Advanced Pharmacy Practice Experience Students Research Articles

Effect of an Advanced Pharmacy Practice Experience on Medication Therapy Management Services in a Centralized Retail Pharmacy Program.

Medication therapy management (MTM) delivery is increasingly important in managed care. Successful delivery positively affects patient health and improves Centers for Medicare & Medicaid Services star ratings, a measure of health plan quality. As MTM services continue to grow, there is an increased need for efficient and effective care models. The primary objectives of this project were to describe the delivery of MTM services by fourth-year Advanced Pharmacy Practice Experience (APPE) students in a centralized retail pharmacy system and to evaluate and quantify the clinical and financial contributions of the students. The secondary objective was to describe the engagement needed to complete comprehensive medication reviews (CMRs) and targeted interventions. From May 2015 to December 2015, thirty-five APPE students from the University of Colorado Skaggs School of Pharmacy provided MTM services at Albertsons Companies using the OutcomesMTM and Mirixa platforms. Students delivered patient care services by phone at the central office and provided face-to-face visits at pharmacies in the region. With implementation of the MTM APPE in 2015, the team consisted of 2 MTM pharmacists and pharmacy students, as compared with 1 MTM pharmacist in 2014. The number of CMRs and targeted interventions completed and the estimated additional revenue generated during the 2015 time period were compared with those completed from May through December 2014. The patient and provider engagement needed to complete the CMRs and targeted interventions was summarized. 125 CMRs and 1,918 targeted interventions were billed in 2015, compared with 13 CMRs and 767 targeted interventions in 2014. An estimated $16,575-$49,272 of additional revenue was generated in 2015. To complete the interventions in 2015, the team engaged in 1,714 CMR opportunities and 4,686 targeted intervention opportunities. In this MTM rotation, students provided real-life care to patients, resulting in financial and clinical contributions. This model of education and care delivery can be replicated in the community pharmacy or managed care setting. APPE students are an important component of this model of care delivery, particularly when considering the level of patient engagement needed to complete MTM interventions. No outside funding supported this research. The authors have no conflicts of interest to disclose related to this work. All authors contributed to study concept and design. Rodgers collected the data, and data interpretation was performed by Vande Griend, along with Rodgers and Nuffer. The manuscript was written and revised primarily by Vande Griend, along with Nuffer and Rodgers. This project was presented at the Pharmacy Quality Alliance Annual Meeting in Arlington, Virginia, in May 2016.

Incorporation of a community pharmacy–based heart failure assessment tool by advanced pharmacy practice experience students

ObjectivesTo incorporate a published clinical tool related to heart failure (HF) assessment into advanced pharmacy practice experiences in the community pharmacy setting to provide a meaningful and innovative learning experience for students. SettingSixteen independent and chain community pharmacies that served as advanced pharmacy practice experience locations. Practice descriptionSixteen community pharmacy locations served as rotation sites and participated in data collection (8 chain and 8 independent). Practice innovationThis was the first study in which pharmacy students used The One-Minute Clinic for Heart Failure (TOM-C HF) tool to assess HF within the community pharmacy setting. InterventionsTrained student pharmacists identified patients who may have heart failure by evaluating medication dispensing records, interviewed the patient using the TOM-C HF tool, and made interventions as clinically appropriate. EvaluationThe number of students using the TOM-C HF tool, the number and types of interventions made, and student perceptions about the educational and professional value of the patient interaction. ResultsThirty-three of 83 (40%) students completed 63 patient assessments. Thirty-five percent of patients (22/63) were candidates for an intervention. Interventions were performed in 9 of 22 patients (41%). More than 65% of students found the patient interaction to have educational and professional value. ConclusionStudents were able to assess HF patients and make interventions in a community pharmacy setting. The majority of students also perceived some value in these assessments. The incorporation of a clinical tool in the community setting driven by fourth-year pharmacy students has been shown to be feasible and to provide both a novel advanced practice experience. In addition, it may be expandable to the services offered at community pharmacies.

Development of a Holistic Assessment Plan to Evaluate a Four-Semester Laboratory Course Series

Objective. To implement a holistic assessment plan to evaluate the impact of a four-semester laboratory course series entitled Integrated Pharmacotherapy Skills on students' readiness to begin advanced pharmacy practice experiences (APPEs) following separation of the laboratory component from the Pharmacotherapy lecture component. Design. Faculty prospectively selected and employed a variety of course assessment methods including student self- and preceptor evaluation during APPEs, course evaluations, and a student confidence survey to evaluate student readiness for APPEs and ensure a quality learning experience for students. Assessment. APPE students' self-perceived confidence to perform skills increased after completion of the redesigned curriculum and after experiencing two APPE rotations. APPE preceptors did not report a change in student performance. Results from course evaluations suggest that separating the laboratory course from the lecture course created a positive learning experience for students. Conclusion. Students completing the new laboratory curriculum were equally prepared to begin APPE rotations as students who had completed the old curriculum. A similar multidimensional, holistic assessment plan could be used at other institutions to evaluate skills-based courses as part of continuous quality improvement.

