bluuebunny/crossref_metadata_2025_split huggingface dataset:
Baseline Knowledge and Education on Patient Safety in the Ambulatory Care Setting for 4th Year Pharmacy Students
Authors: Skelley Jessica W. , Carpenter Chase , Elkins Trisha , Woolley Thomas W. , Dugan B. DeeAnn 
Published: January 2018

Objectives: To assess the baseline knowledge of fourth year student pharmacists on their ability to properly identify and categorize medication related problems (MRP) during their Advanced Pharmacy Practice Experience (APPE) in the ambulatory care setting, and to assess the efficacy of a written resource designed to educate and train users on identification and documentation of MRP's and used for this purpose with participating students on their ambulatory care APPE.
Methods: A pretest consisting of ten multiple-choice questions was administered electronically to fourth year student pharmacists (N=18) at the start of their ambulatory care APPE. The test was designed to assess both the students' baseline knowledge regarding MRP's, and their ability to identify a wide variety of medication-related problems. Students then received a written copy of The Medication Therapy Intervention & Safety Documentation Program training manual and were asked to read it in its entirety in the first week of their APPE. Finally, students were given a posttest survey (identical to the pretest) to complete to assess if their knowledge had increased from baseline.
Results: The average score for the 18 students taking the baseline knowledge pre-test was 63.33%, indicating limited baseline knowledge regarding the identification and classification of MRP's. In assessing the effectiveness of the written training document, the overall posttest results compared to pretest results did not indicate improvement in students' knowledge or ability to properly identify and classify medication related problems (MRP) after reviewing the training manual. The average scores declined from 63.33% on the pretest to 62.78% on the posttest, although this was not found to be statistically significant (p = 0.884). However, a statistically significant decline in students' knowledge occurred on one specific question, which tested their ability to classify MRP's (p = 0.029).
Conclusions: Based on the results of the pre-test, students at our institution enter their APPE year with limited baseline knowledge of medication safety within the ambulatory care setting. Results from the posttest indicate potential ineffectiveness of a written document in providing effective education on MRP's to students in the experiential setting. Education may be made more effective with a hands-on, active learning approach that overcomes the limitations of other passive forms of learning.

Type: Student Project
Incentivizing Antibiotic Research and Development
Authors: Scandlen-Finken Leah , Wertheimer Albert 
Published: January 2018

Antibiotic Resistance is an international threat, killing thousands and infecting millions. Although certain populations may be at an increased risk for infections, anyone can find themselves compromised with a multi-drug resistant infection. Treatments are becoming more complicated as the bacteria becomes more elusive. Cures are becoming less certain, and the future antibiotic arsenal is looking thin. Although there are many talented scientists and capable drug development entities, the funding and returns on investment are not sufficient to entice antibiotic research and development.
This paper explores the current situation regarding antibiotic resistance and its casualties, as well as the mechanisms being employed to overcome the increase in resistance, and decrease in antibiotic effectiveness. Through analysis of antibiotic research, development, and regulation, this paper adds to the discussion by filling in the current gaps regarding the procurement of sustainable funding via an insurance model framework. By incentivizing the pharmaceutical industry to invest in antibiotic research, and by guaranteeing returns on investment, a global solution to the current antibiotic resistance problem can be contained.

Type: Student Project
Exploring Accessibility of Community Pharmacy Services
Authors: Kelling Sarah E. 
Published: January 2018

Objective: To use selected literature to describe strengths and opportunities for improvement related to accessibility of health services in the community pharmacy setting.
Summary: Pharmacists have been described as one of the most accessible health care professionals, particularly as nearly 90% of Americans live within 5 miles of a community pharmacy. However, geography alone does not provide access to health services. Individuals must be able to gain entry into the health care system, access a health care location where needed services are provided, and find a health care provider with whom the patient can communicate and trust. Current and potential opportunities for community pharmacists to increase access via each step are described.
Conclusion: Community pharmacists are highly accessible health care professionals who are trusted by patients. Opportunities exist to further increase access to dispensing and non-dispensing services in order to better meet the needs of the public.

Type: Commentary
Criteria-based Certification and Validation of Online Pharmacies: Opportunities for Improved Quality and Safety
Authors: Ersin Özlem H. , Naistat David M. 
Published: January 2018

Objectives: The objective of this study was to explore the conformity of online sites with established quality standards.
Methods: Online pharmacies with the NABP Verified Internet Pharmacy Practice Sites (VIPPS) designation were scrutinized for their conformity with select criteria established by the National Association of Board of Pharmacies (NABP) and FDA consumer guidelines.
Results: 36 VIPPS certified online pharmacy sites were included in the study. The sites were examined against VIPPS and FDA standards. The criteria related to the design and content of the web site and to the pharmaceutical services being offered through the site. Lack of clear terminological distinction between “online pharmacy” (a business) and “online site” (a tool for a business) was problematic. Sites did not adhere to uniform design principles. The scope and availability of pharmaceutical services for online consumers were not readily apparent.
Conclusion: The very legitimacy of existing criteria for online pharmacies remains to be established. Significant opportunities exist to improve the quality and scope of policies and to tie them more closely to longstanding best-practices in areas such as web usability and pharmaceutical care. Revision recommendations for VIPPS criteria are discussed.

