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1.
Curr Pharm Teach Learn ; 13(7): 739-742, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34074500

RESUMO

INTRODUCTION: One of the challenges of pharmacy schools worldwide is the need to link theoretical training with the mastery of practical skills. A virtual pharmacy simulation, MyDispense, developed by the Faculty of Pharmacy and Pharmaceutical Sciences at Monash University, enables students to practice the skills of a professional pharmacist, from novice to highly advanced, in a safe virtual environment that is web-based and highly accessible. The free online simulation allows students to undertake scenarios where patients can present with prescription or self-care requirements, and are also challenged with validation tasks requiring them to check the work of virtual colleagues for accuracy, legality, and medicine safety. COMMENTARY: This commentary describes the use of a virtual simulation, MyDispense, in enhancing didactic instruction, complementing experiential education, and the challenges of the virtual simulation to pharmacy educators. MyDispense is now deployed to 186 schools of pharmacy across 34 countries to over 25,000 students worldwide who have completed over 963,000 exercises globally. IMPLICATIONS: The severe acute respiratory syndrome 2 (aka COVID-19) pandemic presents challenges to pharmacy education requiring many educators to switch to remote online learning. Simulation programs, such as MyDispense, help to replicate aspects of pharmacy practice and can be used creatively to meet course needs. The use of MyDispense is an excellent example of pharmacy educators collaborating globally and learning from each other to improve student learning.


Assuntos
Simulação por Computador , Currículo , Educação à Distância/métodos , Educação em Farmácia/métodos , Aprendizagem Baseada em Problemas/métodos , Competência Profissional , Humanos
2.
J Am Pharm Assoc (2003) ; 61(5): 533-538.e3, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33893059

RESUMO

OBJECTIVE: The primary objective of our study was to explore older adults' willingness to stop or lower the dose or frequency their chronic benzodiazepine with the long-term goal of developing a patient-centered intervention to support older adults during the deprescribing process. METHODS: We conducted semistructured interviews with adults aged 60 years and older who reported taking a benzodiazepine for at least 3 months. We recruited participants using our institutional research recruitment website between September and November 2019. Eligible participants completed an interview which was audio-recorded and subsequently transcribed. We identified themes related to older adults' willingness to consider deprescribing their benzodiazepine, if recommended by their prescriber in a hypothetical scenario. Secondary outcomes focused on their use and perceptions of taking a benzodiazepine as well as their experiences attempting to stop the medication. RESULTS: Among the 21 participants, most were female (n = 14, 66.7%), white (n = 20, 95.2%), and reported good or fair health (n = 17, 81.0%). More than three-fourths of participants who reported data (n = 14 of 18, 77.8%) had taken a benzodiazepine for 6 or more years. Participants generally reported that the medication was very effective (n = 16, 76.2%) and adverse effects were infrequent (n = 5, 23.8%). Participants varied widely in their attitudes toward the hypothetical questions about changing their current benzodiazepine. A total of 7 people were open to stopping the medication, 4 were willing to potentially consider it, and 10 were resistant. However, most of the participants were open to the idea of de-escalation (n = 17, 81.0%). CONCLUSION: Many older adults were willing to consider deprescribing a long-term benzodiazepine if it were recommended by their prescriber. Older adults were more open to consider lowering the dose or frequency of the chronic benzodiazepine than stopping the medication. Further research is needed to design a patient-centered intervention tool to support prescribers and older adults in deprescribing conversations about benzodiazepines.

