an increase in the amount of MTM services provided by pharmacists. This method could be a useful tool at a variety of community pharmacies to solve challenges associated with MTM completion.

Pharmacy residents' pursuit of academic positions.

OBJECTIVE: To describe pharmacy residents' interest in and pursuit of academic positions. METHODS: An electronic presurvey and postsurvey were sent to pharmacy residents during the 2011-2012 residency year. The initial survey evaluated residents' job preferences and interest in academia at the beginning of residency, and the follow-up survey focused on job selection and reasons for pursuing or not pursuing positions in academia. RESULTS: Nine hundred thirty-six residents responded to the initial survey and 630 participated in both the initial and follow-up survey. Forty-eight percent of those responding to both surveys strongly considered a career in academia in the initial survey, 28% applied for an academic position, and 7% accepted a position. Second-year postgraduate residents were more likely than first-year postgraduate residents to apply for and be offered a faculty position. CONCLUSION: Pharmacy residents are interested in academia. While increasing interest among residents is encouraging for faculty recruitment, the academy should also encourage and develop adequate training experiences to prepare residents to succeed in these positions.

Practical management of anticoagulation in patients with atrial fibrillation.

Anticoagulation for atrial fibrillation has become more complex due to the introduction of new anticoagulant agents, the number and kinds of patients requiring therapy, and the interactions of those patients in the matrix of care. The management of anticoagulation has become a "team sport" involving multiple specialties in multiple sites of care. The American College of Cardiology, through the College's Anticoagulation Initiative, convened a roundtable of experts from multiple specialties to discuss topics important to the management of patients requiring anticoagulation and to make expert recommendations on issues such as the initiation and interruption of anticoagulation, quality of anticoagulation care, management of major and minor bleeding, and treatment of special populations. The attendees continued to work toward consensus on these topics, and present the key findings of this roundtable in a state-of- the-art review focusing on the practical aspects of anticoagulation care for the patient with atrial fibrillation.

Current trends in outpatient pharmacy services and billing.

OBJECTIVES: To provide a summary of community and ambulatory pharmacy practices and billing patterns for medication therapy management (MTM) services and to identify reasons pharmacists report not billing for direct patient care services. DESIGN: Cross-sectional study. SETTING: United States, February 2011. PARTICIPANTS: Members of the American College of Clinical Pharmacy Ambulatory Care Practice and Research Network, American Society of Health-System Pharmacists Ambulatory and Chronic Care Practitioners, and American Pharmacists Association MTM e-community. INTERVENTION: Online survey. MAIN OUTCOME MEASURES: Practice setting, pharmacy services performed, billing technique, and payer, as well as reasons for not billing. RESULTS: MTM services were provided by 287 pharmacists. The most common practice settings included physician office (23.6%), health-system outpatient facility (21.7%), and community pharmacy (20.2%). A total of 149 of 276 pharmacists (54.0%) reported billing for MTM services; 16 of 276 (5.8%) did not know if they were currently billing. Community pharmacists were more likely to bill than all other sites combined (80.5% vs. 53.1%, P < 0.001), and pharmacists with >75% of visits face-to-face were more likely to bill (66.2% vs. 46.6%, P < 0.002). CONCLUSION: A variety of MTM services are provided in outpatient settings with inconsistent billing techniques and reimbursement. Pharmacists should continue to work toward consistent, sustainable reimbursement to expand MTM services.

Risk factors and complications of subconjunctival hemorrhages in patients taking warfarin.

OBJECTIVES: The aim of this study was to identify patients with subconjunctival hemorrhage (SCH) on warfarin therapy, to describe risk factors that may contribute to SCH development, and to identify complications related to SCH. METHODS: A retrospective chart review was conducted including patients treated at a university anticoagulation clinic over 2 years (4,334 patient visits). Data collection included patient demographics; international normalized ratios (INRs) before, at time of, and after SCH; risk factors for increased risk of bleeding; patient-reported complications related to SCH; recent changes in medication use; and warfarin dosage adjustments made in response to the event. The data were summarized using descriptive statistics and frequencies described as percentages. RESULTS: Fifteen SCH events were identified at an event rate of 0.35%. Two were excluded because of related surgeries near the time of SCH events. The average patient age was 67.3 years (range, 51 to 82). A total of 76.9% (n = 10) of patients had INRs within the goal range at the appointment before reporting the SCH. A total of 46.2% (n = 6) of patients reported alterations in medication regimens during the month preceding SCH. Various patient conditions were documented that may increase the risk of SCH development. No ophthalmic complications were associated with SCHs. CONCLUSIONS: An SCH event rate of 0.35% was identified. Many factors may have precipitated SCH; however, ophthalmic complications were uncommon.

Assessment of pharmacy faculty members' opinions regarding required postgraduate pharmacy residencies.

