Megan N. Willson

Using Human Patient Simulation to Prepare Student Pharmacists to Manage Medical Emergencies in an Ambulatory Setting

Objective. To implement a simulation-based educational experience focused on medical emergencies in an ambulatory pharmacy setting. Design. Second-year student pharmacists were assigned randomly to groups and played the role of pharmacists in a community pharmacy setting in which a simulated patient experienced 1 of 5 emergency scenarios: medication-related allergic reaction, acute asthma attack, hypoglycemia, myocardial infarction, and stroke. The students were expected to use patient assessment techniques to determine which emergency the simulated patient was experiencing and the appropriate intervention. Following each simulation, a debriefing session was conducted. Assessment. Eighty-two student pharmacists completed the simulation activity. Ninety-three percent of student groups correctly identified the emergency. A post-activity survey instrument was administered, and 83% of responders indicated this activity was effective or very effective. Conclusion. Simulation of emergencies seen in an ambulatory pharmacy setting allowed students to assert knowledge, practice communication skills, apply assessment techniques, and work as a team in a low-risk environment.

Predicting potential postdischarge adverse drug events and 30-day unplanned hospital readmissions from medication regimen complexity.

Objectives To determine whether medication regimen complexity (MRC) could predict likelihood for occurrence of potential adverse drug events (ADEs), unplanned 30-day hospital readmission, or 30-day emergency department use in patients transitioning from hospital to home care. Methods Hospital discharge medication lists and medication lists constructed during visits to patients’ homes were analyzed for 213 participants. MRC was quantified with the Medication Regimen Complexity Index (MRCI). The potential for ADEs was based on medication discrepancies detected between the discharge and patient reported home medication lists. Unplanned acute care utilization in the 30 days after index hospitalization was tracked. Logistic regression analyses were used to approximate the odds for an ADE and postdischarge acute care utilization from MRCI scores. Results Home medication lists were less complex than hospital discharge medication lists. High home medication list MRCI scores increased the odds more than 4-fold for a potential ADE (P < 0.001). High discharge medication list MRCI scores increased the odds more than 5-fold for an unplanned 30-day hospital readmission (P = 0.026). High regimen complexity did not significantly elevate odds for emergency department use. Conclusions MRC was predictive of patients’ potential for ADEs and unplanned hospital readmission. MRC may be useful in identifying patients that would benefit from additional transitional care interventions. Results indicate that simplifying medication regimens may favorably impact postdischarge outcomes.

Ethnicity/race, use of pharmacotherapy, scope of physician-ordered cholesterol screening, and provision of diet/nutrition or exercise counseling during US office-based visits by patients with hyperlipidemia.

BackgroundElevation of serum cholesterol, or hyperlipidemia, is recognized as one of the major modifiable risk factors in the development of atherosclerosis and cardiovascular disease. On a US population basis, there has been a downward trend in total- and LDL-cholesterol levels, and an increase in cholesterol screening. Nevertheless, previous research suggests that there remain racial/ethnic disparities in the access to and quality of care for hyperlipidemia.ObjectiveThe aim of this study was to examine the extent of racial/ethnic disparities in the provision of pharmacotherapy, cholesterol screening and diet/nutrition or exercise counseling during US office-based physician-patient encounters (visits) by patients with hyperlipidemia.MethodsWe examined data from the 2005 US National Ambulatory Medical Care Survey for office-based visits for hyperlipidemia for patients aged ≥20 years in terms of prescribing for hyperlipidemia, and the ordering/provision of cholesterol testing, diet/nutrition counseling, and exercise counseling.ResultsUse of pharmacotherapy for hyperlipidemia varied by ethnicity/race (χ2, p<0.05). Physician-ordered/provided cholesterol screening occurred in 44.2% of all office-based visits; 46.5% for Whites, 35.4% for Blacks, and 30.3% for Hispanics (χ2, p< 0.05). Diet/nutrition counseling was ordered/provided in 39.7% of office-based visits; 40.4% for Whites, 32.6% for Blacks, and 39.0% for Hispanics (χ2, p<0.05). Exercise counseling was ordered/provided in 32.1% of office-based visits; 32.7% for Whites, 27.2% for Blacks, and 30.6% for Hispanics (χ2, p<0.05).ConclusionThese findings reveal a disparity in use of pharmacotherapy for hyperlipidemia, physicianordered/provided cholesterol screening, diet/nutrition counseling, and exercise counseling by ethnicity/race. Further research is required to discern, in greater detail, reasons for the observed differences reported, and to ensure equitable access to established standards of care.

Telephone Coaching to Improve Diabetes Self-Management for Rural Residents

L ow-cost methods are desperately needed for improving diabetes management for people with diabetes in rural communities. With this understanding, the research team designed a project that used student pharmacists as coaches. High rates of diabetes and its complications in many rural communities point to these sites as diabetes hot spots.1 In Washington States diabetes hot-spot communities, 17% of people > 45 years of age have diabetes on average, compared to 8.6% of people ≥ 45 years of age statewide. In one remote rural community, 40% of the population has diabetes. People in diabetes hot-spot communities also have higher rates of hospitalizations for severe diabetes complications. Controlling diabetes to reduce the incidence of its complications rests largely on individual patients and requires vigorous self-management of the disease.2 Unfortunately, without sustained support, few people achieve their goals or master the tasks that will allow them to live healthfully and reduce their risk of costly complications.3 Telephone follow-up for education and support has been shown to be a cost-effective method for improving healthy lifestyle behaviors in a variety of conditions, including diabetes.4-7 This project tested the use of brief telephone coaching sessions to improve the health of rural residents with diabetes by helping them achieve diabetes self-management goals for regular medical care and adherence to medication, diet, and physical activity regimens. Specifically, the research intent was to determine whether: 1. Participants would be better able to implement self-management tasks and reduce their risk of diabetes complications compared to a historical control group not receiving coaching, 2. Faculty and staff at the Washington State University (WSU) Extension and College of Pharmacy would be able to develop a telephone-coaching program to support additional lifestyle modifications after diabetes education to augment health care in rural areas, and 3. Telephone coaches would be …

Toolkit for US colleges/schools of pharmacy to prepare learners for careers in academia

INTRODUCTION The objective of this article is to provide an academic toolkit for use by colleges/schools of pharmacy to prepare student pharmacists/residents for academic careers. METHODS Through the American Association of Colleges of Pharmac (AACP) Section of Pharmacy Practice, the Student Resident Engagement Task Force (SRETF) collated teaching materials used by colleges/schools of pharmacy from a previously reported national survey. The SRETF developed a toolkit for student pharmacists/residents interested in academic pharmacy. RESULTS Eighteen institutions provided materials; five provided materials describing didactic coursework; over fifteen provided materials for an academia-focused Advanced Pharmacy Practice Experiences (APPE), while one provided materials for an APPE teaching-research elective. SRETF members created a syllabus template and sample lesson plan by integrating submitted resources. Submissions still needed to complete the toolkit include examples of curricular tracks and certificate programs. DISCUSSION AND CONCLUSIONS Pharmacy faculty vacancies still exist in pharmacy education. Engaging student pharmacists/residents about academia pillars of teaching, scholarship and service is critical for the future success of the academy.