Nicholas E. Hagemeier

Prescription Drug Abuse and DEA-Sanctioned Drug Take-Back Events: Characteristics and Outcomes in Rural Appalachia

(froschd@pamfri.org). Financial Disclosure: None reported. Author Contributions: Study concept and design: Elwyn, Légaré, and Frosch. Acquisition of data: Frosch. Analysis and interpretation of data: Adams, Légaré, and Frosch. Drafting of the manuscript: Adams. Critical revision of the manuscript for important intellectual content: Adams, Elwyn, Légaré, and Frosch. Statistical analysis: Adams. Obtained funding: Elwyn, Légaré, and Frosch. Study supervision: Frosch. Funding/Support: This work was funded by unrestricted grant 0140 from the Informed Medical Decisions Foundation (Dr Frosch). Previous Presentation: This research was presented in part at the 33rd Annual Meeting of the Society for Medical Decision Making; October 24, 2011; Chicago, Illinois.

Pharmacy Student Self-Testing as a Predictor of Examination Performance

Objectives. To determine if student self-testing improves performance during a doctor of pharmacy course. Methods. Students were given access to online quizzes with a large pool of randomly selected questions specific to upcoming examination content. Quizzes were electronically scored immediately upon completion and students were provided corrective feedback. Results. Examination scores following implementation of the practice quizzes were significantly higher in all but the last testing period. The upper fiftieth percentile of students scored higher on both the practice quizzes and subsequent examinations in all but the fourth testing period. Conclusions. Providing pharmacy students with self-testing opportunities could increase their retention of course material and provide feedback to both students and educators regarding learning, as well as provide students with a measure of their metacognition.

Prescription Drug Abuse: A Comparison of Prescriber and Pharmacist Perspectives

This study compared perceptions of prescribers and pharmacists (N = 89) regarding multiple aspects of prescription drug abuse. Questionnaires were developed to assess perceptions regarding the prevalence of prescription drug abuse, self-perceived communication competence, and additional communication and prescription drug abuse domains. Pharmacists perceived a larger percentage of patients (41%) to be abusing opioid pain relievers as compared with their prescriber colleagues (17%). Both prescribers and pharmacists indicated improvements in prescriber–pharmacist communication would serve to deter prescription drug abuse. Self-efficacy beliefs for detecting and discussing prescription drug abuse with patients were low for both cohorts. Implications and limitations are noted. Year of data collection: 2012 Setting: Rural Appalachia Data Collection Instruments: Prescriber- and pharmacist-specific survey instruments Data Analysis Techniques: Independent samples t-test; Mann-Whitney U test

Factors Associated With Provision of Addiction Treatment Information by Community Pharmacists

Community pharmacists in the United States have significant opportunity to engage in community-level prescription substance abuse prevention and treatment efforts, including dissemination of information specific to available addiction treatment options. Our cross-sectional study of Tennessee community pharmacists noted that 26% had previously provided addiction treatment facility information to one or more patients in the past. The purpose of this study was to employ multivariate modeling techniques to investigate associations between community pharmacist and community pharmacy factors and past provision of addiction treatment information to pharmacy patients. Multivariate logistic regression indicated having addiction treatment facility information in a pharmacy setting (aOR=8.19; 95% CI=4.36-15.37), having high confidence in ability to discuss treatment facility options (aOR=4.16; 95% CI=2.65-6.52), having participated in prescription opioid abuse-specific continuing education (aOR=2.90; 95% CI=1.70-4.97), being male (aOR=2.23; 95% CI=1.38-3.59), and increased hours per week in the practice setting (aOR=1.02; 95% CI=1.004-1.05) were all significantly associated with provision of information about addiction treatment. Dissemination of addiction treatment information, improvements in communicative self-efficacy beliefs, and dissemination of prescription opioid abuse-specific continuing education are modifiable factors significantly associated with increased provision of addiction treatment information by community pharmacists.

Impact of an interprofessional communication course on nursing, medical, and pharmacy students' communication skill self-efficacy beliefs.

Objective. To describe an interprofessional communication course in an academic health sciences center and to evaluate and compare interpersonal and interprofessional communication self-efficacy beliefs of medical, nursing, and pharmacy students before and after course participation, using Bandura’s self-efficacy theory as a guiding framework. Design. First-year nursing (n=36), first-year medical (n=73), and second-year pharmacy students (n=83) enrolled in an interprofessional communication skills development course voluntarily completed a 33-item survey instrument based on Interprofessional Education Collaborative (IPEC) core competencies prior to and upon completion of the course during the fall semester of 2012. Assessment. Nursing students entered the course with higher interpersonal and interprofessional communication self-efficacy beliefs compared to medical and pharmacy students. Pharmacy students, in particular, noted significant improvements in communication self-efficacy beliefs across multiple domains postcourse. Conclusion. Completion of an interprofessional communications course was associated with a positive impact on health professions students’ interpersonal and interprofessional communication self-efficacy beliefs.

