Amy Werremeyer

A Medical Mission to Guatemala as an Advanced Pharmacy Practice Experience

Objective. To describe the development and outcomes of an advanced pharmacy practice experience (APPE) for a medical mission trip to Guatemala. Design. Pre-mission preparation and post-mission reflection activities were combined with in-country activities to create a 5-week APPE. During the 10-day medical mission trip, pharmacy students dispensed medications, counseled patients, conducted quality improvement assessments, and presented their findings and experiences as part of an interdisciplinary health care team. Assessment. The students who completed the mission trip met the objectives of the APPE and reported substantial learning in the areas of interdisciplinary teamwork and cultural competency. All students’ scores on the Inventory for Assessing the Process of Cultural Competence—Student Version (IAPCC-SV) increased. The majority (81%) of student-generated quality improvement recommendations were implemented by the mission team. Conclusions. The medical mission APPE provided a rich learning environment for pharmacy students and resulted in modifications to the medical mission operation. This type of APPE could be implemented in other colleges of pharmacy via formation of partnerships with established medical mission teams as this one was.

Poster Project to Emphasize Public Health in the Pharmacy Curriculum

Objective. To implement and assess a required public health poster project in a doctor of pharmacy (PharmD) program. Design. Third-year PharmD students collaborated in pairs to research a public health topic relating to pharmacy practice. Each student group prepared an informational poster, while receiving feedback from a faculty mentor at each stage of the project. The students presented their completed posters at a statewide pharmacy conference. Assessment. Faculty members evaluated the posters with a grading rubric, and students completed a survey instrument that assessed the overall experience. In general, faculty members rated the class highly across all domains of the grading rubric. The class generally agreed that the poster project increased their awareness of public health issues related to pharmacy practice, overall knowledge of public health, and presentation skills. Conclusion. The implementation of a poster project was well received by students and faculty members as an effective method for enhancing public health instruction in the PharmD program at North Dakota State University.

Depression Screening in Diabetes Care to Improve Outcomes: Are We Meeting the Challenge?

Purpose Evidence-based guidelines recommend regular depression screening among individuals with type 2 diabetes mellitus (T2DM). The purpose of this study is to examine depression screening patterns among a primary care population with T2DM, through use of the Patient Health Questionnaire-9 (PHQ-9). Methods In total, 1817 patients with T2DM were analyzed through a retrospective observational study at 2 sites, a regional health center and a federally qualified health center (FQHC). The T2DM sample was divided into those with and without a major depressive disorder (MDD) diagnosis. Depression screening rates and depression severity were assessed through the PHQ-9. Results Both sites had higher rates of PHQ-9 screening among individuals with a history of MDD (64.82%) vs those without MDD (11.39%). Individuals from the FQHC without a history of depression had a higher mean PHQ-9 score (10.11) than those with a previous MDD diagnosis at both RHS and FQHC (7.16 and 9.85, respectively). Conclusions Depression screening rates among individuals with diabetes and no history of MDD were remarkably low. Patients with diabetes but no MDD diagnosis who sought health care at a FQHC clinic had more depressive symptoms than those with a history of MDD at both sites. Individuals with diabetes and who have a MDD diagnosis are much more likely to receive regular depression screening than those without MDD, which leaves a substantial proportion of patients with undetected depression. Depression screening must be enhanced for all individuals with diabetes, particularly for low-income individuals and those without a previous diagnosis of MDD.

Use of the 9-Item Patient Health Questionnaire for Depression Assessment in Primary Care Patients With Type 2 Diabetes

The purpose of the current study was to assess the frequency and distribution of the 9-Item Patient Health Questionnaire (PHQ-9) among individuals with type 2 diabetes with and without depression. The current case-control study used electronic medical record data from two primary care institutions. The sample was divided into cases with coexisting depression and type 2 diabetes and controls without depression. Data included demographics, biomarkers, number of services delivered, and clinic visits in 2013. Similar PHQ-9 use was seen between unique primary care practices. However, less than one third of patients at either site received depression screening with the PHQ-9 in 2013. Male and older adult patients were less likely to receive assessment. Guideline ambiguity and lack of accountability in primary care practice has made the use of depression metrics arbitrary in diabetic populations at risk for depression. To assure adequate care provision, it is imperative that proven tools for assessing depressive symptoms are used.

Disease Control Among Patients With Diabetes and Severe Depressive Symptoms.

