Medication persistence and its impact on type 2 diabetes.

OBJECTIVES: Medication persistence in type 2 diabetes (T2D) is a critical factor for preventing adverse clinical events. We assessed persistence among newly treated patients with T2D and documented the impact of persistence on clinical outcomes and costs. STUDY DESIGN: Retrospective study of Optum Clinformatics Data Mart commercial and Medicare Advantage enrollees from 2007 to 2020. METHODS: We identified adult patients who initiated antidiabetic treatments. Patients were required to have at least 1 treatment-free year prior to their first T2D prescription. Persistence was measured as the duration of continuous therapy until a 60-day gap in drug availability appeared in any antidiabetic therapy. Factors associated with duration were documented, focusing on the initial class(es) of T2D drugs. The impact of treatment duration on the risk of hospitalization and on total health care costs was also examined. RESULTS: A total of 673,265 patients were included, with a median follow-up of 7 years. Only 22% of patients maintained continuous treatment, of whom 10% added a second medication. A 1-month increase in duration was associated with reduced risk of hospitalization due to stroke by 0.54% (95% CI, 0.46%-0.60%), acute myocardial infarction by 0.51% (95% CI, 0.44%-0.57%), and all-cause hospitalization by 0.36% (95% CI, 0.34%-0.37%). A 1-month increase in duration was associated with a year-to-year decrease in medical costs of $51 (95% CI, -$54 to -$48) and an increase in year-to-year drug costs of $14 (95% CI, $13-$14). CONCLUSIONS: Our findings show low persistence among patients with T2D and emphasize the importance of medication persistence, which is associated with cost savings and lower risk of hospitalizations.

Mapping student perceptions of experiential interprofessional learning to the Interprofessional Education Collaborative (IPEC) competencies.

INTRODUCTION: Introductory pharmacy practice experiences (IPPEs) and advanced pharmacy practice experiences (APPEs) provide opportunities for interprofessional education (IPE) in doctor of pharmacy (PharmD) programs by facilitating student engagement with other healthcare professionals. It is unknown how well these experiences align with competencies required for interprofessional collaborative practice. This study describes the alignment of student reflections from experiential rotations with the Interprofessional Education Collaborative (IPEC) competencies. METHODS: Following completion of experiential rotations from June 2017 to August 2019, a retrospective analysis of IPE surveys submitted by students was performed to assess types of interprofessional interactions and alignment of student reflections with IPEC competencies. RESULTS: A total of 1360 surveys were analyzed. More than 75% of all PharmD students enrolled in IPPEs or APPEs during the study period completed at least one survey. Across all experiences, survey responses mapped to IPEC competencies at the following rates: Values/Ethics (25%), Roles/Responsibilities (48%), Interprofessional Communication (36%), and Teams/Teamwork (48%). More reflections from inpatient experiences, compared to outpatient experiences, aligned with Roles/Responsibilities and Teams/Teamwork, while fewer inpatient experience reflections aligned with Interprofessional Communication. Active engagement with other health professions increased as students progressed from IPPEs to APPEs. CONCLUSIONS: As PharmD students progress through the experiential curriculum, they engage with IPEC competencies during each professional year. Inpatient and outpatient experiences may highlight different aspects of the IPEC competencies and advanced rotations are more likely to facilitate active engagement with other healthcare professionals.

Integration of Clinical and Scientific Principles in the Teaching of Drug-Drug Interactions.

Evaluation of drug-drug interactions (DDIs) is an integral part of pharmacy practice worldwide. An understanding of the scientific mechanisms behind and the clinical implications of DDIs is important for proper management of pharmacotherapy. Here, we describe an integrated approach to teaching both aspects of DDIs as a standalone module in diverse course settings. These include on-campus and online delivery to international and local audiences in small and large classes. We describe the scientific, clinical, and integrated learning objectives of the module, and we show how these can be achieved through group projects based on published DDI case reports.

Using Interactive Fiction to Teach Clinical Decision-Making in a PharmD Curriculum.

Teaching of clinical decision-making is an important component of health professions education. Patient case examples are widely used in didactic coursework to teach this material, but engaging all learners in large, lecture-based courses remains a challenge. Interactive fiction (IF), a digital choose-your-own-adventure media, provides an accessible way for students to individually explore the narrative of a patient-case in a safe environment. Here, we report the development of interactive, digital patient-cases (eCases) using Twine, a free IF development platform. Fourteen eCases were developed in collaboration with 11 faculty members and were used in seven different PharmD courses over three semesters. eCase content was developed by faculty members for their respective instructional topics and accessed via Web browsers on students' personal electronic devices. eCases were received positively by students, with > 90% of students reporting that eCases were easy to use, helped them learn the material at their own pace, and gave them an opportunity to learn from mistakes. Student self-perceived confidence also increased significantly after eCase use. Faculty reported that eCases took more time to develop than conventional cases, but were easier to deliver and provided better student engagement. IF is an accessible media for creating and delivering low-fidelity interactive patient cases that can engage all students in a large class. eCases allow students to apply their knowledge, practice clinical decision-making, and safely learn from their mistakes. eCases are versatile and well suited for both in-person and virtual teaching across a variety of health professions programs to teach clinical decision-making. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40670-021-01245-7.

Evaluation of provider response to positive depression screenings and physician attitudes on integrating psychiatric pharmacist services in primary care settings.

INTRODUCTION: The aim of this study was to identify potential gaps in the management of depression and assess the perceptions of primary care providers (PCPs) toward integrating psychiatric pharmacists into primary care settings. METHOD: This was a retrospective chart review of patients ≥18 years of age seen in primary care clinics in Los Angeles County with a documented annual health screening (AHS) between January 1, 2015, through December 31, 2015. Primary outcomes were number and percentage of patients screened for depression with patient health questionnaire (PHQ) assessments, positive depression screenings, and interventions made for positive depression screenings. Secondary outcomes were PCPs' perceptions on management of depression, use of AHS, and roles for psychiatric pharmacists through evaluation of provider survey. RESULTS: Of the patients who received an AHS (n = 6797), 63% received PHQ assessments. Of 145 individuals with a positive PHQ-2, 69% had a positive PHQ-9. Greater than 50% of individuals with a positive PHQ-9 had no preexisting depression diagnosis. Seventy-six percent of individuals with a positive PHQ-9 and 78% with reported suicide ideation had no documented intervention. The majority of providers reported there is a role for psychiatric pharmacists in primary care. DISCUSSION: Gaps in the management of depression were identified. Although depression screenings were performed for the majority of individuals receiving an AHS, no documented interventions were made for most of those individuals who screened positive for depression. Primary care clinics could benefit from psychiatric pharmacist involvement in depression screening and follow-up processes.