Leadership development in health professions

BACKGROUND AND PURPOSE

Despite changing clinical care dynamics, health professions education has been slow in addressing gaps in leadership development as teaching and assessment of clinical care-related knowledge, skills, and attitudes remain central across curricula. While accreditation standards across health professions programs acknowledge the importance of leadership development within curricula, it remains an underrepresented aspect of health professions training.

EDUCATIONAL ACTIVITY AND SETTING

Given the varied approach to leadership training, we set out to develop a tailored approach to leadership development that integrated the Center for the Advancement of Pharmacy Education (CAPE) outcomes and was based on self-awareness, skill-building, and application. This pilot included three cohorts of doctor of pharmacy students and measured their knowledge, skills, and self-awareness as they progressed through this year-long program. It also measured leadership competency attainment using a pre- and post-assessment in one cohort.

FINDINGS

Participant satisfaction was assessed using session and program evaluations, while self-perception of growth and leadership competency attainment was assessed using a survey that was administered before and after program participation. Participants found the program to be beneficial in meeting stated objectives and in creating a conducive learning environment. Results of the pre- and post-assessment indicated growth in all dimensions of self-perception of knowledge, skills, and self-awareness, as well as attainment of leadership competency personal leadership commitment and leadership knowledge.

SUMMARY

Offering co-curricular leadership development programs based on CAPE outcomes and leadership competencies provided students with the opportunity to develop leadership skills and acquire knowledge needed to be effective healthcare leaders.

Implementing interactive hiring activity in pharmacy management education

BACKGROUND AND PURPOSE

A major element of management is the process of hiring employees. The purpose of this brief is to describe the implementation of a human resources learning activity asking students to choose an employee to hire, describe student responses, and explore student perspectives of the activity.

EDUCATIONAL ACTIVITY AND SETTING

An interactive hiring activity was presented to third-year students (n = 386) at two different institutions, with varied classroom settings. Students were provided with candidates' curricula vitae and then completed a student-led interview using scripted questions presented in a PowerPoint format. The activity asked students to hire one candidate from five qualified candidates of varying backgrounds and traits. A Qualtrics survey collected students' individual hiring choice, hiring rationale, participant demographic information, and activity perceptions. Demographics and candidate choice were assessed using descriptive analysis. Open-ended answers were analyzed for frequency of terms, followed by a latent class analysis.

FINDINGS

Over 90% of students (n = 386) completed the post-activity survey. Demographic data between student cohorts varied, with only student age similar. Hired candidates differed by institution with one college expressing preference for a specific candidate and the other demonstrating a greater diversity of candidate preferences. Influencing factors on student choice were numerous. Overall, students reported a favorable experience with the activity.

SUMMARY

This management hiring activity allowed students to engage in the practice-ready skills of hiring pharmacy technicians in an interactive classroom activity. This activity allowed the educators involved to develop hypotheses about student preferences in hiring for future study.

Indirect Economic Burden of Sickle Cell Disease

OBJECTIVE

This study aimed to quantify the indirect costs of sickle cell disease in the United States.

METHODS

Adult patients from a sickle cell disease clinic at an urban academic healthcare system completed an adapted Institute for Medical Technology Assessment Productivity Cost Questionnaire related to the impact of their disorder on absenteeism, presenteeism, ability to contribute through unpaid work outside of employment, and other aspects of life. Additional data were collected from patient records about each participant's genotype, total hemoglobin level, and pain level.

RESULTS

Of the 192 individuals, 187 who completed the survey reported experiencing vaso-occlusive crisis pain events during the last year that negatively affected their productivity at work and in daily roles. Three-fourths of respondents reported impairment in their ability to complete everyday tasks, such as caring for children, running errands, doing housework, shopping for groceries, and volunteer (unpaid) work. Only 30% of respondents reported being employed or self-employed. Of those employed, estimated costs of absenteeism and presenteeism attributable to pain events averaged $15 103 per person annually. Estimated total annual losses in unpaid work productivity averaged $3 145 862 for the study respondents and another $2 870 652 for their caregivers.

