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Morningstar-Kywi N, Morris DN, Romero RM, Haworth IS. Teaching of drug disposition using physiologically based pharmacokinetic modeling software: GastroPlus as an educational tool. ADVANCES IN PHYSIOLOGY EDUCATION 2023; 47:718-725. [PMID: 37471218 DOI: 10.1152/advan.00051.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 06/12/2023] [Accepted: 07/17/2023] [Indexed: 07/22/2023]
Abstract
Physiologically based pharmacokinetic (PBPK) modeling requires an understanding of chemical, physiologic, and pharmacokinetic principles. Active learning with PBPK modeling software (GastroPlus) may be useful to teach these scientific principles while also teaching software operation. To examine this issue, a graduate-level course was designed using learning objectives in science, software use, and PBPK model application. These objectives were taught through hands-on PBPK modeling to answer clinically relevant questions. Students demonstrated proficient use of software, based on their responses to these questions, and showed an improved understanding of scientific principles on a pre- and post-course assessment. These outcomes support the effectiveness of simultaneous teaching of interdependent software and science.NEW & NOTEWORTHY Physiologically based pharmacokinetic (PBPK) modeling is a major growth area in drug development, regulatory submissions, and clinical applications. There is a demand for experts in this area with multidisciplinary backgrounds. In this article, we describe a course designed to teach PBPK modeling and the underlying scientific principles in parallel.
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Affiliation(s)
- Noam Morningstar-Kywi
- Department of Pharmacology and Pharmaceutical Sciences, University of Southern California Alfred E. Mann School of Pharmacy and Pharmaceutical Sciences, Los Angeles, California, United States
- Simulations Plus, Inc., Lancaster, California, United States
| | - Denise N Morris
- Simulations Plus, Inc., Lancaster, California, United States
| | - Rebecca M Romero
- Department of Pharmacology and Pharmaceutical Sciences, University of Southern California Alfred E. Mann School of Pharmacy and Pharmaceutical Sciences, Los Angeles, California, United States
| | - Ian S Haworth
- Department of Pharmacology and Pharmaceutical Sciences, University of Southern California Alfred E. Mann School of Pharmacy and Pharmaceutical Sciences, Los Angeles, California, United States
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2
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Kvarnström K, Niittynen I, Kallio S, Lindén-Lahti C, Airaksinen M, Schepel L. Developing an In-House Comprehensive Medication Review Training Program for Clinical Pharmacists in a Finnish Hospital Pharmacy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6158. [PMID: 37372745 DOI: 10.3390/ijerph20126158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 05/31/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023]
Abstract
Long-term continuing education programs have been a key factor in shifting toward more patient-centered clinical pharmacy services. This narrative review aims to describe the development of Helsinki University Hospital (HUS) Pharmacy's in-house Comprehensive Medication Review Training Program (CMRTP) and how it has impacted clinical pharmacy services in HUS. The CMRTP was developed during the years 2017-2020. The program focuses on developing the special skills and competencies needed in comprehensive medication reviews (CMRs), including interprofessional collaboration and pharmacotherapeutic knowledge. The program consists of two modules: (I) Pharmacist-Led Medication Reconciliation, and (II) CMR. The CMRTP includes teaching sessions, self-learning assignments, medication reconciliations, medication review cases, CMRs, a written final report, and a self-assessment of competence development. The one-year-long program is coordinated by a clinical teacher. The program is continuously developed based on the latest guidelines in evidence-based medicine and international benchmarking in cooperation with the University of Helsinki. With the CMRTP, we have adopted a more patient-centered role for our clinical pharmacists and remarkably expanded the services. This program may be benchmarked in other countries where the local education system does not cover clinical pharmacy competence well enough and in hospitals where the clinical pharmacy services are not yet very patient-oriented.
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Affiliation(s)
- Kirsi Kvarnström
- HUS Pharmacy, Helsinki University Hospital and University of Helsinki, 00029 Helsinki, Finland
- HUS Internal Medicine and Rehabilitation, Helsinki University Hospital and University of Helsinki, 00029 Helsinki, Finland
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, 00014 Helsinki, Finland
| | - Ilona Niittynen
- HUS Pharmacy, Helsinki University Hospital and University of Helsinki, 00029 Helsinki, Finland
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, 00014 Helsinki, Finland
| | - Sonja Kallio
- The Association of Finnish Pharmacies, 00510 Helsinki, Finland
| | - Carita Lindén-Lahti
- HUS Pharmacy, Helsinki University Hospital and University of Helsinki, 00029 Helsinki, Finland
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, 00014 Helsinki, Finland
| | - Marja Airaksinen
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, 00014 Helsinki, Finland
| | - Lotta Schepel
- HUS Pharmacy, Helsinki University Hospital and University of Helsinki, 00029 Helsinki, Finland
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, 00014 Helsinki, Finland
- Quality and Patient Safety, Shared Group Services, Helsinki University Hospital and University of Helsinki, 00029 Helsinki, Finland
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3
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van den Hanenberg F, Ozturk E, van Haastrecht M, Tichelaar J, van Goor H, van Agtmael MA, Keijsers CJPW. A comparison of the clinical pharmacotherapy knowledge of medical and surgical residents and consultants. Eur J Clin Pharmacol 2023; 79:671-677. [PMID: 37004542 DOI: 10.1007/s00228-023-03481-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 03/18/2023] [Indexed: 04/04/2023]
Abstract
PURPOSE Knowledge of clinical pharmacotherapy is essential for all who prescribe medication. The aims of this study were to investigate differences in the pharmacotherapy and polypharmacy knowledge of medical and surgical residents and consultants and whether this knowledge can be improved by following an online course. METHODS Design: A before-and-after-measurement. SETTING An online course available for Dutch residents and consultants working in hospitals. STUDY POPULATION Dutch residents and consultants from different disciplines who voluntarily followed an online course on geriatric care. INTERVENTION An online 6-week course on geriatric care, with 1 week dedicated to clinical pharmacotherapy and polypharmacy. Variables, such as medical vs surgical specialty, consultant vs resident, age, and sex, that could predict the level of knowledge. The effects of the online course were studied using repeated measures ANOVA. The study was approved by the National Ethics Review Board of Medical Education (NERB dossier number 996). RESULTS A total of 394 residents and 270 consultants, 220 from surgical and 444 from medical specialties, completed the online course in 2016 and 2017. Residents had higher test scores than consultants for pharmacotherapy (73% vs 70%, p < 0.02) and polypharmacy (75% vs 72%, p < 0.02). The learning effect did not differ. Medical residents/consultants had a better knowledge of pharmacotherapy (74% vs 68%, p < 0.001) and polypharmacy (77% vs 66%, p < 0.001) than surgical residents/consultants, but the learning effect was the same. CONCLUSIONS Residents and consultants had a similar learning curve for acquiring knowledge, but residents outperformed consultants on all measures. In addition, surgical and medical residents/consultants had similar learning curves, but medical residents/consultants had higher test scores on all measures.
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Affiliation(s)
- Floor van den Hanenberg
- Department of Geriatric Medicine, Medical Centre OLVG, Postbus , 9243, 1006 AE, Amsterdam, The Netherlands.
- Research and Expertise Center in Pharmacotherapy Education (RECIPE), Amsterdam, The Netherlands.
| | - Ekin Ozturk
- Department of Surgery, Nijmegen University Medical Center, Nijmegen, The Netherlands
| | - Mariska van Haastrecht
- Department of Geriatric Medicine, Medical Centre OLVG, Postbus , 9243, 1006 AE, Amsterdam, The Netherlands
| | - Jelle Tichelaar
- Department of Internal Medicine, Amsterdam Universities Medical Centers, VU University, Section Pharmacotherapy, Amsterdam, The Netherlands
- Research and Expertise Center in Pharmacotherapy Education (RECIPE), Amsterdam, The Netherlands
| | - Harry van Goor
- Department of Surgery, Nijmegen University Medical Center, Nijmegen, The Netherlands
| | - Michiel A van Agtmael
- Department of Internal Medicine, Amsterdam Universities Medical Centers, VU University, Section Pharmacotherapy, Amsterdam, The Netherlands
- Research and Expertise Center in Pharmacotherapy Education (RECIPE), Amsterdam, The Netherlands
| | - Carolina J P W Keijsers
- Department of Geriatric Medicine, Jeroen Bosch Hospital, 's , Hertogenbosch, The Netherlands
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4
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Westerholm A, Leiman K, Kiiski A, Pohjanoksa-Mäntylä M, Mistry A, Airaksinen M. Developing Medication Review Competency in Undergraduate Pharmacy Training: A Self-Assessment by Third-Year Students. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5079. [PMID: 36981990 PMCID: PMC10049528 DOI: 10.3390/ijerph20065079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 03/07/2023] [Accepted: 03/12/2023] [Indexed: 06/18/2023]
Abstract
Pharmacists are increasingly involved in medication history taking, medication reconciliation, and review in their daily practice. The objectives of this study were to investigate third-year pharmacy students' self-assessed competency in medication reviews and gather their feedback for further development of medication review training in their curriculum. The study was conducted as a self-assessment of third-year pharmacy students at the completion of their second three-month internship period in a community pharmacy in 2017-2018. The students were assigned to review medications of a real patient under the supervision of a medication review accredited pharmacist during their internship. The self-assessment was carried out via an e-form, which was created for this study. Recently established national medication review competence recommendations for pharmacists were used as a reference. Students (n = 95, participation rate: 93%) self-assessed their competency as good or very good in 91% (n = 28) of the competency areas listed in the self-assessment. The highest proportion of competencies that were self-assessed as good or very good included using medication risk management databases and evaluating the clinical importance of the information (97%, n = 92). The lowest proportion of competencies was found in applying clinical information from the key laboratory tests to patient care and knowing which laboratory tests are most important to monitor in each condition and medication (36%, n = 34). The students suggested that their pharmacy education should contain more medication review assignments as group work and that an elective course on medication reviews should be compulsory for all pharmacy students.
