Volume 02, Number 2, 2011

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    What’s Past is Prologue: The History of the Discipline of Pharmacy Administration
    (University of Minnesota, College of Pharmacy, 2011) Bonnarens, Joseph K.
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    An estimation of the effect of 100% Compliance with Diabetes Treatment: Can we reduce cost of illness with higher compliance rates?
    (University of Minnesota, College of Pharmacy, 2011) Koçkaya, Güvenç; Wertheimer, Albert I.
    Introduction: The current study was designed to estimate the direct cost of noncompliance of diabetes patients to the US health system. Understanding these expenses can inform screening and education budget policy regarding expenditure levels that can be calculated to be cost-beneficial. Materials and Method: The study was conducted in three parts. First, a computer search of National Institutes of Health websites and professional society websites for organizations with members that treat diabetes, and a PubMed search were performed to obtain the numbers required for calculations. Second, formulas were developed to estimate the risk of non-compliance and undiagnosed diabetes. Third, risk calculations were performed using the information obtained in part one and the formulas developed in part two. Results: Direct risk reduction for diabetes-related kidney disease, stroke, heart disease, and amputation were estimated for 100% compliance with diabetes treatment. Risk, case and yearly cost reduction calculated for a 100% compliance with diabetes treatment were 13.6%, 0.9 million and US$ 9.3 billion, respectively. Conclusion: Society, insurers, policy makers and other stakeholders could invest up to these amounts in screening, education and prevention efforts in an effort to reduce these costly and traumatic sequelae of noncompliant diabetes patients.
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    Is Mail Service Pharmacy Cost Beneficial to Plan Sponsors?
    (University of Minnesota, College of Pharmacy, 2011) Vulakh, Larisa; Wertheimer, Albert I.
    The objective of this study was to describe and compare prescription drug costs charged to a plan sponsor for the top 50 maintenance medications provided through retail and mail service procurement channels. Data were obtained for covered beneficiaries of a health plan sponsored by an employer with just over 3,000 covered employees The analytics team at the PBM administering the plan sponsor’s prescription drug benefit provided de-identified claims information for the top 50 maintenance prescription drugs delivered through either mail service or retail procurement methods for this employer over a one year period (7/1/2008 to 6/30/2009). Based on these data, (1) dollar amount difference (mail service minus retail), and (2) percentage difference between mail and retail costs (as a percentage of the lower net cost per day) were computed. The findings revealed that 76 percent of the medication products studied were associated with a lower net cost per day to the plan sponsor through mail service procurement and 24 percent were associated with lower net cost through retail procurement.
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    “Until they know how much you care”: A qualitative analysis of an innovative practice in community pharmacy
    (University of Minnesota, College of Pharmacy, 2011) Melczak, Michael; Pringle, Janice
    Purpose: This qualitative study was concerned with investigating community pharmacists’ thoughts on the use of two brief scales to measure patient outcomes and therapeutic alliance in the context of their Medication Therapy Management (MTM) services. The scales were originally developed for use in behavioral healthcare, but were used in a novel (community pharmacy) setting as part of a previous parent study. We describe this practice (using these scales in a novel setting) as an innovative practice, report on the pharmacists’ experiences with the practice, and discuss relative advantages and disadvantages for integrating the use of the scales as part of routine practice. Methods: Six community pharmacy practitioners participated in a semi-structured interview pertaining to the use of the scales in their MTM services. Pharmacist interviews were transcribed, analyzed according to qualitative content analysis methodology, and presented in relation to the guiding interview questions. Results: Pharmacists had varying opinions on the use of the scales as part of their practice. Initial concerns included patient (mis)understanding about the purpose and proper completion of the scales, as well as apprehension about the use of the information. These concerns were largely resolved through education, repeated use, and routinization. Pharmacists, in general, saw a value to using these scales in clinical practice, for clinical and professional reasons, although there was variability on the degree to which pharmacists integrated the scales into practice after the study completion. Pharmacists had varied opinions as well as on the degree to which the use of the scales would impact medication adherence. Pharmacists were most surprised by how much participation in this study prompted them to reflect on their interactions with patients. Conclusions: Pharmacists, in general, were receptive to participating in the parent study and using two brief scales to measure patient outcomes and therapeutic alliance. Pharmacists had varying opinions on the degree to which the use of these scales could impact patient medication adherence, although they perceived other value and benefits secondary to the interactions. While most pharmacists did not maintain formal use of the scales after study end, they took away general principles of patient-centered care and individualized feedback.
