Competencies for the provision of comprehensive medication management services in an experiential learning project

The perspectives of pharmacy student preceptors on a service-learning program in primary health care: A qualitative study

Background

There are a few studies about preceptorship in primary health care settings, but they didn't assess all possible contributions of this experience, such as preceptor behavioral changes and impact on health services.

Objective

This study aimed to analyze the perspective of pharmacy student preceptors on a service-learning program carried out in a primary health care setting.

Methods

This was a qualitative descriptive study, with semi-structured interviews and thematic analysis. The themes were defined deductively, according to levels of Kirkpatrick's theory about the impact of educational activities.

Results

The preceptors showed positive and negative reactions to the structure of the service-learning program, developed their knowledge, changed behaviors such as collaborative interprofessional practice, and reported improvements in the health units.

Conclusions

From the perspective of pharmacy student preceptor preceptors, the service-learning program had an impact on all levels expected for an educational activity according to Kirkpatrick's theory: reaction, learning, behavior, and results. These findings may inform the design of service-learning programs.

Comprehensive Medication Management Services with a Holistic Point of View, a Scoping Review

Implementing Comprehensive Medication Management (CMM) services uncovered the importance of the totality of the patient's perspective in this process. The holistic approach takes into account the physical, mental and emotional well-being of individuals, as well as their socioeconomic circumstances. The aim of this study was to characterize the scientific evidence associated with CMM services that included this holistic approach. A scoping review was conducted based on Arksey and O'Malley's method. Searches were performed in Google Scholar for papers published between 2010 and 2020 in English, Spanish and Portuguese. Study design, health contexts, sample of patients, results obtained, barriers and facilitators, and the integration of a holistic approach were determined. Two hundred and eighteen papers were evaluated, most of which focused on the implementation of this service through prospective observational studies. A minority of studies reported on a holistic approach, a smaller number examined the effect of social determinants of health, the patient's medication experiences and the pharmacotherapy outcomes from the patient's perspective. Despite the progress achieved, most of the referents do not yet reflect a broader view of the patient's life situation and its relationship to pharmacotherapy and the ways in which the pharmacist implements holistic elements to solve or prevent drug-related problems.

Barriers and facilitators to patient-centred care in pharmacy consultations: A qualitative study with Malaysian hospital pharmacists and patients

BACKGROUND

Patient-centred care (PCC) has been suggested to provide benefits such as improved patient-healthcare provider communication and better disease self-management to patients. The practice of PCC should involve all healthcare professionals, including pharmacists who are well-positioned in providing pharmaceutical care to patients. However, a better understanding of the factors that can affect the practice of PCC in pharmacists' consultations is needed.

OBJECTIVE

To explore the perceptions of Malaysian hospital pharmacists and patients on the barriers and facilitators of a PCC approach in pharmacist consultations.

DESIGN

This study employed a qualitative, explorative semi-structured interview design.

SETTING AND PARTICIPANTS

Interviews were conducted with 17 patients and 18 pharmacists from three tertiary hospitals in Malaysia. The interviews were audiotaped and transcribed verbatim. Emerging themes were developed through a constant comparative approach and thematic analysis.

RESULTS

Three themes were identified in this study: (i) patient-related factors (knowledge, role expectations, and sociocultural characteristics), (ii) pharmacist-related factors (personalities and communication), and (iii) healthcare institutional and system-related factors (resources, continuity of care, and interprofessional collaboration). Pharmacists and patients mentioned that factors such as patients' knowledge and attitudes and pharmacists' personality traits and communication styles can affect patients' engagement in the consultation. Long waiting time and insufficient manpower were perceived as barriers to the practice of PCC. Continuity of care and interprofessional collaboration were viewed as crucial in providing supportive and tailored care to patients.

CONCLUSION

The study findings outlined the potential factors of PCC that may influence its implementation in pharmacist consultations. Strategic approaches can be undertaken by policymakers, healthcare institutions, and pharmacists themselves to address the identified barriers to more fully support the implementation of PCC in the pharmacy setting.

A modeler's manifesto: Synthesizing modeling best practices with social science frameworks to support critical approaches to data science

In the face of the "crisis of reproducibility" and the rise of "big data" with its associated issues, modeling needs to be practiced more critically and less automatically. Many modelers are discussing better modeling practices, but to address questions about the transparency, equity, and relevance of modeling, we also need the theoretical grounding of social science and the tools of critical theory. I have therefore synthesized recent work by modelers on better practices for modeling with social science literature (especially feminist science and technology studies) to offer a "modeler’s manifesto": a set of applied practices and framings for critical modeling approaches. Broadly, these practices involve 1) giving greater context to scientific modeling through extended methods sections, appendices, and companion articles, clarifying quantitative and qualitative reasoning and process; 2) greater collaboration in scientific modeling via triangulation with different data sources, gaining feedback from interdisciplinary teams, and viewing uncertainty as openness and invitation for dialogue; and 3) directly engaging with justice and ethics by watching for and mitigating unequal power dynamics in projects, facing the impacts and implications of the work throughout the process rather than only afterwards, and seeking opportunities to collaborate directly with people impacted by the modeling.