3.
J Am Pharm Assoc (2003) ; 61(3): e107-e113, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33353833

RESUMO

BACKGROUND: Trained community pharmacists provided hypertension (HTN) management services in collaboration with a patient-centered medical home (PCMH). OBJECTIVE: To explore primary care provider (PCP) perceptions of a HTN management program in which patients at the PCMH with elevated blood pressure could choose to receive follow-up care with a trained community pharmacist at a chain community pharmacy. METHODS: We conducted informal interviews with 8 PCPs with a range of level of involvement with the collaborative HTN management program to inform the development of a 13-question online survey that was distributed to PCPs at 10 participating Michigan Medicine PCMH clinics. The primary outcome was the percent of PCPs who reported that the program improved their patient's blood pressure. Secondary outcomes included awareness of the program, alternative follow-up strategies, PCP satisfaction, and barriers to using the program. RESULTS: A total of 39 PCPs (30.0%) responded to the survey. More than one-half (n = 21 of 39, 53.9%) of respondents reported that at least 1 of their patients had seen a trained community pharmacist for HTN management services. Almost all of these PCPs (n = 19 of 21, 90.5%) reported being satisfied with the program, and 80.9% (n = 17 of 21) agreed that it helped patients improve their blood pressure control. The most common barriers identified were patients preferring to follow up directly with their PCP (n = 18 of 39, 46.2%), PCPs being more comfortable with patients having a visit with an embedded ambulatory care pharmacist (n = 16 of 39, 41.0%), and a lack of written materials to share with patients about the program (n = 15 of 39, 38.5%). CONCLUSION: PCPs who used the integrated community pharmacy HTN management program were satisfied with the program and thought that it resulted in improved blood pressure control. PCPs may benefit from written information to share with their patients as well as education to increase their awareness of the program and its beneficial effect on patient blood pressure.


Assuntos
Hipertensão , Farmácias , Humanos , Hipertensão/tratamento farmacológico , Assistência Centrada no Paciente , Percepção , Farmacêuticos
4.
J Am Pharm Assoc (2003) ; 60(6): e252-e263, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32943337

RESUMO

BACKGROUND: Quality ratings for health plans and health services have become increasingly available to patients. OBJECTIVE: We sought to explore older adults' understanding of hypothetical community pharmacy report cards and the information they valued on the report card. METHODS: We recruited participants aged 50 years or older to complete a 59-question telephone survey. The participants reviewed 3 different pairs of report cards, which represented a hypothetical pharmacy, and each pair contained different quality metrics. The participants identified which pharmacy of the pair they preferred, and this served as the primary outcome. We asked the participants to rate the level of importance (4-point unidirectional scale, not at all to very important) of the star ratings, source of information, and quality metrics. We also gathered information about the participants personal experiences with medications and pharmacy services, their self-reported health, health literacy, health numeracy, and demographics. The frequency that the pharmacy with higher quality metrics was selected was reported. We used logistic regression to examine factors associated with correctly identifying the highest quality pharmacy for all 3 sets of report cards. RESULTS: Most participants (n = 152) correctly identified all 3 (n = 120, 79.0%) report cards for pharmacies with higher quality metrics. The source of the information, individual quality metrics, and star ratings were all perceived as moderately or very important by most participants. Ratings of importance were strongly correlated (r, 0.70-1.00). CONCLUSION: More than 75% were able to correctly identify all 3 report cards with higher quality ratings. Most participants believed that the source of the information, the individual quality metrics, and the star rating were all important. Research is needed to explore to what extent patients would use these types of quality metric report cards to make decisions about where to obtain their medications.


Assuntos
Serviços Comunitários de Farmácia , Letramento em Saúde , Farmácias , Idoso , Humanos , Modelos Logísticos , Relatório de Pesquisa
5.
J Am Pharm Assoc (2003) ; 60(6): e236-e245, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32855072

RESUMO

OBJECTIVES: To explore how accurately over-the-counter (OTC) medications were documented in an academic nephrology clinic and the benefits of using a novel short questionnaire as part of medication reconciliation (MR). METHODS: We developed a 3-item tailored questionnaire with questions about use of aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), and proton pump inhibitors (PPIs), which clinical leadership identified as medications of interest. Over the course of 20 days, medical assistants administered the questionnaire to clinic patients immediately after the standard MR. We summarized the rate of inaccurate medication documentation by individual drug and drug class, comparing the standard MR process with the questionnaire. We also calculated diagnostic performance characteristics of the questionnaire. We evaluated the severity of drug-drug interactions between OTC medications discovered using the OTC medication questionnaire and patients' other prescription medications. RESULTS: Nearly 30% (n = 133 of 450) of the participants had at least 1 inaccurately documented OTC medication after the standard MR. The sensitivity and specificity of the standard MR were 79.2% and 93.5%, respectively, for aspirin; 14.5% and 99.5% for NSAIDs; and 80.4% and 97.3% for PPIs. Medication omissions were resolved in the electronic health record approximately two-thirds of the time using the questionnaire. At least 1 drug-drug interaction (DDI) involving active use of an OTC medication was identified in 9.6% of the patients. Of the DDIs, the most common portended effects were increased nephrotoxicity (52.9%), increased bleeding risk (22.9%), and enhanced antiplatelet activity (7.1%). CONCLUSION: Despite the standard MR process, inaccurate documentation of commonly used OTC medications occurred in nearly one-third of outpatients in a nephrology clinic. A brief OTC medication questionnaire may be a scalable and effective strategy to address this problem.


