Monica L. Miller

Performance outcomes of a pharmacist-managed anticoagulation clinic in the rural, resource-constrained setting of Eldoret, Kenya

Summary.  Background: It is recommended that warfarin therapy should be managed through an anticoagulation monitoring service to minimize the risk of bleeding and subsequent thromboembolic events. There are few studies in Sub‐Saharan Africa that describe warfarin management in spite of the high incidence of venous thromboembolism (VTE) and rheumatic heart disease. Objective: To examine the feasibility of the Moi Teaching and Referral Hospital anticoagulation monitoring service and compare its performance with clinics in resource‐rich settings. Methods: A retrospective chart review compared the percentage time in the therapeutic range (TTR) and rates of bleeding and thromboembolic events to published performance targets using the inference on proportions test. Wilcoxon’s rank sum analyses were used to establish predictors of TTR. Results: For the 178 patients enrolled, the mean TTR was 64.6% whereas the rates of major bleeds and thromboembolic events per year were 1.25% and 5%, respectively. In the primary analysis, no statistically significant differences were found between the results of TTR, major bleeds and thromboembolic events for the clinic and published performance rates. In the secondary analysis, having an artificial heart valve and a duration of follow‐up of > 120 days were positively associated with a higher TTR (P < 0.05) whereas venous thromboembolism, history of tuberculosis, HIV and a duration of follow‐up of < 120 days were associated with having a lower TTR (P < 0.05). Conclusions: The performance of the MTRH anticoagulation clinic is non‐inferior to published metrics on the performance of clinics in resource‐rich settings.

An elective pharmaceutical care course to prepare students for an advanced pharmacy practice experience in Kenya.

Objective. To develop a prerequisite elective course to prepare students for an advanced pharmacy practice experience (APPE) in Kenya. Design. The course addressed Kenyan culture, travel preparation, patient care, and disease-state management. Instructional formats used were small-group discussions and lectures, including some Web-based presentations by Kenyan pharmacists on disease states commonly treated in Kenya. Cultural activities include instruction in conversational and medical Kiswahili and reading of a novel related to global health programs. Assessment. Student performance was assessed using written care plans, quizzes, reflection papers, a formulary management exercise, and pre- and post-course assessments. Student feedback on course evaluations indicated that the course was well received and students felt prepared for the APPE. Conclusion. This course offered a unique opportunity for students to learn about pharmacy practice in global health and to apply previously acquired skills in a resource-constrained international setting. It prepares students to actively participate in clinical care activities during an international APPE.

Meeting the Needs of Underserved Patients in Western Kenya by Creating the Next Generation of Global Health Pharmacists

Objective. To describe a novel training model used to create a sustainable public health-focused pharmacy residency based in Kenya and to describe the outcomes of this training program on underserved populations. Design. The postgraduate year 2 residency was designed to expose trainees to the unique public health facets of inpatient, outpatient, and community-based care delivery in low and middle-income countries. Public health areas of focus included supply chain management, reproductive health, pediatrics, HIV, chronic disease management, and teaching. Assessment. The outcomes of the residency were assessed based on the number of new clinical programs developed by residents, articles and abstracts written by residents, and resident participation in grant writing. To date, six residents from the United States and eight Kenyan residents have completed the residency. Eleven sustainable patient care services have been implemented as a result of the residency program. Conclusion. This pharmacy residency training model developed accomplished pharmacists in public health pharmacy, with each residency class expanding funding and clinical programming, contributing to curriculum development, and creating jobs.

Constructive ways to prevent, identify, and remediate deficiencies of “challenging trainees” in experiential education

The practice of pharmacy is highly influenced by the training pharmacy clinicians receive through experiential education (EE) programs, for it is within this “total practice immersion” that their skills are shaped, honed, and refined.[1][1] However, not all rotation experiences are positive for

Report of the 2016-2017 Student Affairs Standing Committee

EXECUTIVE SUMMARY The 2016-2017 AACP Student Affairs Standing Committee addressed charges related to recruitment to the profession of pharmacy and a national awareness campaign for pharmacy careers, as well as promotion of student wellness and stress management. The Committee report provides six recommendations to the American Association of Colleges of Pharmacy (AACP) and one proposed policy statement for the AACP House of Delegates related to recruitment to the pharmacy profession. The Committee report also provides three recommendations to AACP and one proposed policy statement for the AACP House of Delegates related to student wellness and stress management. In addition, this report provides recommendations for future AACP Student Affairs Standing Committee work.