Unpacking student learning from an early experience with the Pharmacists' Patient Care Process

BACKGROUND

To illuminate learning, a case study approach was used to examine early, authentic experiences within Pharmacists' Patient Care Process (PPCP)-focused practices.

EDUCATIONAL ACTIVITY

Six students were matched with five practitioners and spent five half-days in a primary care clinic in a PPCP-committed health system. Students practiced interviewing, determining the patient's medication experience, and formulating the beginnings of the assessment, as well as observing and debriefing on the completion of the process by a practitioner mentor. The Five R Model was used to prompt student learning reflection. In addition, instructors examined students' work for evidence of transformative learning and observations were captured using forms of reflective practice and collaborative debriefing.

CRITICAL ANALYSIS OF THE EDUCATIONAL ACTIVITY

Reflection performance ratings varied; however, there was strong evidence of transformative learning for all students. Specifically, most student reflections demonstrated a focus on elaborating on existing frames of reference. The most prevalent indicator of transformative learning was exploration of options for new roles, relationships, and actions. The codes from instructors' observations revealed five categories of learning evidence, with the strongest in the patient centeredness category. The process of reviewing student work products, documenting instructor observations, and collaborative debriefing resulted in insights for curricular improvement and explanations for learning difficulties. Further work is needed in understanding student experiential learning intentions and their influence on learning and reflection. Additionally, further research should explore the value of longitudinal assessment of reflection and the value of assessing student work products using criteria beyond traditional reflection criteria.

Experiential education in the pharmacy undergraduate curricula in Brazil

Objective:

Considering the curriculum reform process taking place in pharmacy undergraduate programs in Brazil and the importance of practical experience to students throughout their learning process in university, this study aims to provide an overview of pharmacy undergraduate programs in Brazil and their respective internships.

Methods:

An observational, descriptive, cross-sectional study. A documentary analysis of pharmacy undergraduate programs in the face-to-face modality was carried out, with data obtained from the Political Pedagogical Projects of the programs, the curricula, and course descriptions containing information on internships, all provided by the Brazilian Ministry of Education. The data collected concerned higher education institutions (HEIs), pharmacy programs and internships.

Results:

Pharmacy undergraduate programs in Brazil have a median duration of 10 semesters, requiring from students a median of 6 internships, from the 6^th semester on, totalizing 826 hours. The programs lack uniformity among their internships, mainly regarding total hours and the semester in which internships start. The pharmacy internships cover, in greater number, the areas of outpatient and community pharmacy, clinical analysis, and pharmaceutical technology, respectively, being clinical analysis the area with more hours. Public and private HEIs have different internship proceedings in their curricula, hence no homogeneity among them in the different regions of Brazil.

Conclusions:

This study demonstrates the diversity of pharmacy programs in Brazil in the context of internships, reflecting on the training and the activity of pharmacists in recent decades. Further studies are needed to deepen the understanding of this theme.

Overview and Prospect of Autoethnography in Pharmacy Education and Practice

Objective. To provide an overview of autoethnography as a valuable qualitative methodology in the human and health sciences and to endorse its use to answer meaningful research questions in pharmacy education and assist with the preparation of person-centered pharmacists. Findings. Today, pharmacists must participate in the health care system as care providers rather than simply drug dispensers. The call for change, which began with the evolution of clinical pharmacy and continued with the introduction of pharmaceutical care practice in the 1990s, is still proving to be dramatic for the profession. Thus, new problems are surfacing demanding new types of research questions and new ways of answering them. Autoethnography is a qualitative methodology that combines the principles of ethnography and autobiography in a way that highlights researchers' reflexivity and subjectivity. The paper describes autoethnography, its diverse forms (eg, evocative or analytical), the process of producing it, and associated standards of high-quality work. It presents autoethnographies carried out in health care research as well as in pharmacy, pointing to the usefulness of this methodology to produce meaningful investigations that can enrich the preparation of future pharmacists and advance the profession. Summary. Autoethnography is gaining recognition in many disciplines in health care. Even though it is still incipient in pharmacy, autoethnography can expand pharmacy students' and pharmacists' consciousness regarding their own situation and open the possibility for pursuing research that might enhance the lives of others and themselves.

Implementation of medication management services at the primary healthcare level - a pilot study

This study employed a mixed-method approach to enable the implementation of comprehensive medication management (CMM) services in Croatia's primary care setting. Drug therapy problems (DTPs) and factors associated with their occurrence were determined in patients with chronic diseases from January 2018 to April 2019. The pre-implementation stage established the foundations for the early implementation stage, in which the practice was set up, the patients' recruitment initiated and various challenges identified. During the study period, 86 patients were recruited for CMM provision. Overall, 2.8 DTPs (± 1.6) per patient were identified and the majority (96.2 %) presented with at least one DTP. Multiple regression analysis showed that type 2 diabetic patients (p = 0.025) and patients using five or more medications (p = 0.011) should be prioritized to receive CMM services as potentially they have a higher number of DTPs, and could, therefore, obtain a greater benefit from the service.