Jeffrey N. Baldwin

A survey of alcohol and other drug use behaviors and risk factors in health profession students.

This survey assessed the alcohol and other drug (AOD) use habits and risk factors of health profession students at a midwestern university health science center. The authors administered a 75-item survey to 1,707 students in selected classrooms: 984 students responded for a return rate of 57.6%. In 1990, they found, alcohol use among the health profession students in the past year was comparable to that of undergraduate college students nationally (86%), although significantly fewer health profession students drank heavily (27% had five or more drinks in the past 2 weeks, compared with 41% of college students). The percentage of health profession students who reported using tobacco or illicit drugs was lower than the percentage of undergraduate students who used these substances. At the time of the study, 16% of the respondents may have had a potential current alcohol problem and 3.5% a potential drug problem. Pharmacy students most often reported negative consequences from their AOD use. Peer pressure influenced the drinking decisions of 55% of the respondents; students in dentistry and pharmacy experienced the least support from peers for their decisions to abstain from drinking. Family histories of alcohol problems were reported by 38% of the respondents, and family histories of drug use by 14.8%. Male health profession students, when compared with the female professional students, drank more and experienced more consequences of their drinking or drug use and were also more influenced by peers.

Assessment of Alcohol and Other Drug Use Behaviors in Health Professions Students.

Abstract Alcohol and other drug (AOD) use behaviors of health professions students (HPS) were assessed by surveying both university-based HPS and other nursing programs in a Midwestern state in 1999. Response was 2,646 (56.4%) of surveyed students. Family history of alcohol-related and drug-related problems were reported by 39.8% and 13.9%, respectively, with 42.6% of respondents reporting one or both. Among nursing respondents, 48.1%, 19.2%, and 51.1%, respectively, reported family problems with alcohol, drugs, or one or both. Past-year alcohol use was comparable to undergraduate college students (UCS) nationally (83%); heavy drinking, tobacco, and recreational drug use by HPS were lower. Past year drug use was highest among medical students. Marijuana was the predominant illicit drug; medical students and males most often reported use. Health professions educational systems should proactively address student AOD prevention, education, and assistance needs.

Cultivating 'habits of mind' in the scholarly pharmacy clinician: report of the 2011-12 Argus Commission.

The American Association of Colleges of Pharmacy (AACP) Argus Commission is comprised of the five immediate past AACP presidents and is annually charged by the AACP President to examine one or more strategic questions related to pharmacy education often in the context of environmental scanning. Depending upon the specific charge, the President may appoint additional individuals to the Commission. President Crabtree requested that the 2011-12 Argus Commission examine the following questions as part of his examination of critical issues of excellence and relevance in academic pharmacy: • What is core with respect to the scientific foundation of clinical education? • How and when do we teach this foundational material? • How can we infuse an attitude of inquisitiveness and scholarly thinking in pharmacists and other health care professionals? • How can we nurture emerging scientists among our students and young faculty? • What ultimately will keep our graduates from being technicians vs. professional clinicians? The work of the Argus Commission was advanced significantly by examining related reports and projects from outside pharmacy and from engaging in dialogue with education leaders across the health professions. When the Commission met in December 2011 they were joined by leaders from academic dentistry, allopathic and osteopathic medicine, nursing, optometry, physicians assistant, public health, veterinary medicine and health administration programs. The meeting began with a presentation by Cynthia Bauerle, Ph.D., Senior Program Officer for PreCollege and Undergraduate Science Education at the Howard Hughes Medical Institute (HHMI) based in Chevy Chase, MD. HHMI and the Association of American Medical Colleges have collaborated on several projects to ensure that the scientific foundation for physician education remains contemporary and strong. They jointly published the “Report of Scientific Foundations for Future Physicians Committee”1 in 2009, which the Argus Commission considered carefully in its work. Dr. Bauerle presented an on-going HHMI project referred to as the NEXUS Project2. The National Experiment in Undergraduate Science Education is relevant to all programs in health professions education which depend on the adequate undergraduate preparation of future clinical scientists in core competencies in mathematics, physics, chemistry and biology. This four year project which began in early 2010 involves grantees at four universities (Purdue University, University of Maryland College Park, University of Maryland Baltimore County and the University of Miami) and draws heavily upon the scientific foundations for future physicians report as the project teams work to significantly modify the pedagogical approach for teaching and assessing learning in the fundamental building blocks of science at the undergraduate level. Throughout the full day meeting and subsequent analysis by the Argus Commission, participants acknowledged the continuum of learning and competency attainment so vital to ensuring that future pharmacists and colleagues across the spectrum of the health professions are inquisitive learners and problem solvers comfortable in applying both the scientific method and evidence-based content to the identification and resolution of clinical issues/problems at the individual patient and population levels. This begins far down the pipeline in pre-collegiate education and continues throughout the period of pre-professional and professional education with an ultimate goal of creating a scientific thinker with the requisite abilities to apply that knowledge in practice.