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Affiliation(s)
- Aleksi Westerholm
- Clinical Pharmacy Group, Department of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Viikinkaari 5 E, P.O. Box 56, 00014 Helsinki, Finland
| | - Katja Leiman
- Clinical Pharmacy Group, Department of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Viikinkaari 5 E, P.O. Box 56, 00014 Helsinki, Finland
| | - Annika Kiiski
- Clinical Pharmacy Group, Department of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Viikinkaari 5 E, P.O. Box 56, 00014 Helsinki, Finland
| | - Marika Pohjanoksa-Mäntylä
- Clinical Pharmacy Group, Department of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Viikinkaari 5 E, P.O. Box 56, 00014 Helsinki, Finland
| | - Anita Mistry
- Faculty of Pharmacy, Pharmacy and Bank Building, Camperdown/Darlington Campus, University of Sydney, Darlington, NSW 2050, Australia
| | - Marja Airaksinen
- Clinical Pharmacy Group, Department of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Viikinkaari 5 E, P.O. Box 56, 00014 Helsinki, Finland
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5
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Budakoğlu Iİ, Coşkun Ö, Kıyak YS, Uluoğlu C. Teaching rational prescribing in undergraduate medical education: a systematic search and review. Eur J Clin Pharmacol 2023; 79:341-348. [PMID: 36622428 DOI: 10.1007/s00228-022-03448-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 12/20/2022] [Indexed: 01/10/2023]
Abstract
AIM This study aimed to reveal the current status of the literature on rational prescribing training in undergraduate medical education. METHODS This study followed the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. An online search using 50 keywords in four databases was performed to access the studies published between 2008 and 2020. Specific features of the training such as aims or objectives of teaching, methods or model, and evaluation of effectiveness were extracted. Kirkpatrick levels were used to evaluate the effectiveness of teaching. RESULTS Of 74 studies included in the full review, 16 (21.6%) of them reported the use of WHO 6-Step Model for Rational Prescribing in their educational interventions. In terms of effectiveness, only two of the studies investigated changes in learner behavior in the context for which they are being trained, and only one study showed the effect of training on patient outcomes. CONCLUSION The evidence on the effectiveness of rational prescribing training has been presented mostly by using student satisfaction surveys and test of knowledge and skills. A higher level of evidence such as patient outcomes of the training needs to be reported.
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Affiliation(s)
- Işıl İrem Budakoğlu
- Department of Medical Education and Informatics, Faculty of Medicine, Gazi University, Gazi Üniversitesi Hastanesi E Blok 9. Kat, 06500, Beşevler, Ankara, Turkey.
| | - Özlem Coşkun
- Department of Medical Education and Informatics, Faculty of Medicine, Gazi University, Gazi Üniversitesi Hastanesi E Blok 9. Kat, 06500, Beşevler, Ankara, Turkey
| | - Yavuz Selim Kıyak
- Department of Medical Education and Informatics, Faculty of Medicine, Gazi University, Gazi Üniversitesi Hastanesi E Blok 9. Kat, 06500, Beşevler, Ankara, Turkey
| | - Canan Uluoğlu
- Department of Medical Pharmacology, Gazi University Faculty of Medicine, Gazi Üniversitesi Hastanesi E Blok 9. Kat, 06500, Beşevler, Ankara, Turkey
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Reumerman MO, Richir MC, Sultan R, Daelmans HEM, Springer H, Grijmans E, Muller M, van Agtmael MA, Tichelaar J. An inter-professional student-run medication review programme. Reducing adverse drug reactions in a memory outpatient clinic: a controlled clinical trial. Expert Opin Drug Saf 2022; 21:1511-1520. [PMID: 35469517 DOI: 10.1080/14740338.2022.2069748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND We investigated if the addition of an inter-professional student-led medication review team (ISP-team) to standard care can increase the number of detected ADRs and reduce the number of ADRs 3 months after an outpatient visit. RESEARCH DESIGN AND METHODS In this controlled clinical trial, patients were allocated to standard care (control group) or standard care plus the ISP team (intervention group). The ISP team consisted of medical and pharmacy students and student nurse practitioners. The team performed a structured medication review and adjusted medication to reduce the number of ADRs. Three months after the outpatient visit, a clinical pharmacologist who was blinded for allocation performed a follow-up telephone interview to determine whether patients experienced ADRs. RESULTS During the outpatient clinic visit, significantly more (p < 0.001) ADRs were detected in the intervention group (n = 48) than in the control group (n = 10). In both groups, 60-63% of all detected ADRs were managed. Three months after the outpatient visit, significantly fewer (predominantly mild and moderately severe) ADRs related to benzodiazepine derivatives and antihypertensive causing dizziness were detected in the patients of the intervention group. CONCLUSIONS An ISP team in addition to standard care increases the detection and management of ADRs in elderly patients resulting in fewer mild and moderately severe ADRs.
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Affiliation(s)
- Michael O Reumerman
- Internal Medicine, section pharmacotherapy, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Research and Expertise Center in Pharmacotherapy Education (RECIPE), Amsterdam, The Netherlands
| | - Milan C Richir
- Internal Medicine, section pharmacotherapy, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Research and Expertise Center in Pharmacotherapy Education (RECIPE), Amsterdam, The Netherlands
| | - Rowan Sultan
- Internal Medicine, section pharmacotherapy, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Research and Expertise Center in Pharmacotherapy Education (RECIPE), Amsterdam, The Netherlands
| | - Hester E M Daelmans
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Research in Education, Amsterdam, The Netherlands
| | | | - Els Grijmans
- Hogeschool Inholland, Amsterdam, The Netherlands
| | - Majon Muller
- Internal Medicine, Section Geriatric Medicine, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Science Research Institute, Amsterdam, The Netherlands
| | - Michiel A van Agtmael
- Internal Medicine, section pharmacotherapy, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Research and Expertise Center in Pharmacotherapy Education (RECIPE), Amsterdam, The Netherlands
| | - Jelle Tichelaar
- Internal Medicine, section pharmacotherapy, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Research and Expertise Center in Pharmacotherapy Education (RECIPE), Amsterdam, The Netherlands
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7
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Husaini DC, Mphuthi DD, Chiroma JA, Abubakar Y, Adeleye AO. Nursing students' experiences of service-learning at community and hospital pharmacies in Belize: Pedagogical implications for nursing pharmacology. PLoS One 2022; 17:e0276656. [PMID: 36327317 PMCID: PMC9632813 DOI: 10.1371/journal.pone.0276656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 10/11/2022] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES Many students seem to find pharmacology learning very challenging due to the complexity and variety of drugs they have to study. The number of drugs the students have to learn, the duration of time to learn the medications, and the evolving nature of diseases demanded learning beyond the classroom walls. This study explored and described nursing students' experiences in community and hospital-based pharmacy practice sites during their service-learning and its implications for pharmacology pedagogical practices. METHODS Kolb's learning theory provided the framework to explore nursing students' 48-hour service-learning experiences at community/hospital-based pharmacies in Belize and its implications for pharmacology pedagogy. The study utilized two qualitative approaches, reflective journals and focus group interviews, to collect data from 46 second-year nursing students. NVivo software and coding schemes were employed to analyze the data from the interviews and reflective journals. RESULTS Students reported learning medications, integrating classroom pharmacological knowledge at pharmacy practice sites, acquiring and enhancing communication skills, interpreting prescriptions, dispensing medications, drug calculations, taking inventory, doing vital signs, and patient education. In addition, students reported experiencing inter-professional relationships as healthcare team members. Anxiety was a major challenge experienced by many students at the beginning of the service-learning experience. CONCLUSIONS This study highlights the importance of experiential learning of pharmacology amongst second year nursing students, offering the opportunity to inform and support pharmacotherapeutics educators in designing strategies for more effective teaching of medications to nursing students. It also supports the addition of pharmacy placements to the nursing curriculum' as it shows that nursing students can learn medications, skills, and teamwork from experiential pharmacy site posting. Combining classroom instruction with pharmacy experiential service learning might be an effective complement for teaching nursing pharmacology.
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Affiliation(s)
- Danladi Chiroma Husaini
- Faculty of Health Sciences, Allied Health Department, University of Belize, Central America, Belmopan, Belize
- * E-mail:
| | - David D. Mphuthi
- Faculty of Health Studies, College of Human Sciences, University of South Africa, Pretoria, South Africa
| | - Jane A. Chiroma
- Department of Leadership and Curriculum Development, Pan Africa Christian University, Nairobi, Kenya
| | - Yusuf Abubakar
- Faculty of Health Sciences, Allied Health Department, University of Belize, Central America, Belmopan, Belize
| | - Adeniyi O. Adeleye
- Central Queensland University, College of Nursing and Midwifery, Rockhampton, Queensland, Australia
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8
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Gorman L, Berry A, Dangiolo M. Virtual Self-learning Modules Integrating Pharmacology Concepts into a Geriatric Elective. MEDICAL SCIENCE EDUCATOR 2021; 31:1767-1772. [PMID: 34956696 PMCID: PMC8651892 DOI: 10.1007/s40670-021-01438-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/05/2021] [Indexed: 06/14/2023]
Abstract
Given barriers to vertical integration during clinical rotations, many struggle with employing effective virtual strategies to revisit foundational sciences during clerkship. To address this, we developed virtual geriatric pharmacology self-learning modules (SLMs) for a fourth-year geriatric elective using cases, interactive exercises, resources, feedback, and quizzes. To evaluate effectiveness, learners were administered a pre- and post-elective quiz with survey. Learners improved performance after using SLMs, valued pharmacology clerkship integration and reinforcement, and agreed SLMs improved understanding, confidence, and attitudes. Thus, SLMs were an effective virtual method for integrating pharmacology that could be modified to teach other foundational sciences during clerkships.
