Student pharmacist opioid risk consultations: a pre-post educational intervention study.

OBJECTIVES: The primary aim was to assess third year student pharmacists' communication skills about opioid risks and safety before and after an educational intervention. This assessment was utilized to identify gaps that skills training programmes need to address for students and pharmacists. METHODS: Seventy-one students in 2018 (pre-intervention/baseline) and 133 students in 2019 (post-intervention) were videotaped during consultation with standardized patients receiving opioid medications for low back pain. The consults were quantitatively coded for what topics students discussed, terms used, eye contact and filler words. Coding of video-recording had high inter-rater reliability (kappa = 0.90). KEY FINDINGS: A significant increase was seen in the post-intervention phase compared with baseline data in the number of students who mentioned the term opioid and initiated conversations about opioid risks. The majority of student pharmacists discussed common opioid side effects and performed teach-back with patients. In both of the phases, students used more filler words when discussing dependence, addiction or overdose risk when compared with the rest of the consult. At baseline, students in the expressed discomfort and desired additional training and resources for communicating about opioids, and students in the post-intervention phase reported increased confidence. CONCLUSIONS: This educational intervention demonstrated improved opioid risk communication skills among student pharmacists. This study warrants national evaluation of student pharmacist preparedness and provision of structured education and training as necessary to help empower student pharmacists as opioid risk and safety educators.

Pharmacists' naloxone offering and dispensing practices.

OBJECTIVE: The primary objective of this paper is to understand pharmacists' naloxone offering and dispensing practices and factors affecting those practices. The secondary objective of this paper is to refine an existing survey instrument and use it to understand pharmacists' naloxone offering and dispensing behaviors and factors affecting it. DESIGN, SETTINGS, AND PARTICIPANTS: A statewide mail survey of pharmacists was conducted in Wisconsin using stratified random sampling. Survey data were analyzed using descriptive statistics to understand pharmacists' naloxone offering and dispensing practices and multiple regression analysis to understand factors affecting these practices. MAIN OUTCOMES: (1) Pharmacists' practices about naloxone offering and dispensing; (2) factors affecting these practices. RESULTS: Most pharmacies stocked naloxone (92.9 percent) and were under the Wisconsin standing order (80.1 percent). The majority of pharmacists reported that they occasionally (36.6 percent), rarely (29.3 percent), or never (21.5 percent) offer naloxone to patients. The majority reported that they occasionally (29.3 percent), rarely (52.4 percent), or never (15.2 percent) dispense naloxone. While most pharmacists were confident in their ability to initiate conversations about nalox-one, they were not confident on how to screen patients at risk for opioid overdose. Pharmacists offered naloxone more when they felt more confident initiating a conversation regarding the need for naloxone with patients (ß = 0.50, p < 0.05). Pharmacists dispensed naloxone more when they have had more previous training about dispensing naloxone (ß = 0.43, p < 0.05). CONCLUSION: Many pharmacists hardly offer or dispense naloxone under the standing order. Pharmacists may benefit from standardized training and resources about screening patients for risk of overdose and overdose risk communication.

Pharmacists opioid risk and safety counseling practices: A latent class analysis approach.

