Development of a patient satisfaction questionnaire (PSQ) for diabetes management in Thailand and Lao PDR.

In a cross-sectional analytical study, a Patient Satisfaction Questionnaire (PSQ) for diabetes management was developed and tested in Thailand and Lao PDR. A systematic review of qualitative studies was conducted to formulate themes of the PSQ. The 20-item PSQ was prepared in Thai and translated to Lao, with subsequent backward translation. Both versions were tested for reliability and construct validity using confirmatory factor analysis and structural equation modeling. The study was performed at a university hospital in Thailand and two central hospitals in Vientiane, Lao PDR. There were 300 diabetic patients from Thailand (n = 150) and Lao PDR (n = 150). The 5-factor Thai version showed 74.52% of total explained variance with good internal consistency and satisfactory goodness-of-fit indices (χ2/df = 1.91, GFI = 0.83, CFI = 0.98, SRMR = 0.063, RMSEA = 0.078). The five factors were 1) Standard of Service, 2) Diabetic Service, 3) Competency of Providers, 4) Competency of Pharmacists, and 5) Communication with Providers. For the Lao version, 20 items showed a 3-factor structure with a total explained variance of 71.09%. Goodness-of-fit indices for the Lao model were satisfactory (χ2/df = 2.45, GFI = 0.78, CFI = 0.95, SRMR = 0.075 and RMSEA = 0.095). The results showed the PSQ Thai and Lao versions were valid and reliable for assessing patient satisfaction with diabetes management, however more testing of the questionnaire is appropriate.

Empowerment interventions for pharmacies to comply with the Good Pharmacy Practice (GPP) in Thailand

Good Pharmacy Practices (GPP) is to provide people with quality pharmacy services as well as to promote drug use safety. Objectives: To find out the effect of the process of empowering modern pharmacies to meet the GPP standards and to investigate the problems and obstacles that affect the pharmacy licensees in complying with the GPP. Methods: An action research using the Deming Cycle (PDCA) to design a process, in collaboration with relevant parties, to promote GPP compliance. The process consisted of a group intervention and an individual intervention designed to be consistent with the SOAP assessment. The action plan was implemented over a 9-month period. The GPP outcomes were assessed. Samples were 32 pharmacy licensees in Nakhon Ratchasima Province, which have not yet passed the GPP assessment. They were randomly selected by the stratified sampling method. Results: After participating in the empowerment process, there were 62.50% or 20 pharmacies passed the GPP assessment in all categories. The average GPP compliance score had statistically significantly higher than before the process (p<0.001). For the satisfaction of the participants, the overall score was at the highest level. Conclusion: The process of empowering modern pharmacies to meet GPP standards showed a positive effect. The rate of pharmacies that passed the GPP criteria also increased. In addition, the participants in the process were highly satisfied. Therefore, the PDCA cycle should be used in pharmacy development. Meanwhile, GPP self-assessment is a tool to help pharmacy licensees in systematic problem resolution. (AU)

Development and Implementation of Diabetes Care by a Community Network Based on a Chronic Care Model.

INTRODUCTION: This participatory action research was conducted by the collaborative health-related team in a district, in Thailand. The community network jointly developed a care model for diabetic patients in primary care using the Chronic Care Model (CCM) and evaluated the effectiveness of implemented model. METHODS: Data was collected between October 2021 and March 2022 and involved 2 groups: 1) a community network of 25 people including representatives of the community hospital, primary care hospital, Sub-district administrative organization, community leaders, community representatives, representatives of diabetic patients, and representatives of caregivers of diabetic patients, and 2) 41 people with type 2 diabetes and 41 of their family caregivers. The research was conducted in 4 stages: planning, action, observation, and reflection. RESULTS: Both quantitative and qualitative data were collected, and the overall average knowledge scores of diabetic patients, family caregivers, and community representatives significantly increased from before (6.07 ± 2.11, 7.07 ± 1.98, P = .024, 5.74 ± 1.88, 7.37 ± 2.25, P < .001, 7.47 ± 2.44, 8.99 ± 1.72, P = .010) respectively. For satisfaction, diabetic patients were most satisfied with family caregiver support, while the community network representatives were most satisfied with their participation in planning a model for diabetic patients in primary care. After model implementation, the blood sugar-controlled patients (HbA1c < 7 mg%) significantly increased (0 and 9.76%, P = .045), although the fasting blood sugar (FBS) of diabetic patients did not improve. CONCLUSION: The development and implementation of diabetes care based on CCM, promoted community participation and involvement in diabetes care. This model mainly affected diabetic patients who could control their HbA1c level and the satisfaction of the community network.

