Inter-rater Reliability of a Clinical Documentation Rubric Within Pharmacotherapy Problem-Based Learning Courses.

Objective. To evaluate a clinical documentation rubric for pharmacotherapy problem-based learning (PBL) courses using inter-rater reliability (IRR) among different evaluators. Methods. A rubric was adapted for use in grading student pharmacists' clinical documentation in pharmacotherapy PBL courses. Multiple faculty evaluators used the rubric to assess student pharmacists' clinical documentation. The mean rubric score given by the evaluators and the standard deviation were calculated. Intra-class correlation coefficients (ICC) were calculated to determine the inter-rater reliability (IRR) of the rubric. Results. Three hundred seventeen clinical documentation submissions were scored twice by multiple evaluators using the rubric. The mean initial evaluation score was 9.1 (SD=0.9) and the mean second evaluation score was 9.1 (SD=0.9), with no significant difference found between the two. The overall ICC was 0.7 across multiple graders, indicating good IRR. Conclusion. The clinical documentation rubric demonstrated overall good IRR between multiple evaluators when used in pharmacotherapy PBL courses. The rubric will undergo additional evaluation and continuous quality improvement to ensure that student pharmacists are provided with the formative feedback they need.

Pharmacy educator evaluation of web-based learning.

BACKGROUND: Web-based learning (WBL), instruction facilitated through the Internet, has demonstrated utility in classroom and clinical education settings; however, there is a void of literature about the use of WBL by clinical educators within pharmacy. The purpose of this research is to evaluate a WBL initiative within clinical pharmacy education. METHODS: Based on the results of a pilot survey, 10 asynchronous WBL clinical modules (videos and interactive patient cases) were developed for pharmacy educators and students in clinical education affiliated with two schools of pharmacy in the midwest USA. A 21-item, cross-sectional, electronic survey was administered to pharmacy educators within acute and primary care to assess the use of WBL within clinical pharmacy education. RESULTS: Of the 115 eligible clinical educators, 69 participated in the survey (60% response rate), with the majority working within acute care; 38% of educators encouraged the use of WBL. Respondents not using WBL stated a lack of awareness (48%) or existing student time commitments (33%) as reasons. For educators encouraging WBL, 87% agreed that it enhanced student clinical knowledge, 68% stated that it decreased direct instruction time commitments and 100% stated they would encourage its use for future clinical education. CONCLUSIONS: Clinical pharmacy educators reported that the WBL initiative resulted in a perceived stronger student clinical foundation, and all pharmacy educators using WBL encouraged its continued use for future clinical education. Web-based learning provides clinical educators with a learning tool to augment clinical experiences by reinforcing student knowledge, at the same time minimising direct instruction time.

Pharmacy residents as primary educators within a professional pharmacy elective.

BACKGROUND AND PURPOSE: The purpose of this study was to evaluate the impact of a course change from a faculty-led professional pharmacy elective to a primarily pharmacy resident-led course on student satisfaction and learning. EDUCATIONAL ACTIVITY AND SETTING: In 2014, pharmacy residents were transitioned into primary teaching roles in a drug-induced diseases elective to increase student exposure to residents and different teaching styles. Student learning roles did not change. Course evaluations and grades were compared between the resident-led year and prior year. FINDINGS: There was no significant difference between overall course grades during the resident-led year (94.2 ± 36.6 in 2014 vs. 94.1 ± 2.7 in 2013; p=0.975). Course evaluations were similar to the previous year and students provided favorable feedback. DISCUSSION AND SUMMARY: This pharmacy resident-led elective allowed for resident integration in to an interactive professional elective. Student satisfaction with the course remained similar to the previous year and overall course grades did not differ.

Assessment of Learner Metacognition in a Professional Pharmacy Elective Course.

Objective. To investigate the effect of strategic feedback and metacognitive processes on learners' ability to predict performance and improve self-awareness. Methods. Strategic faculty and peer feedback, as well as self-assessments, were implemented in a professional pharmacy elective course throughout the semester, focused on three case-based oral presentations. After each presentation, students utilized an objective rubric to determine self-predicted and peer-predicted scores. Actual scores from faculty were compared to students' predicted scores. Results. Students' ability to predict presentation scores did not improve over time; however, students were able to accurately estimate performance in certain rubric sections on individual presentations (depth of problem, presentation). Students were generally overconfident in predicting their performance. When broken down into tertiles, top performing students were more accurate in their self-assessments compared to bottom performing students. Bottom performing students were highly overconfident in their assessment. Conclusion. Self-awareness is essential for professionals, though difficult to cultivate and improve in one semester. Incorporating longitudinal, continuous feedback and metacognitive skills may help learners become more aware of their own performance and devise a plan for enhancement.

