The Intersection of Professional Identity Formation, Bias, and Marginalized Identities.

OBJECTIVES: The objective of this integrative review is to call attention to the limited published literature on professional identity formation (PIF) in students who hold marginalized identities and to promote more inclusive PIF models. FINDINGS: A person's identity is complicated and PIF is a dynamic and continuous lifelong process. A foundational component to PIF is for students to integrate their developing professional identity with their existing selves. Most PIF theoretical frameworks used in health education were created with a dominant culture lens and during a time when most professionals in practice were cisgendered, White, and/or male. These frameworks do not consider ways in which PIF may differ in learners who hold marginalized identities nor the influence that their marginalized identities may have on facilitators and barriers to their PIF journeys. SUMMARY: PIF is a growing area of focus in pharmacy education and scholarship. To effectively support PIF for each member of a diverse student body, pharmacy educators must recognize the limitations of existing PIF theoretical frameworks owing to the historical exclusion of considerations of students' and practitioners' marginalized identities as a layer of professional identity, especially in the context of historical injustices. As members of the pharmacy Academy begin or continue to explore PIF in pharmacy education, they must be mindful and intentional about how they account for the impact that students' marginalized identities may have on their PIF.

Reliability and Validity Evidence for an Academic Gender Equity Questionnaire.

Objective. The majority of practicing pharmacists and student pharmacists are women. However, instruments to assess perceptions of gender equity within pharmacy academia are not available. The objective of this research was to describe the psychometric analysis of a questionnaire developed to assess gender equity by a Gender Equity Task Force and to report reliability and validity evidence.Methods. A questionnaire with 21 items addressing the teaching, research, service, advancement, mentoring, recruitment, and gender of college leaders was created. The survey was distributed via email in December 2020 to all social and administrative science section members of two professional associations. Rasch analysis was performed to evaluate the reliability and validity evidence for the questionnaire.Results. After reverse coding, all items met parameters for unidimensionality necessary for Rasch analysis. Once adjacent categories were merged to create a 3-point scale, the scale and items met parameters for appropriate functionality. Items were ordered hierarchically in order of difficulty. The modified instrument and scale can be treated as interval level data for future use.Conclusion. This analysis provides reliability and validity evidence supporting use of the gender equity questionnaire in the social and administrative academic pharmacy population if recommended edits such as the 3-point scale are used. Future research on gender equity can benefit from use of a psychometrically sound questionnaire for data collection.

Gender equity perceptions among social and administrative science faculty: A qualitative evaluation.

BACKGROUND: Anecdotal evidence suggests that gender inequity persists in academic pharmacy. To date, there are limited published data about the perception of gender inequity in academic pharmacy. OBJECTIVE: The objective of this project was to determine themes associated with gender inequity perceptions in social and administrative science faculty from 2 national pharmacy organizations. METHODS: A gender equity task force comprising 13 members from Social and Administrative Sciences (SAS) sections of the American Pharmacists Association and the American Association of Colleges of Pharmacy was formed. The task force designed a semistructured interview guide comprising questions about demographics and core areas where inequities likely exist. When the survey invitation was sent to faculty members of the SAS sections via Qualtrics, faculty indicated whether they were willing to be interviewed. Interviews were conducted by 2 members of the task force via video conferencing application. The interviews were transcribed. Topic coding involving general categorization by theme followed by refinement to delineate subcategories was used. Coding was conducted independently by 3 coders followed by consensus when discrepancies were identified. RESULTS: A total of 21 faculty participated in the interviews. Respondents were primarily female (71%), were white (90%), had Doctor of Philosophy as their terminal degree (71%), and were in nontenure track positions (57%). Most respondents (90%) experienced gender inequity. A total of 52% reported experiencing gender inequity at all ranks from graduate student to full professor. Four major themes were identified: microaggression (57%), workload (86%), respect (76%), and opportunities (38%). Workload, respect, and opportunities included multiple subthemes. CONCLUSION: Faculty respondents perceive gender inequities in multiple areas of their work. Greater inequity perceptions were present in areas of workload and respect. The task force offers multiple recommendations to address these inequities.