Pharmacy licensees and their characters that affect Good Pharmacy Practice (GPP) Compliance

Objective: To study the licensee’s factors that affect the GPP compliance, including problems and obstacles in the improvement of pharmacies. Methods: Samples: 90 of the licensees of the modern pharmacies in Nakhon Ratchasima province that did not pass the GPP evaluation. A cross-sectional analytical research with mixed method was done with 2 parts 1) questionnaire survey to assess the attitude, perception, and perceived difficulty of the GPP based on Theory of planned behavior (TPB). The response rate at 68.89%. 2) Focus group discussion to find the problems and obstacles in pharmacy improvement to meet the GPP requirement. Results: the licensees who were a pharmacist have more compliance with the GPP than the non-pharmacist licensees (p=0.001), and the open on daytime period pharmacies (≥8 hours/day) have more compliance with the GPP than pharmacies that are open for certain hours (p=0.001). Attitude, perception and perceived difficulty of GPP from survey and focus group discussion could use as inputs for initiating an empowerment plan for pharmacy licensees. Conclusion: For the reasons that have more tendency to comply with the GPP than others, the pharmacists should be promoted to be the licensees, as well as responsible for operating the pharmacies. The pharmacy should have a pharmacist stationed 8 hours/day to provide the customers with professional standard service. (AU)

Implementing Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome management system by hospital pharmacists in Samutsakhon Hospital, Thailand.

Objectives: To study the process of implementing the DRESS management system by pharmacists and its results, during 2016-2020. Research method: Operational Research, starting from the process of implementing the DRESS management system by the pharmacy department of Samutsakhon Hospital and reporting the results to the Pharmacy and Therapeutic Committee in patients diagnosed with DRESS according to the RegiSCAR criteria, collecting data from an electronic medical records database. Study results: The main DRESS management system implementation process is: 1) listing the High alert drugs which may cause an adverse reaction and preparation of pharmacists in DRESS; 2) Using RegiSCAR for patient assessment; 3) Suggesting a genotyping test before the patient receives the drug, starting with carbamazepine and allopurinol; 4) Using a Computerized Decision Support System (CDSS) to facilitate the screening alert. 5) Proposing to the Pharmacy and Therapeutic Committee for approval on gene testing. As a result, a total of 184 patients were sent for genotyping testing, and 92 of the drug allergy genes were identified, making the prevention or monitoring of patients more effectively. 31 patients were diagnosed with DRESS, and 54.84% were male. The 4 drug items with the highest incidence were phenytoin 28.95%, nevirapine 10.53%, rifampicin 7.89%, and pyrazinamide 7.89%. Clinical symptoms were rash 100.00%, fever 90.32%, lymphadenopathy 6.45%, at least one dysfunction in the internal organ system 74.19%, liver dysfunction 80.65%, and eosinophilia 58.65%. Phenytoin had a statistically significant induced eosinophil (p=0.044), which could be used as a factor in the CDSS drug surveillance. Conclusion: Even DRESS is a rare adverse drug reaction symptom but causes life-threatening. Continuous system management by pharmacists is significant with a huge effect. In the drug items, the highest incidence was phenytoin. Implementing a system to monitor patients' drug use, could reduce DRESS, and prevent the recurrence of drug allergies.

Implementing Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome management system by hospital pharmacists in Samutsakhon Hospital, Thailand