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Affiliation(s)
- Laurel Gorman
- Dept. Medical Education, University Central Florida College of Medicine, 6850 Lake Nona Blvd, Orlando, FL 32827 USA
| | - Andrea Berry
- Office of Faculty Life, University Central Florida College of Medicine, Orlando, FL USA
| | - Mariana Dangiolo
- Dept. Internal Medicine, University Central Florida College of Medicine, Orlando, FL USA
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9
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Sultan R, van den Beukel TO, Reumerman MO, Daelmans HEM, Springer H, Grijmans E, Muller M, Richir MC, van Agtmael MA, Tichelaar J. An Interprofessional Student-Run Medication Review Program: The Clinical STOPP/START-Based Outcomes of a Controlled Clinical Trial in a Geriatric Outpatient Clinic. Clin Pharmacol Ther 2021; 111:931-938. [PMID: 34729774 PMCID: PMC9299053 DOI: 10.1002/cpt.2475] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 10/24/2021] [Indexed: 11/10/2022]
Abstract
As the population ages, more people will have comorbid disorders and polypharmacy. Medication should be reviewed regularly in order to avoid adverse drug reactions and medication‐related hospital visits, but this is often not done. As part of our student‐run clinic project, we investigated whether an interprofessional student‐run medication review program (ISP) added to standard care at a geriatric outpatient clinic leads to better prescribing. In this controlled clinical trial, patients visiting a memory outpatient clinic were allocated to standard care (control group) or standard care plus the ISP team (intervention group). The medications of all patients were reviewed by a review panel (“gold standard”), resident, and in the intervention arm also by an ISP team consisting of a group of students from the medicine and pharmacy faculties and students from the higher education school of nursing for advanced nursing practice. For both groups, the number of STOPP/START‐based medication changes mentioned in general practitioner (GP) correspondence and the implementation of these changes about 6 weeks after the outpatient visit were investigated. The data of 216 patients were analyzed (control group = 100, intervention group = 116). More recommendations for STOPP/START‐based medication changes were made in the GP correspondence in the intervention group than in the control group (43% vs. 24%, P = < 0.001). After 6 weeks, a significantly higher proportion of these changes were implemented in the intervention group (19% vs. 9%, P = 0.001). The ISP team, in addition to standard care, is an effective intervention for optimizing pharmacotherapy and medication safety in a geriatric outpatient clinic.
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Affiliation(s)
- Rowan Sultan
- Department of Internal Medicine section Pharmacotherapy, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands.,Research and Expertise Center in Pharmacotherapy Education (RECIPE), Amsterdam, The Netherlands
| | - Tessa O van den Beukel
- Department of Internal Medicine section Pharmacotherapy, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands.,Research and Expertise Center in Pharmacotherapy Education (RECIPE), Amsterdam, The Netherlands
| | - Michael O Reumerman
- Department of Internal Medicine section Pharmacotherapy, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands.,Research and Expertise Center in Pharmacotherapy Education (RECIPE), Amsterdam, The Netherlands
| | - Hester E M Daelmans
- Skills Training Department, Faculty of Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - Els Grijmans
- Hogeschool Inholland, Amsterdam, The Netherlands
| | - Majon Muller
- Department of Internal Medicine section Geriatric Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Milan C Richir
- Department of Internal Medicine section Pharmacotherapy, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands.,Research and Expertise Center in Pharmacotherapy Education (RECIPE), Amsterdam, The Netherlands
| | - Michiel A van Agtmael
- Department of Internal Medicine section Pharmacotherapy, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands.,Research and Expertise Center in Pharmacotherapy Education (RECIPE), Amsterdam, The Netherlands
| | - Jelle Tichelaar
- Department of Internal Medicine section Pharmacotherapy, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands.,Research and Expertise Center in Pharmacotherapy Education (RECIPE), Amsterdam, The Netherlands
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10
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Migliazza K, Bähler C, Liedtke D, Signorell A, Boes S, Blozik E. Potentially inappropriate medications and medication combinations before, during and after hospitalizations: an analysis of pathways and determinants in the Swiss healthcare setting. BMC Health Serv Res 2021; 21:522. [PMID: 34049550 PMCID: PMC8164287 DOI: 10.1186/s12913-021-06550-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 05/17/2021] [Indexed: 11/20/2022] Open
Abstract
Background A hospitalization phase represents a challenge to medication safety especially for multimorbid patients as acute medical needs might interact with pre-existing medications or evoke adverse drug effects. This project aimed to examine the prevalence and risk factors of potentially inappropriate medications (PIMs) and medication combinations (PIMCs) in the context of hospitalizations. Methods Analyses are based on claims data of patients (≥65 years) with basic mandatory health insurance at the Helsana Group, and on data from the Hirslanden Swiss Hospital Group. We assessed PIMs and PIMCs of patients who were hospitalized in 2013 at three different time points (quarter prior, during, after hospitalization). PIMs were identified using the PRISCUS list, whereas PIMCs were derived from compendium.ch. Zero-inflated Poisson regression models were applied to determine risk factors of PIMs and PIMCs. Results Throughout the observation period, more than 80% of patients had at least one PIM, ranging from 49.7% in the pre-hospitalization, 53.6% in the hospitalization to 48.2% in the post-hospitalization period. PIMCs were found in 46.6% of patients prior to hospitalization, in 21.3% during hospitalization, and in 25.0% of patients after discharge. Additional medication prescriptions compared to the preceding period and increasing age were the main risk factors, whereas managed care was associated with a decrease in PIMs and PIMCs. Conclusion We conclude that a patient’s hospitalization offers the possibility to increase medication safety. Nevertheless, the prevalence of PIMs and PIMCs is relatively high in the study population. Therefore, our results indicate a need for interventions to increase medication safety in the Swiss healthcare setting.
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Affiliation(s)
- Kevin Migliazza
- Department of Health Sciences, Helsana Group, Zürich, Switzerland.,Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Caroline Bähler
- Department of Health Sciences, Helsana Group, Zürich, Switzerland
| | | | - Andri Signorell
- Department of Health Sciences, Helsana Group, Zürich, Switzerland
| | - Stefan Boes
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Eva Blozik
- Department of Health Sciences, Helsana Group, Zürich, Switzerland. .,Institute of Primary Care, University of Zürich, Zürich, Switzerland.
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11
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Kallio S, Eskola T, Airaksinen M, Pohjanoksa-Mäntylä M. Identifying Gaps in Community Pharmacists' Competence in Medication Risk Management in Routine Dispensing. Innov Pharm 2021; 12. [PMID: 34007683 PMCID: PMC8102976 DOI: 10.24926/iip.v12i1.3510] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Community pharmacists increasingly contribute to medication risk management while dispensing medicines to outpatients. Their risk management actions are shifting from medication counselling towards reviewing medications and following-up their therapeutic effects and outcomes. Acquiring these more clinical tasks require more patient care-oriented competences. Objective To identify gaps in community pharmacists' competence in medication risk management in routine dispensing. Setting All community pharmacies in Finland. Method A national cross-sectional online survey was conducted through the Association of Finnish Pharmacies (n=574 community pharmacies) and the university pharmacies (n=2) in 2015. One pharmacist from each pharmacy was recommended to report on behalf of their outlet. Main outcome measure Community pharmacists' self-assessed competence to: 1) identify medication-related risks, 2) utilise electronic tools in medication risk management, and 3) identify their perceived needs for developing competence in medication risk management. Results Responses were received from 169 community pharmacies (response rate 29%). The highest proportion of good competency estimates were self-assessed in confirming doses (98% of the respondents evaluated their competence to be good) and identifying drug-drug interactions (83%). Competence to identify adverse effects, such as serotonergic load (10%) and anticholinergic load (12%), was most seldomly perceived as good. Of the wide range of electronic databases available, respondents most commonly reported using daily summaries of product characteristics (97% of the respondents), the checklist-type generic medicines information database that supports in medication counselling (85%), and the programme assisting in identifying drug-drug interactions (83%). The most commonly reported training needs were related to the identification of serotonergic load (63%), anticholinergic load (62%), and evaluating the clinical significance of drug-drug interactions (54%). Conclusion The results indicate remarkable gaps in community pharmacists' current competence in medication risk management, particularly in their competence in applied and geriatric pharmacotherapy.