BACKGROUND: The opioid crisis is a global public health issue, especially present in the United States. Limited research addresses pharmacists' opioid medication counseling practices particularly their risk and safety counseling practices. OBJECTIVES: The objective of this paper is to categorize pharmacists based on their opioid risk and safety counseling practices to inform future interventions and research to improve practice. The percent of pharmacists falling into each of these underlying, unobservable subgroups is identified using latent class analysis. METHODS: This study was conducted as a statewide survey of pharmacists using the modified Dilman technique. The survey consisted of ten items about pharmacists' opioid risk and safety practices when dispensing an opioid medication. Descriptive statistics were conducted followed by latent class analysis. This approach categorized pharmacists based on their responses to the survey items. RESULTS: Responses from 216 pharmacists were used in this study. In the three-class model which was deemed the best fit, the first class shows a profile of pharmacists who counsel on almost all opioid risk and safety topics and composed 16.75% of the total respondent population. The second class shows a profile of pharmacists who hardly counsel on any opioid risks and safety topics and comprised 39.80% of the respondent population. The third class shows a profile of pharmacists counseling on opioid risk and safety topics mostly for new or long-term prescriptions, but not for refill or short-term prescriptions. This group constituted 43.45% of the respondent population. CONCLUSION: This study identifies distinct classes of pharmacists in terms of the frequency with which their opioid counseling does or does not include key elements of risk and safety topics. A small minority usually include the risk and safety issues. Training and resource interventions targeting pharmacists who do not counsel patients about opioid risks are important to help them become more comfortable and adept as opioid risk and safety educators.

Development of the Adolescent Opioid Safety and Learning (AOSL) scale using exploratory factor analysis.

BACKGROUND: While adolescents in the United States are one of the most affected groups by the opioid crisis, their perceptions on opioid misuse and preferences for education are rarely studied. Although it is critical to educate adolescents on proper opioid use and storage, many educational tools need easy measurement scales to systematically document learning of targeted programs. It is essential to understand adolescents' knowledge about opioid risks and perceptions about the opioid crisis to design effective preventive interventions. OBJECTIVE: The purpose of this study was to develop an effective scale that measures adolescents' knowledge about opioid misuse and interest in learning about prescription opioid safety. METHODS: Using survey data from 188 high school students in the Midwest, exploratory factor analysis (EFA) was used to examine the underlying structure of an initial 68 items. Items were adapted from a statewide survey previously designed to document awareness of prescription drug misuse and abuse in the state of Wisconsin. Refinement of the scale used factor analysis iterations and internal consistency measures. Cronbach's alpha was used to determine internal consistency among the items. RESULTS: Three exploratory factor analysis iterations resulted in a 16-item four-factor structure describing adolescents' knowledge of misuse and harm, their interest in learning about prescription opioids, and their tendency to practice misuse behaviors. Internal consistency and the correlation among factors were examined and strong (Cronbach's α > 0.8). The final 16-item instrument was termed the Adolescent Opioid Safety and Learning (AOSL) Scale. CONCLUSIONS: When combined with adolescent opioid education tools, the AOSL Scale can help assess and document medication safety learning. The four subscales could support researchers and practitioners in measuring adolescents' orientation towards prescription opioid misuse. The AOSL Scale may also be used in developing targeted educational materials on prevention of opioid misuse for adolescents.

Humanistic and Economic Burden of Geographic Atrophy: A Systematic Literature Review.

PURPOSE: Geographic atrophy (GA), the advanced form of dry age-related macular degeneration, can result in irreversible blindness over time. We performed a systematic literature review to assess the humanistic and economic burden of GA. METHODS: Predefined search terms were used to identify studies in PubMed, Embase, and Cochrane Library; conference abstracts also were searched. RESULTS: Of 1111 unique studies identified, 25 studies on humanistic burden, 4 on economic burden, and 3 on both humanistic and economic burden of GA were included. Vision-related functioning and health-related quality of life (HRQOL) are poor in patients with GA. HRQOL is commonly measured using the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25); patients with GA have significantly lower composite and subscale scores for near activities, distance activities, dependency, driving, social functioning, mental health, role difficulties, color vision, and peripheral vision than individuals without GA. Driving is a particular concern, and inability to drive affects dependency. Vision-related quality of life (VRQOL) declines as GA progresses. While we identified only 7 reports describing the economic burden of GA, its direct costs may be substantial. In a US study, mean cost to the payer per patient with GA was $11,533 in the year after diagnosis. A multinational study estimated annualized total direct costs of €1772 per patient with GA, mainly driven by diagnostic tests and procedures (€1071). Patients with GA are at increased risk of falls and fractures, potentially increasing direct costs. Only one study evaluated indirect costs, estimating ~$24.4 billion in yearly lost wages among people with severe vision loss due to GA or drusen ≥125 µm. CONCLUSION: GA represents a significant humanistic burden. Evidence on the economic impact of GA is limited; characterizing the economic burden of GA requires further research. Interventions that reduce GA-related disability may improve HRQOL and reduce indirect costs.

