Innovations in pharmacy最新文献

Background: Access to a primary care provider is not guaranteed for many living in rural settings. Notably, rural populations experience a higher degree of burden from chronic diseases compared to urban-dwellers. For example, diabetes can go undiagnosed and undertreated with lack of primary care. To address these care gaps at a large, rural family medicine practice in western North Carolina, a multidisciplinary pharmacist-led diabetes clinic was developed. Objectives: This article describes the implementation, evolution, and impact of the diabetes management clinic and explores future directions for improving the experience of patients and health care providers. Practice Description and Innovation: The diabetes management clinic at Mountain Area Health Education Center (MAHEC) is a pharmacy resident-led interdisciplinary clinic incorporating nutrition and pharmacy learners to provide patient care in both telehealth and in-office settings. Since its inception in 2018, the clinic has facilitated meaningful learning opportunities for students and residents and helped patients manage their diabetes in a multifaceted approach. Evaluation Methods: A retrospective, cross-sectional study evaluated diabetes-related outcomes for 80 patients seen in the diabetes management clinic during twelve months of appointments. The primary outcome measure was change in A1c from baseline. Results: Among patients with a follow-up A1c during the study (n=64), there was a mean reduction in A1c by 0.79% from baseline. Additionally, among those with a second follow-up A1c available (n=32), there was a mean reduction from baseline in A1c of 1.42%. Conclusion: The utilization of pharmacy residents as part of an interdisciplinary diabetes management clinic can extend access to care for underserved patients. The clinic also serves as a structured teaching clinic for interdisciplinary learners, and it has contributed to positive clinical outcomes, strong interprofessional collaboration, and expansion of experiential education opportunities since its inception in 2018.

Description of the Problem. Gamification is used in pharmacy education as an innovative learning strategy to engage learners with educational content. The March Medication Madness activity used bracketology, a type of gamification not previously described in pharmacy education literature, to increase student engagement and knowledge of key disease states. The Innovation. The activity was developed for use in a capstone course during the final semester of the didactic pharmacy curriculum. Students created medication-related pearls that were placed in a tournament-style bracket. Students then completed brackets to predict the winning pearls and voted biweekly to determine the most clinically significant pearl. Student knowledge was assessed pre- and post-activity along with a post-activity perception assessment. Critical Analysis. Of the 52 student participant responses, most agreed or strongly agreed that the activity increased understanding and stimulated interest in course material, while adding a fun element to the course. There was a statistically significant increase (P = .002) in the average percentage of multiple-choice questions students answered correctly from the pre-test (57.7% ± 1.5%) to the posttest (63.1% ± 1.9%). Pearls that received the most votes were no more likely to be associated with an increase in knowledge than pearls receiving fewer votes. Next Steps. Implementation of a bracketology activity was perceived by students as fun, engaging, and beneficial in understanding course material. However, increase in knowledge was limited. This shows the importance of structuring gamification in a way that provides educational value and underscores the need to modify the activity to promote student learning.

Description of the Problem: Rates of pharmacy residency research projects making it to peer review and publication are low (between two and seven percent). Little is known about the influence of preceptor development on moving projects to peer-review and publication. The Innovation: The primary objective was to describe the effect of a preceptor development series on writing and overall manuscript quality leading to submission to a peer-reviewed publisher. Three pharmacy preceptors assigned to a post-graduate year 1 residency project were enrolled in a six-week series focused on writing, peer-reviewed publishing, and advancing resident research to publication. Each preceptor was tasked with implementing development series content in their resident research mentorship. Critical Analysis: Resident project manuscripts were assessed using a previously published 34-item evaluation tool. All papers were blinded for independent evaluation by two investigators. Nine papers were evaluated: three from preceptors who participated in the development program and six from preceptors who did not participate. The mean summary scores for papers with preceptors who participated versus those who did not were 5.8 and 5.4, respectively, on a 10-point scale. Additionally, papers from preceptor participants were noted to achieve satisfactory scores on evaluation tool items 85.3% of the time versus 74.7% of the time for non-participants. Next Steps: Participation in a six-week preceptor development program on advancing resident writing and research to publication provided preceptors the tools needed to mentor higher quality manuscripts ready for publication. Residency programs may consider designing and implementing such a series to promote preceptor and resident research publication.

