The feasibility of an inter-professional transitions of care service in an older adult population.

BACKGROUND: Older adults discharged from the Emergency Department (ED) are at high risk for medication interactions and side effects; examples of practice models addressing this transition of care are lacking. METHODS: This was a prospective cohort study for adults in one of two urban community EDs. Patients ≥50 years of age discharged with at least one new, non-schedule II prescription medication were included. Patients had the option of three transitions of care services: 1) pharmacist-only with home delivery of discharge medications and full medication reconciliation, 2) pharmacist and home health care, including home delivery, medication reconciliation, and a visit from a home health nurse, or 3) either of the above without home delivery. RESULTS: Over seven months, 440 ED patients were screened. Of those, 43 patients were eligible, and three patients elected to join the study. All three patients selected pharmacy-only. Identified barriers to enrollment include the rate of schedule II prescriptions from the ED (53% of potential patients) and high patient loyalty to their community pharmacist. CONCLUSIONS: A pharmacy and home health care transitions of care program was not feasible at an urban community ED. While the pharmacist team identified and managed multiple medication issues, most patients did not qualify due to prescriptions ineligible for delivery. Patients did not want pharmacist or home health nurse involvement in their post ED visit care, many due to loyalty to their community pharmacy. Multiple barriers must be addressed to create a successful inter-professional transition of care model.

Backward Design to Combat Curricular Expansion in a Large, Interdisciplinary, Team-Taught Course.

OBJECTIVE: Recently, there have been calls to action to address curricular expansion, including modifying standards, using curricular analytics, and optimizing interdisciplinary collaboration, all of which focus on program-level changes. The primary objective of this study was to describe how the process of backward design can be used as a strategy to reduce curricular expansion at the individual course level while maintaining student performance and decreasing student and coordinator stress. METHODS: Backward design was applied to a large, interdisciplinary, team-taught pharmacotherapy course to identify opportunities to reduce content volume and align assessment content with course objectives. Didactic content hours were measured and compared with historical controls. Student performance on examinations was measured and compared with previous years. Student feedback on examination alignment and other course-related stressors was gathered via semester-end course evaluations and compared with previous years. Course coordinator reflections before and after implementation were described. RESULTS: The amount of didactic content hours delivered to students decreased by over 37 hours (33%), allowing space for the expansion of application-based practice, study time, and wellness breaks. Student performance on examinations was maintained, while student stress with examination content and the course design was decreased. Coordinators noted less stress and time spent negotiating didactic content time and examination content and alignment with individual instructors. CONCLUSION: Using backward design as a framework to intentionally evaluate didactic content volume and assessment alignment can address curricular expansion while maintaining student learning and decreasing student and instructor stress.

Patient perceptions of pharmacogenomic testing in the community pharmacy setting.

BACKGROUND: In order to optimize community pharmacist roles and patient outcomes, a better understanding of patient perceptions of pharmacogenomic (PGx) testing may be helpful for successful integration into community pharmacy practice. OBJECTIVE: The objective of this study was to identify patient perceptions related to PGx testing in the community pharmacy setting. METHODS: Semi-structured, face-to-face interviews were conducted with adults ≥18 years of age to gather their perceptions of PGx testing. Interview participants were taking either an antiplatelet agent or a selective serotonin reuptake inhibitor listed in Clinical Pharmacogenetics Implementation Consortium (CPIC) guidelines and were patients at one of two community pharmacies in West Michigan. Interview questions were designed to follow the Theory of Planned Behavior and to take into account existing literature on patient perceptions of PGx. Interviews were recorded, transcribed by a third party transcription service, coded by a team of three researchers to identify themes, and analyzed using nVivo qualitative analysis software. RESULTS: A total of 19 interviews were conducted over a period of 16 days in June 2016. Upon preliminary evaluation, four themes related to patient perceptions of PGx testing were consistently observed across multiple interviews: 1) trust, 2) experience, 3) risk/benefit, and 4) clarity. CONCLUSIONS: Semi-structured patient interviews revealed four themes related to PGx testing in the community pharmacy setting. These themes may influence the desire to pursue PGx testing. Future research may seek to identify how community pharmacists can communicate with patients about PGx in the context of these themes to empower patients to make positive health care decisions.