Type: Original Research
Health Literacy Based Communication by Illinois Pharmacists
Authors: Devraj Radhika , Gupchup Gireesh V. 
Published: January 2018

Objectives: Health literacy has received attention as an important issue for pharmacists to consider when interacting with patients. Yet, there is little information about methods pharmacists use to communicate with patients and their extent of use of health literacy based interventions during patient interactions. The purpose of this study was to examine methods of communication and types of health literacy based interventions that practicing pharmacists use in Illinois.
Methods: A survey instrument addressing the study purpose was designed along with other items that were part of a larger study. Eleven items in the survey referred to pharmacist-patient communication. The instrument was pilot tested before administering to a random sample of 1457 pharmacists from the Illinois Pharmacists Association. Data were primarily collected via a mailed survey using Dillman’s five step total design method (TDM). Two reminder letters were mailed at two week intervals to non-respondents.
Results: Usable responses were obtained from 701 respondents (48.1% response rate). Using simple words (96%) and asking patients open-ended questions to determine comprehension (85%) were the most frequent methods that pharmacists used to communicate with patients. Only 18% of respondents always asked patients to repeat medication instructions to confirm understanding. The various recommended types of health literacy interventions were “always” performed by only 8 to 33% of the respondents. More than 50% of respondents indicated that they rarely or never had access to an interpreter (51%), or employed bilingual pharmacists (59%). Only 11% of pharmacists said that they rarely/never pay attention to nonverbal cues that may suggest low health literacy.
Conclusions: Pharmacists infrequently use action oriented health literacy interventions such as using visual aids, having interpreter access, medication calendars, etc. Additional training on health literacy, its scope, and related interventions coupled with system redesign and compensation for time spent counseling are essential to encourage health literacy tailored communication with patients.

Type: Original Research
Identifying Community Pharmacists' Readiness to Participate in Transitions of Care
Authors: Gibson Nicole , Kebodeaux Clark , Smith Daron , Holtgrave Kellye , Gattas Nicole 
Published: January 2018

Objective: To determine the readiness of community pharmacists to participate in transitions of care and to identify barriers related to participation.
Methods: A questionnaire was developed to identify community pharmacists’ willingness, attitudes, and barriers to participating in transitions of care programs. The questionnaire was piloted with community pharmacists prior to implementation. The questionnaire was distributed to a population of chain, supermarket/grocery, and independent community pharmacists (n=200). Descriptive statistics, correlations, and chi square tests were used to analyze demographic trends and final results.
Results: Of the 200 questionnaires distributed, 147 pharmacists responded (73.5%). Community pharmacists agreed transitions of care services have the potential to improve patients’ understanding of medications (97.3%), decrease medication-related errors (95.9%), and enhance relationships with patients (96.6%). The largest pharmacist perceived barriers included time (69.7%), communication/lack of patient data (14.6%), and lack of physician acceptance (6.7%). Of the respondents who indicated time as the greatest barrier to participation, 76.9% of pharmacists were still willing to participate in transitions of care given the opportunity. Willingness to participate in transitions of care did not differ by gender (p=0.139), years in practice (p=0.133), or degree of education (p=0.382).
Conclusion: Community pharmacists are in a unique position to widely impact patient health outcomes and decrease hospital readmission rates through improved care coordination. This research demonstrates community pharmacists’ readiness and willingness to participate in transitions of care. Awareness of perceived barriers can allow stakeholders to address these areas when designing and implementing transitions of care programs with pharmacists.