Case report: Medical cannabis-warfarin drug-drug interaction.

AIM: A case of an 85-year-old patient with concurrent use of warfarin and medical cannabis containing delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) is described. Warfarin continues to be a cornerstone of anticoagulation treatment despite the recent addition of FDA-approved anticoagulant agents. It is well known that warfarin has numerous drug interactions; however, much remains unknown about its interaction with THC and CBD. A literature review was conducted to identify documented cases of possible interactions between cannabis and warfarin. The case reports we identified noted that cannabis may potentially increase warfarin's effect. Therefore, we aimed to determine why an effect was not seen on our patient's warfarin dose despite daily use of medical cannabis. CASE: This case report describes an 85-year-old patient who despite starting an oromucosal medical cannabis regimen of THC and CBD (which provided 0.3 mg of THC and 5.3 mg CBD once daily and an additional 0.625 mg of THC and 0.625 mg CBD once daily as needed) had minimal INR fluctuations from October 2018 to September 2019. CONCLUSION: Despite the introduction and use of medical cannabis therapy, with both THC and CBD components, an elderly patient with concurrent warfarin use did not see major INR fluctuations, in contrast to published literature. The potential for warfarin and THC/CBD interactions may be dependent on route of administration and dose of the cannabis product.

Engaging in Authentic Allyship as Part of Our Professional Development.

Educational institutions increasingly recognize the importance of diversity, equity, and inclusion (DEI) efforts to combat and dismantle structures that sustain inequities. However, successful DEI work hinges on individuals being authentic allies and incorporating allyship into their professional development. Allyship involves members of dominant groups recognizing their privilege and engaging in actions to create inclusivity and equitable spaces for all. Individuals from dominant groups with desires to actively support others from marginalized groups are often unsure how to fight oppression and prejudice. Our goal as faculty with diverse perspectives and heterogeneous intersectional identities is to provide readers with the tools to develop as an authentic ally through educating themselves about the identities and experiences of others, challenging their own discomfort and prejudices, dedicating the time and patience to learning how to be an ally, and taking action to promote change toward personal, institutional, and societal justice and equality. Ultimately, each person must advocate for change because we all hold the responsibility. When everyone is an authentic ally, we all thrive and rise together.

Predictors of Hemoglobin A1c Goal Attainment in Patients Treated With Insulin at a VA Pharmacist-Managed Insulin Clinic.

Showing up to appointments and adherence to treatment recommendations correlated with glycemic goal attainment for patients.

Frequency of Attainment of Low-Density Lipoprotein Cholesterol and Non-High-Density Lipoprotein Cholesterol Goals in Cardiovascular Clinical Practice (from the National Cardiovascular Data Registry PINNACLE Registry).

Studies have found that non-high-density lipoprotein cholesterol (non-HDL-C) is a superior marker for coronary heart disease compared to low-density lipoprotein cholesterol (LDL-C). Little is known about achievement of non-HDL-C goals outside clinical trials. Within a population of 146,064 patients with dyslipidemia in the PINNACLE Registry and a subgroup of 36,188 patients with diabetes mellitus (DM), we examined the proportion of patients and patient characteristics associated with having LDL-C, non-HDL-C, and both LDL-C and non-HDL-C levels at National Cholesterol Education Program goals. LDL-C, non-HDL-C, and both LDL-C and non-HDL-C goals in the overall cohort were achieved by 73%, 73.4%, and 68.9% patients, respectively. Significant predictors of meeting all 3 goals were age, male gender, statin, nonstatin, and combined statin plus nonstatin use. Patients with co-morbidities of hypertension, previous stroke or transient ischemic attack, peripheral arterial disease, myocardial infarction, and smoking were less likely to have LDL-C, non-HDL-C, and both LDL-C and non-HDL-C levels at National Cholesterol Education Program goal. In the overall cohort, patients with DM were less likely to meet non-HDL-C and both LDL-C and non-HDL-C goals. In the subgroup of patients with DM, predictors of meeting lipid goals were similar to the overall cohort. In conclusion, these data suggest contemporary treatment patterns by cardiologists successfully achieve lipid goals in most patients. Younger, female patients and those with atherosclerotic cardiovascular disease and risk factors, such as hypertension and DM, are less likely to achieve goals and may require more careful follow-up after statin initiation. Both LDL-C and non-HDL-C goals are achieved in <70% of patients, suggesting room for improvement if a goal-targeted individualized strategy is adopted.