CONCLUSIONS

Sickle cell disease affected the work productivity, nonwork productivity, and the daily lives of adults seen with the disorder in an academic medical center.

Understanding the dissemination of appointment-based synchronization models using the CFIR framework

BACKGROUND

The appointment based model (ABM) is a innovative model of pharmacy practice that combines medication synchronization with scheduled monthly appointments to improve patient medication adherence and convenience. It is being implemented in many pharmacies across the United States.

OBJECTIVE

The purpose of this article is to use the Consolidated Framework for Implementation Research (CFIR) to discuss the barriers and facilitators of ABM implementation in community pharmacies while identifying priorities for additional implementation research.

METHODS

A review of current evidence of ABM was examined using the five domains within the CFIR taxonomy. Interactions between these domains (the intervention, the individuals involved, the process used to implement the intervention, the inner setting, and the outer setting) and their sub domains were used to explain the current success of ABM and future barriers.

RESULTS

The CFIR is an effective theoretical framework for assessing ABM. It helps identify key constructs in ABM implementation and their relationships. It also suggests future research to facilitate its adoption as a standard of pharmacy practice.

CONCLUSIONS

The adoption of ABM by pharmacies will be facilitated by better evidence of its clinical and economic impact on patient health outcomes, standardization of ABM, and integrating it into current workflows.

Impact of Appointment-Based Medication Synchronization on Existing Users of Chronic Medications

BACKGROUND

Appointment-based medication synchronization (ABMS) has been associated with greater patient adherence and persistence when patients begin taking chronic medications. It is not known whether similar results will be seen for patients who have been taking chronic medications for 6 months or more.

OBJECTIVE

To compare the impact of a community pharmacy chain's ABMS program on medication adherence and persistence of existing users of chronic medications with individuals who are not enrolled in the program.

METHODS

A retrospective cohort study compared patients receiving ABMS with matched comparison groups receiving usual care. ABMS consisted of synchronizing a patient's medications to be dispensed on a single appointment day every month, a call to the patient prior to the appointment day to address any prescription changes and to remind the patient, and a patient visit to the pharmacy to pick up the medications. Outcomes were 1-year adherence rates using proportion of days covered (PDC) and 1-year nonpersistence rates. Data for this study came from prescription claims records of patients taking 1 of 6 chronic medication classes during the period of December 1, 2011, to February 28, 2014. ABMS patients were matched with comparison groups according to prior adherence behavior, medication class, age, gender, and geographic region.

RESULTS

Mean PDC scores ranged from 0.73 to 0.91 for ABMS patients (n = 205 to 716) and from 0.57 to 0.71 for usual care depending on the medication class. The percentage of adherent individuals (i.e., PDC ≥ 0.80) was 55% to 84% for ABMS participants and 37% to 62% for usual care. Odds of adherence was 2.3 to 3.6 times greater with ABMS. Usual care patients became nonpersistent (61% to 74%) more often than ABMS patients (33% to 44%) with hazard ratios of nonpersistence being 0.39 to 0.67 for individuals in the program.

CONCLUSIONS

An ABMS program in a community pharmacy setting was associated with higher rates of adherence and persistence for patients who had been taking chronic medications for at least 6 months. Approximately 18 to 35 additional ABMS participants were adherent for every 100 patients enrolled when compared with usual care. For every 100 patients receiving usual care, 17 to 40 additional patients in the ABMS group were persistent. This study shows that ABMS programs can improve medication adherence and persistence for patients who are newly prescribed or currently taking chronic medications.

The economic impact of childhood food allergy in the United States

IMPORTANCE

Describing the economic impact of childhood food allergy in the United States is important to guide public health policies.

OBJECTIVE

To determine the economic impact of childhood food allergy in the United States and caregivers' willingness to pay for food allergy treatment.

DESIGN, SETTING, AND PARTICIPANTS

A cross-sectional survey was conducted from November 28, 2011, through January 26, 2012. A representative sample of 1643 US caregivers of a child with a current food allergy were recruited for participation.