Documentation of clinical encounters continues to be a challenge to implement in practice and there is a lack of literature on documentation best practices in pharmacy. In order to inform documentation practices at an academic pharmacy clinic, a quality assurance (QA) initiative was implemented at the UBC Pharmacists Clinic (the Clinic). The goal of this QA initiative was to determine what facilitators and barriers to documentation existed for Clinic pharmacists and improve the efficiency of consultation note writing. Phase 1 conducted an online survey to assess each pharmacist's documentation practice at baseline. Phase 2 implemented new interventions that could advance these skills. There were five main interventions introduced: 1) revised consultation note templates, 2) a documentation "checklist", 3) a documentation "decision tree", 4) a clinical documentation guide and 5) a documentation peer-feedback workshop. During Phase 3, pharmacists re-answered the same survey questions 10 months later. This allowed for a direct comparison of documentation practices and skills before and after the interventions. After the interventions, pharmacists reduced the time to complete their notes by nearly 14 min. The revised note structure resulted in an increased uptake of template use from 37% to 100%. Furthermore, prior to the interventions, the majority of pharmacists ranked writing consultation notes as the most burdensome aspect of their daily workflow. Afterwards, the perceived level of burden reduced significantly. These findings can be used to inform how students are taught documentation and improve the quality of documentation by pharmacists in team-based or primary care settings.

Objective: Leadership discussion, including leadership development programs, is common. However, discussion of followership as a component of leadership seems less frequently discussed. With a focus on leadership and followership, this investigation reviewed the health-professions education literature and characterized leadership-followership within health-professions education. Methods: Using PubMed, ERIC, and Google Scholar, two investigators independently and systematically searched health-professions education literature for articles related to leadership and followership. Reports were categorized based on the articles by type, application, profession, leadership, and followership qualities. Results: Eighty-one articles were included. More than half [59% (48/81)] were theoretical, 27% (22/81) empirical, 7% (6/81) commentaries, and 6% (5/81) letters-to-the-editor). Empirical studies did not share outcomes that could be meaningfully combined quantitatively by meta-analysis; however, the vast majority (96%) of theoretical articles discussed a healthcare-related application of leadership and followership (e.g., improving patient care, improving communication, improving organizational efficiency). Thus, a qualitative review was completed. Of the 81 articles, 57% (n=46) involved multiple professions, while 43% (n=35) focused on a specific profession [Nursing (n=16), Medicine (n=7), Others (n=5) Surgery (n=3), Pharmacy (n=2), Veterinary Medicine (n=2)]. While most articles (75%) discussed leadership qualities (with top qualities of effective communication, visionary, and delegating tasks), fewer (57%) discussed followership qualities (with top qualities of being responsible, committed, and supportive). Of note, some qualities overlapped in both leadership and followership (with top qualities of effective communication, being supportive, and providing/receiving feedback). Conclusions: Leadership-Followership was described in many health-professions' education literature. However, Pharmacy and Veterinary Medicine had substantially fewer articles published on this topic. Notably, followership did not receive nearly as much attention as leadership. Leadership has a dynamic and complex interaction with followership highlighting that an effective leader must know how to be an effective follower and vice versa. To improve leadership within healthcare teamwork, education should focus on both leadership-followership.