Objectives: To study the process of implementing the DRESS management system by pharmacists and its results, during 2016-2020. Research Method: Operational Research, starting from the process of implementing the DRESS management system by the pharmacy department of Samutsakhon Hospital and reporting the results to the Pharmacy and Therapeutic Committee in patients diagnosed with DRESS according to the RegiSCAR criteria, collecting data from an electronic medical records database. Study Results: The main DRESS management system implementation process is: 1) listing the High alert drugs which may cause an adverse reaction and preparation of pharmacists in DRESS; 2) Using RegiSCAR for patient assessment; 3) Suggesting a genotyping test before the patient receives the drug, starting with carbamazepine and allopurinol; 4) Using a Computerized Decision Support System (CDSS) to facilitate the screening alert. 5) Proposing to the Pharmacy and Therapeutic Committee for approval on gene testing. As a result, a total of 184 patients were sent for genotyping testing, and 92 of the drug allergy genes were identified, making the prevention or monitoring of patients more effectively. 31 patients were diagnosed with DRESS, and 54.84% were male. The 4 drug items with the highest incidence were phenytoin 28.95%, nevirapine 10.53%, rifampicin 7.89%, and pyrazinamide 7.89%. Clinical symptoms were rash 100.00%, fever 90.32%, lymphadenopathy 6.45%, at least one dysfunction in the internal organ system 74.19%, liver dysfunction 80.65%, and eosinophilia 58.65%. Phenytoin had a statistically significant induced eosinophil (p=0.044), which could be used as a factor in the CDSS drug surveillance. (AU)

Promoting rational herb-drug use through pharmacy-led advice and home visits in NCD patients

Introduction: There has been a considerable increase in the concurrent use of prescribed medicines and herbal products, but most users do not have any information about drug-herb interactions. Objective: Therefore, this study aimed to investigate the effects of pharmacological advice by community pharmacists on promoting the rational use of prescribed medicines together with herbal products. Methods: The study was one group pretest-posttest experimental design, performed on a sample of 32 people who met the following criteria: aged ≥18 years, lived in an urbanized area, have NCDs such as diabetes, hypertension, dyslipidemia, or cardiovascular disease, and have used prescribed medicines and herbal products concurrently. The participants were informed and practically advised on the rational use of herbal products simultaneously with prescribed medicines, the possibility of drug-herb interactions, and self-monitoring of possible adverse effects. Results: After implementing pharmacological advice, the participants showed a significant increase in knowledge of rational drug-herb use: from 5.8±1.8 to 8.4±1.6 out of a total of 10 (p<0.001), and their score in terms of appropriate behavior rose from 21.7±2.9 to 24.4±3.1 out of a total of 30 (p<0.001). Additionally, the number of patients with herb-drug interaction risk decreased statistically significantly (37.5% and 25.0%, p=0.031). Conclusion: Pharmacy-led advice on rational use of herbal products with prescribed NCD medicines is effective in terms of promoting increases in knowledge and appropriate behavior in these matters. This is a strategy for risk management of herb-drug interactions in NCD patients. (AU)

Pharmacy students' preparation to provide pharmaceutical care for patients with non-communicable diseases in six ASEAN countries: A qualitative study.

INTRODUCTION: Pharmacy education programs prepare graduates to promote health for patients with noncommunicable disease (NCDs), but there is limited information concerning Association of South East Asia Nations (ASEAN) countries. The study aim was to synthesize academic staff's, alumni's, and alumni supervisors' perspectives on preparation for students to provide pharmaceutical care in NCDs. METHODS: A qualitative research design was used. In-depth interviews with structured questions following the Context, Input, Process, and Product/Outcomes model framework were conducted with four academic staff, three alumni, and three alumni supervisors from six study sites in six countries. Interview questions were constructed in Thai and translated to English by using forward and backward translation. Verbatim transcriptions were used to perform thematic analysis with investigator triangulation. RESULTS: Sixty participants were included. The context showed three main themes related to Burden of NCDs, Pharmacist Roles in NCDs, and Goals. The input showed three main themes of Teaching Methods, Development Plans for Academic Staff, and Budgets and Infrastructure. The process showed one main theme of Struggles in Teaching Methods. The outcomes/outputs showed three main themes of Individual, Organizational, and Professional Levels. Schools need curricula that focus on NCDs, pharmacist competency and skills, and academic preparation of students for practice. Gaps limiting achievement of goals included lack of well-trained academic staff, limited learning facilities, self-learning opportunities, acceptance from other health professionals, and career ladders. CONCLUSIONS: The preparation of pharmacy students varied in six ASEAN countries. Pharmacy education programs must address existing gaps that limit achievement of goals related to NCDs.

Promoting rational herb-drug use through pharmacy-led advice and home visits in NCD patients.