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Affiliation(s)
- Sonja Kallio
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Finland.,Hyvinkää 3 Pharmacy, Hyvinkää, Finland
| | - Tiina Eskola
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Finland.,Forssa 1 Pharmacy, Forssa, Finland
| | - Marja Airaksinen
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Finland
| | - Marika Pohjanoksa-Mäntylä
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Finland
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12
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Begum F, Mutsatsa S, Gul N, Thomas B, Flood C. Antipsychotic medication side effects knowledge amongst registered mental health nurses in England: A national survey. J Psychiatr Ment Health Nurs 2020; 27:521-532. [PMID: 31960574 DOI: 10.1111/jpm.12600] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 01/15/2020] [Accepted: 01/17/2020] [Indexed: 12/01/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Research findings indicate the percentage of knowledge-related errors in medicines management is high, accounting for approximately 75% of all errors, with insufficient knowledge levels one of the most significant contributors of medication errors. Patients should be able to trust nurses to engage therapeutically and actively listen to their needs and concerns, responding using skills that are helpful, providing information that is clear, accurate, meaningful and free from jargon. However, without knowledge of pharmacology, it is impossible for nurses to be able to provide adequate advice. WHAT THE PAPER ADDS TO THE EXISTING KNOWLEDGE?: This study has examined an area that had not yet been systematically examined previously, which draws together previous research findings on mental health nurses' knowledge of adverse events, including side effects and medication errors, related to antipsychotic medication within NHS inpatient settings. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: A recent study has found that almost three-quarters (73%) of patients taking antipsychotic medication reported side effects to some degree. This high number of people experiencing antipsychotic medication side effects is likely to compromise care, especially in situations where nurses have inadequate knowledge of side effects and are unable to provide effective advice to patients. The findings from this study allow the mental health nursing profession an opportunity to reflect on the best means to increase knowledge and increase patient safety awareness and benefits for mental health service users. ABSTRACT: Introduction Antipsychotic medications play a significant role in the treatment and recovery of people with several psychiatric disorders. However, research findings indicate mental health nurses are insufficiently knowledgeable about antipsychotic medication side effects. Aim To assess practising mental health nurses' knowledge of antipsychotic medication side effects using a Multiple-Choice Questionnaire (MCQ) across National Health Service (NHS) Trusts in England. Hypothesis Knowledge of antipsychotic medication side effects amongst registered mental health nurses is related to their academic qualification, clinical banding and length of experience. Method A national survey of registered mental health nurses was carried out using an online questionnaire which was disseminated by Research and Development departments. Results A total of 504 questionnaires were returned, 245 of which had full data and further analysed. The mean score for the sample was 14.4 and only 21 participants attained a mark of >80%. Implications for Practice Two out of three of our hypotheses (that length of experience and clinical banding are directly related to knowledge of antipsychotic medication side effects) were supported. Our study found many nurses have a suboptimal working knowledge of antipsychotic medication side effects which has the potential to compromise care. Strategies need to be put in place to enhance pharmacology knowledge.
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Affiliation(s)
- Fareha Begum
- East London NHS Foundation Trust, Trust HQ, London, UK.,Centre for Mental Health Research, City, University of London, London, UK
| | - Stanley Mutsatsa
- Centre for Mental Health Research, City, University of London, London, UK
| | - Noreen Gul
- National Learning and Reporting System, NHS Improvement, London, UK
| | - Ben Thomas
- Mental Health and Learning Disabilities, London South Bank University, London, UK
| | - Chris Flood
- Centre for Mental Health Research, City, University of London, London, UK
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13
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Reumerman MO, Richir MC, Domela Nieuwenhuis PM, Sultan R, Daelmans HEM, Springer H, Muller M, van Agtmael MA, Tichelaar J. The clinical and educational outcomes of an inter-professional student-led medication review team, a pilot study. Eur J Clin Pharmacol 2020; 77:117-123. [PMID: 32770387 PMCID: PMC7782385 DOI: 10.1007/s00228-020-02972-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 07/27/2020] [Indexed: 12/04/2022]
Abstract
Aims The involvement of an inter-professional healthcare student team in the review of medications used by geriatric patients could not only provide patients with optimized therapy but also provide students with a valuable inter-professional learning experience. We describe and evaluate the clinical and learning outcomes of an inter-professional student-run mediation review program (ISP). Subject and method A variable team consisting of students in medicine, pharmacy, master advanced nursing practice, and master physician assistant reviewed the medication lists of patients attending a specialized geriatric outpatient clinic. Results During 32 outpatient visits, 188 medications were reviewed. The students identified 14 medication-related problems, of which 4 were not recognized by healthcare professionals. The ISP team advised 95 medication changes, of which 68 (71.6%) were directly implemented. Students evaluated this pilot program positively and considered it educational (median score 4 out of 5) and thought it would contribute to their future inter-professional relationships. Conclusion An inter-professional team of healthcare students is an innovative healthcare improvement for (academic) hospitals to increase medication safety. Most formulated advices were directly incorporated in daily practice and could prevent future medication-related harm. The ISP also offers students a first opportunity to work in an inter-professional manner and get insight into the perspectives and qualities of their future colleagues. Electronic supplementary material The online version of this article (10.1007/s00228-020-02972-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Michael O Reumerman
- Department of Internal Medicine, Section Pharmacotherapy, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands. .,Research & Expertise Center In Pharmacotherapy Education (RECIPE), Amsterdam, Netherlands.
| | - Milan C Richir
- Department of Internal Medicine, Section Pharmacotherapy, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands.,Research & Expertise Center In Pharmacotherapy Education (RECIPE), Amsterdam, Netherlands
| | - Philippe M Domela Nieuwenhuis
- Department of Internal Medicine, Section Pharmacotherapy, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands.,Research & Expertise Center In Pharmacotherapy Education (RECIPE), Amsterdam, Netherlands
| | - Rowan Sultan
- Department of Internal Medicine, Section Pharmacotherapy, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands.,Research & Expertise Center In Pharmacotherapy Education (RECIPE), Amsterdam, Netherlands
| | - Hester E M Daelmans
- VUmc School of Medical Sciences, Institute of Education and Training, Amsterdam, Netherlands
| | | | - Majon Muller
- Department of Internal Medicine and Geriatrics, Amsterdam UMC, location VUmc, Amsterdam, Netherlands
| | - Michiel A van Agtmael
- Department of Internal Medicine, Section Pharmacotherapy, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands.,Research & Expertise Center In Pharmacotherapy Education (RECIPE), Amsterdam, Netherlands
| | - Jelle Tichelaar
- Department of Internal Medicine, Section Pharmacotherapy, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands.,Research & Expertise Center In Pharmacotherapy Education (RECIPE), Amsterdam, Netherlands
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Koren G, Korn L. Chloroquine for Covid 19: introducing drug repurposing to medical students. INTERNATIONAL JOURNAL OF MEDICAL EDUCATION 2020; 11:155-157. [PMID: 32712597 PMCID: PMC7870452 DOI: 10.5116/ijme.5f09.79e2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 07/11/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Gideon Koren
- Adelson School of Medicine, Ariel University, Ariel, Israel
| | - Liat Korn
- Faculty of Health Sciences, Ariel University, Ariel, Israel
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15
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Jirau-Rosaly W, Brown SP, Wood EA, Rockich-Winston N. Integrating an Interprofessional Geriatric Active Learning Workshop Into Undergraduate Medical Curriculum. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2020; 7:2382120520923680. [PMID: 32548306 PMCID: PMC7271265 DOI: 10.1177/2382120520923680] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 04/08/2020] [Indexed: 06/11/2023]
Abstract
PURPOSE The aging population in the United States poses a substantial challenge to our health care system, and particularly affects the training of physicians in geriatric care. To introduce undergraduate medical students to a variety of clinical skills and concepts emphasized in geriatrics, we created an interprofessional geriatric workshop and examined changes in student perceptions of working in interprofessional teams, knowledge regarding geriatric concepts, perceptions of the pre-work material, and suggestions for curricular improvement to enhance the workshop for future students. METHODS Second-year medical students participated in a 4-hour workshop with tasks that emphasized activities of daily living, geriatric physical assessment, end-of-life discussions, Beers Criteria, and a home health assessment. Pre- and post-surveys were administered including the Students Perceptions of Interprofessional Clinical Education-Revised (SPICE-R) survey and a knowledge assessment. Student perceptions of pre-work and overall program assessment were captured after the workshop. Descriptive statistics and paired t tests assessed for significant differences. Emerging themes were analyzed using the Glaser constant comparative method. RESULTS Of the 186 medical student participants, 178 students completed the SPICE-R survey, demonstrating significant increases in students' perceptions of the value of interprofessional education (P < .001). In addition, 111 students completed the pre- and post-test for the knowledge assessment, demonstrating significant gains in geriatric concepts (P < .001). Overall, most students perceived the pre-work as useful and felt prepared to evaluate geriatric patients. Open-ended question analysis supported results, in which 34 students indicated that they felt most comfortable performing a home health assessment and emphasized the usage of the home health simulation. CONCLUSIONS Introducing medical students to a variety of geriatric assessments and concepts in an interprofessional environment early in their career positively influences their perceptions of working as an interprofessional team member to deliver comprehensive care to older adults.