Interactive web-based learning modules prior to general medicine advanced pharmacy practice experiences.

OBJECTIVE: To implement and evaluate interactive web-based learning modules prior to advanced pharmacy practice experiences (APPEs) on inpatient general medicine. DESIGN: Three clinical web-based learning modules were developed for use prior to APPEs in 4 health care systems. The aim of the interactive modules was to strengthen baseline clinical knowledge before the APPE to enable the application of learned material through the delivery of patient care. ASSESSMENT: For the primary endpoint, postassessment scores increased overall and for each individual module compared to preassessment scores. Postassessment scores were similar among the health care systems. The survey demonstrated positive student perceptions of this learning experience. CONCLUSION: Prior to inpatient general medicine APPEs, web-based learning enabled the standardization and assessment of baseline student knowledge across 4 health care systems.

Survey of pharmacist-managed primary care clinics using healthcare failure mode and effect analysis.

OBJECTIVE: The primary objective was to expand upon results of a previously piloted patient perception survey with Healthcare Failure Mode and Effect Analysis (HFMEA), to identify areas within pharmacist-managed clinics needing improvement. METHODS: The survey was adapted for use in pharmacist-managed clinics. Patients completed the survey following regularly scheduled pharmacist appointments. Data were analyzed with a method adapted from HFMEA. Product scores could range from five to 25. A product of five indicates that pharmacists are doing a good job on the items that patients place the most value on, while a product score of 25 indicates that pharmacists are doing a poor job. A score greater than or equal to ten was used to identify areas for improvement. RESULTS: Seventy-one patients completed surveys. Thirteen components were assessed and no item achieved a mean product greater than or equal to ten. The survey item with the highest mean product pertained to discussion of potential medication side effects (mean: 7.06; interquartile range: 5-10). Analysis of each survey item found that all survey items had multiple individual responses that provided a product score of greater than or equal to ten. The survey items most frequently listed in the overall population as being most valued were "Told you the name of each of your medicines and what they are used for", "Answered your questions fully," and "Explained what your medicines do". CONCLUSIONS: Educational components provided during pharmacist-managed clinic appointments are aligned with patients' needs and are successfully incorporating the components that patients value highly in a patient-healthcare provider interaction. The HFMEA model can be an important teaching tool to identify specific processes in need of improvement and to help enhance pharmacists' self-efficacy, which may further improve patient care.

Survey of pharmacist-managed primary care clinics using healthcare failure mode and effect analysis / Estudio de consultas de atención primaria gestionadas por farmacéuticos usando el análisis de modos y efectos de fallos en salud

OBJECTIVES: The primary objective was to expand upon results of a previously piloted patient perception survey with Healthcare Failure Mode and Effect Analysis (HFMEA), to identify areas within pharmacist-managed clinics needing improvement. METHODS: The survey was adapted for use in pharmacist-managed clinics. Patients completed the survey following regularly scheduled pharmacist appointments. Data were analyzed with a method adapted from HFMEA. Product scores could range from five to 25. A product of five indicates that pharmacists are doing a good job on the items that patients place the most value on, while a product score of 25 indicates that pharmacists are doing a poor job. A score greater than or equal to ten was used to identify areas for improvement. RESULTS: Seventy-one patients completed surveys. Thirteen components were assessed and no item achieved a mean product greater than or equal to ten. The survey item with the highest mean product pertained to discussion of potential medication side effects (mean: 7.06; interquartile range: 5-10). Analysis of each survey item found that all survey items had multiple individual responses that provided a product score of greater than or equal to ten. The survey items most frequently listed in the overall population as being most valued were "Told you the name of each of your medicines and what they are used for", "Answered your questions fully," and "Explained what your medicines do". CONCLUSIONS: Educational components provided during pharmacist-managed clinic appointments are aligned with patients' needs and are successfully incorporating the components that patients value highly in a patient-healthcare provider interaction. The HFMEA model can be an important teaching tool to identify specific processes in need of improvement and to help enhance pharmacists' self-efficacy, which may further improve patient care (AU)