Type: Original Research
Efficacy and Satisfaction of a Smoking Cessation Telephone Counseling Service Provided by Pharmacy Students
Authors: Soong Jie Lin , Wilken Lori 
Published: January 2018

Objective: This was a prospective, research survey assessing patient satisfaction and efficacy of the smoking cessation telephone counseling service provided by pharmacy students at the University of Illinois Hospital.
Methods: From September 2012 through May 2013, 82 patients received telephone counseling post hospital discharge and were followed up at 30 days for a telephone survey. Primary outcomes included improvement in stages of change, motivation and confidence levels in quitting tobacco, as well as patient satisfaction of the service. Secondary outcomes included self-reported continuous and point prevalence abstinence rates at 30 days.
Results: Eighteen patients completed the survey. There was no significant difference before and after the service with regards to the stage of change (p = 0.14), motivation levels (p = 0.80) nor confidence levels (p = 0.89) to quit tobacco. Majority of patients felt the duration of the call was just nice (83.3%), but having only one call was too little (77.8%). Overall satisfaction of the service was 83.1%. Self-reported continuous and point prevalence abstinence rates at 30 days were 16.7% and 22.2%, respectively.
Conclusion: Although there was no statistically significant improvement in the stages of change, motivation and confidence levels to quit smoking, patients were highly satisfied with the telephone counseling service provided by pharmacy students.

Type: Clinical Experience
Transitions of Care Operations at a Family Medicine Clinic: Patient Follow Up and Financial Outcome Analysis
Authors: Thomas Ashley , Skelley Jessica , Wheeler Julie , Gonzalez English 
Published: January 2018

Introduction: Coordinating smooth patient transitions remains a growing area of interest among healthcare professionals in light of the addition of the Readmission Reductions Program to the Affordable Care Act, which enables CMS to penalize hospitals for 30-day readmissions due to myocardial infarction, pneumonia, heart failure, and in due time, COPD. 2 Many facilities have tested varying TOC models previously piloted at other institutions, focusing on ensuring the proper measures are in place before patients depart. However, there is a significant lack in data quantifying the rate of timely patient follow up after discharge, despite the evidence supporting the value of this visit. The purpose of this study is to analyze TOC outcomes at a local family medicine clinic to assess potential lack of billing utilization and gaps of care related to patient follow up.
Methods: The investigators were provided with emergency department discharge charts from the local hospital affiliated with the family medicine clinic; discharge dates ranged from April 2014 to August 2014. Discharge charts were analyzed to establish medical complexity. Investigators used electronic medical records to extract descriptive data to analyze patient and financial outcomes. A subgroup analysis was performed utilizing a subset of patients identified as “established” at the clinic.
Results: A total of 317 unique discharge reports were evaluated, with 104 of those in the “established” patient subgroup. During the study period, 8.8% of the total group of patients demonstrated timely follow-up. Additionally, rate of incorrect billing techniques was 79%. A consequence of the low percentage of patient follow up and improper billing is missed revenue opportunity for the clinic; financial consequences range from $3,248.60-$67,150 over the 5 month period.
Conclusion: A coordinated outpatient TOC procedure cannot be determined from this study. However, need for further analysis of outcomes at outpatient facilities has been identified.

Type: Original Research
An Innovative Approach to Pharmacy Law Education Utilizing a Mock Board of Pharmacy Meeting
Authors: Bess D. Todd , Taylor Jade , Schwab Carol A , Wang Junling , Carter Jason A 
Published: January 2018

A thorough understanding of pharmacy law by students is important in the molding of future pharmacy practitioners, but a standardized template for the best way to educate students in this area has not been created. A mock Board of Pharmacy meeting was designed and incorporated into the Pharmacy Law course at the University of Tennessee College of Pharmacy. Students acted as Board of Pharmacy members and utilized technology to decide outcomes of cases and requests addressed in a typical 2 day Tennessee Board of Pharmacy meeting. The actual responses to those cases, as well as similar cases and requests addressed over a 5 year period, were revealed to students after they made motions on mock scenarios. The mock Board of Pharmacy meeting engages the students in a way that lectures alone often fail to achieve with some initial evidence of successful student learning. Utilizing this teaching format as a law education tool challenges the status quo of pharmacy education and may serve as an impetus and catalyst for future innovations.
Conflict of Interest
We declare no conflicts of interest or financial interests that the authors or members of their immediate families have in any product or service discussed in the manuscript, including grants (pending or received), employment, gifts, stock holdings or options, honoraria, consultancies, expert testimony, patents, and royalties. Dr. Wang’s time was partly supported by the National Institute on Aging of the National Institutes of Health under Award Number R01AG040146 and R01AG049696. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Type: Idea Paper
From Drug Literature Evaluation to Evidence-Based Medicine: Transforming the Focus of a First Year Pharmacy Curriculum
Authors: Reidt Shannon , Hager Keri , Beattie James , Pittenger Amy , Smith Maureen , Janke Kristin 
Published: January 2018