Introduction: There has been a considerable increase in the concurrent use of prescribed medicines and herbal products, but most users do not have any information about drug-herb interactions. Objective: Therefore, this study aimed to investigate the effects of pharmacological advice by community pharmacists on promoting the rational use of prescribed medicines together with herbal products. Methods: The study was one group pretest-posttest experimental design, performed on a sample of 32 people who met the following criteria: aged ≥18 years, lived in an urbanized area, have NCDs such as diabetes, hypertension, dyslipidemia, or cardiovascular disease, and have used prescribed medicines and herbal products concurrently. The participants were informed and practically advised on the rational use of herbal products simultaneously with prescribed medicines, the possibility of drug-herb interactions, and self-monitoring of possible adverse effects. Results: After implementing pharmacological advice, the participants showed a significant increase in knowledge of rational drug-herb use: from 5.8±1.8 to 8.4±1.6 out of a total of 10 (p<0.001), and their score in terms of appropriate behavior rose from 21.7±2.9 to 24.4±3.1 out of a total of 30 (p<0.001). Additionally, the number of patients with herb-drug interaction risk decreased statistically significantly (37.5% and 25.0%, p=0.031). Conclusion: Pharmacy-led advice on rational use of herbal products with prescribed NCD medicines is effective in terms of promoting increases in knowledge and appropriate behavior in these matters. This is a strategy for risk management of herb-drug interactions in NCD patients.

Prevalence and Factors that Influence Potentially Inappropriate Medication Use among Thai Elderly in Primary Care Settings.

BACKGROUND: Older age increases the likelihood of chronic diseases and polypharmacy with the likelihood of potentially inappropriate medications (PIMs) in secondary and tertiary care levels, but in the primary care settings of Thailand there still is a need for more evidence. This study aimed to examine the prevalence of PIM in primary care settings, and to identify factors that influence the use of PIM. METHODS: A cross-sectional retrospective study was conducted in 2017. Eight primary care units from four regions of Thailand were randomly selected. People aged ≥ 60 years in the eight units were studied as participants. The List of Risk Drugs for Thai Elderly (LRDTE) was used as the reference. Multivariate logistic regression was carried out to identify factors that influence. RESULTS: A total of 4,848 patients aged ≥60 years with 20,671 prescriptions were studied. The mean age was 70.7±8.3 years for males, and 61.2% for females. A little more than 5% (5.1%) had ≥ 3 chronic diseases and 15.0% received polypharmacy (≥5 medications). The prevalence of prescriptions with PIMs was 65.9%. The most frequent PIMs were antidepressants: amitriptyline (28.1%), antihistamines: dimenhydrinate (22.4%) and chlorpheniramine maleate (CPM) (11.2%); and Benzodiazepines: lorazepam (6.5%). Three factors that significantly influenced prescribing of PIMs were polypharmacy (adjusted OR 3.51; 95% CI 2.81-4.32), having ≥3 chronic diseases (adjusted OR 1.44; 95% CI 1.04-2.01), and age ≥75 years (adjusted OR 1.18; 95% CI 1.01-1.38). CONCLUSION: More than two-thirds of elderly Thai patients in the primary care settings were prescribed PIMs. Multidisciplinary prescription review and PIM screening in patients aged ≥75 years who have ≥3 chronic diseases or polypharmacy should be implemented in primary care and supportive computerized PIMs alert system is needed.

Effects of Home-Based Care Inter-Professional Education on Students' Outcomes: Mahasarakham University Experiences.

This mixed-method research aimed to implement inter-professional education (IPE) as a training process for producing and shaping health and social sciences professionals in three faculties: Medicine, Pharmacy, and Architecture, Urban Design and Creative Arts in Mahasarakham University (MSU), Thailand. Two hundred thirty-two students who registered as second-year students in the 2015 academic year, and third-year students in the 2016 academic year, and fifty patients in six catchment areas of the Faculty of Medicine Hospital, MSU, participated in the study. Six steps of IPE implementation were involved. They were conducted by twenty-four teachers from three faculties, twelve health volunteers in six communities, and five municipality officers. After the IPE activities, students showed significant improvement in their attitudes towards collaborative teamwork. Their performance with regard to IPE home-based care for medical patients improved substantially from year 2 to year 3 (73.4% and 80.9%, p = 0.001). Patients and community representatives were satisfied with students' home visits, and scored them at > 80%. The after-action review among all of the teachers provided information about their views on IPE projects and their recommendations with respect to inter-professional education. IPE schemes can produce beneficial effects for students, teachers, and patients in the community. As a study result of MSU experience, we recommended IPE for higher education institutions.

Effect of a computerized decision support system on potentially inappropriate medication prescriptions for elderly patients in Thailand.