Handout use to facilitate opioid risk and safety communication in community pharmacies.

BACKGROUND: A number of opioid handouts exist for pharmacists to use for patient education. However, there is limited evidence about what pharmacists most want them to cover and how useful pharmacists perceive them to be. OBJECTIVES: This study sought to (1) refine and revise an opioid safety handout to facilitate opioid risks and safety communication in community pharmacies and (2) assess the feasibility and acceptability of this tool using a statewide survey of community pharmacists. METHODS: In phase 1, 8 community pharmacists were interviewed to refine and evaluate the opioid safety handout. In phase 2, a statewide sample of 700 pharmacists were surveyed to identify acceptability and feasibility of using the revised handout. Survey data were analyzed using descriptive statistics and multiple regression analysis. RESULTS: A total of 140 surveys were returned from community pharmacists. Over 60% of pharmacists reported that the handout would be useful in counseling patients on opioid risks and safety and would be a good opioid education tool for patients. Pharmacists who had practiced for many years (P = 0.002) and pharmacists who discussed safe opioid disposal and storage regularly (P = 0.002) reported a higher likelihood of using the handout. Pharmacists were much more likely to counsel patients on opioid risks and safety using this handout for a long-term opioid prescription than for a short-term opioid prescription. CONCLUSION: A participatory research design successfully refined a handout for opioid risks and safety counseling, which the majority of pharmacists evaluated as feasible and useful for community pharmacists.

Factors influencing patient participation in medication counseling at the community pharmacy: A systematic review.

BACKGROUND: Findings document that patient participation in pharmacy encounters is associated with favorable outcomes. However, there is a need to understand factors that may enhance or hinder patient engagement and pharmacist counseling behaviors during their medication discussions. This review aims to: (1) identify barriers and facilitators for patient engagement in pharmacy consultations, (2) explore the relationship between patient factors (such as demographics and communication behavior) and subsequent pharmacist counseling behavior. METHODS: A systematic review of literature using PRISMA guidelines examined studies published in English addressing influences on patient participation and the relationship between patient factors and pharmacist counseling behavior. Four databases were used - PubMed, CINAHL, PsycINFO, and Scopus. Findings were framed thematically within the constructs of Street's Linguistic Model of Patient Participation in Care (LM). FINDINGS: Fifty studies from 1983 to 2019, including 37 using self-reported data, were identified. Patient involvement in patient-pharmacist communication was influenced by enabling factors such as patient knowledge, communication skills, and pharmacy environment. Predisposing factors for participation ranged from patients' beliefs and past experiences to demographic characteristics such as gender and age. Pharmacists' participative behavior with patients was positively associated with patients' engagement and perceived patient cues in the conversation. CONCLUSION: This systematic review identified predictors of patients' engagement in pharmacy encounters drawing on LM framework. Various predisposing factors, enabling factors, and pharmacist' responses impacted patients' willingness to actively participate in medication counseling at community pharmacies. Equally important, studies documented considerable impact by patients on pharmacists' counseling behavior. Pharmacy encounters should no longer be viewed as controlled simply by pharmacists' expertise and agendas. Patient characteristics and factors such as patient question-asking and expectations also appear to be associated with and influence patient-pharmacist interpersonal communication. Additional research needs to address the identified facilitators and barriers to enhance patient participation and pharmacist counseling behavior.

Evaluating the Effect a of Handout on Community Pharmacists' Opioid Safety Counseling.