Survey of Alcohol and Other Drug Use Attitudes and Behaviors in Nursing Students

ABSTRACT Statewide nursing student alcohol and other drug (AOD) use attitudes and behaviors were assessed. Response was 929/2017 (46%) (practical nursing [n = 173/301] 57.3%; diploma and associate degree in nursing [n = 282/417] 67.6%; bachelor of science in nursing [n = 474/1299] 36.5%). Nearly 44% reported inadequate substance abuse education. Past-year AOD use included tobacco 36.9%, marijuana 6.8%, sedatives 4.6%, and opioids 2.6%. Past-year AOD-related events included blackouts 19.8%, class/work under the influence 6.3%, patient care under the influence 3.9%, lowered grades/job evaluations 6.6%, and legal charges 3.6%. Heavy drinking was reported by 28.9%. Practical nursing (PN) students most often reported tobacco use and sedative use, whereas Bachelor of Science in nursing (BSN) students most often reported marijuana use. Family histories of alcohol-related problems and drug-related problems were reported, respectively, by 48.1% and 19.2% of respondents; 51.1% reported at least one of these. PN students most often reported such family histories. Nursing educational systems should proactively address student AOD prevention, education, and assistance.

Substance Use Attitudes and Behaviors at Three Pharmacy Colleges.

The objective of this study was to profile and compare alcohol and other drug (AOD) use attitudes and behaviors in three pharmacy colleges. Student surveys of AOD use attitudes and behaviors were conducted at one southwestern and two midwestern pharmacy colleges. Response was 86.5% (566/654). Reported past-year use included alcohol 82.8%, tobacco 25.4%, and marijuana 6.9%. Past-year AOD-associated events included blackouts 18.2%, class or work under influence 7.8%, patient care under influence 1.4%, lowered grades or job evaluations 5.8%, legal charges 2.7%, and heavy drinking 29.0%. Family histories of alcohol or drug problems were reported by 35.5% and 13.1%, respectively. A number of significant differences in AOD use attitudes and behaviors between the three colleges were identified. Pharmacy students reported a number of risky drug-use attitudes and behaviors in this survey. Student AOD prevention, assistance, and education should be proactively addressed by pharmacy colleges.

Substance Use Disorders in Health Care Professionals

In light of the publics trust, their advanced education, and responsibilities to the public, health care professionals are generally expected by the public to be unaffected by the substances they understand so well, prescribe, dispense and administer. However, like the general population, recent reports to the contrary have highlighted alcohol and drug abuse by health care workers. While understudied, drug abuse by health care professionals is not a new issue as most evidence supports the notion that a small but significant proportion of health care professionals such as dentists, physicians, pharmacists and nurses do use alcohol, tobacco and other addictive drugs resulting in serious consequences to themselves and to the public. A general review of the literature finds that studies of substance use and abuse by health care professionals have often used unreliable outcome measures of substance use, surveyed only one or two of the health professions, used a self-select group or have not studied dentists. The evidence suggests, however, that: (1) past-year use of alcohol and tobacco by health care professionals is less than reported by age-matched samples from the general population; (2) self-reported lifetime drug use by health care professionals is no more than that of the general population, but with greater reported use of prescription medications rather than recreational drugs by health care professionals; and (3) alcohol, tobacco and drug abuse vary somewhat according to the given profession with each health care group having distinct temporal substance abuse histories. Highlighting the various aspects of substance abuse by health care professionals should be a continual educational process starting in college and continuing throughout a clinician’s career.

Serum Theophylline Levels in Young Children Receiving a Sustained-Release Theophylline Tablet

This study indicates that a sustained-release tablet may be used in certain young children on an every-12-hr dosing schedule with acceptable serum theophylline fluctuation. Many young children are able to swallow the tablet and dosing increments are convenient.