Pharmacists implementing transitions of care in inpatient, ambulatory and community practice settings [updated] / Farmacéuticos implantando transiciones de pacientes en ambiente de práctica hospitalario, ambulatorio y comunitario [actualizado]

Objective: To introduce pharmacists to the process, challenges, and opportunities of creating transitions of care (TOC) models in the inpatient, ambulatory, and community practice settings. Methods: TOC literature and resources were obtained through searching PubMed, Ovid, and GoogleScholar. The pharmacist clinicians, who are the authors in this manuscript are reporting their experiences in the development, implementation of, and practice within the TOC models. Results: Pharmacists are an essential part of the multidisciplinary team and play a key role in providing care to patients as they move between health care settings or from a health care setting to home. Pharmacists can participate in many aspects of the inpatient, ambulatory care, and community pharmacy practice settings to implement and ensure optimal TOC processes. This article describes establishing the pharmacist’s TOC role and practicing within multiple health care settings. In these models, pharmacists focus on medication reconciliation, discharge counseling, and optim ization of medications.[a sentence was deleted]. Conclusion: Optimizing the TOC process, reducing medication errors, and preventing adverse events are important focus areas in the current health care system, as emphasized by The Joint Commission and other health care organizations. Pharmacists have the unique opportunity and skillset to develop and participate in TOC processes that will enhance medication safety and improve patient care (AU)

Objetivo: Presentar a los farmacéuticos el proceso, los retos y las oportunidades de crear modelos de transiciones de cuidados (TOC) en ambiente de práctica hospitalario, ambulatorio y comunitario. Métodos: Se obtuvieron literatura y fuentes sobre TOC a través de una búsqueda en PubMed, Ovid, and GoogleScholar. Los farmacéuticos clínicos, que son autores de este trabajo, presentan sus experiencias en el desarrollo, implantación y ejercicio con los modelos de TOC. Resultados: Los farmacéuticos son una parte esencial del equipo multidisciplinario y juegan un papel clave cuidando a los pacientes cuando se mueven entre niveles de asistencia o de un nivel de asistencia a su hogar. Los farmacéuticos pueden participar en muchos aspectos de cuidaos en ambientes hospitalarios ambulatorios y comunitarios para implantar y asegurar procesos de TOC óptimos. Este artículo describe el establecimiento y la práctica del papel del farmacéutico en los TOC en múltiples niveles de cuidados de la salud. En estos modelos, los farmacéuticos se centran en la reconciliación de la medicación, el consejo al alta, y la optimización de la medicación. Adicionalmente, se ha creado un checklist para ayudar a otros farmacéuticos a desarrollar los papeles del farmacéutico en TOC en un ambiente de ejercicio profesional o a incorporar más elementos de TOC a su establecimiento sanitario. Conclusión: Optimizar el proceso de TOC, reducir los errores de medicación, y prevenir eventos adversos son áreas importantes de del farmacéutico en el actual sistema sanitario, tal y como fue remarcado por The Joint Commission y otras organizaciones sanitarias. Los farmacéuticos tienen una oportunidad única y un conjunto de habilidades que de sarrollar y participar en el proceso de TOC que elevar án la seguridad en la medicación y mejorarán la asistencia del paciente (AU)

Pharmacists implementing transitions of care in inpatient, ambulatory and community practice settings.

