Cost savings and cost avoidance with the inpatient clinical pharmacist interventions in a tertiary cancer care hospital.

BACKGROUND: The economic benefit of the clinical pharmacist's role in ensuring the optimum use of medicines is potentially considerable, particularly when it comes to cancer management. We sought to evaluate the overall economic impact of clinical pharmacist interventions in the main cancer setting in Qatar. METHODS: The total economic benefit of the clinical pharmacy interventions were analyzed from the public hospital perspective. Patient records in March 2018, July/August 2018, and January 2019 were retrospectively reviewed at the National Center for Cancer Care and Research, Qatar. The total benefit from interventions was the total cost avoidance due to preventable adverse drug events plus any cost savings associated with therapeutic-based resource use. Sensitivity analyses confirmed the results' robustness and increased generalizability. RESULTS: A total of 1352 interventions based on 281 patients were analyzed. The majority of the drug-related problems were related to the appropriateness of therapy, followed by dosing and administration. The total population benefit over the 3-months study period was QAR 4,879,185 (USD 1,336,763), constituting cost avoidance of QAR 4,234,012 (USD 1,160,003) and negative resource-use cost savings of -QAR 645,174 (-USD 176,760). Projected annual overall benefit was QAR 14,355,354 (USD 3,932,974). The increase in resource use with therapies was mostly because of the addition of other medications. Cost avoidance was mostly driven by recommending additional medications and discontinuation of medications. The uncertainty analysis demonstrated the robustness of outcomes. CONCLUSIONS: The clinical pharmacist intervention increased resource use and its cost. In overall, however, taking avoided cost of adverse drug events in consideration, it is an economically beneficial practice in the National Center for Cancer Care and Research setting, associated with adverse drug events prevention and substantial economic benefits.

Reducing health provider stereotypes through undergraduate interprofessional education.

Objective: Stereotypes among health professionals can jeopardize the delivery of collaborative healthcare and the achievement of positive patient outcomes. However, interprofessional education (IPE) can promote early clarification of roles, and understanding and mutual respect among trainees from different health disciplines. We studied the effects of IPE activities on the views and attitudes of pharmacy students toward nurse- and physician-trainees. Methods: Pharmacy students completed a structured written reflection exercise immediately following two separate IPE activities with nursing and medical students, both oriented around diabetes care. We conducted an inductive content analysis of these texts to identify key themes according to the domains of the contact hypothesis theoretical framework: organizational authority, common goals, intergroup cooperation, equal group status and intergroup status. Pharmacy students were also asked how these IPE activities have influenced their views regarding their future pharmacy practice. Results: Pharmacy students felt that their groups had cooperated to solve the common patient care goals in each IPE activity, and noted no distinction between the nursing and medical students. However, through either explicit or implicit negotiation of overlapping roles, many pharmacy students ultimately assumed deferential positions relative to medical students. Overall, pharmacy students' attitudes and views regarding the abilities and roles of nursing and medical students in patient care were favorably altered through the IPE activities. Notably, nurses' drug knowledge and diagnostic abilities of nurses and physicians' familiarity with the primary literature and prescribing regimens was previously under-rated but became recognized after IPE activities. Conclusion: Pharmacy students' stereotypical views towards nursing and medical students were positively shifted when IPE activity conditions were optimized for intergroup contact.

Diversity in health professional education scholarship: a document analysis of international author representation in leading journals.

OBJECTIVES: The global distribution of health professionals and associated training programmes is wide but prior study has demonstrated reported scholarship of teaching and learning arises from predominantly Western perspectives. DESIGN: We conducted a document analysis to examine authorship of recent publications to explore current international representation. DATA SOURCES: The table of contents of seven high-impact English-language health professional education journals between 2008 and 2018 was extracted from Embase. ELIGIBILITY CRITERIA: The journals were selected according to highest aggregate ranking across specific scientific impact indices and stating health professional education in scope; only original research and review articles from these publications were included for analysis. DATA EXTRACTION AND SYNTHESIS: The table of contents was extracted and eligible publications screened by independent reviewers who further characterised the geographic affiliations of the publishing research teams and study settings (if applicable). RESULTS: A total 12 018 titles were screened and 7793 (64.8%) articles included. Most were collaborations (7048, 90.4%) conducted by authors from single geographic regions (5851, 86%). Single-region teams were most often formed from countries in North America (56%), Northern Europe (14%) or Western Europe (10%). Overall lead authorship from Asian, African or South American regions was less than 15%, 5% and 1%, respectively. Geographic representation varied somewhat by journal, but not across time. CONCLUSIONS: Diversity in health professional education scholarship, as marked by nation of authors' professional affiliations, remains low. Under-representation of published research outside Global North regions limits dissemination of novel ideas resulting in unidirectional flow of experiences and a concentrated worldview of teaching and learning.

