The development and evaluation of a predictive productivity model in the ambulatory oncology infusion setting.

PURPOSE: Accurately describing pharmacy productivity in the ambulatory oncology infusion setting is important to ensure appropriate labor utilization. The purpose of this study was to develop a productivity model utilizing weighted medication complexity and prospective schedule data to determine if predicted productivity corresponds to actual productivity across 6 ambulatory oncology infusion sites. METHODS: This study was a 2-part analysis. Part 1 was to modify the historic productivity model from dispense code weighting to individual medication complexity weighting. Medication-specific relative value units were determined by analyzing 12 months of historic timestamp data from the electronic health record and gravimetric technology software. The productivity model containing updated relative value units was compared to the historic model to determine if the difference in total calculated full-time equivalents (FTEs) was within 2.0 FTEs. Part 2 applied prospective infusion schedule data to the updated model to determine if predicted productivity corresponded to actual productivity (within 2.0 FTEs) for pharmacy infusion services. RESULTS: The mean difference in total calculated FTEs for infusion during the study period was 2.46 (standard deviation = 1.87) and was within the range of 2.0 FTEs (P = 0.54), indicating that the updated model was not statistically different from the historic model. The mean difference in total calculated FTEs between the predictive and actual productivity model for infusion was 18.28 (standard deviation = 1.00) and was out of the range of 2.0 FTEs (P < 0.001), indicating that predicted productivity was statistically different from the actual productivity. CONCLUSION: Medication complexity weighting can be used to provide a comprehensive assessment of workload and productivity across pharmacy infusion services. The methodology used to assess predictive productivity should be explored further.

Investigating the impact of student loan debt on new practitioners.

BACKGROUND: United States student loan debt has surpassed $1.7 trillion and continues to rise. Generally described as a "crisis," the state of student loan debt in the United States is a subject of increasing consideration, research, and analysis by federal government agencies, nonprofit organizations, economists, and students who carry the balance. Excessive student loan debt has been hypothesized to affect students' career choice, diminish quality of life, negatively affect their ability to give back to society at large, and delay progress on achieving other financial goals such as saving for retirement. Current available research evaluating the impact of this debt on student pharmacists and new practitioners is limited. OBJECTIVE: To assess the impact of student loan debt on financial stability, career choice, professional development, and overall well-being among pharmacists who received first licensure in Ohio within a 5-year period; hereafter referred to as "new practitioners." METHODS: An anonymous survey, consisting of 39 items, was administered using Verint survey software to new practitioners holding an active pharmacist license in Ohio with date of first licensure between May 1, 2012 and March 1, 2017. RESULTS: Total of 4026 pharmacists were invited to participate in the survey, and there were 471 responses, yielding a response rate of 11.7%. Higher student loan debt was associated with perceived limitations regarding amount of available disposable income, career mobility, work satisfaction, charitable contributions, participation in professional organizations, retirement savings, purchasing a home, delay in starting a family, diminished quality of life, and worries about paying off student loans. However, this study did not find a statistically significant relationship between student loan debt and the decision to pursue a residency. CONCLUSION: On the basis of the results of this study, higher student loan debt has statistically significant effect on new practitioner's perception of their financial stability, ability to pursue professional development opportunities, and overall well-being.

The Effect of Pharmacy-Led, Small-Group Academic Detailing on Prescribing Patterns in an Ambulatory Care Clinic.

Background: While academic detailing seems to be the most promising intervention to improve prescribing patterns, implementation could be challenging for small community practices. Objective: A pharmacy-led, interactive, and tailored small-group academic detailing in a federally qualified health center is described. The primary objective of the study was to determine if the small-group academic detailing improved the prescribing patterns of the medical providers for select disease states: type 2 diabetes mellitus (T2DM), hyperlipidemia (HLD), and essential hypertension (HTN). Methods: Prescribing patterns in a federally qualified health center were examined in relation to small-group academic detailing sessions from April 2010 to March 2015. The markers for improvement were the increase in utilizing metformin and statins in patients diagnosed with T2DM and HLD, respectively, and the reduction of ß-blocker use in patients diagnosed with essential HTN. Changes in prescribing patterns were evaluated using Pearson's χ2 and Fisher's exact tests. Results: The average number of active, adult patients with T2DM, HLD, and essential HTN was 839, 1768, and 2547, respectively. Utilization of metformin in T2DM increased from 5.5% at baseline to 37.7%, statin utilization in HLD increased from 77.1% to 86.9%, and ß-blocker use in HTN decreased from 17.9% to 13.8% (P < .005). Conclusions: A pharmacy-led, small-group academic detailing program improved and maintained appropriate prescribing patterns in an underserved community practice. This study serves as a successful pilot emphasizing the pharmacist's role as an educator and a resource to medical providers regarding appropriate medication use.