Roles of the Pharmacy Academy in Informing Consumers about the New American Pharmacist: 2010-2011 Argus Commission Report

The AACP Argus Commission is comprised of the five immediate past AACP presidents and is annually charged by the AACP President to examine one or more strategic questions related to pharmacy education often in the context of environmental scanning. Depending upon the specific charge, the President may appoint additional individuals to the Commission. The 2010-2011 Argus Commission was charged to examine how AACP and its members can engage with appropriate consumer and payer groups to increase awareness of “the new American pharmacist” and the pharmacists role and value in patient-centered care. President Carter emphasized that although increasing public awareness will require broad action by all pharmacy organizations, the Argus Commission was to focus their discussions on the unique roles of the Pharmacy Academy in increasing public awareness about “the new American pharmacist” as compared to what other professional organizations may contribute. The following individuals were invited to participate in the discussions with the Argus Commission: Artem Gulish (Citizen Advocacy Center), Marsha Henderson, MCRP (Office of Womens Health, Food and Drug Administration), and Karen Williams (Office of Womens Health, Food and Drug Administration). In preparation of the Argus Commission meeting, these participants were informed that pharmacist roles have changed and that pharmacy educators need to identify the Academys role in increasing consumer awareness. In preparation of the meeting, Commission members read the article by Worley, et al., which reported the results of a study that investigated both patient and pharmacist views about what patients and pharmacists expect of each other in the patient-pharmacist relationship.1 This study reported that both patients and pharmacists have similar views about the pharmacists role in sharing information such as how to watch for medication side effects and whether a medication should be taken with over-the-counter products. However, patients agreed less about pharmacist behaviors such as showing interest in working with patients to meet their health needs and communicating a desire to help patients with their medication concerns. Patients also had less agreement about the pharmacists role in providing a patient-centered relationship such as being approachable when a patient wants to discuss medication concerns. There was also less agreement among patients about the pharmacists role in interpersonal communications such as greeting patients at the prescription counter and taking prescription information. Furthermore, patients had less agreement about the role of the pharmacist in general healthcare communications such as pharmacist availability when patients call the pharmacist via phone to discuss a new medication question. Argus Commission members also reviewed resources from the Patient Safety and Clinical Pharmacy Services Collaborative which included documents communicating the new roles of pharmacists and patient-focused information.2 Articles summarizing the current roles of pharmacists and the value they bring to patient care were also reviewed. Specifically, the 2009-2010 Professional Affairs Committee Report provided a summary of evidence supporting pharmacist integration in primary care practice within community settings where there were also partnerships with patients and other healthcare service providers.3 The recent study by Kassam et al. stimulated Argus Commission members to think about the role of practice experiences in helping the profession increase consumer awareness about the roles of the pharmacist.4 This study compared patients’ expectations and experiences at pharmacies offering traditional APPE learning opportunities to APPEs which provided pharmaceutical care learning activities and found significantly higher in-store satisfaction and fewer service gaps in the later. Several other publications that highlighted the value of pharmacists were also reviewed. A report by the National Association of Chain Drug Stores provided a review of how pharmacies are improving health and reducing costs.5 The recent article by Chisholm-Burns et al. which provided evidence that pharmacists positively impact patient care also provided the Argus Commission with insights.6 The Commission noted this article was published in Medical Care and provided readers such as health systems leaders, payers, health-care CEOs and CFOs with greater awareness about the role of the pharmacist. As the Argus Commission members read this article, they realized the importance of informing healthcare leaders outside the pharmacy profession and the value of having faculty write publications outside the pharmacy profession as a means for communicating to others about the role of “the new American pharmacist.”6 The Argus Commission meeting initially focused on the roles of “the new American pharmacist” and reasons why the public has a low awareness about the value of pharmacists in improving medication therapy outcomes of patients. Discussions then addressed how pharmacy educators can promote greater awareness among consumers, healthcare payer groups, and other stakeholders.