Community pharmacists are the most accessible healthcare professionals to counsel patients about opioid risks and safety. Resources such as handouts are needed to improve pharmacists' self-efficacy about opioid safety counseling. This study aims to understand the effects and usefulness of handouts in opioid risk and safety counseling in community pharmacists. Three community pharmacies participated in this study for three weeks, where five pharmacists participated in completing a survey about the process and integration of a handout in opioid medication consultation. Pharmacists filled the survey after counseling patients for opioid medication/s. Field observations were conducted at one of these sites as well. A total of 57 consults were recorded via surveys in these pharmacies. Only using the handout to guide the conversation was rated much less useful than integrating the handout and showing it to patient in the consult (ß = 0.94, adjusted R2 = 0.29, p< .00001). Satisfaction about the patient education provided increased if opioid risks and safety topics were discussed (ß = 0.7, adjusted R2 = 0.32, p = 0.00015). Patients seemed engaged in the consults, which was evident from the head nods, questions asked, and attention toward the pharmacist. Effective communication with patients or patient caregivers about opioid safety can be accomplished by using and modeling use of this handout and by providing structured instructions to use this handout optimally.

Involving caregivers in design and assessment of opioid risk and safety communication intervention in children.

BACKGROUND: Opportunities to enhance opioid medication safety among children are frequently overlooked. There is little information about what information caregivers want when a child receives an opioid prescription following surgery. OBJECTIVE: This paper explores pediatric caregivers' baseline knowledge and expectations for opioid medication consults in order to refine an opioid safety consultation intervention. Second, it, assesses caregivers' post-consult knowledge and evaluation after they received the refined opioid safety consultation. PATIENT INVOLVEMENT: Pediatric patient caregivers were involved in designing and evaluating an opioid education intervention. METHODS: Fifteen pediatric caregivers were interviewed about opioid consultations in the pre-intervention phase to inform the design of the subsequent opioid risk and safety consultation intervention. An opioid safety consultation intervention was then developed. Another 15 pediatric caregivers were interviewed in the post-intervention phase to explore impact of the revised intervention. Inductive content analysis was used to analyze data. RESULTS: Caregivers in the pre-intervention phase reported some knowledge about opioids, wanted to know if their child was prescribed an opioid and wanted information about its opioid risks and safety. Caregivers in the post-intervention phase reported an increase in knowledge about opioid risks and safety, recognized benefit of pharmacists describing the medication as an "opioid", appreciated the handout and were satisfied with the topics covered in the consultation. DISCUSSION: Discussing opioid risks can be uncomfortable for pharmacists and patients. This study explored pediatric caregivers' expectations about opioid consults and information they wanted to receive from pharmacists. This was used to develop a patient-centered education intervention which was then evaluated by caregivers for effectiveness, convenience, and comfort. PRACTICAL VALUE: This study reports pediatric caregivers' perspectives and expectations about opioid consults which provide guidance for pharmacists to facilitate open and informative counseling for opioid medications.

Adolescents' Perspectives on Prescription Opioid Misuse and Medication Safety.

OBJECTIVES: This study explored adolescents' perspectives on prescription opioids, opioid safety and misuse, and sources of opioid information. METHODS: High school students participated in focus groups that elicited information about adolescent perspectives on prescription opioids and opioid safety. Demographic information was collected. Focus groups consisted of 5 to 8 student participants and 2 moderators. Focus groups were audio-recorded and professionally transcribed. Transcript content was thematically analyzed using NVivo. RESULTS: A total of 54 high school students (59% female, 44% white, 44% Latino) participated in 8 focus groups. Participants ranged from ages 14 to 18 years and grades 9 to 12. Five major themes emerged: 1) perceptions of prescription opioids and misuse; 2) prevalence of prescription opioid misuse; 3) reasons for prescription opioid misuse; 4) consequences of prescription opioid misuse; and 5) sources of medication information. Participants identified examples of misuse and reasons for and consequences of teen opioid misuse, including mental and physical health challenges, peer and family influences, and addiction. Sources of opioid-related information included family, peers, online Web sites, and television shows. CONCLUSIONS: Adolescents had some knowledge pertaining to prescription opioids, but they had misconceptions related to safety. Participants were aware of safety risks and negative consequences of misuse. Adolescents obtained medication information from various sources, including health care professionals, family and peers, and online sources. Educational efforts that target adolescents should provide opportunities for addressing misconceptions about safe and responsible use of medications.