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    Pharmacists’ social authority to transform community pharmacy practice
    (University of Minnesota, College of Pharmacy, 2011) McPherson, Timothy; Fontane, Patrick
    Leaders in the profession of pharmacy have articulated a vision of pharmacists as providers of patient-centered care (PCC) services and the Doctor of Pharmacy was established as the required practice degree to achieve this vision. Pharmacist-provided PCC services have been shown to reduce medication costs and improve patient compliance with therapies. While community pharmacists are capable of, and are ideally placed for, providing PCC services, in fact they devote most of their time to prescription dispensing rather than direct patient care. As professionals, community pharmacists are charged with protecting society by providing expert services to help consumers manage risks associated with drug therapies. Historically pharmacists fulfilled this responsibility by accurately dispensing prescription medications, verifying doses, and allergy checking. This limited view of pharmacy practice is insufficient in light of the modern view of pharmacists as providers of PCC. The consumers’ view of community pharmacy as a profession represents a barrier to transforming the basis of community pharmacy from product distribution to providing PCC services. Community pharmacists are conferred with social authority to dictate the manner in which their professional services are provided. Pharmacists can therefore facilitate the transition to PCC as the primary function of community pharmacy by exercising their social authority to engage consumers in their roles in the new patient-pharmacist relationship. Each pharmacist must decide to provide PCC services. Suggestions for initiating PCC services in community pharmacy are offered.
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    Using Multiple Choice Questions Written at Various Bloom’s Taxonomy Levels to Evaluate Student Performance across a Therapeutics Sequence
    (University of Minnesota, College of Pharmacy, 2011) Tiemeier, Amy M.; Stacy, Zachary A.; Burke, John M.
    Objective: To evaluate the results of a prospectively developed plan for using multiple choice questions (MCQs) developed at defined Bloom’s levels to assess student performance across a Therapeutics sequence. Methods: Faculty were prospectively instructed to prepare a specific number of MCQs for exams in a Therapeutics sequence. Questions were distributed into one of three cognitive levels based on a modified Bloom’s taxonomy, including recall, application, and analysis. Student performance on MCQs was compared between and within each Bloom’s level throughout the Therapeutics sequence. In addition, correlations between MCQ performance and case performance were assessed. Results: A total of 168 pharmacy students were prospectively followed in a Therapeutics sequence over two years. The overall average MCQ score on 10 exams was 68.8%. A significant difference in student performance was observed between recall, application, and analysis domain averages (73.1%, 70.2% and 60.1%; p<0.001). Student performance within each Bloom’s level across the three courses was significantly different for recall (p<0.001), application (p<0.001), and analysis (p<0.001) MCQs. A significant correlation was observed between the recall domain and the case (0.67; p<0.01), application domain and the case (0.62; p<0.01), and analysis domain and the case (0.64; p<0.01). Conclusions: As students progress through the curriculum, faculty may need to find ways to promote recall knowledge for more advanced topics while continuing to develop their ability to apply and analyze information. Exams with well-designed MCQs that prospectively target various cognitive levels can facilitate assessment of student performance.