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Affiliation(s)
- Wanda Jirau-Rosaly
- Department of Medicine, Medical College
of Georgia, Augusta University, Augusta, GA, USA
| | - Shilpa P Brown
- Department of Medicine, Medical College
of Georgia, Augusta University, Augusta, GA, USA
| | - Elena A Wood
- Department of Medicine, Medical College
of Georgia, Augusta University, Augusta, GA, USA
- Educational Innovation Institute,
Augusta University, Augusta, GA, USA
| | - Nicole Rockich-Winston
- Department of Pharmacology and
Toxicology, Medical College of Georgia, Augusta University, Augusta, GA, USA
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16
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Mecca MC, Thomas JM, Niehoff KM, Hyson A, Jeffery SM, Sellinger J, Mecca AP, Van Ness PH, Fried TR, Brienza R. Assessing an Interprofessional Polypharmacy and Deprescribing Educational Intervention for Primary Care Post-graduate Trainees: a Quantitative and Qualitative Evaluation. J Gen Intern Med 2019; 34:1220-1227. [PMID: 30972554 PMCID: PMC6614292 DOI: 10.1007/s11606-019-04932-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 11/30/2018] [Accepted: 02/26/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Polypharmacy and potentially inappropriate medications (PIMs) are increasingly common and associated with adverse health effects. However, post-graduate education in polypharmacy and complex medication management for older adults remain limited. OBJECTIVE The Initiative to Minimize Pharmaceutical Risk in Older Veterans (IMPROVE) polypharmacy clinic was created to provide a platform for teaching internal medicine (IM) and nurse practitioner (NP) residents about outpatient medication management and deprescribing for older adults. We aimed to assess residents' knowledge of polypharmacy and perceptions of this interprofessional education intervention. DESIGN A prospective cohort study with an internal comparison group. PARTICIPANTS IM residents and NP residents; Veterans ≥ 65 years and taking ≥ 10 medications. INTERVENTION IMPROVE consists of a pre-clinic conference, shared medical appointment, individual appointment, and interprofessional precepting model. MAIN MEASURES We assessed residents' performance on a pre-post knowledge test, residents' qualitative assessment of the educational impact of IMPROVE, and the number and type of medications discontinued or decreased. KEY RESULTS The IMPROVE intervention group (n = 18) had a significantly greater improvement in test scores than the control group (n = 18) (14% ± 15% versus - 1.3% ± 16%) over a period of 6 months (Wilcoxon rank sum, p = 0.019). In focus groups, residents (n = 17) reported perceived improvements in knowledge and skills, noting that the experience changed their practice in other clinical settings. In addition, residents valued the unique interprofessional experience. Veterans (n = 71) had a median of 15 medications (IQR 12-19), and a median of 2 medications (IQR 1-3) was discontinued. Vitamins, supplements, and cardiovascular medications were the most commonly discontinued medications, and cardiovascular medications were the most commonly decreased in dose or frequency. CONCLUSIONS Overall, IMPROVE is an effective model of post-graduate primary care training in complex medication management and deprescribing that improves residents' knowledge and skills, and is perceived by residents to influence their practice outside the program.
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Affiliation(s)
- Marcia C Mecca
- Department of Medicine, Yale School of Medicine, New Haven, CT, USA.
- Center of Excellence in Primary Care Education, Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA.
- Clinical Epidemiology Research Center, VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT, USA.
| | - John M Thomas
- Department of Medicine, Yale School of Medicine, New Haven, CT, USA
- Center of Excellence in Primary Care Education, Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA
- Dominican House of Studies, Pontifical Faculty of the Immaculate Conception, Washington, DC, USA
| | - Kristina M Niehoff
- Vanderbilt University Medical Center, Nashville, TN, USA
- Integrated Care Partners, Hartford HealthCare Group, Wethersfield, CT, USA
| | - Anne Hyson
- Department of Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Sean M Jeffery
- Integrated Care Partners, Hartford HealthCare Group, Wethersfield, CT, USA
- University of Connecticut School of Pharmacy, Storrs, CT, USA
| | - John Sellinger
- Center of Excellence in Primary Care Education, Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA
- Department of Psychology, Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA
| | - Adam P Mecca
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Peter H Van Ness
- Department of Medicine, Yale School of Medicine, New Haven, CT, USA
- Program on Aging, Yale School of Medicine, New Haven, CT, USA
| | - Terri R Fried
- Department of Medicine, Yale School of Medicine, New Haven, CT, USA
- Integrated Care Partners, Hartford HealthCare Group, Wethersfield, CT, USA
- Program on Aging, Yale School of Medicine, New Haven, CT, USA
| | - Rebecca Brienza
- Department of Medicine, Yale School of Medicine, New Haven, CT, USA
- Center of Excellence in Primary Care Education, Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA
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17
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Abstract
Introduction: With the majority of elderly persons consuming multiple drugs, inappropriate drug use is a major issue in geriatric medicine. Areas covered: We reviewed PubMed, Embase, and Cochrane from inception to 1 May 2019 for potentially inappropriate use of medications, polypharmacy, and age-dependent changes in pharmacokinetics and pharmacodynamics. We selected to highlight new aspects that have emerged in recent years: appropriate monitoring of drug adherence and the introduction of Big Data analysis in advancing geriatric pharmacology. Expert opinion: There are major gaps in the pharmacological treatment of the elderly. Most drugs were designed and tested in adults, with no pharmacokinetic and pharmacodynamic data on changes in old age. This void must be corrected through systematic and well-designed research programs. Potentially inappropriate use of medications (PIM) in the elderly is a serious issue in advanced age. Analysis of PIM shows relatively low predictive value in real life medicine. Most physicians continue to prescribe to the elderly medicines which should not be given at all, or not combined. Polypharmacy is a complex issue in old age, and in many cases treating physicians are not conducting critical assessment of the need for numerous medications.
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Affiliation(s)
- Gideon Koren
- a Maccabi-Kahn Institute of Research and Innovation , Tel Aviv , Israel.,b Ariel University , Ariel , Israel.,c Technion Institute of Technology , Haifa , Israel
| | - Galia Nordon
- c Technion Institute of Technology , Haifa , Israel
| | | | - Varda Shalev
- a Maccabi-Kahn Institute of Research and Innovation , Tel Aviv , Israel.,d Tel Aviv University , Tel Aviv , Israel
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18
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Steffen J, Lenski M, Herrmann FE, Mückter H, Dimitriadis K, Fischer MR. Improving the Pharmacology Curriculum at a German Medical School: A Structured Plan Based on a Student-Guided Large-Scale Study. J Clin Pharmacol 2019; 59:1151-1157. [PMID: 30875103 DOI: 10.1002/jcph.1410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Accepted: 02/28/2019] [Indexed: 11/08/2022]
Abstract
With rapid progress in medicine, a thorough understanding of pharmacology remains crucial. Currently, lecturers are implementing competency-based learning objectives in medical curricula around the world. Advancing teaching modalities need to be integrated into pharmacology courses in a reasonable way. At Ludwig-Maximilians-Universität (LMU) Munich Medical Faculty, a systematic evidence-based approach was used to modernize pharmacology classes. The needs assessment was conducted by final-year students. It included focus groups and a large-scale online survey, which was distributed among all medical students at LMU, with 1018 students participating (response rate 20%). Survey results showed that most of the students (92%) aimed to become pharmacology-adept doctors. Also, a majority (88%) stated that their goal was to understand the material most critical to application of pharmacology concepts as well as prescribing practice. Only 38% of the students reported satisfaction with the current curriculum, and 93% supported modernization. Thus far, pharmacology teaching at LMU Munich had mainly consisted of lectures attended by 200 students. Now, students advocated for a stronger integration of clinical pharmacology teaching into clinical subjects in the last 2 years of medical school. Specifically, they called for classes with smaller groups of students including problem-based learning as well as video podcasts. These results provided the foundation for change in curriculum at the LMU medical school. In conclusion, a structured approach for curriculum development that considers students' views is feasible and can reveal their actual goals and demands. The approach has proven successful at LMU Munich and is transferrable to other universities.
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Affiliation(s)
- Julius Steffen
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig-Maximilians-Universität (LMU), Munich, Germany
| | - Markus Lenski
- Neurochirurgische Klinik und Poliklinik, Klinikum der Universität München, Ludwig-Maximilians-Universität (LMU), Munich, Germany
| | - Florian E Herrmann
- Herzchirurgische Klinik und Poliklinik, Klinikum der Universität München, Ludwig-Maximilians-Universität (LMU), Munich, Germany
| | - Harald Mückter
- Walther-Straub-Institut für Pharmakologie und Toxikologie, Klinikum der Universität München, Ludwig-Maximilians-Universität (LMU), Munich, Germany
| | - Konstantinos Dimitriadis
- Neurologische Klinik und Poliklinik, Klinikum der Universität München, Ludwig-Maximilians-Universität (LMU), Munich, Germany
| | - Martin R Fischer
- Institut für Didaktik und Ausbildungsforschung in der Medizin, Klinikum der Universität München, Ludwig-Maximilians-Universität (LMU), Munich, Germany
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Gill M, Andersen E, Hilsmann N. Best practices for teaching pharmacology to undergraduate nursing students: A systematic review of the literature. NURSE EDUCATION TODAY 2019; 74:15-24. [PMID: 30554030 DOI: 10.1016/j.nedt.2018.11.017] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 10/15/2018] [Accepted: 11/23/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE In this systematic review we describe best practices for teaching pharmacology to undergraduate baccalaureate nursing students based on the available evidence. Numerous teaching strategies employed in undergraduate pharmacology courses for nursing students have been summarized and compared for their impact on pharmacology knowledge retention, application of pharmacology theory to practice, and student satisfaction. Future directions for research are discussed. DESIGN The review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for systematic reviews and meta-analyses. DATA SOURCES The Cumulative Index of Nursing and Allied Health Literature (CINAHL), Academic Search Complete, Education Resources Information Center (ERIC), and Education Source and Health Reference Centre Academic were searched using key search terms and phrases. Twenty studies, conducted between 2001 and 2017, met the inclusion criteria. METHOD Quality assessment was made in accordance with two appraisal tools: Kirkpatrick's framework and the Medical Education Research Quality Instrument (MERSQI) for quantitative studies. RESULTS Online, simulation, and integrated methods of teaching pharmacology were most beneficial for pharmacology knowledge acquisition and student satisfaction. Traditional lecture, problem-based learning, and a flipped classroom were least effective strategies for teaching pharmacology to undergraduate students. CONCLUSIONS This systematic review will contribute to the body of knowledge used by nurse educators who teach in undergraduate nursing programs, may be particularly useful for undergraduate nursing program directors/administrators who are considering undergoing curricular changes, and may be a conduit for future researchers who wish to design studies aimed at improving teaching and learning within undergraduate nursing education.