Students as catalysts to increase community pharmacy-led direct patient care services.

OBJECTIVE: To describe the impact on community pharmacy service development of a faculty-student-pharmacist collaborative program offered by five U.S. colleges. SETTING: Colleges of pharmacy and community pharmacies in Arizona, Illinois, Ohio, Utah, and West Virginia. PRACTICE DESCRIPTION: Partner for Promotion (PFP) is an elective, longitudinal advanced pharmacy practice experience (APPE) focused on enhancement of community pharmacy management skills, specifically the development and implementation of direct patient care services. This faculty-student-pharmacist collaborative model has been implemented in five U.S. colleges of pharmacy beyond the originating institution. EVALUATION: Data on pharmacy demographics and the impact of PFP on service creation and longevity at these partnering schools were reported via annual online surveys completed by faculty directors at each partnering college of pharmacy. RESULTS: Over a 3-year period, 19 pharmacy teams across five states worked to create a total of 15 direct patient care services, 12 of which were still being offered to patients at the time of data collection (80% longevity). The PFP program guided 38 students through the process of developing and implementing a sustainable service at a community pharmacy. All participating faculty from partnering colleges of pharmacy (100%) indicated that PFP model materials were "very useful" (4-point Likert scale; 1, not useful, to 4, very useful), and all five colleges plan to continue offering the program moving forward. CONCLUSION: The PFP model of training and service development can have a positive impact on the pharmacy profession, serve as an avenue for training students in the development of clinical services, and be a catalyst for establishing the growth of community pharmacy as a patient-centered, service-oriented partner in the health care system.

Coaching for Success: A Residency Search Primer and Update for Preceptors and Faculty.

Pharmacy residency programs have become increasingly competitive in recent years, and changes to the residency search and application process have altered the process for matching with a residency. In this article, major residency topics, from the benefits of residency training to searching for and ranking programs, are summarized. A discussion of tips and tricks for applying for residencies and interviewing for positions is included along with specific suggestions developed with data following the implementation of the Pharmacy Online Residency Centralized Application Service (PhORCAS). The article is organized in a question and answer format to help facilitate understanding of key concepts and common questions that may arise from applicants. Many changes have taken place in the residency search and application process in recent years, and the process of obtaining a residency is complex. Residency applicants and those advising applicants may find value in the answers to commonly asked residency application questions to help ensure the greatest chance of a successful residency match.

Factors influencing community pharmacists' enrollment in a state prescription monitoring program.

OBJECTIVES: To determine factors influencing enrollment for community pharmacists registered and not registered in Ohio's prescription monitoring program (PMP), the Ohio Automated Rx Reporting System (OARRS); to identify association of OARRS enrollment with demographics, availability of Internet access at work, educational background, and/or previous PMP education received; and to compare knowledge of OARRS for enrollees versus nonenrollees. DESIGN: Descriptive, nonexperimental, cross-sectional study. SETTING: Ohio in November and December 2008. PARTICIPANTS: Pharmacists licensed and living in Ohio with a valid e-mail address on file with the state board of pharmacy. INTERVENTION: Online survey developed and administered via Zoomerang. MAIN OUTCOME MEASURE: Factors influencing enrollment for community pharmacists registered and not registered with OARRS. RESULTS: 2,511 complete responses were recorded, and 1,434 respondents indicated community pharmacy as their primary practice setting. Pharmacists not registered with OARRS noted "time available to access the OARRS report" as the top factor influencing their decision not to enroll in OARRS. Pharmacists registered with OARRS noted "being able to assist with decreasing doctor shopping" as the top factor influencing their decision to enroll in OARRS. CONCLUSION: Factors influencing enrollment as indicated by pharmacists not registered with OARRS should be the primary focus of initial efforts to increase enrollment.

The effect of an interprofessional pain service on nonmalignant pain control.

