Journal of the American College of Clinical Pharmacy : JACCP最新文献

Background

One of the most potent barriers to treatment for substance use disorder (SUD) is stigma. Stigmatizing beliefs and attitudes by health care practitioners can negatively impact diagnosis, referral, and treatment. We implemented an interprofessional workshop using best practice principles of instructional design intended to reduce stigmatizing beliefs, attitudes, and behaviors among health professionals.

Methods

Stigma Unraveled/Addiction Unmasked was a 5.5-h interprofessional workshop conducted six times between May 2024 and January 2025. The workshops included instruction about the sources and consequences of stigma, personal reflection, participant-to-participant interaction, case studies, and direct contact with individuals with lived experience. Participants were asked to complete a 91-item pre-workshop (before) and 54-item post-workshop (3 months after) questionnaire containing items from the Shatterproof Addiction Stigma Index measuring desire for social distance, attitudes, and beliefs toward persons with a SUD (stimulants, alcohol, or opioids). The questionnaire also included items related to knowledge and public policy.

Results

A total of 214 individuals from 8 health professions participated in the workshops with 66 participants completing both the pre and post-workshop questionnaires (matched cohort). Comparing the pre and post-workshop responses from the matched cohort, there were significant reductions in the desire for social distance (27.0 ± 5.7 to 23.2 ± 6.5; p < 0.01; d = 0.62), stigmatizing beliefs (14.8 ± 4.7 to 12.1 ± 4.2; p < 0.01; d = 0.61), stigmatizing attitudes (13.8 ± 3.0 to 11.8 ± 3.4; p = 0.01; d = 0.62), and stigmatizing behavior (14.8 ± 4.1 to 12.8 ± 3.6; p = 0.04; d = 0.52) composite scores, as well as improvements in knowledge related to screening for SUD, stigmatizing language, and medication therapy. There was a high level of agreement for public policies to support individuals with SUD at baseline, with no change following the workshop.

Conclusions

The Stigma Unraveled/Addiction Unmasked interprofessional workshop prompted meaningful and statistically significant changes in participant beliefs, attitudes, behaviors, and knowledge.

Introduction

Addressing substance use disorders (SUD) stigma via interprofessional collaboration prior to patient exposure may empower more students to provide care to people with SUD (PwSUD) across settings.

Objective

To assess the impact of a SUD interprofessional educational program (SUD-IPEP) on medical (MS) and pharmacy students' (PS) attitudes about SUD treatment efficacy and personal characteristics of PwSUD.

Methods

Between February and March 2022, 288 students completed two self-study components and an active learning component. A 13-item perception survey was administered pre-IPEP and immediately post-IPEP. The survey consisted of five positive statements about treatment efficacy (e.g., treatment is effective and worth the effort) and the desired response was an increase in agreement with these statements. The remaining items were negative statements about the personal characteristics of PwSUD (e.g., these patients overuse health care resources and provide nothing in return) and the desired response was an increase in disagreement. Differences between subgroups (sex and race/ethnicity) were investigated. A third survey about the program's usefulness was administered 30 days post-IPEP.

Results

The response rate to the pre- and post-intervention surveys was 63.5%. At pre-intervention, there was agreement with positive statements, with no differences among subgroups. At post-intervention, PS showed a significant increase in agreement with statements about treatment efficacy. At pre-intervention, there was disagreement with negative statements about PwSUD, especially by females, MS, and Whites. No changes in perceptions were observed post-intervention for any group. Thirty-eight students completed the 30-day survey and 92% believed the SUD-IPEP benefited their professional development and/or practice, while 97% expected to continue using the information in the future.

Conclusions

Participation in the SUD-IPEP resulted in a general improvement in students' perceptions towards this patient population. Future studies should include whether additional educational components can help shift perceptions to reduce stigma towards PwSUD.

Background

The growth in ambulatory care positions for pharmacists demonstrates a need to recruit and train highly qualified pharmacists into the specialty. This paper describes how student skills related to patient care and practice advancement in ambulatory care pharmacy were enhanced through a partnership between one school of pharmacy (SOP) and a regional health system.

Methods

A concentration with didactic and experiential components created foundational learning opportunities for students interested in ambulatory care earlier in their curriculum, including a new course focused on ambulatory care pharmacy service development using real-world cases. Student perceptions were assessed using survey data and post-graduate outcomes are described.

