Pharmacists' perceptions of the pharmacists' patient care process and performance in a simulated patient interaction

Medication histories to identify medication-related problems through the pharmacists' patient care process in a simulated ambulatory care laboratory

BACKGROUND AND PURPOSE

Assessment of the Pharmacists' Patient Care Process (PPCP) in pharmacy curricula has been reported in a variety of contexts, but results have not described individual student performance in a controlled ambulatory care skills laboratory to purposefully identify medication-related problems (MRP) and develop plans for resolution.

EDUCATIONAL ACTIVITY AND SETTING

One of five MRPs was embedded within standardized medication profiles to facilitate student completion of three graded ambulatory care medication history encounters in a third-year skills laboratory. Data analysis included student performance in aggregate and according to MRP type from the first to the third medication history encounter.

FINDINGS

One hundred thirty-six students completed three medication histories for 408 encounters. Regardless of MRP, the total and subscale scores for adjusted marginal means were significantly higher in Sessions 2 and 3. Performance on MRP scenarios for drug interactions and adverse effects were significantly lower and higher, respectively. Successful collection of patient history significantly influenced marginal mean scores for respective MRPs.

SUMMARY

Improvement in student application of PPCP Steps 1 through 3 may be evident using three simulated ambulatory care medication history patient encounters toward the end of the third professional year, with potential influences by MRP type, MRP repetition, and adequate collection of patient history. Repetition with individualized grading and formative feedback are essential for skill development to identify MRPs in this setting. Confirmation of findings and extension into experiential education with higher complexity are needed to develop consistent and effective application of the PPCP to patient care.

Inclusion of the Pharmacist Patient Care Process in Doctor of Pharmacy Curricula

Objective. With the inclusion of the Pharmacists' Patient Care Process (PPCP) in the most recent Accreditation Council for Pharmacy Education standards, institutions must determine how best to vertically and horizontally integrate and assess the PPCP in the curriculum. The objective of this study was to identify the breadth and depth of PPCP implementation as well as faculty involvement in teaching the PPCP at ACPE-accredited institutions.Methods. A survey to address the study objectives was developed, piloted, and distributed electronically to all US pharmacy institutions in candidate or accredited status. Electronic reminders were implemented to improve response rates. The data were analyzed descriptively.Results. Approximately 70% of institutions responded to the survey. Integration of the PPCP was most often championed by an individual faculty member and/or a committee. Practice faculty taught PPCP at nearly all institutions, while only a third of survey respondents reported that foundational and social administrative faculty taught the PPCP. Development related to PPCP curricular integration mainly focused on preceptors. Most institutions integrated the PPCP through the didactic and experiential curriculum in an approach that allowed for reinforcement or mastery of concepts. There were limited integration efforts into interprofessional education. Institutions had a plan for assessing the effectiveness of the integration, but were varied in their approach.Conclusion. Institutions have embraced integrating the PPCP into their curricula, didactically and experientially. Progress still needs to be made regarding inclusion of all faculty in teaching the PPCP as well as integrating the PPCP into other key curricular areas, such as interprofessional learning. Faculty development efforts may be beneficial to address these aspects.

Expanding pharmacists' roles: Pharmacists' perspectives on barriers and facilitators to collaborative practice

OBJECTIVE

The pharmacy profession is shifting from transactional dispensing of medication to a more comprehensive, patient-centered model of care. Collaborative practice agreements (CPAs) extend the role of a pharmacist to initiate, monitor, modify, and discontinue drug therapies and provide other clinical services. Although collaborative practice has been shown to improve health system efficiency and patient outcomes, little is known about how pharmacists perceive CPAs. To explore pharmacists' perspectives of CPAs, including barriers and facilitators to CPA implementation.

METHODS

Semistructured key informant interviews were used to elicit information from licensed pharmacists practicing in a variety of settings in Arizona. Thematic analysis was used to identify key qualitative themes.

RESULTS

Seventeen interviews of pharmacists with (n = 11, 64.7%) and without (n = 6, 35.3%) CPAs were conducted in April-May 2019. The pharmacists saw their role in CPAs as supportive, filling a care gap for overburdened providers. A heightened sense of job satisfaction was reported owing to increased pharmacist autonomy, application of advanced knowledge and clinical skills, and ability to have a positive impact on patients' health. Challenges to the implementation of CPAs included liability and billing issues, logistic concerns, some experiences with provider hesitancy, and lack of information and resources to establish and maintain a CPA. The barriers could be overcome with conscious team-building efforts to establish trust and prove the worth of pharmacists in health care teams; strategic engagement of stakeholders in the development of CPAs, including billing and legal departments; and mentorship in the CPA creation process.

CONCLUSIONS

The pharmacists in this study enjoyed practicing collaboratively and had overall positive perceptions of CPAs. As health worker shortages become more dire and pharmacy practice evolves to expand the role of pharmacists in providing direct patient care, CPAs will be an important tool for restructuring care tasks within health systems.