PURPOSE: The primary objective of this project was to evaluate an existing interprofessional, nonmalignant pain service by measuring the difference in patient pain scores (numeric rating scale-11) before and after a pharmacist-led pain education class and medication therapy management (MTM) visit. Secondary objectives included determining the percentage of pharmacist recommendations approved, patient satisfaction, and difference in immediate release (IR) and extended release (ER) opioid use before and after enrollment. METHODS: Baseline data were obtained from a retrospective chart review. Enrolled patients attended an educational pain class with the pharmacist. At the MTM visit with the pharmacist 3-14 days after the initial education class, the patient's pain score was assessed along with his/her medication use, and a care plan was developed and forwarded to the referring provider for implementation. Three months after the pain class and participation in the MTM visit, patients were contacted via telephone to complete a survey. The survey questions assessed patient satisfaction with the pain education program, their current pain score, and their knowledge of information covered during the pain class. RESULTS: Patients reported an average preenrollment pain score of 8.3/10 (n = 39) and a post-survey pain score of 5.6/10 (n = 39). The IR opioid use averaged 19.7 morphine equivalent daily dose (MEDD) at enrollment and decreased by 40% to 11.8 MEDD. The provider approval rate of the pharmacist-recommended interventions ranged from 80% to 92%, depending on the predesignated disease state category. CONCLUSION: An interprofessional, nonmalignant-pain service including a pharmacist-led class resulted in a decrease in average pain scores and MEDD in an underserved population.

Impact of an inpatient anticoagulation management service on clinical outcomes.

BACKGROUND: Antithrombotic medications require careful management to avoid thrombotic or hemorrhagic complications. The benefits of specialized anticoagulation management services (AMS) in the outpatient setting are well established; less evidence of benefit in the hospital setting is available. OBJECTIVE: To evaluate the clinical benefits of an inpatient AMS to cardiac surgery patients requiring warfarin anticoagulation therapy. METHODS: After obtaining institutional review board approval, we conducted a retrospective, single-center, cohort study of consecutive cardiac surgery patients treated before (January 2003-May 2005) and after (June-December 2005) establishment of an inpatient AMS. Demographic and clinical characteristics as well as laboratory and clinical data were retrieved from institutional electronic databases and compared between the 2 patient cohorts. Comparisons between study groups were conducted using a chi(2) or Fisher's Exact test for categorical variables and a Student's t-test for continuous variables. Analysis of rare event data was conducted using Poisson regression analysis. RESULTS: Of 1919 patients admitted during the study interval, 826 received warfarin (674 pre-AMS, 152 post-AMS). The number of patients with postsurgical panic international normalized ratio (INR) values declined after initiation of the AMS (pre-AMS 90/674 [13.4%] vs post-AMS 11/152 [7.2%]; p = 0.036). There was a trend toward fewer clinically significant postoperative bleeding events (pre-AMS 21/674 [3.1%] vs post-AMS 2/152 [1.3%]; p = 0.22) and fewer repeat surgeries for late postoperative bleeding (pre-AMS 8/674 [1.2%] vs post-AMS 0/152 [0%]; p = 0.08). AMS intervention was associated with a 17% decrease in the average postsurgical length of stay (13.9 days vs 11.6 days; p = 0.015). CONCLUSIONS: A multidisciplinary AMS can improve anticoagulation management, leading to fewer panic INR values and a reduced length of hospital stay.

Evaluating the Changing Financial Burdens for Graduating Pharmacists.

Objective. To compare new practitioners in 2009 and 2014 by modeling net income from available salary, expenditure, and student loan data. Methods. A Monte Carlo simulation with probabilistic sensitivity analysis was conducted to model net income for graduating pharmacists in 2009 and 2014. Mean and standard deviations were recorded for each model parameter. Student t-tests were used to compare the mean differences between 2009 and 2014 cohorts. Results. Pharmacist salary and disposable income were higher on average in 2014 compared with 2009. Consumer expenditures were higher in 2014, offsetting the higher salary resulting in a 2014 discretionary income that was less than in 2009 [95% CI: -$2,336, -$1,587]. Net income decreased from 2009 to 2014 for all pharmacy school types. Conclusion. Regardless of loan payment strategy, net incomes for pharmacists graduating from public and private institutions were less in 2014 compared with 2009.