OBJETIVOS: El objetivo primario fue profundizar sobre los resultados de un cuestionario pre-pilotado de percepciones de los pacientes con el análisis de modos y efectos de fallos en salud (HFMEA) para identificar áreas en las que las consultas de farmacéuticas necesitan mejorar. MÉTODOS: El cuestionario fue adaptado para su uso en consultas farmacéuticas. Los pacientes cubrieron el cuestionario después de las citas farmacéuticas acordadas. Los datos se analizaron usando un método adaptado del HFMEA. Las puntuaciones de producto podían oscilar de 5 a 25. Un producto de 5 indicaba que el farmacéutico estaba realizando un buen trabajo en los ítems que el paciente valorizaba más, mientras que una puntuación de 25 indicaba que el farmacéutico estaba haciendo un mal trabajo. Se utilizaron las puntuaciones de 10 o más para identificar áreas de mejoría. RESULTADOS: 71 pacientes completaron cuestionarios. Se evaluaron 33 componentes y ningún ítem alcanzó un producto medio mayor o igual a 10. El punto de la encuesta que alcanzó la media más alta trataba de la discusión de los potenciales efectos secundarios de la medicación (media: 7.06; rango intercuartilico: 5-10). El análisis de cada ítem del cuestionario encontró que todos los ítems tenían varias respuestas individuales que proporcionaban una puntuación igual o mayor de 10. Los ítems más frecuentemente considerados por la población total como siendo los más valorados fueron "le dijo el nombre de todos sus medicamentos y para que se usan", "respondió completamente sus preguntas" y "explico lo que hacen los medicamentos". CONCLUSIONES: Los componentes educativos proporcionados en las visitas a las consultas farmacéuticas se alinean con las necesidades de los pacientes e incorporan con éxito los componentes que los pacientes valoran más en la interacción paciente-profesional de la salud. El modelo HFMEA puede ser una importante herramienta educativa para identificar procesos específicos que necesitan mejorar y para ayudar a aumentar la autoeficacia de los farmacéuticos, lo que podrá en el futuro mejorar la atención a pacientes (AU)

Canagliflozin, a new sodium-glucose cotransporter 2 inhibitor, in the treatment of diabetes.

PURPOSE: The published evidence on the pharmacology, pharmacodynamics, pharmacokinetics, safety, and efficacy of a promising investigational agent for managing type 2 diabetes is evaluated. SUMMARY: Canagliflozin belongs to a class of agents-the sodium-glucose co-transporter 2 (SGLT2) inhibitors-whose novel mechanism of action offers potential advantages over other antihyperglycemic agents, including a relatively low hypoglycemia risk and weight loss-promoting effects. Canagliflozin has dose-dependent pharmacokinetics, and research in laboratory animals demonstrated high oral bioavailability (85%) and rapid effects in lowering glycosylated hemoglobin (HbA(1c)) values. In four early-stage clinical trials involving a total of over 500 patients, the use of canagliflozin for varying periods was associated with significant mean reductions in HbA(1c) (absolute reductions of 0.45-0.92%) and fasting plasma glucose (decreases ranged from 16.2% to 42.4%) and weight loss ranging from 0.7 to 3.5 kg. More than a dozen Phase II or III clinical trials of canagliflozin in adults are ongoing or were recently completed, but the final results of most of those studies have not been published. Adverse effects reported in clinical trials of canagliflozin include urinary tract and genital infections, occurring in about 10% of patients. Additional and larger Phase III clinical trials to delineate the potential role of canagliflozin and other SGLT2 inhibitors in the management of diabetes (including studies involving the elderly, children, and patients with renal or hepatic dysfunction) are planned or currently underway. CONCLUSION: Canagliflozin and other investigational SGLT2 inhibitors have a novel mechanism of action that may offer a future alternative treatment pathway for managing type 2 diabetes.

Teratogen use in women of childbearing potential: an intervention study.

PURPOSE: The purpose of this study was to quantify the number of women of childbearing potential who are prescribed angiotensin-converting enzyme inhibitor (ACE inhibitor), angiotensin receptor blocker (ARB), or HMG-coenzyme A reductase inhibitor (statin) and to determine the number of documented teratogenic risk discussions (risk documentation) before and after educational interventions. METHODS: The institutional review board-approved retrospective chart review included female patients ages 15 to 45 years who were prescribed an ACE inhibitor, ARB, or statin between January 1, 2007, and March 1, 2009. Exclusion criteria were tubal ligation and hysterectomy. A survey determined physician knowledge of teratogenic risks and prescribing practices for targeted medications. Educational interventions were implemented. Data was reviewed and analyzed quarterly for 1 year. RESULTS: Baseline analysis included 200 patients. A total of 129 (64.5%) patients were prescribed an ACE inhibitor, 29 (14.5%) were prescribed an ARB, and 88 (44.0%) were prescribed a statin. Risk documentation occurred for 40 (20%) patients. Analysis after intervention of 131 patients revealed that risk documentation was 2.4 times greater than before intervention (odds ratio, 2.4; 95% CI, 1.5-3.9). No significant difference identified in survey responses before and after intervention; however, resident physicians overestimated risk documentation. CONCLUSIONS: Physicians' baseline awareness of ACE inhibitor, ARB, or statin teratogenic risks and risk documentation was lacking. Improvement in risk documentation was seen after intervention; however, continual improvement is essential.