Student pharmacist opioid consultations with standardized limited English proficiency patients: A pre-post educational intervention study.

BACKGROUND AND PURPOSE: This study explored the effect of a structured educational intervention for student pharmacists to counsel limited English proficiency (LEP) patients on risks and safety of opioid medications for chronic pain. Specific aims were to compare 2018 pre-intervention versus 2019 post-intervention groups regarding: (1) dose and side effects discussed, (2) opioid risks and safety measures covered, and (3) LEP specific communication practices. EDUCATIONAL ACTIVITY AND SETTING: Third-year student pharmacists (P3s) in a required communications course consulted LEP standardized patients (SPs) on opioid medications in 2018 and 2019. An educational intervention for the 2019 P3s consisted of a 50-min lecture, pre-lab instructions about techniques for communication about opioid risks and safety, and for LEP specific communication stressing teach-back. All consultations in the pre- and post-intervention phases were video recorded and quantitatively coded for verbal and non-verbal communication skills. Descriptive statistics and Fisher's exact tests were conducted on data. FINDINGS: Twenty-three consultations were recorded in 2018 for the pre-intervention phase and 49 consultations were recorded in 2019 for the post-intervention phase. Only 17% of students in the pre- intervention phase called the medication an "opioid" or "narcotic" in the consultation as compared to 84% in the post-intervention phase. While 100% of students in the post-intervention phase used teach-back, only 61% did so in the pre-intervention group. Significant differences between the two groups were observed for minimizing dependency and overdose, offering naloxone, teach-back, integrating a patient handout into the consultation, and discussing use of alternate pain medications.

Communication between patients and health care professionals about opioid medications.

Prescription opioids contribute to 40% of opioid overdose deaths in the United States. Healthcare professionals (HCPs) play an important role in mitigating the prescription opioid epidemic by appropriate opioid prescribing and patient education. Yet, little empirical literature addresses pharmacist (and other HCP) communication with patients related to risks of opioid use associated with dependence, misuse, and overdose. Nor is there much research on the barriers and facilitators which affect whether and how much opioid-related information is discussed. This commentary, based on an extensive literature search, seeks to inform future communication, education, and research agendas by describing (1) topics commonly discussed or excluded from opioid medication counseling, (2) patient and HCP perceptions regarding opioid medication communication, and (3) barriers and facilitators to opioid risk communication. Based on this literature, recommendations are provided for opioid counseling practices, pharmacist education, and research agendas.

Pharmacy intervention to facilitate transparent opioid-risk and safety communication.

OBJECTIVE: This paper seeks to explore the impact of training, a handout, and patients' questions on pharmacists' comfort and satisfaction in discussing opioid risks with pediatric caregivers. METHODS: In a mixed methods intervention study in a children's hospital outpatient pharmacy, 2 practicing pharmacists and 1 student pharmacist counseled 100 caregivers using their standard practices (not telling a caregiver the pain medicine was an opioid or informing them about opioid risks). After the training, the same 2 pharmacists and another student pharmacist counseled 97 caregivers about opioid-risk by assessing their beliefs, explaining that the medication was an "opioid," and integrating a safety handout into the consult. The pharmacists completed short surveys after each consult in both phases and were interviewed. Qualitative data were coded using NVivo version 12 (QSR International). Descriptive statistics and multivariate regression analyses were performed on the data collected from the surveys. RESULTS: During the preintervention phase, opioid risks were not discussed; no pharmacist described the pain medication as an opioid. The pharmacists reported that they needed training and resources to assist opioid counseling. In the postintervention phase, the pharmacists indicated that the medication was an opioid in all consults. The pharmacists' comfort increased significantly over time and decreased with caregivers' concerns at posttest (adjusted R2 = 0.40). The pharmacists' satisfaction increased with time and caregiver questions (adjusted R2 = 0.15). The pharmacists reported that the training and handout facilitated opioid-risk and safety discussions. CONCLUSION: The intervention positively affected pharmacists' comfort and satisfaction. It should be evaluated in different settings and populations.

