Rural public health education as a pharmacist-led team endeavor.

OBJECTIVE: To examine the state of public health provision and education in North Dakota and to identify the current and potential future roles pharmacists and pharmacy educators play in these activities. SETTING: Rural, medically underserved areas of North Dakota, as well as professional training sites for the practitioners working in these areas. PRACTICE DESCRIPTION: Practice sites encompass both rural community pharmacies and critical-access hospital pharmacies. The primary education practice site is North Dakota State University. PRACTICE INNOVATION: Pharmacists in rural North Dakota are proactive leaders in providing public health care to their patients. For example, they participate in a statewide diabetes disease management project similar to the Asheville, NC, project. Pharmacy educators are leading the formation of a new interprofessional Master of Public Health program. MAIN OUTCOME MEASURE: Development of an interprofessional public health education program that allows for greater collaboration among rural health practitioners. RESULTS: The new degree program is successfully negotiating the academic approval process. CONCLUSION: Because of the efforts of pharmacists and pharmacy educators, North Dakota is better prepared to face current and future public health challenges.

Assessment of Practice Management Entrustable Professional Activities by Pharmacists in North Dakota.

Objective. To quantify the use of core entrustable practice activities (EPAs) in contemporary pharmacy practice in North Dakota. Methods. Given the large number of core EPAs, this study focused on those supporting tasks categorized within the practice manager domain. The survey instrument was sent to all registered pharmacists living and practicing in North Dakota (n=990). This manuscript reports on the practice manager domain and the activities and examples of supportive tasks in this domain. Results. Four hundred fifty-seven (46.1%) of the pharmacists responded; however, only 102 survey instruments were fully completed and usable. Respondents rated the "fulfill a medication order" activity the highest EPA overall (mean=9.1, SD=2.7). The "oversee the pharmacy operations for an assigned work shift" activity (mean=7.8, SD=3.9) was also rated highly. Responses to "oversee the pharmacy operations for an assigned work shift" were significantly different between independent practice settings and all other practice settings. The manager was more likely than other pharmacy positions to report performing seven of the nine tasks within this EPA. Significant differences in five of nine tasks were found across pharmacies located in rural or more urban communities, including "assist in the evaluation of pharmacy technicians" and "identify pharmacy service problems and/or medication safety issues." Conclusion. This study provides empirical evidence suggesting that EPAs can be a useful means to assess outcomes in pharmacy education.

Patient-Centered Communication.

As the population ages, morbidity and mortality associated with chronic disease will increase. Some patient-centered improvements have been made in health care services, but optimal health has not been fully realized. Only when pharmacists have a holistic understanding of an individual patient, including their experience of illness and medication, can they effectively assess appropriateness, safety, efficacy, and adherence to medications and develop realistic treatment plans. When patients are involved in their care, they are better able to manage complex chronic conditions by understanding and adhering to their plan of care. Pharmacists can enable patients to participate fully using patient-centered communication. There are relatively few published articles on patient-centered communication specific to pharmacists, but the Calgary-Cambridge guide and Four Habits model have applicability to pharmacy practice. The Patient-Centered Communication Tools (PaCT), created for use in pharmacy education and loosely based on the Four Habits model, can assist pharmacists in developing their patient-centered communication skills. Lastly, best practices for patient-centered communication in pharmacy practice are described.

Expanding Dress Code Requirements in the Doctor of Pharmacy Program.

Although the use of a professional dress code is standard practice across colleges and schools of pharmacy during introductory and advanced pharmacy practice experiences, requiring professional attire is not applied consistently during the didactic portion of students' education. There are arguments for and against the adoption of a professional dress code throughout the entire doctor of pharmacy program, including the classroom setting. Given uncertainty regarding the potential benefits and challenges that may arise from adopting a professional dress code in the didactic portion of a student pharmacist's education, it is perhaps not surprising that programs adopt disparate policies regarding its use. This exploration was conducted as part of a series of debates held in conjunction with the American Association of Colleges of Pharmacy's (AACP) Academic Leadership Fellows Program (ALFP) and was presented at the 2015 AACP Interim Meeting on February 7, 2015.

Stability of multidose, preserved formulation epoetin alfa in syringes for three and six weeks.

The integrity and biological activity of multidose, preserved formulation epoetin alfa stored in syringes at 2-8 degrees C were studied. Three independent 1.0-mL hubless syringes of epoetin alfa 20,000 units/mL were aseptically prepared and refrigerated for three and six weeks (a total of six syringes). Protein integrity was assayed by SDS-polyacrylamide gel electrophoresis (SDS-PAGE), immunoblotting, and glycoprotein detection. Biological activity was determined through a cell-based proliferation assay. The presence or absence of microbial contamination was observed after a one-week culture. A multidose, preserved formulation of epoetin alfa that was opened only at the time of assay served as the reference standard. SDS-PAGE silver-stained gels and immunoblots demonstrated no evidence of erythropoietin degradation after three and six weeks of storage when compared with the reference standard. In addition, SDS-PAGE, immunoblotting, and direct glycoprotein detection found that protein glycosylation was unaffected by the storage. Student's t test detected no significant difference between stored samples and the reference standard in biological activity (p > 0.05). A culture of epoetin alfa in bacterial and eukaryotic cell growth media showed no evidence of contamination. The results suggest that epoetin alfa can be dispensed to patients in prefilled syringes every four to six weeks to coincide with their peritoneal dialysis schedule. The integrity and biological activity of 20,000 units/mL epoetin alfa in prefilled syringes remain intact after three and six weeks when stored at 2-8 degrees C.