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Affiliation(s)
- Manu Gill
- Faculty of Nursing, School of Health Sciences, British Columbia Institute of Technology, Burnaby, BC, Canada.
| | - Elizabeth Andersen
- Faculty of Health and Social Development, School of Nursing, University of British Columbia, Kelowna, BC, Canada
| | - Norma Hilsmann
- Faculty of Health and Social Development, School of Nursing, University of British Columbia, Kelowna, BC, Canada
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Fialová D, Laffon B, Marinković V, Tasić L, Doro P, Sόos G, Mota J, Dogan S, Brkić J, Teixeira JP, Valdiglesias V, Costa S. Medication use in older patients and age-blind approach: narrative literature review (insufficient evidence on the efficacy and safety of drugs in older age, frequent use of PIMs and polypharmacy, and underuse of highly beneficial nonpharmacological strategies). Eur J Clin Pharmacol 2019; 75:451-466. [PMID: 30610276 DOI: 10.1007/s00228-018-2603-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 11/22/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION The importance of rational drug therapy is increasing with the aging of the population. Since one of the main reasons for inappropriate drug prescribing is also the "age-blind" approach, which results in ageist practices, this narrative literature review focuses on the description of the main barriers related to insufficient individualization of drug regimens associated with such age-blind approaches. METHODOLOGY A narrative literature review using the PubMed, WoS, Embase, and Scopus databases was conducted by the EU COST Action IS1402. Experts in different scientific fields from six countries (the Czech Republic, Spain, Portugal, Hungary, Serbia, and Turkey) worked in four specific areas: (1) underrepresentation of older adults in clinical trials and clinical and ethical consequences; (2) insufficient consideration of age-related changes and geriatric frailty in the evaluation of the therapeutic value of drugs; (3) frequent prescribing of potentially inappropriate medications (PIMs); and (4) frequent underuse of highly beneficial nonpharmacological strategies (e.g., exercise). RESULTS Older patients are underrepresented in clinical trials. Therefore, rigorous observational geriatric research is needed in order to obtain evidence on the real efficacy and safety of frequently used drugs, and e.g. developed geriatric scales and frailty indexes for claims databases should help to stimulate such research. The use of PIMs, unfortunately, is still highly prevalent in Europe: 22.6% in community-dwelling older patients and 49.0% in institutionalized older adults. Specific tests to detect the majority of age-related pharmacological changes are usually not available in everyday clinical practice, which limits the estimation of drug risks and possibilities to individualize drug therapy in geriatric patients before drug prescription. Moreover, the role of some nonpharmacological strategies is highly underestimated in older adults in contrast to frequent use of polypharmacy. Among nonpharmacological strategies, particularly physical exercise was highly effective in reducing functional decline, frailty, and the risk of falls in the majority of clinical studies. CONCLUSION Several regulatory and clinical barriers contribute to insufficient knowledge on the therapeutic value of drugs in older patients, age-blind approach, and inappropriate prescribing. New clinical and observational research is needed, including data on comprehensive geriatric assessment and frailty, to document the real efficacy and safety of frequently used medications.
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Affiliation(s)
- Daniela Fialová
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University, Prague, Czech Republic. .,Department of Geriatrics and Gerontology, 1st Faculty of Medicine in Prague, Charles University, Prague, Czech Republic.
| | - Blanca Laffon
- DICOMOSA Group, Department of Psychology, Area of Psychobiology, Universidade da Coruña, A Coruña, Spain
| | - Valentina Marinković
- Department of Social Pharmacy and Pharmaceutical Legislation, Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
| | - Ljiljana Tasić
- Department of Social Pharmacy and Pharmaceutical Legislation, Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
| | - Peter Doro
- Department of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, Szeged, Hungary
| | - Gyӧngyver Sόos
- Department of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, Szeged, Hungary
| | - Jorge Mota
- Centro de Investigação em Actividade Fìsica, Saúde e Lazer (CIAFEL), University of Porto, Porto, Portugal
| | - Soner Dogan
- Department of Medical Biology, School of Medicine, Yeditepe University, Istanbul, Turkey
| | - Jovana Brkić
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University, Prague, Czech Republic
| | - João Paulo Teixeira
- Department of Environmental Health, Portuguese National Institute of Health, Porto, Portugal.,EPIUnit, Institute of Public Health, University of Porto, Porto, Portugal
| | - Vanessa Valdiglesias
- DICOMOSA Group, Department of Psychology, Area of Psychobiology, Universidade da Coruña, A Coruña, Spain
| | - Solange Costa
- Department of Environmental Health, Portuguese National Institute of Health, Porto, Portugal.,EPIUnit, Institute of Public Health, University of Porto, Porto, Portugal
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21
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General recommendations paper on the management of older patients with cancer: the SEOM geriatric oncology task force's position statement. Clin Transl Oncol 2018; 20:1246-1251. [PMID: 29633183 PMCID: PMC6153856 DOI: 10.1007/s12094-018-1856-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Accepted: 03/02/2018] [Indexed: 01/03/2023]
Abstract
Population aging is associated with greater numbers of older people with cancer. Thanks to treatment advances, not only are more seniors diagnosed with cancer, but there are also more and more older cancer survivors. This upward trend will continue. Given the heterogeneity of aging, managing older patients with cancer poses a significant challenge for Medical Oncology. In Spain, a Geriatric Oncology Task Force has been set up within the framework of the Spanish Society for Medical Oncology (SEOM). With the aim of generating evidence and raising awareness, as well as helping medical oncologists in their training with respect to seniors with cancer, we have put together a series of basic management recommendations for this population. Many of the patients who are assessed in routine clinical practice in Oncology are older. CGA is the basic tool by means of which to evaluate older people with cancer and to understand their needs. Training and the correct use of recommendations regarding treatment for comorbidities and geriatric syndromes, support care, and drug–drug interactions and toxicities, including those of antineoplastic agents, as detailed in this article, will ensure that this population is properly managed.
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Baumann P, Spies M, Möller HJ, Kasper S, Bitter I, Laux G. A proposal for a psychopharmacology-pharmacotherapy catalogue of learning objectives and a curriculum in Europe. World J Biol Psychiatry 2017; 18:29-38. [PMID: 26850137 DOI: 10.3109/15622975.2016.1149219] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objectives Post-graduate training for specialisation in psychiatry and psychotherapy is part of a 4-6-year programme. This paper aims to inform on the general situation of teaching and training of psychopharmacology-psychopharmacotherapy in Europe. It presents the need for a psychopharmacotherapy education in psychiatric training programmes. Arguments as well as a proposal for a catalogue of learning objectives and an outline of a psychopharmacology curriculum are presented. Methods Based on their experience and on an analysis of the literature, the authors, experts in psychopharmacology-pharmacotherapy teaching, critically analyse the present situation and propose the development of a curriculum at the European level. Results Teaching programmes vary widely between European countries and, generally, teaching of psychopharmacology and pharmacotherapy does not exceed two-dozen hours. This is insufficient if one considers the central importance of psychopharmacology. A psychopharmacology-psychopharmacotherapy curriculum for the professional training of specialists in psychiatry and psychotherapy is proposed. Conclusions As the number of hours of theoretical teaching and practical training is insufficient, a catalogue of learning objectives should be established, which would then be part of a comprehensive curriculum at the European level. It could be inspired partly by those few previously proposed by other groups of authors and organisations.
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Affiliation(s)
- Pierre Baumann
- a Department of Psychiatry (DP-CHUV) , University of Lausanne, Site de Cery , Prilly-Lausanne , Switzerland
| | - Marie Spies
- b Department of Psychiatry and Psychotherapy , Medical University of Vienna , Vienna , Austria
| | - Hans-Jürgen Möller
- c Department of Psychiatry and Psychotherapy , Ludwig-Maximilians-University , Munich , Germany
| | - Siegfried Kasper
- b Department of Psychiatry and Psychotherapy , Medical University of Vienna , Vienna , Austria
| | - Istvan Bitter
- d Department of Psychiatry and Psychotherapy , Semmelweis University , Budapest , Hungary
| | - Gerd Laux
- e Institute of Psychological Medicine (IPM), Haag i.OB, and Department of Psychiatry and Psychotherapy , Ludwig-Maximilians-University , Munich , Germany
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Bos JM, van den Bemt PMLA, de Smet PAGM, Kramers C. The effect of prescriber education on medication-related patient harm in the hospital: a systematic review. Br J Clin Pharmacol 2017; 83:953-961. [PMID: 27918623 DOI: 10.1111/bcp.13200] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 11/25/2016] [Accepted: 11/25/2016] [Indexed: 12/14/2022] Open
Abstract
AIMS Educating prescribers is a strategy to reduce prescription errors in hospitals. The present systematic review gives an overview of original research papers on the education of prescribers and reporting outcomes on (potential) patient harm. METHODS A search of the databases Embase and Medline, using the Ovid interface, was performed. Research on the effect of physician education in order to prevent medication-related problems in inpatients, and on reporting original data and outcomes on prescribing errors and/or (potential) patient harm, was included. The assessment of methodological quality and risk of bias was performed using the Methodological Index for Non-Randomized studies (MINORS) checklist and the suggested risk of bias criteria for Effective Practice and Organization of Care (EPOC) reviews. RESULTS Eight studies investigated an intervention on education alone, and in seven studies education was the main part of a multifaceted intervention. All studies were small and had short follow-up periods. The educational programmes varied and were given to physicians of different specialties and levels of experience. Most studies reported intermediate process parameters as the outcome. The risk of performance and reporting bias were high. CONCLUSION All included studies suffered from poor methodology. The majority, especially studies in which education was part of a multifaceted intervention, reported effectiveness on intermediate outcome markers as prescription errors and potential adverse drug events. However, we found no firm evidence that educating prescribers in the hospital leads to a decrease in patient harm. Further work is needed to develop educational programmes, accompanied by more high-quality research with outcomes on the improvement of patient care.
