Rick Hess

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.

Impact of automated telephone messaging on zoster vaccination rates in community pharmacies

OBJECTIVE To measure the impact of an automated outbound telephone messaging system on herpes zoster (HZ) vaccinations among older adults in the community pharmacy setting. DESIGN Randomized controlled trial. SETTING 16 grocery store chain community pharmacies in Georgia and Tennessee, between December 2006 and May 2007. PATIENTS Adults 60 years or older who filled at least one prescription at a participating study pharmacy. INTERVENTION A 30-second automated outbound telephone message was delivered to patient households monthly during the first week of March through May 2007. The message advertised that older adults should speak with their pharmacist about the risk for HZ and the availability of a new vaccine. MAIN OUTCOME MEASURE HZ vaccinations based on pharmacy profile records. RESULTS After 3 months, 146 and 46 vaccinations were administered to older adults among the study cohort populations, translating into HZ vaccination rates of 2.60% and 0.72% at intervention and control pharmacies, respectively (odds ratio 3.69 [95% CI 2.64-5.15], P < 0.001). CONCLUSION Use of an automated outbound telephone messaging tool to inform older adults about their risk for HZ and the availability of a vaccine significantly improved vaccination rates in the community pharmacy setting.

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.

The Safety and Efficacy of Lorcaserin in the Management of Obesity

Abstract Lorcaserin represents a new serotonergic medication used as an adjunct to a reduced-calorie diet and increased physical activity treatment plan for chronic weight management in adult patients with an initial body mass index ≥ 30 kg/m2 or in adult patients with an initial body mass index ≥ 27 kg/m2 who have ≥ 1 comorbid condition associated with weight (eg, hypertension, dyslipidemia, or type 2 diabetes mellitus). In 2012, lorcaserin became the first obesity treatment medication to gain US Food and Drug Administration (FDA) approval since 1999. Lorcaserin is a centrally acting, selective serotonin C (5-HT2C) receptor full agonist that is associated with increased satiety and decreased food consumption in patients. The selectivity of lorcaserin for 5-HT2C receptors should reduce patient risk for the serious adverse complications that are associated with nonselective 5-HT agonist therapies, such as cardiac valvulopathy and pulmonary hypertension. The safety and efficacy of lorcaserin (10 mg twice daily) for ≥ 52 weeks has been evaluated in 3 separate Phase 3 trials. The primary outcome of patient weight loss in the 3 trials satisfied the FDA categorical benchmark but patient outcomes in the trials failed to achieve the FDA mean benchmark of patient weight loss. Secondary patient outcomes after lorcaserin therapy were favorable. Lorcaserin appears to be well tolerated in patients and the most common adverse events reported did not include serious complications. The incidence of FDA-defined valvulopathy in patients after 1 year of treatment was low and nonsignificant, but the statistical analysis of this safety endpoint was limited due to the small size of the study populations and high patient dropout rates. Continued post-marketing surveillance of patients taking lorcaserin is warranted.

A two-year review of suicide ideation assessments among medical, nursing, and pharmacy students

ABSTRACT Suicide is the 10th leading cause of death in the U.S. and has increased in prevalence during the past 15 years. Patients who attempt suicide are more likely to have contact with their primary care provider than a mental health provider in the month before attempting suicide, highlighting the need for competency in suicide ideation (SI) assessment. The Communications Skills for Health Professionals is an interprofessional course involving first-year medical, nursing, and pharmacy students. Specific instruction regarding assessment of SI was delivered through an online module and later practiced by students with standardized patients (SP). A final Objective Structured Clinical Examination featured an SP with depression, but without SI, though an assessment of SI was indicated. Three hundred fifty six interviews were reviewed and 55.1% (196/356) of students assessed for SI. Across professions, 65.5% (93/142) of medical students, 52.5% (32/61) of nursing students, and 46.4% (71/153) of pharmacy students performed an assessment. Medical students’ SI assessment was highest across the groups (p = 0.001), while pharmacy students’ SI assessment was lowest (p = 0.004). Results suggest that additional educational strategies should be developed and implemented to increase SI assessment performance in all professions, but especially in pharmacy students.

Comparison of Teaching Methods on Skin Disorders: Standardized Patients Dressed with Moulage Versus Paper Cases

Objective. To determine whether using standardized patients dressed in moulage improves pharmacy students’ ability to assess skin disorders compared to using picture-based paper cases. To determine pharmacy student preferences when learning assessment of skin disorders through these two educational methods. Methods. Faculty members investigated student assessments of drug-induced skin disorders and contact dermatitis by using picture-based paper cases compared with using standardized patients dressed in moulage in a patient assessment course. Faculty members measured student knowledge via multiple-choice questions before laboratory, immediately after laboratory, and during a final examination 3 weeks later. Student preferences were measured immediately after laboratory via survey instrument in this randomized, non-blinded, crossover design educational study. Results. No significant differences in knowledge scores related to skin disorders were found after laboratory or 3 weeks later when comparing the two educational methods. However, survey results suggested student preferences for using standardized patients dressed in moulage for drug-induced skin disorders. No significant differences were found for contact dermatitis cases. Conclusion. Using standardized patients dressed in moulage did not improve pharmacy students’ ability to assess skin disorders compared to using picture-based paper cases. Pharmacy students preferred standardized patients dressed in moulage only when learning assessment of drug-induced skin disorders.

