Incorporation of Innovative Strategies for Patient Education in Pharmacist-Led Transition of Care Initiatives

As patients transition between health care settings, they are at an increased risk of adverse events and medication errors as a result of medication changes and miscommunication. Pharmacists have traditionally provided transitions of care (TOC) services, including patient education, in a face-to-face manner with the goal of reducing medication errors and enhancing patient safety and understanding. However, changes in care delivery models, a burdened health care workforce, and diminishing resources necessitate innovative approaches for the provision of patient education within TOC. Pharmacists should consider novel approaches to expand scope, reduce barriers, and creatively use existing resources to optimize patient education in TOC.

A Scoping Review of Student Pharmacist-Led Transitions-of-Care Initiatives

OBJECTIVES

To identify and evaluate the current literature pertaining to student pharmacist-led transitions-of-care (TOC) initiatives and to inform pharmacy educators regarding the current and future roles of pharmacy learners in TOC.

FINDINGS

A total of 14 articles were identified describing student-led initiatives in care transitions to the inpatient setting and from the inpatient to the outpatient setting. In most studies, student pharmacists involved in delivering TOC services were completing either an advanced pharmacy practice experience or an introductory pharmacy practice experience and were most commonly performing services such as admission medication history and reconciliation. The studies evaluated the impact of student-led TOC services through the identification or resolution of medication-related problems, interventions, and/or discrepancies and included limited and conflicting results pertaining to patient care-based outcomes.

SUMMARY

Student pharmacists are involved in delivering and leading a variety of TOC services in the inpatient setting and postdischarge period. These student-led TOC initiatives not only provide added value to patient care and the health system but also enhance students' preparation and readiness for pharmacy practice. Colleges and schools of pharmacy should incorporate learning experiences into the curriculum that equip students to contribute to TOC efforts and promote continuity of care across the health system.

Development of a script concordance test to assess clinical reasoning in a pharmacy curriculum

INTRODUCTION

Clinical reasoning is a vital skill for student pharmacists in the provision of patient-centered care, but these skills are often difficult to assess in the didactic curriculum. A script concordance test (SCT) is an innovative assessment method that can be used to assess clinical reasoning skills. The objective of this study was to develop and refine an SCT to assess clinical reasoning skills of third year student pharmacists (P3s).

METHODS

An SCT was written and administered to P3s. Pharmacy practice faculty members served as the expert group. The SCT was scored and Rasch analysis was performed.

RESULTS

The SCT included 20 case vignettes and 60 questions. Test reliability was 0.34 with mean square values for all items between 0.7 and 1.3. Forty-two questions had a difficulty score between 0 and - 1 logits, indicating there were multiple questions with similar difficulty levels. Two case vignettes and 43.3% of questions (n = 26) were revised to enhance clarity and decrease ambiguity.

CONCLUSIONS

The SCT is a tool to assess clinical reasoning in the didactic curriculum. Faculty can create the SCT and use statistical methods such as Rasch analysis to assess validity and reliability of the SCT.

Use of Digital vs Printed Posters for Teaching and Learning in Pharmacy Education

Objective. To characterize student pharmacists' perceptions of the use of posters as a learning tool and their preferences regarding digital posters compared to printed posters for presentation and review.Methods. Student pharmacists presented and peer-reviewed posters in a digital format using a tablet and an overhead monitor or in a printed format mounted on a poster board. The perceptions of two cohorts of pharmacy students were characterized by comparing their responses on pre- and post-activity surveys.Results. The pre- and post-activity surveys were completed by 543 students (95.3%) in the 2017-2018 academic year and 553 students (97%) in the 2018-2019 academic year, respectively. Over 95% of students perceived that the poster activity enhanced their poster creation, literature evaluation, and communication skills, while also improving their learning of pharmacy-related topics. There was a significant increase on the post-activity survey in the number of students who preferred the digital poster format, with students indicating that the digital format was straightforward (87.3%), enhanced their presentation (77.2%), and promoted learning (70.5%).Conclusion. Poster presentations provide a platform for the dissemination and discussion of topics and allow students to improve their presentation and communication skills. Digital posters represent a convenient, cost-effective, and preferred presentation method for pharmacy students compared to printed posters.

A Survey of Provider-Reported Use and Perceived Effectiveness of Medications for Symptom Management in Telemedicine and Outpatient Visits for Mild COVID-19

INTRODUCTION

Many patients with mild coronavirus disease 2019 (COVID-19) have symptoms requiring acute and follow-up care. The aims of this study were to assess (1) provider-reported use of medications and their perceived effectiveness and (2) degree of difficulty managing specific symptoms at episodic COVID-19 care sites and in a longitudinal monitoring program.