This case study describes a longitudinal curricular sequence implemented to teach evidence-based medicine (EBM) skills. The longitudinal sequence is innovative in its approach, design, and assessment of EBM. This approach moves away from the conventional strategy of teaching drug information and drug literature evaluation as stand-alone courses and instead embraces the EBM Framework and its use in the context of authentic problem solving. The EBM Framework—Ask, Acquire, Appraise, and Apply—was used as the basis for defining seven EBM skills. These skills were targeted in the evidence-based, integrated design of 17 learning episodes delivered with eight faculty members through six courses in the first year. Student perceptions of relevance of EBM and performance on assessments and learning activities throughout the sequence suggest that integrating EBM across the first year of the curriculum is an effective strategy for teaching EBM skills. Three themes emerged from analysis of the data and experience, including the need for: a strong teaching team, a whole task approach with a focus on solving authentic problems, and care in interpreting the progression of assessments and patterns of student performance. Through instructor observations and peer review, the longitudinal sequence has been refined and has had an impact on the rest of the curriculum.

Type: Case Study
Four Themes to Enhanced Interprofessional Education Integration: Lessons Learned from Early Implementation and Curricular Redesign
Authors: De Voest Margaret , Meny Lisa , VanLangen Kali , DeVuyst-Miller Susan , Salvati Lisa , Bright David , Elder Jodie , Vava Kari 
Published: January 2018

With the release of the Accreditation Council for Pharmacy Education (ACPE) Standards 2016, interprofessional education (IPE) has become more formalized and needs to be embedded into the curricula of colleges and schools of pharmacy. While IPE is not new to the practice and training of pharmacists, the call for IPE has become more robust over the last several years creating challenges to widespread implementation. The purpose of this Case Study Report is to describe a twelve-year progression of IPE implementation at a college of pharmacy without an academic medical center. Focused strategies for the development, integration, and expansion of IPE are provided through the context of four themes: working through program differences; collaborators and effective collaboration; attention to implementation planning; and prebriefing and debriefing. Each theme is defined and reviewed using specific examples and lessons learned. Finally, in consideration of the ACPE Standards 2016, potential next steps are discussed.

Type: Case Study
Modeling Imaginary Worlds: Version 4 of the AMCP Format for Formulary Submissions
Authors: Langley Paul C 
Published: January 2018

The question of demarcation between normal science and pseudoscience is critical to the discovery of new facts. The core elements supporting progress in science are: (i) empirically evaluable coherent theories and (ii) the testing of hypotheses through experimentation or systematic observation. If modeled or simulation-based claims for cost-effectiveness are to be accepted as a credible input to health care decision making than they must conform to these standards. Claims should be testable, falsifiable and replicable. If not then they are best seen as pseudoscience. This assessment of the latest version of the Academy of Managed Care Pharmacy (AMCP) Format for Formulary Submissions (Version 4.0; April 2016) concludes that, in their recommendations for cost-effectiveness modeling, the proposed standards do not meet those of normal science. Rather, in common with previous versions of the AMCP Format, the modeling framework proposed not only puts to one side the issue of testable claims, but supports the modeling of imaginary worlds or thought experiments where claims are immune to falsification. In consequence, the payer or other recipient of a modeled or simulated claim that follows the AMCP Format has no idea, in the absence of observation or experimentation, whether the claim is right or even if it is wrong. The claims are potentially misleading, possibly harmful, but to an unknown extent. They have no place in evidence-based medicine.
Conflict of Interest
None
Type: Commentary
Cost-Effectiveness and Formulary Evaluation: Imaginary Worlds and Entresto Claims in Heart Failure
Authors: Langley Paul C 
Published: January 2018

The Program in Social and Administrative Pharmacy at the University of Minnesota recently released its proposed guidelines for formulary evaluation. The guidelines were focused on ensuring that comparative claims made for pharmaceutical products and devices rested on a credible evidence base. The argument was put forward that if value claims for clinical and cost-effectiveness outcomes were to be accepted then they had to be empirically evaluable. The purpose of this commentary is to explore alternative modeled claims for Entresto, an angiotensin receptor neprilysin inhibitor, versus the standard of care with an ACE inhibitor in patients with chronic heart failure. Two models are compared: a lifetime cost-per-QALY model and a 3-year cost and budget impact model. The primary reason for this comparison is the puzzling feature that for a product which is over 120 time as expensive compared to the standard of care (Entresto $380 per month vs. ACE inhibitor $3 per month) the modeled claim can be made that the product is, in willingness to pay terms, cost-effective. The analysis illustrates that, perhaps not surprisingly, different models can generate quite different perspectives on the presumption of ‘cost-effectiveness’. In the present case the simple decision model yields a breakeven monthly cost for Entresto of only $23.74. If modeled claims are to be useful for formulary decision making, then we need to eschew ‘black box’ models with non-evaluable claims in favor of those models that yield credible, evaluable and replicable claims that can support defensible product placement and pricing decisions.
Conflict of Interest
None

Type: Commentary