A comparative analysis of pharmacists' self-confidence beliefs for regular U-500 (concentrated) insulin and U-100 insulin

The purpose of this research was to assess pharmacist confidence levels in the accurate and safe counseling on Humulin R regular U-500 (concentrated) insulin compared to U-100 insulin. The investigators developed a 34-item survey instrument assessing pharmacist insulin counseling confidence levels. Categories measured included demographics, common insulin patient counseling practices, pharmacist confidence levels, and perceived barriers. A survey invitation was emailed to East Tennessee State University Gatton College of Pharmacy preceptors every 2 weeks over a six-week period. Descriptive and parametric statistics were used to examine response frequencies and differences in confidence levels. A response rate of 30% (n138) was received. Most respondents (70%) practice in an outpatient setting (i.e., ambulatory care, chain, or independent pharmacies) and over 80% indicated they have dispensed U-500. Overall, pharmacists feel less confident in their ability to dispense and safely counsel patients on U-500 insulin compared to U-100 (p0.001). The largest perceived barriers were job-related time constraints and a lack of knowledge about U-500 insulin. Pharmacists have lower confidence in their ability to counsel patients prescribed U-500 insulin compared with U-100 insulin types. Future research is warranted to determine what training and/or resources would improve confidence levels.

Sodium glucose co-transporter inhibitors for the management of diabetes mellitus: an opinion paper from the Endocrine and Metabolism Practice and Research Network of the American College of Clinical Pharmacy

Abstract Type 2 diabetes mellitus (T2DM) carries a high prevalence in the United States and worldwide. Therefore, the number of medication classes being developed and studied has grown. The individualized management of diabetes is accomplished by evaluating a medication’s efficacy, safety, and cost, along with the patient’s preference and tolerance to the medication. Sodium glucose co-transporter 2 inhibitors are a new therapeutic class indicated for the treatment of diabetes and have a unique mechanism of action, independent of beta-cell function. The first agent approved by the Food and Drug Administration (FDA) was canagliflozin in March 2013. Two agents – dapagliflozin and empagliflozin – were FDA-approved in January and July 2014, respectively. A clear understanding of the new class is needed to identify its appropriate use in clinical practice. Members of the American College of Clinical Pharmacy Endocrine and Metabolism Practice and Research Network reviewed available literature regarding this therapeutic class. The article addresses the advantages, disadvantages, emerging role, and patient education for sodium glucose co-transporter 2 inhibitors. Key limitations for this article include limited access to clinical trial data not published by the pharmaceutical company and limited data on products produced outside the United States.

Impact of clinical pharmacist collaboration in patients beginning insulin pump therapy: a retrospective and cross-sectional analysis

Abstract Objective: To measure clinical and qualitative outcomes in patients with diabetes mellitus transitioning from intensive insulin therapy using multiple daily injections (MDI) to continuous subcutaneous insulin infusion (CSII) initiated and managed by clinical pharmacists under a collaborative practice agreement in a primary care setting without an endocrinologist. Research design and methods: This study was a retrospective and cross-sectional analysis of data from an electronic medical record (EMR) and patient survey at a large primary care private practice. Patients with type 1 or type 2 diabetes who were ≥18 years old, started on CSII between 2007 and 2010, and had at least one follow-up visit post-CSII were analyzed. Mean HbA1c results were stratified across 3-month intervals post-CSII initiation and compared to pre-CSII levels. Body mass index (BMI), the number of diabetes-related clinic visits with the primary care physician (PCP), and non-insulin diabetes medication use was compared pre- and post-CSII initiation. Paper-based questionnaires were used to assess patient satisfaction with CSII vs MDI and pharmacist-led services. Results: Twenty-five patients were included in the analysis. HbA1c decreased from 8.69 to 7.52% pre and post-CSII, respectively (p < 0.001). HbA1c also decreased across all 3-month intervals post-CSII. BMI decreased from 33.0 to 32.3 kg/m2 pre- and post-CSII, respectively (p = 0.085). Fewer diabetes-related PCP visits were completed post-CSII (5.09 vs 3.78 visits/year, p = 0.009), and less non-insulin diabetes medications were prescribed post-CSII (p < 0.001). Patients felt more comfortable controlling glycemic excursions and resultant insulin adjustments with CSII compared to MDI (p < 0.001). Conclusions: Pharmacist-led CSII services appear to improve diabetes control in patients requiring intensive insulin therapy. Patients report greater comfort using CSII and strong confidence in the abilities of the pharmacist. Physician–pharmacist collaboration in the management of intensive insulin therapy in the primary care setting should be further explored.

Insulin Therapy in Home Health A Review

Diabetes mellitus, whether type 1 or type 2, offers special challenges to home health care providers. Treatment of diabetes can become increasing complex. While insulin remains the cornerstone of treatment in patients with type 1 diabetes (T1DM), the utilization of insulin to safely control blood glucose is also necessary for many patients with type 2 diabetes (T2DM). Many different insulin products are available, with each product possessing different characteristics and adverse effect potential. Balancing glycemic control with patient safety is paramount. The individualization of insulin therapy can be challenging for both patients and health care professionals. Regular evaluation of blood glucose monitoring is vital for patient assessment. This article provides a review of insulin for providers caring for patients in the home health care setting.