RATIONALE, AIMS, AND OBJECTIVES: The prescription of potentially inappropriate medication (PIM) is a global issue associated with increased adverse drug events, mortality, and health care expenditure. Computerized decision support system (CDSS) for the detection of PIM is a novel alert system in Thailand for reducing PIM prescriptions. The aim of this study was to evaluate the effect of a CDSS on PIM prescriptions for elderly patients in Thai community hospitals. METHODS: The study design comprised two phases with a duration of 12 months each: pre-CDSS implementation (October 2015-March 2016) and post-CDSS implementation (October 2016-March 2017). Medical services and prescription claims data from four hospitals were used to calculate the prevalence of PIM prescriptions among elderly patients aged 60 years and older. Chi-square tests were used to analyse changes in PIM prescriptions across hospitals post CDSS. RESULTS: The overall prevalence of PIM prescriptions post-CDSS implementation significantly decreased from 87.7% to 74.4%. The severity of mild and moderate PIMs was significantly reduced from 71.9% to 49.0% and from 64.5% to 48.7%, respectively. All hospitals had only one severe PIM, which was hyoscine. It was reduced from 4.7% to 1.5%, but the change was not significant (P = 0.74). The proportion of frequently prescribed PIMs in all PIM levels was significantly decreased, regardless of existing alternative medications. CONCLUSIONS: Specific CDSS for PIM in community hospital setting was associated with a reduction of PIM prescription in elderly patients. This CDSS can change physician's prescription behaviour to avoid inappropriate medications.

Applying the Lists of Risk Drugs for Thai Elderly (LRDTE) as a mechanism to account for patient age and medicine severity in assessing potentially inappropriate medication use.

BACKGROUND: Potential inappropriate medication (PIM) prescribing is a medication that puts patients at risk rather than having benefits. PIM use has been associated with hospitalization, morbidity, and mortality resulting from ADRs in elderly patients. The Lists of Risk Drugs for Thai Elderly (LRDTE) was developed as the new screening tool to identify PIMs use. The prevalence of PIM use using the LRDTE has not been determined in Thailand. PURPOSE: The main purpose of this study was to examine the prevalence of PIM use based on the LRDTE. In addition, this aimed to address the PIM problem by identifying factors that influenced PIM use among elderly patients in Thailand. METHODS: A retrospective cross-sectional descriptive study was conducted using the computerized database at four community hospitals in Thailand during fiscal year 2014. The LRDTE criteria were used as a screening tool for identifying the medicine items of PIM use. Descriptive statistics and multivariate logistic regression were used to identify common and Thai region-specific predictors of PIM use. RESULTS: Of a total of 13274 elderly patients, 79% were prescribed at least one PIM, as indicated by the LRDTE criteria. Amlodipine (32%), omeprazole (30%), and tramadol (18%) were the most commonly prescribed PIMs in elderly patients aged 60 years and older. Hospital and physician characteristics were identified as independent predictors after adjustment for patient and utilization factors. CONCLUSION: PIM use in Thai elderly patients was highly prevalent in community hospitals because the LRDTE criteria reflected clinical practice in Thailand. Hospital and physician factors were identified as region-specific factors that were highly associated with PIM use. Revision of hospital formularies and educational programs for physicians are needed to improve prescribing and avoid PIM use.

Unit cost of common illness management: a comparison between a primary care unit and a community pharmacy in Thailand.

Aim This study was to perform unit cost analysis of managing common illnesses comparing between a primary care unit (PCU) and a community pharmacy. BACKGROUND: PCU is a key point of access for primary care in Thailand. Although a community pharmacy is an ideal setting, it has not been successfully incorporated in Thailand's health service. Common illnesses are encountered everyday by community pharmacists, an appropriate compensation for this service has not been established. METHODS: A primary care service of one educational institution was a study site. Eight common illnesses were emphasised. Patient visits were observed, prospectively at community pharmacy and retrospectively at PCU, during August to October 2013. Labour and material costs related to management of common illnesses were recorded. Total cost divided by total patient visits determined the unit cost. For the community pharmacy, patients were followed up after 3-14 days of visit to evaluate the effectiveness. Sensitivity analysis was performed by varying direct medical cost at ±10-30%. Findings At the community pharmacy, community pharmacists performed multiple tasks including interviewing and assessing patients, choosing an appropriate treatment and dispensing. Of 9141 visits, 775 (8.5%) with common illnesses were included. Upper respiratory disorder was found the highest 41.9% (325/755). Unit cost of treatment ranged from 54.16 baht (£1.18) for pain to 82.71 baht (£1.80) for skin disorder. Two-thirds of pharmacy visits (77.9%, 539/692) reported complete recovery. Managing common illnesses at the PCU was performed by nurse assistants, nurses, doctors and pharmacists. Of 6701 patient visits to the PCU, 1545 (23.1%) visits were at least one of the eight illnesses. Upper respiratory disorder was the majority, 53.0% (771/1454). Unit cost of treatment ranged from 85.39 baht (£1.86) for eye/ear to 245.93 baht (£5.36) for sexual health. Managing common illness at a community pharmacy shows satisfactory effectiveness with lower unit cost.