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Affiliation(s)
- Jacqueline M Bos
- Department of Clinical Pharmacy, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands
| | | | - Peter A G M de Smet
- Department of Clinical Pharmacy and Scientific Institute for Quality of Healthcare, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Cornelis Kramers
- Department of Clinical Pharmacy, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands.,Departement of Clinical Pharmacology and Toxicology, Radboud University Medical Centre, Nijmegen, the Netherlands
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Keijsers CJPW, Segers WS, de Wildt DJ, Brouwers JRBJ, Keijsers L, Jansen PAF. Implementation of the WHO-6-step method in the medical curriculum to improve pharmacology knowledge and pharmacotherapy skills. Br J Clin Pharmacol 2016; 79:896-906. [PMID: 25556708 DOI: 10.1111/bcp.12575] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Revised: 12/15/2014] [Accepted: 12/18/2014] [Indexed: 11/29/2022] Open
Abstract
AIM The only validated tool for pharmacotherapy education for medical students is the 6-step method of the World Health Organization. It has proven effective in experimental studies with short term interventions. The generalizability of this effect after implementation in a contextual-rich medical curriculum was investigated. METHODS The pharmacology knowledge and pharmacotherapy skills of cohorts of students, from years before, during and after implementation of a WHO-6-step-based integrated learning programme were tested using a standardized assessment containing 50 items covering knowledge of basic (n = 25) and clinical (n = 24) pharmacology, and pharmacotherapy skills (n = 1 open question). All scores are expressed as a percentage of the maximum score possible per (sub)domain. RESULTS In total, 1652 students were included between September 2010 and July 2014 (participation rate 89%). The WHO-6-step-based learning programme improved students' knowledge of basic pharmacology (mean score ± SD, 60.6 ± 10.5% vs. 63.4 ± 10.9%, P < 0.01) and clinical or applied pharmacology (63.7 ± 10.4% vs. 67.4 ± 10.3%, P < 0.01), and improved their pharmacotherapy skills (68.8 ± 26.1% vs. 74.6% ± 22.9%, P 0.02). Moreover, satisfaction with education increased (5.7 ± 1.3 vs. 6.3 ± 1.0 on a 10-point scale, P < 0.01) and as did students' confidence in daily practice (from -0.81 ± 0.72 to -0.50 ± 0.79 on a -2 to +2 scale, P < 0.01). CONCLUSIONS The WHO-6-step method was successfully implemented in a medical curriculum. In this observational study, the integrated learning programme had positive effects on students' knowledge of basic and applied pharmacology, improved their pharmacotherapy skills, and increased satisfaction with education and self-confidence in prescribing. Whether this training method leads to better patient care remains to be established.
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Affiliation(s)
- Carolina J P W Keijsers
- Department of Geriatric Medicine, Jeroen Bosch Hospital, 's-Hertogenbosch.,Department of Geriatric Medicine and Expertise Centre Pharmacotherapy in Old Persons, University Medical Centre Utrecht, Utrecht
| | - Wieke S Segers
- Department of Geriatric Medicine and Expertise Centre Pharmacotherapy in Old Persons, University Medical Centre Utrecht, Utrecht
| | - Dick J de Wildt
- Department of Translational Neuroscience, University Medical Centre Utrecht, Utrecht
| | - Jacobus R B J Brouwers
- Department of Geriatric Medicine and Expertise Centre Pharmacotherapy in Old Persons, University Medical Centre Utrecht, Utrecht
| | - Loes Keijsers
- Faculty of Social Sciences, Utrecht University, Utrecht, The Netherlands
| | - Paul A F Jansen
- Department of Geriatric Medicine and Expertise Centre Pharmacotherapy in Old Persons, University Medical Centre Utrecht, Utrecht
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Brinkman DJ, Keijsers CJPW, Tichelaar J, Richir MC, van Agtmael MA. Evaluating pharmacotherapy education: urgent need for hard outcomes. Br J Clin Pharmacol 2015; 81:1000-1. [PMID: 26663464 DOI: 10.1111/bcp.12862] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 11/27/2015] [Accepted: 12/07/2015] [Indexed: 11/28/2022] Open
Affiliation(s)
- David J Brinkman
- Research and Expertise Center In Pharmacotherapy Education (RECIPE), Amsterdam, The Netherlands.,Department of Internal Medicine, Section Pharmacotherapy, VU University Medical Center, Amsterdam, The Netherlands
| | | | - Jelle Tichelaar
- Research and Expertise Center In Pharmacotherapy Education (RECIPE), Amsterdam, The Netherlands.,Department of Internal Medicine, Section Pharmacotherapy, VU University Medical Center, Amsterdam, The Netherlands
| | - Milan C Richir
- Research and Expertise Center In Pharmacotherapy Education (RECIPE), Amsterdam, The Netherlands.,Department of Internal Medicine, Section Pharmacotherapy, VU University Medical Center, Amsterdam, The Netherlands
| | - Michiel A van Agtmael
- Research and Expertise Center In Pharmacotherapy Education (RECIPE), Amsterdam, The Netherlands.,Department of Internal Medicine, Section Pharmacotherapy, VU University Medical Center, Amsterdam, The Netherlands
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Biganzoli L, Lichtman S, Michel JP, Papamichael D, Quoix E, Walko C, Aapro M. Oral single-agent chemotherapy in older patients with solid tumours: A position paper from the International Society of Geriatric Oncology (SIOG). Eur J Cancer 2015; 51:2491-500. [DOI: 10.1016/j.ejca.2015.08.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 08/09/2015] [Indexed: 10/23/2022]
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Keijsers CJPW, Ross S. A pharmacological approach to education. Br J Clin Pharmacol 2015; 80:329-30. [PMID: 26095016 DOI: 10.1111/bcp.12700] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 06/17/2015] [Indexed: 11/26/2022] Open
Affiliation(s)
| | - Sarah Ross
- Division of Medical and Dental Education, University of Aberdeen, Aberdeen, UK
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Keijsers CJPW, Leendertse AJ, Faber A, Brouwers JRBJ, de Wildt DJ, Jansen PAF. Pharmacists' and general practitioners' pharmacology knowledge and pharmacotherapy skills. J Clin Pharmacol 2015; 55:936-43. [PMID: 25810359 DOI: 10.1002/jcph.500] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 03/17/2015] [Indexed: 11/10/2022]
Abstract
Understanding differences in the pharmacology knowledge and pharmacotherapy skills of pharmacists and physicians is vital to optimizing interprofessional collaboration and education. This study investigated these differences and the potential influence of work experience. The pharmacology knowledge and pharmacotherapy skills of pharmacists, general practitioners (GPs), and trainees were compared, using a written assessment; 294 participants were included. Overall scores (mean ± SD) ranged from 69.3% ± 6.5% to 76.5% ± 9.5% for basic knowledge, 70.3% ± 10.8% to 79.7% ± 8.4% for applied knowledge, and 66.3% ± 21.1% to 84.7% ± 20.7% for pharmacotherapy skills (analysis of variance all P < .05). The pharmacists had the highest scores for all domains (P < .05), with the exception of pharmacist trainees, who had comparable scores for basic knowledge and pharmacotherapy skills (both P > .05). The GPs scored the lowest for pharmacotherapy skills (P < .05). More work experience was associated with better knowledge of applied pharmacology among pharmacists (by 2% per 10 work-years), but with poorer pharmacotherapy skills among pharmacists and GPs (by 3% and 4% per 10 work-years, respectively). In conclusion, pharmacists and GPs differ in their knowledge and skills, and these differences become more pronounced with more work experience. In general, pharmacists outperform pharmacist trainees, whereas GP trainees outperform GPs. These differences could be important for interdisciplinary collaboration and education.