METHODS

We sent an online survey to physicians, advanced practice providers, and registered nurses redeployed to COVID-19 care sites at an academic medical center from March to May 2020. We asked about the use of medications and perceived effectiveness of medications to treat symptoms of COVID-19 and the perceived challenge of symptom management. Comparison was made by provider type (episodic or longitudinal site of care).

RESULTS

Responses from 64 providers were included. The most frequently used medications were acetaminophen (87.1% of respondents), benzonatate (83.9%), and albuterol metered dose inhalers (MDI) (80.6%). Therapies for lower respiratory tract symptoms were reported as more commonly used by longitudinal follow-up providers compared to episodic providers including guaifenesin (90.6% vs 60.0%, p = 0.007), benzonatate (93.8% vs 73.3%, p = 0.04), nebulized albuterol for patients with asthma (75.0% vs 43.3%, p = 0.019), and albuterol MDIs for patients without asthma (90.6% vs 66.7%, p = 0.029). Medications found to have the highest perceived efficacy by respondents using the therapy (> 80% reporting "very efficacious") included albuterol, acetaminophen for fever, non-sedating antihistamines, nasal steroid spray, and non-steroidal anti-inflammatory drugs (NSAIDs) for myalgia, arthralgia, or headache. Lower respiratory symptoms and anxiety were rated as the most challenging symptoms to manage.

CONCLUSIONS

Providers reported that clinical care of mild COVID-19 with medications in common use for other respiratory infections is effective, both at episodic care and longitudinal sites of care, but that specific symptoms are still challenging to manage.

Facilitation of a multisite student topic discussion series using web-based conferencing technology

INTRODUCTION

While technology's use and impact in the classroom setting is well-documented in literature, use during experiential education is less defined. Our objectives were to assess the change in clinical knowledge and application skills following a multisite topic discussion (TD) series using web-based conferencing technology during ambulatory care advanced pharmacy practice experiences (APPEs) and to assess student perceptions of learning through use of this modality.

METHODS

A multisite TD series was created using web-based conferencing technology for students assigned to a clinical faculty member's ambulatory care APPE. Five topic discussions were conducted during each five-week rotation block covering disease states integral to ambulatory care practice. Pre- and post-assessments were administered to assess student learning and a survey was administered to assess student perceptions of learning.

RESULTS

A total of 151 students were invited to participate in the study with 114 (75.5%) included in the final analysis. Overall student performance improved significantly from 53.3 ± 12.7% on the pre-assessment to 65.8 ± 14.3% on the post-assessment, with student performance on the post-assessment improving significantly in all topic areas. Students perceived that the TD series enhanced their learning and ability to apply clinical information while creating an online learning community.

CONCLUSIONS

The addition of a multisite TD series using web-based conferencing technology successfully enhanced student knowledge. Student perceptions of this new web-based learning community were positive overall, despite some technological limitations. The results of this study support the use of web-based conferencing technology to enhance student learning during APPEs.

Professional development series in postgraduate pharmacy residency training: Experiences and opportunities

INTRODUCTION

The American Society of Health-System Pharmacists (ASHP) identifies competency areas that categorize clinical and non-clinical skills to develop during postgraduate residency training. To address the competency areas related to non-clinical skills, some residencies have developed programs to focus on interpersonal, leadership, and other professional skills. There is limited guidance in the literature regarding the development or impact of these programs.

PERSPECTIVE

Professional development series have been implemented at two academic institutions to support the development of non-clinical skills during postgraduate residency training. While these programs address many of the non-clinical skills described in the competency areas, barriers such as program support, logistics, and need for assessment may impede the creation, growth, and success of similar programs.

IMPLICATIONS

With the continued increase in the number of residency programs and trainees, scalability and sustainability are vital components for the success of professional development programs. Assessment of the impact of current programs and further guidance from pharmacy organizations regarding important aspects of professional development would help standardize this process.

Primary Prevention of Atherosclerotic Cardiovascular Disease

A new guideline for the treatment of blood cholesterol was recently released by the American College of Cardiology (ACC) and the American Heart Association (AHA), serving as an update to the National Cholesterol Education Program’s (NCEP) Adult Treatment Panel III cholesterol guideline first released in 2001. With significant changes to key definitions, treatment strategy, and therapy selection, the guideline has transformed the treatment of blood cholesterol and also created controversy within the health care community. This controversy is largely focused on appropriate identification and treatment of patients for the primary prevention of atherosclerotic cardiovascular disease (ASCVD). Whereas statins play an integral role in the treatment and secondary prevention of ASCVD, their use for primary prevention is less clearly defined. It is imperative that health care providers are well versed in the concepts and controversies of the new guideline recommendations for primary prevention of ASCVD and can effectively assess the risks and benefits of statin therapy in this patient population.