Modifying homes for persons with physical disabilities in Thailand.

PROBLEM: Thailand passed the Persons with Disabilities Empowerment Act in 2007. The Act, which is in compliance with the United Nations Convention on the Rights of Persons with Disabilities, ensures that registered persons with disabilities are entitled to home environment modifications' benefits up to a maximum of 20 000 baht (670 United States dollars); however, the Act's enforcement is still weak in Thailand. APPROACH: In 2013, researchers developed a home modification programme, consisting of a multidisciplinary team of medical and nonmedical practitioners and volunteers, to modify homes for persons with disabilities. The programme recruited participants with physical disabilities and assessed their functioning difficulties. Participants' homes were modified to address identified functioning difficulties. LOCAL SETTING: The project was implemented in four provinces in collaboration with staff from 27 district hospitals located in north-eastern Thailand. RELEVANT CHANGES: After the home modifications, all 43 recruited participants reported reduced difficulties in all areas, except for participants with severe degrees of difficulties, such as those reporting being unable to walk and unable to get up from the floor. The participants' quality of life had also improved. The average EQ-5D-5L score, measuring quality of life, increased by 0.203 - from 0.346 at baseline to 0.549 after the modifications. LESSONS LEARNT: Home modifications in low-resourced settings are technically and financially feasible and can lead to reducing functioning difficulties and improving the quality of life of persons with disabilities. Implementation requires government subsidies to finance home modifications and the availability of technical guidelines and training on home modifications for implementing agents.

Diabetes and hypertension screening by pharmacy students in Thai communities.

OBJECTIVE. To integrate pharmacy education into a diabetes and hypertension screening program to improve pharmacy student disease knowledge and screening skills and provide a valuable service to the community. METHODS. One hundred eighty third-year PharmD students were trained and subsequently screened people aged ≥35 years in 2 Thai communities. Those with high risk factors were encouraged to see a pharmacist or nurse for further evaluation and referral to a physician for diagnosis. RESULTS. After training, the third-year students showed significantly higher knowledge scores on diabetes and hypertension than a control group of second-year students (p<0.05). More than 80% of the third-year students were rated by pharmacist observers as having good community screening skills. More than 95% of community participants were satisfied or very satisfied with the screening session. The active screening program improved the screening coverage in the targeted communities from 41 people/month under the passive screening program to 127 people/month and improved the coverage rate over a 6-month period from 24% to 73%. CONCLUSION. This active screening project by pharmacy students enhanced the health knowledge and awareness of members of the targeted communities and increased pharmacy students' knowledge of and ability to screen for hypertension and diabetes.

Health promotion integrated into a Thai PharmD curriculum to improve pharmacy practice skills.

OBJECTIVE: To implement and evaluate 5 integrated teaching modules in the fifth-year doctor of pharmacy (PharmD) curriculum to increase students' ability to promote patients' health as part of their pharmacy practice. DESIGN: Activity-based learning was added to each module: (1) a practice experience in which students provided health information and counseling to the public; (2) academic debates on current issues in pharmacy (3) journal clubs on articles from the pharmacy literature; and (4) research projects relating to ongoing faculty research on diabetes. Students on 12-week practice experiences had visits to patients in inpatient wards, outpatient clinics, and either primary care units or community pharmacies. ASSESSMENT: Practice examinations at the end of the first semester, the average student score was above 80% as determined by preceptors in experience sites and from faculty members. Group interviews found that students were positive about the benefits of integrated teaching. CONCLUSION: The integration of the teaching between modules in the same semester is possible and greatly benefits student learning.