Objective: Major depressive disorder and type 2 diabetes commonly co-occur and disease control tends to be poorer when both conditions are present. However, little research has examined the disease characteristics of patients with diabetes and more severe depressive symptoms. Methods: We report a retrospective observational study of 517 patients with diabetes from 2 primary care centers. Patients with diabetes and moderately-severe/severe depression symptoms (Patient Health Questionnaire [PHQ-9] score >15) were compared with patients with diabetes without moderate or severe depression symptoms (PHQ-9 score <15; the comparison group) with regard to control of diabetes, blood pressure, and lipid parameters. Frequency of HbA1c and PHQ-9 testing were also examined. Results: Patients with diabetes and moderately severe/severe depressive symptoms had higher HbA1c (7.56% vs 7.09%), diastolic blood pressure (78.43 vs 75.67 mm Hg), and low-density lipoprotein cholesterol (109.12 vs 94.22 mg/dL) versus the comparison group. Patients with diabetes and moderately-severe/severe depression underwent HbA1c and PHQ-9 testing with similar frequency to the comparison group. Conclusions: The presence of moderately severe/severe depressive symptoms was associated with poorer glucose, lipid, and blood pressure control among patients with diabetes. Further research should prospectively examine whether a targeted depression treatment goal (PHQ-9 score <15) in patients with diabetes results in improved control of these important disease parameters.

Pharmacist provision of patient medication education groups

In the United States, medication nonadherence accounts for 10% of all hospital admissions and 33–69% of medication-related admissions, resulting in direct costs of

Exploration of Learning during an International Health Elective Using Photovoice Methodology

100–

Self-stigma of antidepressant users through secondary analysis of PhotoVoice data

289 billion annually.[1][1]–[6][2] Inadequate information about medication and a lack of understanding are barriers to

Use of Photovoice to Understand the Experience of Taking Psychotropic Medications

Based on surveys and structured interviews, International Health Experiences (IHEs) improve cultural sensitivity, communication, and self-confidence among health professions students. However, open-ended methods to explore student learning during an IHE are not widely utilized. We sought to explore pharmacy student-identified learning during an IHE in an open-ended fashion using Photovoice methodology. Pharmacy students on an IHE in Guatemala were given disposable cameras and asked to photograph images that reflected their learning. Through the application of Photovoice methodology students captured, reflected upon, and presented photos to describe the learning they experienced. Themes were drawn from the reflective and focus group data collected. During three IHEs, six students captured seventy-seven photos. Four main learning themes emerged: culture/cultural competence, professional growth, shifting of attitudes, and meaningful/emotional experiences. Pharmacy students documented learning in expected (cultural competence, professional growth) and unexpected (emotional experiences) domains during an IHE. Photovoice may be an effective methodology for the exploration of learning, allowing students to capture their own learning including and beyond what is expected by their instructors.

Use of an Auditory Hallucination Simulation to Increase Student Pharmacist Empathy for Patients with Mental Illness

Introduction: Aspects of self-stigma and medication-related stigma among individuals with depressive disorders remain largely unexplored. The primary objective of this study is to highlight and characterize self-stigma and medication-related stigma experiences of antidepressant users. Methods: This is a secondary analysis of data obtained from PhotoVoice studies examining psychotropic medication experiences. Transcripts of reflections from 12 individuals self-reporting a depressive disorder diagnosis and receipt of a prescription for an antidepressant were included. A directed content analysis approach based on expansion of the Self-Stigma of Depression Scale and an iterative process of identification of medication-stigma and stigma-resistance were used. Total mentions of self-stigma, stigma resistance, medication stigma, and underlying themes were tallied and evaluated. Results: Self-stigma was mentioned a total of 100 times with at least 2 mentions per participant. Self-blame was the most prominent construct of self-stigma and was mentioned nearly twice as often as any other self-stigma construct. Most participants also made mentions of self-stigma resistance. Half of the individual participants mentioned stigma resistance more times than they mentioned self-stigma, which suggests some surmounting of self-stigma. Medication-related stigma was also prominent, denoting negativity about the presence of medications in ones life. Discussion: Self-stigma related to self-blame may be problematic for antidepressant users. Identification and measurement of stigma resistance, especially in peer interactions, may represent a promising concept in overcoming self-stigma. Future work should explore emphasizing self-blame aspects when designing interventions to reduce self-stigma among individuals with depressive disorders and explore development of tools to measure stigma resistance.