OBJECTIVE: To introduce pharmacists to the process, challenges, and opportunities of creating transitions of care (TOC) models in the inpatient, ambulatory, and community practice settings. METHODS: TOC literature and resources were obtained through searching PubMed, Ovid, and GoogleScholar. The pharmacist clinicians, who are the authors in this manuscript are reporting their experiences in the development, implementation of, and practice within the TOC models. RESULTS: Pharmacists are an essential part of the multidisciplinary team and play a key role in providing care to patients as they move between health care settings or from a health care setting to home. Pharmacists can participate in many aspects of the inpatient, ambulatory care, and community pharmacy practice settings to implement and ensure optimal TOC processes. This article describes establishing the pharmacist's TOC role and practicing within multiple health care settings. In these models, pharmacists focus on medication reconciliation, discharge counseling, and optimization of medications [corrected]. CONCLUSION: Optimizing the TOC process, reducing medication errors, and preventing adverse events are important focus areas in the current health care system, as emphasized by The Joint Commission and other health care organizations. Pharmacists have the unique opportunity and skillset to develop and participate in TOC processes that will enhance medication safety and improve patient care.

Pharmacists implementing transitions of care in inpatient, ambulatory and community practice setting / Farmacéuticos implantando transiciones de pacientes en ambiente de práctica hospitalario, ambulatorio y comunitario

Objective: To introduce pharmacists to the process, challenges, and opportunities of creating transitions of care (TOC) models in the inpatient, ambulatory, and community practice settings. Methods: TOC literature and resources were obtained through searching PubMed, Ovid, and GoogleScholar. The pharmacist clinicians, who are the authors in this manuscript are reporting their experiences in the development, implementation of, and practice within the TOC models. Results: Pharmacists are an essential part of the multidisciplinary team and play a key role in providing care to patients as they move between health care settings or from a health care setting to home. Pharmacists can participate in many aspects of the inpatient, ambulatory care, and community pharmacy practice settings to implement and ensure optimal TOC processes. This article describes establishing the pharmacist’s TOC role and practicing within multiple health care settings. In these models, pharmacists focus on medication reconciliation, discharge counseling, and optimization of medications. Additionally, a checklist has been created to assist other pharmacists in developing the pharmacist’s TOC roles in a practice environment or incorporating more TOC elements in their practice setting. Conclusion: Optimizing the TOC process, reducing medication errors, and preventing adverse events are important focus areas in the current health care system, as emphasized by The Joint Commission and other health care organizations. Pharmacists have the unique opportunity and skillset to develop and participate in TOC processes that will enhance medication safety and improve patient care (AU)

Objetivo: Presentar a los farmacéuticos el proceso, los retos y las oportunidades de crear modelos de transiciones de cuidados (TOC) en ambiente de práctica hospitalario, ambulatorio y comunitario. Métodos: Se obtuvieron literatura y fuentes sobre TOC a través de una búsqueda en PubMed, Ovid, and GoogleScholar. Los farmacéuticos clínicos, que son autores de este trabajo, presentan sus experiencias en el desarrollo, implantación y ejercicio con los modelos de TOC. Resultados: Los farmacéuticos son una parte esencial del equipo multidisciplinario y juegan un papel clave cuidando a los pacientes cuando se mueven entre niveles de asistencia o de un nivel de asistencia a su hogar. Los farmacéuticos pueden participar en muchos aspectos de cuidaos en ambientes hospitalarios ambulatorios y comunitarios para implantar y asegurar procesos de TOC óptimos. Este artículo describe el establecimiento y la práctica del papel del farmacéutico en los TOC en múltiples niveles de cuidados de la salud. En estos modelos, los farmacéuticos se centran en la reconciliación de la medicación, el consejo al alta, y la optimización de la medicación. Adicionalmente, se ha creado un checklist para ayudar a otros farmacéuticos a desarrollar los papeles del farmacéutico en TOC en un ambiente de ejercicio profesional o a incorporar más elementos de TOC a su establecimiento sanitario. Conclusión: Optimizar el proceso de TOC, reducir los errores de medicación, y prevenir eventos adversos son áreas importantes de del farmacéutico en el actual sistema sanitario, tal y como fue remarcado por The Joint Commission y otras organizaciones sanitarias. Los farmacéuticos tienen una oportunidad única y un conjunto de habilidades que desarrollar y participar en el proceso de TOC que elevarán la seguridad en la medicación y mejorarán la asistencia del paciente (AU)