Student Performance in a Pharmacotherapy Oncology Module Before and After Flipping the Classroom

Objective. To determine if a flipped classroom improved student examination performance in a pharmacotherapy oncology module. Design. Third-year pharmacy students in 2012 experienced the oncology module as interactive lectures with optional case studies as supplemental homework. In 2013, students experienced the same content in a primarily flipped classroom. Students were instructed to watch vodcasts (video podcasts) before in-class case studies but were not held accountable (ie, quizzed) for preclass preparation. Examination questions were identical in both cohorts. Performance on examination questions was compared between the two cohorts using analysis of covariance (ANCOVA), with prior academic performance variables (grade point average [GPA]) as covariates. Assessment. The students who experienced the flipped classroom approach performed poorer on examination questions than the cohort who experienced interactive lecture, with previous GPA used as a covariate. Conclusion. A flipped classroom does not necessarily improve student performance. Further research is needed to determine optimal classroom flipping techniques.

A Graduate Student Mentoring Program to Develop Interest in Research

Objective. To assess the impact of a graduate student mentoring program on student interest in research and postgraduate education and on graduate student confidence in mentoring. Methods. Undergraduate and pharmacy students (mentees) and graduate students (mentors) were matched and participated in the study, which required them to engage in at least 2 discussions regarding research and careers. Mentees completed a pre- and post-assessment of their perceptions of research, postgraduate training plans, and perceptions about mentors. Mentors completed a pre- and post-assessment of their perceptions about themselves as mentors and their confidence in mentoring. Results. Although there were no significant differences among the mentees’ perceptions of research or the mentors’ confidence in mentoring, qualitative analysis indicated that the mentees’ perceptions of research improved and that the mentors believed their mentoring skills improved. Conclusions. Based on the results of the qualitative analysis, implementing a graduate student mentoring program may help improve students’ perceptions of research and graduate students’ confidence in mentoring, which could increase student interest in postgraduate education and prepare mentors for future leadership roles.

Prescription Disposal Practices: A 2-Year Ecological Study of Drug Drop Box Donations in Appalachia

OBJECTIVES We quantified controlled substance donations via permanent drug donation boxes over 2 years in a region with high prescription abuse, assessing medication characteristics, time between dispensing and donation, and weight of medications donated per capita. METHODS In partnership with Drug Enforcement Administration and local law enforcement, we analyzed permanent drug donation box collections in 8 Northeast Tennessee locations from June 2012 to April 2014. We recorded controlled substance dosage units along with the product dispensing date. RESULTS We collected 4841 pounds of pharmaceutical waste, 4.9% (238.5 pounds) of which were controlled substances, totaling 106,464 controlled substance doses. Analysis of dispensing dates for controlled substances indicated a median of 34 months lapsed from dispensing to donation (range = 1-484 months). The mean controlled substance donation rate was 1.39 pounds per 1000 residents. Communities with fewer than 10,000 residents had a statistically higher controlled substance donation rate (P = .002) compared with communities with 10,000 or more residents. CONCLUSIONS Permanent drug donation boxes can be an effective mechanism to remove controlled substances from community settings. Rural and urban community residents should be provided convenient and timely access to drug disposal options.

Teaching Communication Skills to Medical and Pharmacy Students through a Blended Learning Course

Objective. To evaluate the impact of an interprofessional blended learning course on medical and pharmacy students’ patient-centered interpersonal communication skills and to compare precourse and postcourse communication skills across first-year medical and second-year pharmacy student cohorts. Methods. Students completed ten 1-hour online modules and participated in five 3-hour group sessions over one semester. Objective structured clinical examinations (OSCEs) were administered before and after the course and were evaluated using the validated Common Ground Instrument. Nonparametric statistical tests were used to examine pre/postcourse domain scores within and across professions. Results. Performance in all communication skill domains increased significantly for all students. No additional significant pre/postcourse differences were noted across disciplines. Conclusion. Students’ patient-centered interpersonal communication skills improved across multiple domains using a blended learning educational platform. Interview abilities were embodied similarly between medical and pharmacy students postcourse, suggesting both groups respond well to this form of instruction.

Economic analysis of earning a PhD degree after completion of a PharmD degree.

Objective. To determine the net present value (NPV) and internal rate of return (IRR) for earning a doctor of philosophy (PhD) degree and pursuing careers commonly associated with that degree after completion of a doctor of pharmacy (PharmD) degree compared to entering pharmacy practice directly upon completion of the PharmD degree. Methods. Income profiles were constructed based on 2008 annual salary data. NPV and IRR were calculated for careers resulting from the PhD degree and compared to those of the practicing community pharmacist. Trends in IRR also were examined across career paths from 1982 to 2008. A priori assumptions were developed and sensitivity analyses were conducted. Results. The NPVs for all careers associated with the PhD degree were negative compared to that of the practicing community pharmacist. IRRs ranged from -1.4% to 1.3% for PhD careers. Longitudinal examination of IRRs indicated a negative trend from 1982 to 2008. Conclusions. Economic financial incentives for PharmD graduates to pursue graduate school are lacking. The study illustrates the need to consider financial incentives when developing recruitment methods for PharmD graduates to pharmacy graduate programs.