MAIN OUTCOMES AND MEASURES

Caregivers of children with food allergies were asked to quantify the direct medical, out-of-pocket, lost labor productivity, and related opportunity costs. As an alternative valuation approach, caregivers were asked their willingness to pay for an effective food allergy treatment.

RESULTS

The overall economic cost of food allergy was estimated at $24.8 (95% CI, $20.6-$29.4) billion annually ($4184 per year per child). Direct medical costs were $4.3 (95% CI, $2.8-$6.3) billion annually, including clinician visits, emergency department visits, and hospitalizations. Costs borne by the family totaled $20.5 billion annually, including lost labor productivity, out-of-pocket, and opportunity costs. Lost labor productivity costs totaled $0.77 (95% CI, $0.53-$1.0) billion annually, accounting for caregiver time off work for medical visits. Out-of-pocket costs were $5.5 (95% CI, $4.7-$6.4) billion annually, with 31% stemming from the cost of special foods. Opportunity costs totaled $14.2 (95% CI, $10.5-$18.4) billion annually, relating to a caregiver needing to leave or change jobs. Caregivers reported a willingness to pay of $20.8 billion annually ($3504 per year per child) for food allergy treatment.

CONCLUSIONS AND RELEVANCE

Childhood food allergy results in significant direct medical costs for the US health care system and even larger costs for families with a food-allergic child.

Educating Pharmacy Students to Improve Quality (EPIQ) in colleges and schools of pharmacy

OBJECTIVE

To assess course instructors' and students' perceptions of the Educating Pharmacy Students and Pharmacists to Improve Quality (EPIQ) curriculum.

METHODS

Seven colleges and schools of pharmacy that were using the EPIQ program in their curricula agreed to participate in the study. Five of the 7 collected student retrospective pre- and post-intervention questionnaires. Changes in students' perceptions were evaluated to assess their relationships with demographics and course variables. Instructors who implemented the EPIQ program at each of the 7 colleges and schools were also asked to complete a questionnaire.

RESULTS

Scores on all questionnaire items indicated improvement in students' perceived knowledge of quality improvement. The university the students attended, completion of a class project, and length of coverage of material were significantly related to improvement in the students' scores. Instructors at all colleges and schools felt the EPIQ curriculum was a strong program that fulfilled the criteria for quality improvement and medication error reduction education.

CONCLUSION

The EPIQ program is a viable, turnkey option for colleges and schools of pharmacy to use in teaching students about quality improvement.

Faculty perceptions of the Educating Pharmacy Students to Improve Quality (EPIQ) program

OBJECTIVE

To investigate users' initial perceptions of and potential applications for the Educating Pharmacy Students and Pharmacists to Improve Quality (EPIQ) program, a 5-module education program designed to educate pharmacists and pharmacy students about quality improvement in pharmacy practice.

METHODS

The 5-module EPIQ program was distributed to pharmacy faculty members, pharmacy practitioners, and other health professionals across the country upon request. A 6-item survey instrument was sent to the first 97 people who requested the program.

RESULTS

Twenty-seven (56%) of the 55 respondents had reviewed the EPIQ program and 22 (82%) intended to use some or all of the content to teach about quality improvement or patient safety primarily in pharmacy management and medication safety courses.

CONCLUSION

Initial perceptions of the EPIQ program were positive; however, further evaluation is needed after more extensive implementation of the program in pharmacy colleges and schools and other settings.

Service scripts: a tool for teaching pharmacy students how to handle common practice situations

OBJECTIVES

This paper describes the use of service scripts to teach pharmacy students how to manage specific practice situations by learning and following scripted behaviors.

DESIGN

Based upon role theory, service scripts require specific behaviors for a broad range of practice problems and communicate consistent messages about the responsibilities of all people involved. Service scripts are developed by (1) identifying scenarios for the script, (2) eliciting the script's structure and content, and (3) documenting the reasoning behind the steps in the script.

ASSESSMENT

Students in a nontraditional doctor of pharmacy program developed scripts for their practice settings. They concluded that scripts were useful for quickly learning new, routine tasks, but expressed concern that scripts could be misused by pharmacists and managers. The process of script development itself was useful in gaining feedback about common practice problems.