Role of novel and emerging oral anticoagulants for secondary prevention of acute coronary syndromes.

Dual antiplatelet therapy has become a mainstay of long-term management of patients after an acute coronary syndrome (ACS). Mortality for these patients remains high despite current evidence-based treatment strategies. The coagulation cascade plays a role in the pathophysiology of ACS, and trials with warfarin in combination with dual antiplatelet therapy have found decreased rates of ischemic events at the expense of increased bleeding risk. Novel oral anticoagulants (NOACs) in the direct factor Xa (FXa) inhibitor and direct thrombin inhibitor (DTI) categories have been evaluated in combination with standard post-ACS therapy. Rivaroxaban, a FXa inhibitor, reduced the rates of ischemic events but increased major bleeding rates. Apixaban did not decrease the rates of ischemic events and also increased major bleeding rates. Other FXa inhibitors have not been studied in the long-term management of ACS (e.g., otamixaban), are not currently being studied in ongoing phase III trials (e.g., TAK-442), or have been discontinued by the manufacturer (e.g., darexaban). The DTI dabigatran had a 2- to 4-fold increased risk of major bleeding with unclear benefit for reducing ischemic events. The factor IXa inhibitor pegnivacogin is an RNA-based aptamer that has been studied in patients undergoing cardiac catheterization but has not been studied for long-term post-ACS management. The European Society of Cardiology Working Group on Thrombosis recommends the use of newer antiplatelet agents over addition of NOACs. Additional guidelines are available to guide management in patients requiring triple antithrombotic therapy but do not provide definitive recommendations on NOACs. Many questions remain about the place of NOACs for long-term post-ACS management. Recent trials have evaluated double versus triple antithrombotic therapy to balance efficacy and bleeding risk, but they did not include NOACs. It also remains unclear if NOACs hold a place in post-ACS therapy in the era of more potent antiplatelet agents such as prasugrel and ticagrelor.

Rivaroxaban: an oral factor Xa inhibitor.

BACKGROUND: Currently available anticoagulants utilized for venous thromboembolism (VTE) treatment and prevention and stroke prevention in patients with atrial fibrillation (AF) have proven effectiveness but are not optimally utilized because of barriers such as the need for subcutaneous administration and requisite routine laboratory monitoring. Rivaroxaban, a novel oral Xa inhibitor, is an alternative to standard therapies utilized for VTE prevention after elective orthopedic surgery, primary and secondary stroke prevention in nonvalvular AF, VTE treatment after an acute VTE event, and secondary prevention after the acute coronary syndromes (ACS). OBJECTIVE: This article reviews the pharmacology, efficacy, and tolerability of rivaroxaban for VTE prophylaxis in post-orthopedic surgery and medically ill patients, stroke prevention in nonvalvular AF, adjunctive therapy in patients with ACS, and VTE treatment. METHODS: International Pharmaceutical Abstracts and EMBASE were searched for English-only clinical trials and reviews published between 1970 and March 15, 2012. PubMed was searched for articles published between 1970 and June 30, 2012. Additional trials and reviews were identified from the citations of published articles. RESULTS: Eighty-nine publications were identified: 10 clinical trials and 1 meta-analysis were used to obtain efficacy and tolerability data, and 1 analysis of pooled data from the clinical trials was included; 17 pharmacokinetic, pharmacodynamic, and drug-drug interaction studies were included; and 5 cost-analyses were reviewed. These data showed rivaroxaban to be noninferior to enoxaparin for thromboprophylaxis of VTE after total knee and total hip replacement surgery. It was also shown to be noninferior to vitamin K antagonist therapy for primary and recurrent stroke prevention in nonvalvular AF as well as for the treatment of VTE after an acute deep vein thrombosis or pulmonary embolism. It also showed benefit in lowering the risk for major adverse cardiovascular events after ACS. Differences in major bleeding rates were not statistically significant between rivaroxaban and comparators across the various studies, with the exception of ACS, in which there were higher rates of non-coronary artery bypass graft surgery related bleeding and intracranial hemorrhage. CONCLUSIONS: Based on the findings of the studies reported in this review, rivaroxaban is an effective option for the prevention of VTE after orthopedic surgery, stroke prevention for nonvalvular AF, and treatment of VTE. At this time, rivaroxaban cannot be recommended for secondary risk reduction after ACS because of the increased bleeding risk.