Preparing students for residency interviews through a residency interview boot camp.

BACKGROUND AND PURPOSE: To describe the offering of the residency boot camp activity at one college of pharmacy for students in their fourth professional year. EDUCATIONAL ACTIVITY AND SETTING: Student pharmacists in their final professional year of pharmacy school were invited to participate in a voluntary residency boot camp activity. Originally, the activity consisted of four parts: (1) guidance on preparing for residency interviews; (2) a 1:1 mock interview with a resident, faculty member, residency preceptor or area program director; (3) a review of the student's curriculum vitae (CV) and letter of intent; and (4) a review of the application timeline and process. Based on the feedback, the activity was changed to include five parts: (1) orientation/welcome session, (2) mock interview, (3) case presentation, (4) podium presentation, and (5) a debriefing session on the day's activities and to answer any remaining student questions about the residency application process. In the second offering of the residency boot camp, students were invited to complete a voluntary pre- and post-assessment of their perceived readiness for residency interviews. The activity has evolved based on student feedback to focus predominately on the group and 1:1 interviews. FINDINGS: Since starting the activity in 2013, 14 of the 21 students (67%) from the class of 2014, 16 of the 25 students (64%) from the class of 2015 and 24 of the 26 students (92%) from the class of 2016 that applied for residency training participated in the residency boot camp activity. For the Fall 2014 offering where a survey was conducted, the pre- and post-survey instrument used a Likert Scale, ranging from "strongly disagree" (score of 1) to "strongly agree" (score of "5"). DISCUSSION: and conclusions: Simulated exercises such as a residency boot camp can expose student pharmacists to important interview readiness skills. Student pharmacists involved in this activity demonstrated a perceived positive effect of such activities.

Identifying motivators and barriers to student completion of instructor evaluations: A multi-faceted, collaborative approach from four colleges of pharmacy.

OBJECTIVE: To identify motivators and barriers to pharmacy student completion of instructor evaluations, and to develop potential strategies to improve the evaluation process. METHODS: Completed at four Ohio Colleges of Pharmacy, Phase I consisted of a student/faculty survey and Phase II consisted of joint student/faculty focus groups to discuss Phase I data and to problem solve. RESULTS: In Phase I, the top three student-identified and faculty-perceived motivators to completion of evaluations were to (1) make the course better, (2) earn bonus points, and (3) improve the instructor's teaching. The top three student-identified barriers to completion of evaluations were having to (1) evaluate multiple instructors, (2) complete several evaluations around the same time, and (3) complete lengthy evaluations. Phase II focus groups identified a number of potential ways to enhance the motivators and reduce barriers, including but not limited to making sure faculty convey to students that the feedback they provide is useful and to provide examples of how student feedback has been used to improve their teaching/the course. CONCLUSIONS: Students and faculty identified motivators and barriers to completing instructor evaluations and were willing to work together to improve the process.

Debating the Effectiveness and Necessity of Tenure in Pharmacy Education.

Academic tenure is a controversial and highly debated topic. Is tenure truly outdated or does it simply need to be reformed? On one hand, the tenure system has shortcomings including deincentivizing productive faculty members, inconsistent application of tenure policies and procedures, and the potential for discrimination during tenure decisions. On the other hand, the tenure system is a long held tradition in the academy, essential in higher education to ensure academic standards and values are upheld in the best interest of students. It provides faculty members with the academic freedom to try innovative teaching strategies and conduct research and assists with faculty retention and recruitment. Regardless of one's opinion, the tenure debate is not going away and warrants further discussion. This paper represents the work of a group of academic leaders participating in the 2014-2015 AACP Academic Leadership Fellowship Program. This work was presented as a debate at the 2015 AACP Interim Meeting in Austin, TX in February 2015.

Teaching and learning curriculum programs: recommendations for postgraduate pharmacy experiences in education.