Assuntos
Nefrologia , Anti-Inflamatórios não Esteroides/efeitos adversos , Aspirina , Interações Medicamentosas , Humanos , Medicamentos sem Prescrição/efeitos adversos
6.
J Am Pharm Assoc (2003) ; 60(6): 915-922.e4, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32680780

RESUMO

OBJECTIVE: To determine whether older adults would avoid going to the pharmacy (e.g., by restricting medications or requesting delivery) due to the risk of coronavirus disease (COVID-19). Our secondary objectives were to determine the types of medications that the older adults are more likely to restrict and to determine the factors that influence these decisions. DESIGN: Cross-sectional survey experiment in which participants read 6 scenarios, each stating that they had a 3-day supply of a particular medication remaining. SETTING AND PARTICIPANTS: National Web-based survey distributed to 1457 U.S. adults aged 65 years and older by Dynata from March 25, 2020, to April 1, 2020. OUTCOME MEASURES: Participants reported whether they would go to a pharmacy, have a medication delivered, or restrict the use of each medication. They reported their perceptions and experiences with COVID-19, health risk factors, preferences for more or less care (medical maximizer-minimizer), medication attitudes (beliefs about medicines questionnaire), health literacy, prescription insurance status, and demographics. RESULTS: Most participants (84%) were told to shelter in place, but only 12% reported attempting to obtain extra medications. Participants most often reported that they would go to the pharmacy to obtain each medication (ranging from tramadol 48.9% to insulin 64.9%) except for zolpidem, which they were most likely to restrict (45.4%). Participants who reported comorbidities that increased their risk of COVID-19 were just as likely to go to the pharmacy as those without. In multinomial logistic regression analyses, women and the oldest participants were more likely to seek delivery of medications. Restricting medications was most common for 2 symptom-focused medications (tramadol and zolpidem), and both demographic factors (e.g., gender) and beliefs (e.g., medical maximizing-minimizing preferences) were associated with such decisions. CONCLUSION: Many older adults intend to continue to go to the pharmacy to obtain their medications during a pandemic, even those who have health conditions that further increase their risk for COVID-19.


Assuntos
COVID-19/psicologia , Comportamento do Consumidor/estatística & dados numéricos , Preparações Farmacêuticas/provisão & distribuição , Assistência Farmacêutica/estatística & dados numéricos , Assunção de Riscos , Idoso , Comportamento do Consumidor/economia , Estudos Transversais , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Letramento em Saúde , Humanos , Seguro de Serviços Farmacêuticos , Modelos Logísticos , Masculino , Assistência Farmacêutica/organização & administração , Fatores de Risco , Inquéritos e Questionários
7.
J Am Pharm Assoc (2003) ; 60(6): 773-780, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32115393

RESUMO

OBJECTIVE: To predict the association between demographic, psychological, and medication-specific characteristics and the level of concern about stopping medications among older adults. DESIGN: Cross-sectional study in which participants read 6 vignettes in which a primary care provider broached the idea of stopping a medication. Medications differed in risk, regulatory status, and indication for discontinuation. SETTING AND PARTICIPANTS: National Web-based survey distributed to adults aged 65 years or older by Dynata in January 2019. OUTCOME MEASURES: Participants reported their concern about stopping each medication (7-point scale, not at all to extremely), their preferences for more versus less care (Medical Maximizer-Minimizer Scale, MMS), medication attitudes (Beliefs about Medicines Questionnaire, BMQ), demographic characteristics, and health literacy. We used a generalized estimating equations population-averaged model to examine characteristics associated with concern about stopping medications among all the vignettes and linear regressions to explore levels of concern for individual vignettes. Regressions included the MMS, BMQ, health literacy, and demographics. RESULTS: A total of 942 individuals started the survey, and 823 were included in our analysis. Approximately one-half of participants (range: glyburide, 49.5% to aspirin, 56.0%) reported substantial concern (≥ 4 on a 1-7 scale) about stopping each medication. Characteristics that significantly increased concern about stopping medications included female gender, identifying as black or African American, higher MMS score, and higher BMQ specific score. Higher MMS score predicted increased concern about stopping medications for each of the 6 medications. CONCLUSION: Characteristics of older adults (e.g., medical maximizing-minimizing preferences), as opposed to medication-specific characteristics, predict concern about stopping medications.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Letramento em Saúde , Idoso , Estudos Transversais , Feminino , Humanos , Adesão à Medicação , Inquéritos e Questionários
8.
Curr Pharm Teach Learn ; 12(1): 74-83, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31843168