Evaluation of a Sustained-Release Theophylline Tablet in Young Asthmatics

A sustained-release theophylline (SRT) tablet was evaluated in 15 children with moderately severe asthma between the ages of 3 and 5 years (4.2 +/- 0.83 years). They received a mean daily dose of 20.4 mg/kg given q12h for 3 or more weeks with daily symptom scores and twice daily peak flow rates (PFR) measured. Serum theophylline levels (STL) were then obtained at 0, 1, 2, 4, 6, 8, 10, and 12 hr (eight children had 24-hr samples obtained), along with PFRs every 3 hr. The mean peak STL (x +/- SD) was 16.6 +/- 4.4 and the trough was 5.9 +/- 2.8, with a peak-trough difference of 10.6 +/- 3.9. The average time to peak level was 3.9 hr. The mean +/- SD clearance was 1.42 +/- 0.63 ml/kg per min and the apparent T1/2 was 5.11 +/- 1.34 hr. The average weekly morning PFR for the 3-week period ranged from 116.8 +/- 41.2 to 127.4 +/- 37.4 L/min, and the evening PFT ranged from 126.5 +/- 38.4 to 137.0 +/- 40.9 L/min. In conclusion, the SRT tablet is effective in treating many young asthmatics on a 12-hr dosage schedule. For some children who experience excessive peak-trough differences, an 8-hr dosage schedule may be indicated.

The Revolution Continues.

It is hard for me to believe that it has been 12 months since I stood before you as your 2009-2010 president, encouraging you to explore opportunities, expand our educational and professional horizons, and ‘‘Lead the Revolution’’! I described several major initiatives that would be priorities during my presidential year. These were: * Faculty recruitment and retention and assessment services as issues ‘‘Z-1’’ and ‘‘Z-2’’; * Curricular reform and global pharmacy education as issues ‘‘Y-1’’ and ‘‘Y-2’’; and * Primary care as issue ‘‘X.’’ I will quickly summarize the progress that the American Association of Colleges of Pharmacy (AACP) has made over the past year on our strategic agenda as we worked to expand our horizons in academic pharmacy and healthcare. First, having sufficient numbers of well-qualified faculty members will always be a priority for our members and for AACP. Building upon our successful regional and national meeting exhibit program, AACP rolled out ‘‘American Pharmacy Educator Week’’ during American Pharmacists Month in October. Each college or school of pharmacy received a kit filled with resources to help you host events, mentor or adopt a student pharmacist and communicate that academic pharmacy is an excellent and exciting career choice. By all accounts, events and programs were well received and appreciated by faculty, staff and students alike. I am pleased that the AACP Board of Directors has unanimously agreed to continue with the program and the second annual ‘‘American Pharmacy Educator Week’’ will be held during the last week of October 2010. I hope that your college or school will actively participate this year, and that you will continue these and other efforts to stimulate many of our doctor of pharmacy (PharmD) and graduate students to consider academic pharmacy as their career. I selected the issue of primary care as the highest priority area for new activity within AACP’s agenda this past year. With health reform decidedly on the horizon, my goal was to have several key committees examine the contributions pharmacists could make to expanding access and improving the quality of primary care services for our patients. What an exciting journey it turned out to be at an opportune time in history! With the passage of reform legislation in March, more than 30 million people will soon have access to care that was not previously possible. However, all acknowledge that our current care systems are not ready to accommodate this bolus of patients with primary care needs. The Professional Affairs Committee was charged to examine the evidence for pharmacists’ integration into primary care practice and provide analysis of current and potential care delivery models. In response, the committee, chaired by Dr. Seena L. Haines, conducted an extensive literature search that revealed more than 150 articles that were then analyzed to depict each article’s connection to academic pharmacy, practice setting, onsite health providers, outcomes observed, and standard demographics. The analysis provides a firm demonstration to the Academy and others that the pharmacist’s role in primary care is evidence-based; the committee used the findings to describe pockets of excellence for pharmacy as the nation looks toward the future of the PatientCentered Health Home. Finally, the report builds upon the 1994 Professional Affairs Committee policy statements that pharmacists are essential figures in primary care and puts forth several recommendations for the Academy to serve as the leader for the research agenda for pharmacists in primary care. The second committee charged in studying primary care was our Advocacy Committee, chaired by Dr. Nancy DeGuire. They addressed our ability to align education to support and enhance the strategic goals of the federal government’s agencies focused on meeting the public need for primary healthcare. Evidence generated by faculty members at dozens of colleges and schools of pharmacy led to the inclusion of medication therapy management (MTM) in the Patient Protection and Affordable Care Act. Faculty members responded to a call for research related to improved health outcomes through increased access to MTM. The evidence helped convince congressional staff members that MTM is an essential tool for improving the quality of care. MTM can be found in a number of provisions American Journal of Pharmaceutical Education 2010; 74 (8) Article 153.