Exploring the Influence of Language on Assessment Given a Mismatch Between Language of Instruction and Language of Practice.

STATEMENT: A phenomenon is occurring in international settings where the language of program delivery and assessment does not match the primary language of practice. It is unknown whether determining competence in English disadvantages students for practice in non-English settings. As such, we conducted a pilot study to determine student performance and perceptions after completion of two Objective Structured Clinical Examinations (OSCEs) examinations, one conducted in English and one conducted in Arabic within an Arabic-speaking Middle Eastern setting. Twenty-two students completed both OSCEs. Overall scores were similar but student rankings differed. Students were more confident performing in Arabic, felt that the Arabic examination was more reflective of practice, and believed that use of Arabic OSCEs can promote better patient care. Findings support the notion that student success may be influenced by language of assessment and that we may need to rethink how we determine assessment validity in these emerging international education settings.

Overcoming pitfalls: Results from a mandatory peer review process for written examinations.

PROBLEM DESCRIPTION: Written assessments are essential components of higher education practices. However, faculty members encounter common pitfalls when designing questions intended to evaluate student-learning outcomes. The objective of this project was to determine the impact of a mandatory examination peer review process on question accuracy, alignment with learning objectives, use of best practices in question design, and language/grammar. QUALITY IMPROVEMENT METHODS: A mandatory peer review process was implemented for all midterm (before phase) and final (after phase) examinations. Peer review occurred by two reviewers and followed a pre-defined guidance document. Non-punitive feedback given to faculty members served as the intervention. Frequencies of flagged questions according to guidance categories were compared between phases. RESULTS OF CQI INQUIRY: A total of 21 midterm and 21 final exam reviews were included in the analysis. A total of 637 questions were reviewed across all midterms and 1003 questions were reviewed across all finals. Few questions were flagged for accuracy and alignment with learning outcomes. The median total proportion of questions flagged for best practices was significantly lower for final exams versus midterm exams (15.8 vs. 6.45%, p = 0.014). The intervention did not influence language and grammar errors (9.68 vs. 10.0% of questions flagged before and after, respectively, p = 0.305). CONCLUSIONS: A non-punitive peer review process for written examinations can overcome pitfalls in exam creation and improve best practices in question writing. The peer-review process had a substantial effect at flagging language/grammar errors but error rate did not differ between midterm and final exams.

Utilization of Evidence-Based Secondary Prevention Medications at the Time of Discharge in Patients with Acute Coronary Syndrome (ACS) in Qatar.

BACKGROUND AND OBJECTIVES: In Qatar, ACS (Acute Coronary Syndrome) has become the leading cause of morbidity and mortality. Guidelines recommend that ACS patients should receive indefinite treatment with antiplatelets, ß-blockers, angiotensin converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) and statins. The study objectives were to assess the use of evidence-based secondary prevention medication at discharge among ACS patients in Qatar and to determine the clinical and demographic characteristics associated with the use of these medications. SETTING AND METHODS: A retrospective medical record review was conducted at the Heart Hospital in Qatar. A random sample of 1068 ACS patients was selected. Patient characteristics were summarized. Prevalence of medications at discharge were computed for each medication as well as for medication combinations. Multiple logistic regression was used to detect patient variables that were associated with the outcomes. A p≤0.05 was considered significant. MAIN OUTCOME MEASURES: -Percentage of ACS patients discharged on each of the following medications: antiplatelets (aspirin, clopidogrel), ß-blockers, ACEI or ARBs and statins and on the combination of these medications-Association between the use of these medications and patient characteristics. RESULTS: In total, 1064 records were reviewed. The majority were males (85.3%) and about 1 in 5 (18.7%) were Qatari. At discharge, patients were prescribed the following: aspirin (96.0%), clopidogrel (92.0%), ß-blockers (90.6%) and statins (97.7%). ACEI and ARBs were prescribed to 63.5 and 11.3%, respectively. The concurrent 4 medications (aspirin or clopidogrel, statins or other lowering cholesterol medication, ß-blockers and ACEI or ARB) were prescribed to 773 patients (77.8%; 95% confidence interval: 75.2-80.4%). Being overweight or obese, and having PCI (percutaneous coronary intervention) or hypertension were associated with higher prescription of the concurrent medications. Those with diabetes had a 52% increase in the odds of prescribing the 4 medications. Those with kidney disease had a 67% reduction in the odds of prescribing. CONCLUSION: Most ACS patients were prescribed antiplatelets, ß-blockers and statins, but the use of ACEIs or ARBs was suboptimal. Strategies are needed to enhance ACEI or ARB prescribing, especially for high risk patients who would have the greatest therapeutic benefit from these drugs.