CONCLUSION

By mastering managerial, clinical, and communication scripts, students can develop capabilities to provide professional services.

Transparency needed for economic analyses of PA programs

Transparency Needed for Economic Analyses of PA Programs Dear Editor, I am writing in response to the article Pharmacoeconomic Modeling of Prior-Authorization Intervention for COX-2 Specific Inhibitors in a 3-Tier Copay Plan in the July/August 2003 issue of the Journal of Managed Care Pharmacy. 1 While the authors are to be commended for using an economic analysis to assess the impact of a prior-authorization (PA) program, I have some objections with the paper that I wish to express. My primary objection addresses the lack of transparency in methods used.

Effect of technical and functional quality on patient perceptions of pharmaceutical service quality

PURPOSE

To evaluate the relative importance of functional quality (how services were provided) and technical quality (what was received for those services) on patient perceptions of pharmaceutical service quality.

METHODS

A scenario-based experimental design was chosen to manipulate functional (FQ) and technical quality (TQ). Subjects were asked to read one of four scenarios describing a pharmacy service experience and imagine that he or she were in the situation described. High and low TQ were manipulated by describing the presence or absence of a prescription medication dispensing error made by the pharmacist in the scenario. Each subject completed a survey about their evaluations of the service provided in the scenario. An ANOVA using a 2 x 2 completely randomized factorial design was conducted to compare the effects of TQ, FQ, and their interaction on perceptions of service quality and behavioral intention. Effect sizes were measured with the calculation of omega-square.

RESULTS

FQ had the greatest impact on patient perceptions of service quality and behavioral intentions. FQ explained 44% of the variance in service quality and 39% in intention to return. TQ and the interaction accounted for a significant but much lesser effect. The interaction showed that the effect of FQ was greatest under conditions of high TQ. There were no significant associations between any demographic characteristics and responses to service quality.

CONCLUSIONS

The results suggest that FQ has the greatest impact on consumer perceptions of pharmaceutical service quality even under conditions of an obvious example of low TQ which respondents perceive as serious and possibly harmful. This study underscores the limitations of relying on patient perceptions in evaluating pharmaceutical services. Although patient evaluations are important, they can be inadequate for assessing the professional quality of services.

Prostate cancer education in African American churches

The use of churches as recruitment sites of African Americans into health promotion activities is a popular theme in the 1990s literature. This research measured the impact of previous exposure to cancer on participation in an educational program and a free prostate cancer screening. Cues to action from the Health Belief Model provided the conceptual framework. Over 500 men attended a prostate cancer educational program at their church. Men who participated in the educational program and completed the questionnaire were given a voucher that they could take to their doctor of choice for a free prostate cancer examination. Having a member of the congregation who was previously diagnosed with cancer was a significant cue to attendance at the educational program (P = 0.03). Recommendations for future cancer screening in churches are given.

Implementing disease management in community pharmacy practice

Disease management (DM) is a comprehensive approach to preventing and treating disease that: (1) targets patients with specific diseases; (2) provides integrated services across organizational and professional boundaries; (3) utilizes services based on the best scientific evidence available; and (4) focuses on outcomes. DM differs from pharmaceutical care in that pharmaceutical care targets not only patients with specific diseases but also those with risk factors for drug-related problems, a history of nonadherence, and frequent changes in medication regimens. Steps to starting a DM program include: (1) identifying a target population based on the population's strategic importance to the goals and aims of the organization; (2) assessing the organization's available resources, both internal and external; (3) defining key indicators with which to assess the program for the purposes of internal quality control and of obtaining compensation from third-party payers; (4) implementing the program using the best scientific methods available; and (5) assessing the impact of the program. The development of a smoking cessation program at a nationwide retail pharmacy chain is used as an example of a DM program initiated in community pharmacy practice. Pharmacists are well positioned to take a major role in DM, because they are accessible to the community and because DM frequently involves drug therapy. DM is also widely used in managed care. It is important that community pharmacists be closely involved in the DM approach as it evolves.