Expanding the Horizon: Global Health Management for Pharmacy Students

The advancement of global engagement opportunities will promote pharmacy students’ cultural awareness and sensitivity, expose students to treatment of diseases not commonly seen in modern Western medicine, and cultivate future leadership for the growth of global pharmacy practice. At Purdue University College of Pharmacy (PUCOP), limited opportunities exist for student pharmacists. As a result, identifying the needs and expanding student pharmacist access to global engagement experiences are critical to meet the changing needs of the US population. A survey was developed and distributed to 460 students at PUCOP, and 148 of them participated. Of those students, 89.2% were interested in global health and/or international clinical rotations or an elective course coupled with an experience abroad. The majority of students were interested in going to London, UK (56.3%), whereas 24.4% were interested in traveling to Eldoret, Kenya, 13.1% to Colombia, and 6.9% to Kilimanjaro, Tanzania. The top three reasons for participation were “to explore differences in medical care outside of the US” (13.0%), “challenge myself” (12.5%), and “work in an interdisciplinary team including attending physicians, residents, and medical students” (11.5%). For students who were not interested, top reasons were “time away from family and friends” (40.0%), “scheduling confl icts” (20.0%), “safety” (20.0%), and “fi nancial constraints” (20.0%). This article demonstrates PUCOP student pharmacists’ desire for participation in global engagement opportunities and describes the potential impact on various members of the community through innovative implementations.

Student Pharmacists and Street Children: A Mutually Beneficial Relationship

The Tumaini Children’s Drop-In Center is a daytime drop-in center for the street children of Eldoret, Kenya. It is part of a partnership between the Purdue University College of Pharmacy, the Academic Model Providing Access to Healthcare program, Eldoret community members, and numerous individuals in both Kenya and the US. Through the efforts of local staff and Purdue student pharmacists, who work at the local hospital on an eight-week clinical rotation, the center has helped a population of nearly 400 local street children by providing a safe haven from life on the streets. Purdue student pharmacists aid the center by applying for grants to fund service-learning projects. These projects, run by the students, help provide the children with basic necessities in addition to screening and education sessions regarding local health issues. In turn, the street children aid the students by providing a break from the stress of the hospital and by providing a broader view of what health care should look like.

Criteria for evaluating global health partnerships in colleges of pharmacy and health sciences

BACKGROUND AND PURPOSE The demand for international experiences as part of education and training for healthcare providers continues to increase. As schools/colleges of pharmacy increase training opportunities in global health, there is a demand for a strategic way to evaluate opportunities. Evaluation tools can be utilized to facilitate this type of assessment. EDUCATIONAL ACTIVITY AND SETTING The purpose of this article is to highlight two different international experiential education site evaluation tools, discuss lessons learned when applying these tools in the field, and outline steps for a college of pharmacy to create their own tool to meet institution specific needs. FINDINGS The involvement of key stakeholders is important to developing an evaluation tool. Identification and prioritization of key criteria for assessing partnerships is essential. There are many criteria and each institution may consider a unique set of criteria, the most appropriate way to evaluate these, and who should be completing this evaluation. DISCUSSION AND SUMMARY An evaluation tool may serve as a framework of discussion for new and existing international partnerships. The use of a global partnership evaluation tool allows for a more consistent discussion when deciding if the partnership is appropriate for both parties, helps the involved faculty know what criteria are required to be evaluated and outlines what resources should be considered.

Learning to Sew: A Student Pharmacist’s Service-Learning Experience

The collaboration between Purdue University College of Pharmacy and the USAID—AMPATH partnership gives student pharmacists the opportunity to complete an internal medicine experience in Eldoret, Kenya. Student pharmacists act as the pharmaceutical resource on multidisciplinary teams at Moi Teaching and Referral Hospital (MTRH). Adding to the experience, the sewing initiative is one of numerous service-learning opportunities that have evolved in this resource-constrained setting. The initiative takes place at the Sally Test Pediatric Center, a place for children to learn and play while in the hospital. The program teaches sewing, an income-generating skill, to parents of hospitalized children. Students assist with sewing lessons, provide health care education for parents, and care for children while their parents learn a skill that can potentially provide a sustainable income. This program aids student pharmacists in balancing service and learning while working in a resource-constrained setting. This article describes the implementation of the sewing initiative, the goals of the project, the participants and students, and the initial impact. Karolina M. Grzesiak; Craig A. Vargo, PharmD, BCOP; Ellen M. Schellhase, PharmD; Monica L. Miller, PharmD, MS; Rakhi Karwa, PharmD, BCPS; Sonak D. Pastakia, PharmD, MPh, BCPS; and Beatrice Jakait, BPharm, PharmD