Prescribed Opioid Use in Wisconsin 2008-2016: Findings From the Survey of the Health of Wisconsin.

BACKGROUND: The opioid epidemic is a national crisis. The objectives of this report were to describe prescription opioid use in Wisconsin from 2008 through 2016 using unique populationrepresentative data and to assess which demographic, health, and behavioral health characteristics were related to past 30-day prescribed opioid use. METHODS: Data were obtained from the Survey of the Health of Wisconsin (SHOW), a statewide representative sample of 4,487 adults. Prescription medication use was ascertained via in-person interviews that included an inventory of all prescription medications used by the respondent in the past 30 days. The data were weighted to represent the adult population of Wisconsin, aged 21 to 74. Chi-square, logistic regression, and descriptive statistics were used to analyze data. RESULTS: From 2008 to 2016, 6.4% (95% CI, 5.5-7.3) of adults age 21 years or older reported using a prescribed opioid in the past 30 days. Hydrocodone was the most prescribed opioid class followed by oxycodone. People 50 years of age and older, self-identified black or Hispanic, urban dwellers, those with a high school education or less, and those having incomes below 200% of the federal poverty level (FPL) reported significantly higher rates of prescribed opioid use relative to others. Participants reporting physician-diagnosed drug or alcohol abuse, current smokers, and those currently suffering from depression also reported significantly higher use. CONCLUSION: These data from 2008-2016 demonstrate concerning levels of prescription opioid use and provide data on which population groups may be most vulnerable. While policies and clinical practice have changed since 2016, ongoing evaluation of prescribing practices, including consideration of behavioral health issues when prescribing opioids, is called for.

Developing a Theory-Driven Serious Game to Promote Prescription Opioid Safety Among Adolescents: Mixed Methods Study.

BACKGROUND: Adolescents in North America are severely affected by the opioid crisis, yet there are limited educational resources for educating teens about prescription opioid safety and misuse. Empirical literature lacks evidence regarding teen education about prescription opioid safety through serious games and lacks conceptual models and frameworks to guide the process of game development for this purpose. OBJECTIVE: This study aims to conceptualize and design a serious game prototype to teach teens about prescription opioid safety and propose a conceptual framework for developing a serious game to educate youth about safe and responsible use of prescription opioids. METHODS: The initial steps of the project comprised of the formulation of an integrated conceptual framework that included factors from health behavior models and game development models. This was followed by the formal process of serious game development, which resulted in a game prototype. The assessment of the game prototype was done through group discussions, individual interviews, and questionnaires with adolescents following gameplay. Field notes were used to keep track of the responses from the group discussions. Content and thematic analyses were used to analyze field notes and responses to the open-ended questionnaire, which were then used to refine the game prototype. RESULTS: A total of 10 playtests with over 319 adolescents and emerging young adults (AYAs) in community settings such as middle schools, high schools, and colleges were conducted by the project team between March and June 2019. The AYAs provided feedback on the initial game prototype using questionnaires administered through Qualtrics or in-person on paper. Preliminary feedback suggested that the teens found the game objectives, outcomes, and design appealing. Overall, the game was perceived as realistic, and learning outcomes seemed achievable. Suggestions for improvement included the need for additional direction on gameplay, clearer instructions, concise dialog, and reduced technical problems in the gameplay. CONCLUSIONS: We propose a conceptual framework for developing a serious game prototype to educate youth about prescription opioid safety. The project used a theory-driven conceptual framework for the development of a serious game targeting the prevention of adolescent opioid misuse and garnered preliminary feedback on the game to improve the quality of gameplay and the prototype. Feedback through informal assessments in community settings suggests that the youth and their families are interested in a game-based approach to learn about prescription opioid safety in homes and schools. The next steps include modifications to the game prototype based on feedback from the community, integration of learning analytics to track the in-game behaviors of players, and formal testing of the final prototype.