RESUMO

BACKGROUND AND PURPOSE: Pharmacy education programs use simulation to provide a realistic and safe environment for student learning. We studied whether incorporation of virtual simulation into a required first year self-care therapeutics course impacted frequency of interactions, self-reported student confidence, and preceptor-reported student performance during second-year community pharmacy introductory pharmacy practice experiences (IPPEs). EDUCATIONAL ACTIVITY AND SETTING: Virtual simulation cases using MyDispense were incorporated into a self-care therapeutics course in winter 2017. Students and preceptors were surveyed at the end of the fall semester community pharmacy IPPE. Data from IPPE experiences was compared with students who took the self-care therapeutics course in winter 2016 (control). FINDINGS: Students completed 30 virtual simulation cases and three cases as part of the final examination (n = 33). Students in the intervention group reported more patient care interactions during their IPPEs than students who did not complete virtual simulation cases, but there was no difference in self-reported confidence. Preceptors did not report any differences in the ability of students to complete over-the-counter medication interactions during IPPEs. SUMMARY: Cases were well received by students although they took longer to complete than initially anticipated. Students in the intervention group reported significantly more patient care interactions during IPPEs than those in the control group; however, there were no differences in self-reported confidence. Incorporation of virtual simulation was a sustainable change as the cases were able to be re-used the following year with minimal edits.


Assuntos
Relações Profissional-Paciente , Autocuidado/métodos , Treinamento por Simulação/métodos , Realidade Virtual , Currículo/tendências , Educação em Farmácia/métodos , Educação em Farmácia/tendências , Humanos , Inquéritos e Questionários , Universidades/organização & administração , Universidades/estatística & dados numéricos
9.
Am J Manag Care ; 25(7): e219-e223, 2019 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-31318513

RESUMO

OBJECTIVES: To evaluate the effect of an interdisciplinary transitions of care (TOC) service on readmission rates in a geriatric population. STUDY DESIGN: Single-center retrospective cohort study of adults 60 years or older discharged from an academic medical center. METHODS: From July 1, 2013, to February 21, 2016, a total of 4626 patients discharged from 1 hospital, including inpatient, emergency department, observation, and short-stay units, were included. Cases were scheduled for a TOC service with the interdisciplinary team. Controls received usual care at other sites. All-cause 14-, 30-, and 90-day readmission rates between propensity score-matched study groups were evaluated by intention-to-treat (ITT), per-protocol (PP), and as-treated methods. RESULTS: During the study period, 513 patients were scheduled for at least 1 component of the TOC intervention (ITT group). Of those patients, 215 completed all scheduled visits (PP group). Readmission rate after 30 days demonstrated no difference in the ITT group compared with the control group (12.8% vs 10.7%; P = .215), although it was significantly lower in the PP group in comparison with the control group (12.8% vs 7.9%; P = .042). CONCLUSIONS: An interdisciplinary team based in a patient-centered medical home improved readmission rates for all patients who completed the intervention (PP group).


Assuntos
Atenção à Saúde/organização & administração , Serviços de Saúde para Idosos/organização & administração , Equipe de Assistência ao Paciente/organização & administração , Alta do Paciente/estatística & dados numéricos , Readmissão do Paciente/estatística & dados numéricos , Transferência de Pacientes/organização & administração , Centros Médicos Acadêmicos/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Atenção à Saúde/estatística & dados numéricos , Feminino , Serviços de Saúde para Idosos/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Equipe de Assistência ao Paciente/estatística & dados numéricos , Transferência de Pacientes/estatística & dados numéricos , Estudos Retrospectivos , Estados Unidos
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