Background: Continuous glucose monitoring (CGM) is an evolving technology that provides a wealth of information to aid in managing diabetes. Professional CGM (ProCGM) is recommended when personal CGM is not desired or available. Patients in medically underserved areas may have limited access to personal CGM devices, thus ProCGM devices can be used for short-term monitoring and medication adjustment. Clinical pharmacists are well-positioned to help set up and establish personal and professional CGM management services. Objectives: To determine the effect of ProCGM in patients with persistently uncontrolled type 2 diabetes in a medically underserved population (MUP). Methods: Pre-post intervention analysis of a single cohort of patients in a public health center. Patients with persistently uncontrolled (A1c > 9%) and taking at least one daily dose of insulin were included. Included participants wore a ProCGM sensor and met with the clinical pharmacist at least once for ProCGM data interpretation and education. The primary analysis evaluated patients who achieved an A1c <9% 1-6 months after intervention. The change in A1c was also evaluated. Participants completed a pre- and post-survey about their experience. Results: Twenty-two patients were included in the final analysis. Ten patients achieved an A1c <9% (45%). The mean A1c pre- and post-ProCGM was 11.0% and 9.8% respectively, with a decrease of -1.2% (p=0.055) overall and a decrease of -1.7% for patients who wore the sensor for at least 10 days (p=0.012; n=15). Using the CGM data 91% of participants had a change to their medication regimen and 45% achieved an A1c <9%. Six participants experienced hypoglycemia per the CGM report, but only two were aware of it. After reviewing their glucose report with the pharmacist, 95% of the respondents agreed or strongly agreed to feeling more knowledgeable about blood sugar patterns after reviewing the report with a pharmacist. Conclusion: Almost half of the patients in the study achieved an A1c <9%. This study demonstrated glycemic benefit in patients in a MUP who wore a ProCGM for at least 10 days and met with a clinical pharmacist. Data from ProCGM enabled patients to better understand glucose patterns in those with persistently uncontrolled type 2 diabetes.

Introduction: Leadership training is a crucial component of the pharmacy education curriculum. The Accreditation Council for Pharmacy Education (ACPE) emphasizes and encourages the use of different leadership initiatives, and universities employ tactics with varying levels of success to implement these initiatives. "Leadership theory" debates if leadership can be learned or if it is a natural-born skill. This article explores learned leadership and describes a small study deployed to different levels of pharmacy learners to foster leadership confidence and self-awareness. Educational Context and Methods: Second- and third-year didactic students in a leadership elective, voluntary fourth-year Advanced Pharmacy Practice Experience (APPE) students on an ambulatory care rotation, and first postgraduate year (PGY1) pharmacy residents were included in this initiative. Each cohort facilitated a leadership book club discussion and completed professional development activities over the course of their experience. Learners' perspectives on leadership were surveyed utilizing a pre-post survey study, administered prior to beginning the initiative and after completing the initiative. Findings and Discussion: Results demonstrated learners' perceived confidence and self-awareness in their leadership skills increased from pre-survey to post-survey. Evaluation of qualitative responses exhibited that participants found value in adding more leadership development to their pharmacy training. Most participants noted leadership book discussion facilitation as the most valuable part of the initiative and posited they would utilize skills gained through these discussions nearly every day in their careers. Results suggest PGY1 pharmacy residents showed the most significant increase in their scores from pre- to post-study, while didactic students showed the least significant increase. Implications: Our findings suggest learner-driven leadership initiatives, specifically learner-facilitated book club discussions, are beneficial to incorporate into both didactic and experiential coursework. Implementation of these discussions could be applied in many aspects of the curriculum with minimal resources and a reasonable expectation of perceived benefit to student leadership development.