Assessing Medicare Beneficiary Eligibility for Medication Therapy Management Programs Using PINNACLE, a National Cardiovascular Data Registry.

BACKGROUND: Medication therapy management (MTM) is a mandated component of the 2003 Medicare Modernization Act for Part D prescription drug plans and Medicare Advantage plans, authorizing the pharmacist or other qualified provider to identify, resolve, and prevent medication-related problems for patients with chronic diseases. MTM programs have been shown to improve medication adherence and reduce medication errors while reducing overall costs in patients with cardiovascular (CV) disease; however, MTM has been greatly underutilized for patients with chronic diseases. OBJECTIVE: To identify the proportion of Medicare beneficiaries who are eligible for, and who could potentially benefit from, participating in MTM among patients enrolled in the National Cardiovascular Data Registry's PINNACLE Registry. METHODS: Patient MTM eligibility is based on the presence of multiple chronic diseases and meeting a minimum annual insurance medication costs. We used patient data from 462 academic and private cardiology practices in the United States who participated in the PINNACLE Registry between May 1, 2008, and September 30, 2010, to determine Medicare beneficiaries' eligibility to participate in an MTM program for patients meeting the MTM criteria of (1) a number of chronic diseases (in this case, the number of CV conditions) and (2) an estimated minimum annual medication expenses, using a weighted average cost calculated based on the average wholesale price of the most often prescribed medications, by class, as extracted from the HealthCore Integrated Research Database and weighted according to prescribing frequency within a class. RESULTS: Among the Medicare beneficiaries in the PINNACLE Registry, 93,089 (58%) had ≥3 chronic CV conditions, and the median annual estimated medication expenditure per patient enrolled in the PINNACLE Registry was $1329. Of the total of 93,089 Medicare beneficiaries, 21.4% were eligible for MTM, based on the 2010 minimum eligibility criterion of an annual insurer medication expenditure of $3000 or more. These costs ranged from $366 for low-cost generics to $3958 for the highest-cost drug in a class. In addition, based on the 2010 minimum eligibility rule, the proportion of patients eligible for MTM ranged from 7.9% for those eligible for MTM for low-cost generics to 64% of patients eligible for MTM for the highest-cost medication in a class. CONCLUSIONS: These data serve to raise awareness regarding patients' potential eligibility to receive the benefits of MTM programs. Providers caring for patients with multiple CV conditions, including specialists such as cardiologists, should explain to eligible patients about MTM programs and encourage these patients to take advantage of such programs.

An active-learning strategies primer for achieving ability-based educational outcomes.

Active learning is an important component of pharmacy education. By engaging students in the learning process, they are better able to apply the knowledge they gain. This paper describes evidence supporting the use of active-learning strategies in pharmacy education and also offers strategies for implementing active learning in pharmacy curricula in the classroom and during pharmacy practice experiences.