Patient and pediatric caregiver experiences and expectations about opioid risk education and counselling.

OBJECTIVE: This pilot study seeks to explore patient and caregiver experiences, perceptions, and expectations about opioid risk counselling. DESIGN: Semistructured interviews were conducted in Madison, WI. Inductive content analysis was used for analysis. PARTICIPANTS: Adult patients and pediatric caregivers for patients prescribed opioids in the last 30 days. OUTCOME MEASURE: Patient's experiences, perceptions, and expectations about opioid risk and safety counselling. RESULTS: Two out of 16 patients were reported being counseled about risks, and only one patient was told about medication being an opioid. Respondents expressed their desire to learn about dependency and overdose risks and the fact that the medication is an opioid. While patients wanted to be educated by all healthcare providers, pharmacists were deemed most important for opioid risk counseling. CONCLUSION: This unique study points out the need for more research, training, and resources for aligning opioid risk counselling and education with patient expectations as a patient centered effort.

Pharmacy Student Opioid Consultations with Standardized Limited English Proficiency Patients.

INTRODUCTION: Limited healthcare studies have analyzed communication practices with limited English proficiency (LEP) patients. Empirical literature lacks evidence about LEP patient-pharmacist communication about opioid risks. This study aimed to (1) explore topics discussed in opioid medication consults, (2) assess if students inform patients about dependency and overdose risks associated with opioid use and the manner in which those risks were introduced and discussed, and (3) assess LEP specific communication practices. METHODS: Third-year pharmacy students in a required communications course consulted LEP standardized patients (SPs) who spoke 30% English and 70% non-English language. The SP followed a script simulating an encounter between a pharmacist and patient picking up a new, month long prescription of oxycodone. All consultations were video recorded and quantitatively coded for verbal and non-verbal communication skills. RESULTS: Twenty-three pharmacy students conducted consultations with LEP SPs. The majority of students discussed common side effects, but only a few discussed severe side effects. Four of 23 students named the medication as an "opioid" or "narcotic" and described dependency, overdose, or other opioid specific risks. Students used several filler words, long sentences, and a fast pace. A majority of students used teach back methods to identify patient understanding. Students expressed the need for more structured education and training in providing patient counseling for opioids and communicating with LEP patients. CONCLUSIONS: Pharmacy students lack confidence and skills in communicating with LEP patients regarding opioid-specific risks, suggesting structured training is needed.

Investigating Serious Games That Incorporate Medication Use for Patients: Systematic Literature Review.