PURPOSE: Agreement between pharmacy faculty members and the American College of Clinical Pharmacy (ACCP) recommendations regarding the requirement of residency training to provide direct patient care or attain a position in academia is discussed. METHODS: Faculty members of the American Association of Colleges of Pharmacy participated in a survey administered by an online survey tool. The survey contained a variety of yes/no, multiple choice, and Likert scale questions. Participants were asked to disclose whether they agreed with the ACCP recommendations. Other data collected included faculty demographics, individual awareness of the ACCP position statement, and postgraduate training recommendations before receiving the survey. RESULTS: The survey was sent to 2414 faculty members, and 623 (26%) of those responded. A majority of the respondents (74.8%) identified themselves as pharmacy practice faculty. Of those who replied, 55.6% agreed that one year of residency training should be required to provide direct patient care. Approximately 64% agreed that a postgraduate year 1 residency should be required in order to be appointed as adjunct clinical faculty or preceptor of pharmacy students, while 50.1% agreed that two years of residency training should be required in order to be appointed to rank assistant professor. CONCLUSION: A slight majority of faculty members responding to this survey agreed with recommendations in a 2006 ACCP position statement that proposed requiring residencies for all pharmacy students graduating from pharmacy school in order to attain positions in academia or settings providing direct patient care.

Assessment of factors influencing community pharmacy residents' pursuit of academic positions.

OBJECTIVES: To determine the percentage of residents accepting faculty positions following completion of a community pharmacy residency program (CPRP) and identify influences to pursue/not pursue an academic career. METHODS: CPRP directors and preceptors across the United States were contacted and 53 community pharmacy residents were identified. The residents were invited to participate in surveys at the beginning and end of the 2005-2006 residency year. RESULTS: Forty-five residents (85%) completed the preliminary survey instrument and 40 (75%) completed the follow-up survey instrument. Of these, 36 completed both survey instruments. Initially, 28 (62%) respondents indicated a faculty position as one of their potential job preferences. After completing their residency program, 3 (8%) residents accepted faculty positions; and 3 (8%) others were awaiting offers at follow-up. Reasons for accepting a faculty position were positive teaching experiences and the influence of a mentor or preceptor. Reasons for not pursuing a faculty position included lack of interest, geographic location, disliked teaching experiences, lack of preparedness, and non-competitive salary. CONCLUSION: Many community pharmacy residents consider faculty positions early in their residency but few pursue faculty positions. CPRPs and colleges of pharmacy should work together to enhance residents' experiences to foster interest in academia.

Practice-based research network as a research training model for community/ambulatory pharmacy residents.

OBJECTIVE: To describe our experience with a practice-based research training network (PBRTN) in a 1-year residency program. SETTING: Ohio State University in Columbus from 1997 to 2007. PRACTICE DESCRIPTION: The program includes two accredited postgraduate year 1 residencies and one postgraduate year 2 residency. Seven residents, 11 preceptors, and three faculty members participated during the time frame discussed in this article. Practice settings included three community sites and three ambulatory sites. PRACTICE INNOVATION: The PBRTN includes a residency director, a research director, preceptor and resident members, and research faculty. The group works collaboratively to meet training goals. The PBRTN maintains a project timeline, foundational training, and structured research development, implementation, and presentation phases. Each resident submits five required research products: abstract, grant, poster, podium presentation, and research manuscript. MAIN OUTCOME MEASURES: Quantitative measures included the number of abstracts, grants, and peer-reviewed publications over two time periods, one before and one after a deliberate attempt to increase the research focus of the residencies. The ratio of research products to number of residents was used as a measure of productivity. Postresidency career choice and postresidency publications are reported. RESULTS: Over a decade, the program has produced 37 graduates, 50 abstracts, 15 grants, and 12 peer-reviewed publications. The publication-to-resident ratio increased from 0.25 in the pre-emphasis period of 1997-2001 to 0.56 in 2002-2007, after the research focus was intensified. Of graduates, 38% are in faculty positions, with 48 postresidency publications. CONCLUSION: Use of a PBRTN has successfully provided research training and improved research outcomes for the program. This model could be implemented in other residencies.

Community and ambulatory pharmacy: evaluation of patient care services and billing patterns before implementation of Medicare part D.

OBJECTIVE: To provide a summary of community and ambulatory pharmacy practice and billing patterns for medication therapy management services before implementation of Medicare Prescription Drug Improvement and Modernization Act of 2003 (MMA). DESIGN: Cross-sectional survey. SETTING: Ambulatory care and community pharmacy practice settings in the United States in January 2004. PARTICIPANTS: Members of the American College of Clinical Pharmacy Ambulatory Practice and Research Network, preceptors of the American Pharmacists Association (APhA) Community Pharmacy Residency Programs, and participants in the APhA Immunizing Pharmacist listserv. INTERVENTIONS: E-mail invitations to participate in a Web-based survey. MAIN OUTCOME MEASURES: Practice setting; pharmacy services performed; whether pharmacists were billing for pharmacy services; if billing, the billing technique used; if not billing, the reason for not billing. RESULTS: Of 349 respondents, 127 (36.4%) were practicing within a physician office, while 121 (34.7%) were practicing in community pharmacies. Diabetes, anticoagulation, dyslipidemia, hypertension, and smoking cessation management services were performed significantly more often in physician offices. Immunization delivery and diabetes, dyslipidemia, and osteoporosis screenings were performed significantly more often in community settings. A total of 190 (54.5%) pharmacists stated that they were billing for pharmacy services. More community pharmacists were billing for services compared with other combined practice settings (69.2% versus 46.7%, P < .001). Top reasons identified for not billing for services were salaried position, indigent population, and discomfort with the billing process. CONCLUSION: Valuable baseline data are provided regarding pharmacy services that have been successfully implemented in ambulatory and community practice settings and which billing techniques were used to receive reimbursement before the implementation of MMA.