Comparison of pharmacy students' perceived and actual knowledge using the Pharmacy Curricular Outcomes Assessment.

OBJECTIVE: To determine whether a correlation exists between third-year PharmD students' perceived pharmacy knowledge and actual pharmacy knowledge as assessed by the Pharmacy Curricular Outcomes Assessment (PCOA). METHODS: In 2010 and 2011, the PCOA was administered in a low-stakes environment to third-year pharmacy students at North Dakota State University College of Pharmacy, Nursing, and Allied Sciences (COPNAS). A survey instrument was also administered on which students self-assessed their perceived competencies in each of the core areas covered by the PCOA examination. RESULTS: The pharmacy students rated their competencies slightly higher than average. Performance on the PCOA was similar to but slightly higher than national averages. Correlations between each of the 4 content areas (basic biomedical sciences, pharmaceutical sciences, social/administrative sciences, and clinical sciences) mirrored those reported nationally by the National Association of Boards of Pharmacy (NABP). Student performance on the basic biomedical sciences portion of the PCOA was significantly correlated with students' perceived competencies in the biomedical sciences. No other correlations between actual and perceived competencies were significant. CONCLUSION: A lack of correlation exists between what students perceive they know and what they actually know in the areas of pharmaceutical science; social, behavioral, and administrative science; and clinical science. Therefore, additional standardized measures are needed to assess curricular effectiveness and provide comparisons among pharmacy programs.

A critical appraisal of and recommendations for faculty development.

The 2009-2010 American Association of Colleges of Pharmacy (AACP) Council of Faculties Faculty Affairs Committee reviewed published literature assessing the scope and outcomes of faculty development for tenure and promotion. Relevant articles were identified via a PubMed search, review of pharmacy education journals, and identification of position papers from major healthcare professions academic organizations. While programs intended to enhance faculty development were described by some healthcare professions, relatively little specific to pharmacy has been published and none of the healthcare professions have adequately evaluated the impact of various faculty-development programs on associated outcomes.The paucity of published information strongly suggests a lack of outcomes-oriented faculty-development programs in colleges and schools of pharmacy. Substantial steps are required toward the development and scholarly evaluation of faculty-development programs. As these programs are developed and assessed, evaluations must encompass all faculty subgroups, including tenure- and nontenure track faculty members, volunteer faculty members, women, and underrepresented minorities. This paper proposes AACP, college and school, and department-level recommendations intended to ensure faculty success in achieving tenure and promotion.

Designing a master of public health degree within a department of pharmacy practice.

The demand for public health services is being outpaced by a shrinking public health workforce. This creates a unique opportunity for pharmacists to become more engaged in public health activities, particularly in rural underserved areas. To meet the need for additional public health professionals, we designed a master of public health (MPH) program in a rural state under the leadership of a department of pharmacy practice. In addition to a core set of courses, the MPH program has public health specialty tracks (disease state management, emergency management, health promotion practice, infectious disease management, food safety, gerontology, and medical management and administration) that could be completed as a certificate program or used towards an MPH degree. The program allows students to complete the graduate degree with a minimum of prerequisite coursework. The MPH degree provides an opportunity for pharmacists and other health care professionals to gain an understanding of the interprofessional approach to solving public health problems and will enhance their role in public health and within their health care team.

Drug-induced nephrotoxicity.

Drugs are a common source of acute kidney injury. Compared with 30 years ago, the average patient today is older, has more comorbidities, and is exposed to more diagnostic and therapeutic procedures with the potential to harm kidney function. Drugs shown to cause nephrotoxicity exert their toxic effects by one or more common pathogenic mechanisms. Drug-induced nephrotoxicity tends to be more common among certain patients and in specific clinical situations. Therefore, successful prevention requires knowledge of pathogenic mechanisms of renal injury, patient-related risk factors, drug-related risk factors, and preemptive measures, coupled with vigilance and early intervention. Some patient-related risk factors for drug-induced nephrotoxicity are age older than 60 years, underlying renal insufficiency (e.g., glomerular filtration rate of less than 60 mL per minute per 1.73 m2), volume depletion, diabetes, heart failure, and sepsis. General preventive measures include using alternative non-nephrotoxic drugs whenever possible; correcting risk factors, if possible; assessing baseline renal function before initiation of therapy, followed by adjusting the dosage; monitoring renal function and vital signs during therapy; and avoiding nephrotoxic drug combinations.