Results

One hundred students from the classes of 2020 through 2025 have completed the concentration. Most students (95%) perceived better preparedness for ambulatory care rotations and agreed that the Ambulatory Care concentration made them more interested in pursuing a career in the field (88.2%) or a residency (82.4%). The health system perspective was assessed based on informal feedback from leadership and review of student projects. The health system described benefits in validating and informing service development. Longer term benefits are also discussed.

Conclusion

This unique partnership between an SOP and a regional health system creates opportunities that offer mutual benefits to the school, students, and the health system. The results of this evaluation indicate that students and health systems find immediate value from the collaboration and suggest possible longer-term benefits regarding practice advancement and the development of future practice specialists.

Background

Approximately 280 million adults worldwide are diagnosed with depression. Undiagnosed and untreated patients with depression have a reduced quality of life and may lead to suicidal ideation. Increasing diagnostic and treatment access is critical, and community pharmacies are advantageously positioned to provide mental health services such as screening, treatment, and education. Patients visit community pharmacies more often than primary care providers, enabling regular depression screening and medication management. Despite their potential, few review articles comprehensively address the role of community pharmacy interventions in managing depression. The objective of this review is to systematically describe the current literature on depression interventions provided in community pharmacy settings.

Methods

Studies published in English that reported depression-related interventions conducted in community pharmacy settings and by community pharmacists or students were included. PubMed and Web of Science databases were searched for published articles using keywords. Data were extracted and summarized on study design, setting, pharmacist interventions, patient demographics, and outcomes. Both experimental and observational studies were analyzed.

Results

Twenty-three studies were included, comprising randomized and non-randomized controlled trials, feasibility studies, cohort studies, and cross-sectional analyses conducted across multiple countries. Interventions included pharmacist or student pharmacist-led depression screenings, cognitive behavioral therapy, antidepressant adherence support, and referral services. Community pharmacists utilized tools such as the Patient Health Questionnaire-9 (PHQ-9) and Geriatric Depression Scale-15 (GDS-15) and provided mental health counseling. Studies demonstrated positive trends in adherence, depression symptom improvement, patient satisfaction, and screening reach. Barriers included lack of training, reimbursement mechanisms, and workflow integration.

Conclusion

Community pharmacies offer a promising, underutilized setting for depression screening and intervention. Pharmacist-led services can support early identification of depression and medication adherence. Future work should standardize intervention protocols, assess long-term outcomes, and address implementation barriers to scale these services in diverse practice settings.

Opioids are classified as high-alert medications by the Institute for Safe Medication Practices due to their potential for significant harm when misused. To address these risks, our institution established an interprofessional pain consult team in 2016. In 2017, pain pharmacists developed an opioid stewardship service which aligned with the 2018 Joint Commission pain management standards focusing on oversedation, safe prescribing, high-risk patients, and quality improvement. By 2023, both services expanded across multiple hospitals, adapting to site-specific needs.

Following a 2019 merger which expanded our health system to 12 acute-care hospitals and one long-term acute care hospital across four regions (North, East, South, and Central), we leveraged telehealth in 2020 to enable remote pain consults by providers and pharmacists. Our interprofessional model includes three dedicated pain management pharmacists and five dedicated pain management providers conducting daily consultations, opioid stewardship reviews, quality improvement initiatives, and site-specific education. Collaborating closely with hospitalists, specialists, and surgical teams, treatment recommendations are communicated directly to primary teams. Outcomes tracked via the electronic health record include relative value units billed, the number and types of interventions, provider acceptance rates, and preventable naloxone events analyzed using descriptive statistics.

Our adaptable, interprofessional pain program model used the Interprofessional Education Collaborative (IPEC) competencies to address opioid safety through tailored local practices, role-defined collaboration, and integrated communication. By aligning values, ethics, and teamwork, we achieved data-driven improvements, including reduced intravenous (IV) opioid use, naloxone events, and high provider acceptance.

Improvements are driven by, but not limited to, opioid stewardship, education, pain consults, orderset enhancements, policy updates, prescriber compliance, and adherence to evidence-based practices. Annual goals are tailored to patient outcomes and site-specific needs. The interprofessional pain management team has enhanced patient safety and care quality through targeted opioid interventions and consultative support.