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    Evaluation of a Continuing Professional Development program for first year student pharmacists undergoing an Introductory Pharmacy Practice Experience
    (University of Minnesota, College of Pharmacy, 2011) Tofade, Toyin; Franklin, Brianna; Noell, Bennett; Leadon, Kim
    Objectives: The purpose of the study was to evaluate a live and online training program for first year pharmacy students in implementing Continuing Professional Development (CPD) principles (Reflect, Plan, Act, and Evaluate), writing SMART learning objectives, and documenting learning activities prior to and during a hospital introductory professional practice experience. Design: Cohort Study. Setting: Introductory professional practice experience. Participants: First year (PY1) students at the University of North Carolina Eshelman School of Pharmacy. Intervention: Live training or online training to introduce the concept of Continuing Professional Development in practice. Main Outcomes: Implementation of CPD principles through 1) completed pre-rotation education action plans with specific, measurable, achievable, relevant and time-bound (SMART) learning objectives; and 2) completed learning activity worksheets post-rotation indicating stimuli for learning, resources used and accomplished learning. objectives; and 3) documented suggestions and content feedback for future lectures and pharmaceutical care lab experiences. Results: Out of the whole cohort (N=154), 14 (87.5%) live (in person) trainees and 122 (88%) online trainees submitted an education action plan. Objectives were scored using a rubric on a scale of 1-5. A rating of 5 means “satisfactory”, 3 means “work in progress” and 1 means “unacceptable”. There were significant differences between the mean live trainee scores and the mean online trainee scores for the following respective section comparisons: Specific 4.7 versus 3.29 (p<0.001); Measurable 3.9 versus 2.05 (p<0.001); number of objectives 3.6 versus 4.6 (p<0.001); and average grade 92.9 versus 77.7 (p<0.001). Of the 396 learning activity worksheets reviewed, 75% selected discussion with peers and/or health providers as a stimulus for learning. Students reported spending an average of 50.2 hours completing the learning objectives. All of the pre-stated objectives were fulfilled completely or partially. Conclusion: Live trainees performed significantly better than online trainees in writing SMART learning objectives. With focused training, students are more capable of implementing principles of CPD.
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    Clinical Pharmacy Clerkship in Pakistan: A leap from paper to practice
    (University of Minnesota, College of Pharmacy, 2011) Aslam, Nousheen; Ahmed, Khwaja Zafar
    This is the first article of its type to describe the advances taking place in clinical pharmacy education in Pakistan. The Pharmacy Council of Pakistan has developed a five-year Pharm.D program to replace the four-year B.Pharm degree. Completing clinical pharmacy clerkships is a prerequisite for receiving the Pharm.D degree. To meet this requirement, Ziauddin College of Pharmacy has developed a specialized clerkship program for its 4th and 5th year students. The College is fortunate to be linked with well developed tertiary care hospitals at three prime locations in the in the metropolitan city of Karachi, which provides opportunity for the students to gain exposure to real life situations and work with patients. The article presents an account of the efforts taken for development of the clinical pharmacy clerkship program, the problems encountered during its development, and the main outcomes of a clerkship program.
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    What can StrengthsFinder® add to a pharmacy curriculum?
    (University of Minnesota, College of Pharmacy, 2011) Young, Brandon
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    Performance and Perceptions of Pharmacy Students using Team-based Learning (TBL) within a Global Health Course
    (University of Minnesota, College of Pharmacy, 2011) Addo-Atuah, Joyce
    Purpose: Team-based learning (TBL) has been shown to be a very useful active learning tool in a variety of disciplines and educational settings. The objectives of this study in a Global Health elective course within a PharmD curriculum were to (1) determine whether TBL contributes to performance (as measured by iRAT scores, tRAT scores, and grades); and (2) evaluate students’ perceptions of TBL as an instructional strategy. Case Study: TBL sessions were incorporated into a new elective course in Global Health along with other teaching methodologies. Student performance was evaluated during the TBL sessions and course team projects, among others. An anonymous student qualitative survey explored their perceptions of and experiences with TBL at the end of the course. Students’ performance in the TBL sessions improved as reflected in the comparison of individual Readiness Assurance Tests (iRATs) and the team Readiness Assurance Tests (tRATs) scores. Overall students’ performance in the course resulted in over 88% earning the letter grade A. Students’ performance in the TBL sessions, especially their iRATs, was reflected in their overall course grades. Over 75% of the students believed that TBL increased their analytical skills and nearly 50% believed that learning utilizing TBL would have the most lasting effect on their careers. Conclusion: TBL was successfully implemented in a Global Health elective course in a PharmD curriculum and students perceived it as a beneficial instructional strategy. This study adds to the TBL literature by providing some evidence of the applicability of TBL in a course not traditionally taught in the PharmD curriculum (i.e., Global Health). Future research and intervention(s) leading to the development and growth of TBL in pharmacy education are recommended.