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Affiliation(s)
- Carolina J P W Keijsers
- Department of Geriatric Medicine, Jeroen Bosch Hospital, Den Bosch, the Netherlands.,Department of Geriatric Medicine and Expertise Centre Pharmacotherapy in Old Persons (EPHOR), University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Anne J Leendertse
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Adrianne Faber
- SIR Institute for Pharmacy Practice and Policy, Leiden, the Netherlands
| | - Jacobus R B J Brouwers
- Department of Geriatric Medicine and Expertise Centre Pharmacotherapy in Old Persons (EPHOR), University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Dick J de Wildt
- Department of Translational Neuroscience, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Paul A F Jansen
- Department of Geriatric Medicine and Expertise Centre Pharmacotherapy in Old Persons (EPHOR), University Medical Centre Utrecht, Utrecht, the Netherlands
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Blozik E, Rapold R, Reich O. Prescription of potentially inappropriate medication in older persons in Switzerland: does the dispensing channel make a difference? Risk Manag Healthc Policy 2015; 8:73-80. [PMID: 25977609 PMCID: PMC4418391 DOI: 10.2147/rmhp.s78179] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Drugs can be supplied either directly from the prescribing physician (physician dispensing [PD]) or via a pharmacy. It is unclear whether the dispensing channel is associated with quality problems. Potentially inappropriate medication (PIM) is associated with adverse outcomes in older persons and can be considered a marker for quality deficits in prescribing. We investigated whether prevalence of PIM differs across dispensing channels. Patients and methods We analyzed basic health insurance claims of 50,747 person quarter years with PIM use of residents of the Swiss cantons Aargau and Lucerne of the years 2012 and 2013. PIM was identified using the Beers 2012 criteria and the PRISCUS list. We calculated PIM prevalence stratified by supply channel. Adjusted mixed effects logistic regression analysis was done to estimate the effect of obtaining medications through the dispensing physician as compared to the pharmacy channel on receipt of PIM. The most frequent PIMs were identified. Results There is a small but detectable difference in total PIM prevalence: 30.7% of the population supplied by a dispensing physician as opposed to 29.3% individuals who received medication in a pharmacy. According to adjusted logistic regression individuals who obtained the majority of their medications from their prescribing physician had a 15% higher chance to receive a PIM (odds ratio 1.15, 95% confidence interval 1.08–1.22; P<0.001). Conclusion Physician dispensing seems to affect quality and safety of drug prescriptions. Quality issues should not be neglected in the political discussion about the regulations on PD. Future studies should explore whether PD is related to other indicators of inefficiency or quality flaws. The present study also underlines the need for interventions to reduce the high rates of PIM prescribing in Switzerland.
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Affiliation(s)
- Eva Blozik
- Department of Health Sciences, Helsana Group, Zürich, Switzerland ; Department of Medicine, Division of General Practice, University Medical Centre Freiburg, Freiburg, Germany
| | - Roland Rapold
- Department of Health Sciences, Helsana Group, Zürich, Switzerland
| | - Oliver Reich
- Department of Health Sciences, Helsana Group, Zürich, Switzerland
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Education on prescribing for older patients in the Netherlands: a curriculum mapping. Eur J Clin Pharmacol 2015; 71:603-9. [PMID: 25753290 DOI: 10.1007/s00228-015-1830-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 02/08/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Pharmacology and pharmacotherapy education is being increasingly integrated in medical curricula, which might lead to a specific loss of knowledge in these subjects. This, in turn, could lead to harmful prescribing errors, especially in vulnerable older patients. METHODS Teachers who coordinated education in Dutch medical schools completed a structured interview on (geriatric) pharmacology and pharmacotherapy education. A list of core learning goals was developed. Pharmacology and pharmacotherapy education in general was compared to geriatric pharmacology and pharmacotherapy education. RESULTS All Dutch medical schools participated. Contact hours for education in pharmacology and pharmacotherapy ranged from 39 to 107 h; ECTSs (representing 28 study hours) ranged from 0 to 3. The various curricula covered, on average, 79% of all learning goals for these subjects: knowledge 85%, skills 76%, and attitudes 66%; the curricula also covered specific geriatric goals: knowledge 87% and skills 65%. All geriatric learning goals were met if a geriatrician was among the coordinators. Half (4 of 8) of the medical schools lacked appropriate assessment procedures. Evaluation was mostly based on students' opinions. Teachers rated students as being moderately well prepared for daily practice. CONCLUSIONS There are large differences in the quantity and quality of (geriatric) pharmacology and pharmacotherapy education in Dutch medical schools. In general, more time should be devoted to skills and attitude, and the assessment procedures should be optimized with high priority. Other curricula with a problem-based approach might benefit from the points of improvement described in this article.
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McCarthy RM, Hilmer SN. Teaching Junior Medical Officers safe and effective prescribing. Intern Med J 2014; 43:1250-3. [PMID: 24237649 DOI: 10.1111/imj.12279] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Accepted: 03/27/2013] [Indexed: 11/30/2022]
Abstract
Medication errors are an iatrogenic threat to patient safety, and recently graduated Junior Medical Officers (JMOs) are a common source of these errors. A ward-based, physician-led, small-group interactive teaching session was developed to improve JMOs competence in prescribing. The ability of JMOs to detect problems in mock medication charts before and after the teaching session was assessed, with the majority improving after the intervention, a result sustained on re-testing later in the year. The teaching sessions were well received by JMOs.
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Affiliation(s)
- R M McCarthy
- Department of Clinical Pharmacology, Royal North Shore Hospital, Sydney, New South Wales, Australia; Aged Care and Rehabilitation, Concord Hospital, Sydney, New South Wales, Australia
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Gardner DM. Competent psychopharmacology. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2014; 59:406-11. [PMID: 25161064 PMCID: PMC4143296 DOI: 10.1177/070674371405900802] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 05/01/2014] [Indexed: 11/16/2022]
Abstract
There is little doubt that undergraduate and post-graduate training of physicians, pharmacists, and nurses is insufficient to prepare them to use psychotropics safely and effectively, especially in the context of their expanded off-label uses. Therefore, the development of competencies in psychotropic prescribing needs to be approached as a long-term, practice-based learning commitment. Proposed are the abilities and knowledge components necessary for safe and effective use of psychotropics. Typical challenges in prescribing for chronic and recurrent illnesses include highly variable responses and tolerability, drug interactions, and adverse effects that can be serious, irreversible, and even fatal. Prescribing psychotropics is further complicated by negative public and professional reports and growing patient concerns about the quality of care, and questions about the efficacy, safety, and addictive risks of psychotropics. Increased efforts are needed to enhance clinical training and knowledge in psychopharmacology among trainees and practising clinicians, with more comprehensive and sustained attention to the assessment of individual patients, and greater reliance on patient education and collaboration. Improved competence in psychotropic prescribing should lead to more informed, thoughtful, and better-targeted applications as one component of more comprehensive clinical care.
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Affiliation(s)
- David M Gardner
- Professor, Department of Psychiatry and College of Pharmacy, Dalhousie University, Halifax, Nova Scotia
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Keijsers CJPW, van Doorn ABD, van Kalles A, de Wildt DJ, Brouwers JRBJ, van de Kamp HJ, Jansen PAF. Structured pharmaceutical analysis of the Systematic Tool to Reduce Inappropriate Prescribing is an effective method for final-year medical students to improve polypharmacy skills: a randomized controlled trial. J Am Geriatr Soc 2014; 62:1353-9. [PMID: 24916615 DOI: 10.1111/jgs.12884] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Medical students may not be adequately trained to prescribe appropriately to older adults with polypharmacy. This study addressed how to teach students to minimize inappropriate polypharmacy. Final-year medical students (N = 106) from two Dutch schools of medicine participated in this randomized controlled trial with a pre/posttest design. The Systematic Tool to Reduce Inappropriate Prescribing (STRIP) was used as the intervention. This medication review tool consists of five steps and is part of the Dutch multidisciplinary guideline on polypharmacy. Step two is a structured pharmaceutical analysis of drug use, assessed using six questions regarding undertreatment, ineffective treatment, overtreatment, potential adverse effects, contraindications or interactions, and dose adjustments. It is used in combination with the Screening Tool to Alert doctors to Right Treatment and the Screening Tool of Older Person's Prescriptions checklists. Students were asked to optimize the medication lists of real people, making use, or not, of the STRIP. The number of correct or potentially harmful decisions that the students made when revising the lists was determined by comparison with expert consensus. Students who used the STRIP had better scores than control students; they made more correct decisions (9.3 vs 7.0, 34%; P < .001, correlation coefficient (r) = 0.365) and fewer potentially harmful decisions (3.9 vs 5.6, -30%; P < .001, r = 0.386). E-learning did not have a different effect from that of non-E-learning methods. Students were satisfied with the method. The STRIP method is effective in helping final-year medical students improve their prescribing skills.
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Affiliation(s)
- Carolina J P W Keijsers
- Expertise Centre Pharmacotherapy in Old Persons, University Medical Centre Utrecht, Utrecht, The Netherlands; Jeroen Bosch Hospital, 's Hertogenbosch, The Netherlands
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Hanlon JT, Schmader KE, Semla TP. Update of studies on drug-related problems in older adults. J Am Geriatr Soc 2013; 61:1365-8. [PMID: 23731022 PMCID: PMC3743943 DOI: 10.1111/jgs.12354] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Joseph T Hanlon
- Division of Geriatrics, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA.
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Stahlmann R, Lode HM. Risks associated with the therapeutic use of fluoroquinolones. Expert Opin Drug Saf 2013; 12:497-505. [DOI: 10.1517/14740338.2013.796362] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Jansen PAF, Brouwers JRBJ. Clinical pharmacology in old persons. SCIENTIFICA 2012; 2012:723678. [PMID: 24278735 PMCID: PMC3820465 DOI: 10.6064/2012/723678] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Accepted: 06/28/2012] [Indexed: 06/02/2023]
Abstract
The epidemiological transition, with a rapid increase in the proportion in the global population aged over 65 years from 11% in 2010 to 22% in 2050 and 32% in 2100, represents a challenge for public health. More and more old persons have multimorbidities and are treated with a large number of medicines. In advanced age, the pharmacokinetics and pharmacodynamics of many drugs are altered. In addition, pharmacotherapy may be complicated by difficulties with obtaining drugs or adherence and persistence with drug regimens. Safe and effective pharmacotherapy remains one of the greatest challenges in geriatric medicine. In this paper, the main principles of geriatric pharmacology are presented.
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Affiliation(s)
- Paul A. F. Jansen
- Expertise Centre Pharmacotherapy in Old Persons, University Medical Centre Utrecht, B05.256, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
| | - Jacobus R. B. J. Brouwers
- Expertise Centre Pharmacotherapy in Old Persons, University Medical Centre Utrecht, B05.256, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
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