BACKGROUND: The United States spends more than US $100 billion annually on the impact of medication misuse. Serious games are effective and innovative digital tools for educating patients about positive health behaviors. There are limited systematic reviews that examine the prevalence of serious games that incorporate medication use. OBJECTIVE: This systematic review aimed to identify (1) serious games intended to educate patients about medication adherence, education, and safety; (2) types of theoretical frameworks used to develop serious games for medication use; and (3) sampling frames for evaluating serious games on medication use. METHODS: PubMed, Scopus, and Web of Science databases were searched for literature about medication-based serious games for patients. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed for article selection. RESULTS: Using PRISMA guidelines, 953 publications and 749 unique titles were identified from PubMed, Scopus, and Web of Science. A total of 16 studies featuring 12 unique serious games were included with components of medication adherence, education, and safety, published from 2003 to 2019. Of the 12 games included, eight serious games were tested in adolescents, three games were tested in young adults, and one game was tested in adults. Most studies (n=11) used small sample sizes to test the usability of serious games. Theoretical frameworks identified in the 12 serious games included information, motivation, and behavior theory; social cognitive theory; precede-proceed model; middle-range theory of chronic illness; adult learning theory; experiential learning theory; and the theory of reasoned action. Existing reviews explore serious games focused on the management of specific disease states, such as HIV, diabetes, and asthma, and on the positive impact of serious game education in each respective disease state. Although other reviews target broad topics such as health care gamification and serious games to educate health care workers, no reviews focus solely on medication use. Serious games were mainly focused on improving adherence, whereas medication safety was not widely explored. Little is known about the efficacy and usability of medication-focused serious games often because of small and nonrepresentative sample sizes, which limit the generalizability of existing studies. CONCLUSIONS: Limited studies exist on serious games for health that incorporate medication use. The findings from these studies focus on developing and testing serious games that teach patients about medication use and safety. Many of these studies do not apply a theoretical framework in the design and assessment of these games. In the future, serious game effectiveness could be improved by increasing study sample size and diversity of study participants, so that the results are generalizable to broader populations. Serious games should describe the extent of theoretical framework incorporated into game design and evaluate success by testing the player's retention of learning objectives.

Student Pharmacists' Assessment of a Serious Game on Opioid Medication Safety.

OBJECTIVE: To explore second- and third-year student pharmacists' perspectives on the design and use of a digital game to teach opioid medication safety. To explore the game-based learning approach to teach about appropriate drug use and pediatric education. INNOVATION: The lead author developed MedSMART: Adventures in PharmaCity, an educational video game focused on adolescent opioid safety. Second- and third-year students in a Midwestern School of Pharmacy enrolled in an elective course focused on appropriate use of abused drugs, played the digital game during a classroom session on adolescent opioid misuse. Using a small group discussion guide, students summarized their reflections and perspectives on gameplay. CRITICAL ANALYSIS: Students retained fundamental messages of the game including opioid safety and identified that social interactions contribute to decision-making and consequences of opioid misuse. Student pharmacists found the game's visual appearance engaging, dialogue amusing, and the settings and scenarios relatable. Feedback regarding game controls, environment, dialogue, instructions, and level summaries was provided by students to improve the game design and content. This project provides an example of a thoughtful approach to game-based learning in pharmacy classrooms with the purpose of enhancing student pharmacists' knowledge about opioid safety education, communication, social collaboration, and critical-thinking. NEXT STEPS: Future projects can further investigate student pharmacists' preferences of using game-based active learning. Additionally, retention rates of students from joint lectures and game-based learning activities can be analyzed.

Patient Centered Studies Focusing on Diabetes Self-Management: A Scoping Review.

BACKGROUND: Type 2 diabetes continues to be a significant burden to patients and health systems globally. Addressing this condition from an alternative perspective, patients and various other stakeholders from three northern Mississippi communities co-created patient-centered research questions focused on type 2 diabetes management. OBJECTIVE: The objective of this scoping review was to explore current literature focusing on nine patient- centered research questions to establish current knowledge and identify future research needs in the area of type 2 diabetes. METHODS: A scoping review was conducted to obtain an overview of research related to the study purpose. The PubMed database was searched from March 2013 to March 2018 to identify patient-centered studies focused on type 2 diabetes and relevant to one of the nine research questions. RESULTS: A total of 33 studies were identified and included. For five of the research questions, there was either no previous research literature or only "related" studies could be identified. These largely unexplored topics included how the understanding of guidelines by healthcare providers, specialty, and communication of medication side-effects impact patients' understanding and outcomes, the impact of improving patients' preparedness to communicate with providers, and whether younger patients require weight management programs that account for this populations' needs. CONCLUSION: This lack of previous literature presents a unique opportunity to partner with patients to conduct this study and help improve the management of type 2 diabetes.