Background: Warfarin has many indications; however, it is the only anticoagulant that is indicated for mechanical mitral value and antiphospholipid syndrome. Management may be conducted by pharmacists in medical clinic settings. Objectives: To evaluate the percentage difference in the international normalized ratio (INR) target range when managed by a community-based pharmacist with a collaborative practice agreement (CPA) versus a physician and to analyze patient satisfaction of an anticoagulation clinic when managed by a community-based pharmacist with a CPA versus a physician. Practice Description: Independent community-based pharmacy. Practice Innovation: Community-based pharmacist managed anticoagulation clinic. Pharmacist provides anticoagulation services under a collaborative practice agreement or conducts INR testing and reporting with physician management of anticoagulation. Methods: Quasi-experiment study design with retrospective and prospective evaluation of warfarin management and patient satisfaction. A retrospective chart review was conducted of patients enrolled in the anticoagulation clinic from January 1^st, 2020 to June 30^th, 2022. Patients, 18 years or older with an indication for warfarin and attendance of at least 3 anticoagulation appointments were included. The Time in Therapeutic Range (TTR) was determined using the traditional method. TTR differences across the two groups were reported using descriptive, bi-variate, and multivariate statistics. All statistical tests were conducted using SAS 9.0. Patient satisfaction was collected for 6 months using a survey created by the investigators. Survey consisted of 18 questions using a 3-point Likert scale. Survey was assessed using descriptive statistics. Results: Thirty-seven patients met the inclusion criteria, 26 were in the pharmacist management group with 609 appointments, and 11 patients were in the physician management group with 123 appointments. There was no statistical significance for the time in the therapeutic range between the pharmacist-managed group (60.7%) and the physician-managed group (59.4%); p-value of <0.829. Results of the satisfaction survey suggest that patients slightly prefer management by a pharmacist over a physician. Conclusion: Community-based pharmacist warfarin management of time in therapeutic range was equivalent to physician management and with similar patient satisfaction.

An ability to effectively self-manage medications is the result of several factors influencing a person's decision to take medications. The need for new approaches to medication self-management are evident in the persistent trends of ineffective medication use and unfortunate consequences, referred to as drug-related morbidity and mortality. Fortunately, pioneering initiatives have emerged to reshape our approach for developing a rational organizational paradigm so that patients can confidently self-manage medications. Favorable outcomes of studies pertaining to the delivery of comprehensive medication therapy management services within the practice of pharmaceutical care prompts the question, 'Can patients and family members apply a consistent and systematic 4-step pharmacotherapy assessment process to better organize their decision-making and confidence in medication self-management?' To answer this question an Effective Medication Self-Management Toolkit based on this 4-step process, and a Medication Management Self-efficacy Checklist, were developed and evaluated for feasibility, acceptability, and internal consistency reliability. The first evaluation established the preliminary acceptability and feasibility of the toolkit using a convenience sample of 39 residents of independent living facilities in focus group sessions. All participants indicated they perceive that the 4-step process can help individuals successfully self-manage medications. At the conclusion of the focus group sessions, all 39 participants completed the 7-item post-session checklist. This paper presents the second evaluation to establish the internal consistency reliability of the toolkit's Medication Management Self-efficacy Checklist using Cronbach's alpha. There was good internal consistency of the self-efficacy checklist with a Cronbach's alpha value of 0.82. This investigation of a novel approach for applying the 4-step pharmacotherapy assessment process by patients suggests that the medication self-efficacy checklist provides a reliable and useful measure of a patient's confidence in self-managing medications.

Background: Physicians often prescribe original biologic products to patients who have not used them before and are reluctant to switch to biosimilars. Biosimilars are highly similar versions of already-approved biologics, but healthcare professionals typically hesitate to transition patients from the original products to biosimilars. This study aims to investigate the factors that influence U.S. healthcare professionals' intentions to use biosimilars. Methods: A cross-sectional study was conducted. 510 participants were eligible healthcare professionals (279 physicians and 231 pharmacists). The theory of planned behavior (TPB) is used to identify which factors affect healthcare professionals' intentions. Descriptive statistics, chi-square, and the logistic regression model tested the TPB constructs as predictors of intentions toward biosimilars. Results: Among 279 physicians, most were aged 61 and above, with high (n = 142) and low (n = 137) intentions. Male physicians constituted 71% of the population. Attending physicians (66.3%) showed consistent perceptions towards biosimilars, primarily in the private sector (76.3%). Pharmacists (n = 231), a higher percentage of females demonstrated higher intentions compared to males (35.5% vs. 28.1%); the majority were community pharmacists. Associations between years of practice and intentions were significant. Positive correlations existed between beliefs and intentions, except for normative beliefs. Conclusions: This study revealed diverse attitudes among healthcare professionals towards biosimilars in the USA. Pharmacists and physicians, especially those with limited experience, require ongoing education on biosimilar manufacturing pathways. This education supports the appropriate use of biosimilars and helps standardize federal and state legislation.