PURPOSE: Recommendations for the development and support of teaching and learning curriculum (TLC) experiences within postgraduate pharmacy training programs are discussed. SUMMARY: Recent attention has turned toward meeting teaching- and learning-related educational outcomes through a programmatic process during the first or second year of postgraduate education. These programs are usually coordinated by schools and colleges of pharmacy and often referred to as "teaching certificate programs," though no national standards or regulation of these programs currently exists. In an effort to describe the landscape of these programs and to develop a framework for their basic design and content, the American Association of Colleges of Pharmacy Pharmacy Practice Section's Task Force on Student Engagement and Involvement, with input from the American Society of Health-System Pharmacists, reviewed evidence from the literature and conference proceedings and considered author experience and expertise over a two-year period. The members of the task force created and reached consensus on a policy statement and 12 recommendations to guide the development of best practices of TLC programs. The recommendations address topics such as the value of TLC programs, program content, teaching and learning experiences, feedback for participants, the development of a teaching portfolio, the provision of adequate resources for TLC programs, programmatic assessment and improvement, program transparency, and accreditation. CONCLUSION: TLC programs provide postgraduate participants with valuable knowledge and skills in teaching applicable to the practitioner and academician. Postgraduate programs should be transparent to candidates and seek to ensure the best experiences for participants through systematic program implementation and assessments.

Second-year pharmacy students' perceptions of adhering to a complex simulated medication regimen.

OBJECTIVE: To conduct a simulated medication regimen with second-year pharmacy students to determine their anticipated versus actual difficulty in adhering to it. METHODS: Second-year pharmacy students were given 6 fictitious medications (jellybeans) and a drug regimen to adhere to for 6 days. Pre- and post-intervention surveys were conducted to compare participants anticipated vs. actual difficulty with adherence and changes in empathy toward patients. RESULTS: The 69 (96%) students who participated in the study missed on average 16% of all simulated medication doses and noted that adhering to the complex medication regimen was more difficult than they had anticipated. Eighty-nine percent of students agreed or strongly agreed the project was valuable in developing empathy towards patients taking complex medication regimens. CONCLUSIONS: Pharmacy students participating in a simulated medication regimen missed a notable number of doses and reported a greater level of empathy for patients taking complex medication regiments. Finding meaningful ways to integrate adherence into the curriculum is essential.

Pharmacy faculty members' perspectives on the student/faculty relationship in online social networks.

OBJECTIVE: To describe pharmacy faculty members' use of the online social network Facebook and compare the perspectives of faculty members with and without Facebook profiles regarding student/faculty relationships. METHODS: An electronic survey instrument was sent to full-time faculty members (n = 183) at 4 colleges of pharmacy in Ohio seeking their opinions on student/faculty relationships on Facebook. If respondents answered "yes" to having a Facebook profile, they were asked 14 questions on aspects of being "friends" with students. If respondents answered "no," they were asked 4 questions. RESULTS: Of the 95 respondents (52%) to the survey instrument, 44 faculty members (46%) had a Facebook profile, while 51 faculty members (54%) did not. Those who had a profile had been faculty members for an average of 8.6 years, versus 11.4 years for those who did not have a Facebook profile. Seventy-nine percent of faculty members who used Facebook were not "friends" with their students. The majority of respondents reported that they would decline/ignore a "friend" request from a student, or decline until after the student graduated. Although a limited number of faculty members had used Facebook for online discussions, teaching purposes, or student organizations, the majority of universities did not have policies on the use of social networking sites. CONCLUSION: Online social network sites are used widely by students and faculty members, which may raise questions regarding professionalism and appropriate faculty/student relationships. Further research should address the student/preceptor relationship, other online social networking sites, and whether students are interested in using these sites within the classroom and/or professional organizations.

Probiotics and prebiotics: why are they "bugging" us in the pharmacy?

OBJECTIVES: Specific organisms can be added to foods to target an effect (probiotics) or non-digestible carbohydrates can be used to foster the development of a favorable flora in the intestinal tract (prebiotics). The significance of pro- and prebiotics have been studied extensively, providing many current and theoretical treatment options. The objective of this paper is to provide a brief overview of commercial products available for the practicing clinician. METHODS: The literature was evaluated for the most commonly used and studied pre- and probiotics available. In addition, information regarding each of the products was obtained from the manufacturer. RESULTS: We found that all products are not formulated the same and the content of live organisms can differ. Currently available products are relatively safe but caution should be used for any patients that may have allergies to inactive ingredients in the product or are immunocompromised. CONCLUSIONS: Many probiotics and prebiotics are commercially available to aid in promoting healthy bowel flora to resist disease. This reference can be a helpful tool for the pharmacist when answering questions or making recommendations to a patient.