Assessment of clinical and educational interventions that Advanced Pharmacy Practice Experience (APPE) students contributed to a family medicine residency program

Background and purposeThe literature firmly establishes that clinical interventions made by pharmacy students on Advanced Pharmacy Practice Experience (APPE) rotations contribute significantly to cost-savings realized by the hosting practice sites. The Accreditation Council for Pharmacy Education (ACPE) specifies the experiential curricula include opportunities for students to learn about, from, and with other members of the healthcare team through interprofessional education activities. Educational activityThis study assesses clinical and educational interventions contributed by APPE students at a family medicine residency program to determine the extent students were engaged in the interprofessional team and physicians’ receptiveness to the recommendations. FindingsStudent interventions made from January 2009 to September 2012 were recorded in a Microsoft Excel Spreadsheet. Data was evaluated to determine 1) the most common types of clinical and educational interventions, 2) potential associated cost-savings/avoidance, and 3) provider receptiveness to recommendations based upon acceptance rates. A standardized scheme was utilized to assign a cost savings value according to Midwest America Division of Hospital Corporation of America (HCA) clinical savings standards. Pharmacy students contributed 2868 interventions in 3.5 years. A total of 59.2% of interventions were clinical and accounted for an estimated cost savings of $55,892. The remaining 40.8% of interventions were pharmacy care activities, none were associated with a cost savings and three-fourths were considered educational. Intervention acceptance rate was over 80%, showing providers were very receptive to pharmacy students. SummaryThis study lends support that APPE students provide substantial clinical and educational contributions to healthcare providers and patients affiliated with family medicine residency programs. Additionally, healthcare providers and patients are very receptive to pharmacy students as members of the interprofessional team.

Residency Program Directors’ View on the Value of Teaching

Purpose: There is no standardization for teaching activities or a requirement for residency programs to offer specific teaching programs to pharmacy residents. This study will determine the perceived value of providing teaching opportunities to postgraduate year 1 (PGY-1) pharmacy residents in the perspective of the residency program director. The study will also identify the features, depth, and breadth of the teaching experiences afforded to PGY-1 pharmacy residents. Methods: A 20-question survey was distributed electronically to 868 American Society of Health-System Pharmacists-accredited PGY-1 residency program directors. Results: The survey was completed by 322 program directors. Developing pharmacy educators was found to be highly valued by 57% of the program directors. Advertisement of teaching opportunities was found to be statistically significant when comparing program directors with a high perceived value for providing teaching opportunities to program demographics. Statistically significant differences were identified associating development of a teaching portfolio, evaluation of Advanced Pharmacy Practice Experiences students, and delivery of didactic lectures with program directors who highly value developing pharmacy educators. Conclusions: Future residency candidates interested in teaching or a career in academia may utilize these findings to identify programs that are more likely to value developing pharmacy educators. The implementation of a standardized teaching experience among all programs may be difficult.

Three-year assessment of advanced pharmacy practice experience student and faculty change requests at a college of pharmacy

ObjectiveExperiential education is a critical component of the curriculum of all colleges of pharmacy. Thus, having access to quality and adequate numbers of Advanced Pharmacy Practice Experiences (APPEs) is essential. This study examines APPE change requests from preceptor faculty and students over a three-year period. Such requests are the primary reason to obtain an excess of APPEs. The objective was to determine whether class size influences the excess percentage needed. MethodsData were collected from student records regarding APPE change requests and granted requests for the graduating classes of 2011–2013 at the University of Tennessee College of Pharmacy. Percentages of change requests and granted requests were calculated. ANOVA was conducted to assess differences in change requests and granted requests over the study period. ResultsThere were 660 APPE change requests in 2011, 331 in 2012, and 232 in 2013. The percentage of granted requests calculated from total APPEs was 29% in 2011, 15.8% in 2012, and 12.1% in 2013. The number of change requests and granted requests were significantly higher for the Class of 2011, which had 203 students, compared to 2012 and 2013 (p < 0.05), that had 183 and 147 students, respectively. ConclusionTo conduct a viable experiential program, a public college of pharmacy should maintain a 12–20% excess in APPEs for class sizes of 140 or more. As class size increases to 200 or more, excess percentage of APPEs needed also increases considerably.

Recognition of Advanced Pharmacy Practice Experience Student Participation Within Antimicrobial Stewardship Activities.

Background: Antimicrobial stewardship is important in managing patients with infectious diseases. Limited data exist documenting the extent of pharmacy student involvement within antimicrobial stewardship activities. Objectives: The purpose of this study was to document the types of hospital-based antimicrobial stewardship activities in which Advanced Pharmacy Practice Experience (APPE) students are involved. Methods: A questionnaire was developed using the most current guideline for developing an institutional antimicrobial stewardship program. It was designed to collect preceptor-reported perceptions and APPE student involvement in antimicrobial stewardship activities. Pharmacist preceptors of APPE students from 2 Florida Colleges of Pharmacy were surveyed in October 2011. Questionnaires fully completed by hospital pharmacists currently serving as an APPE preceptor were included. Results: Forty-eight questionnaires met all inclusion criteria, collectively reporting APPE student participation within every element of antimicrobial stewardship. The most common areas of student participation were dose optimization based on patient characteristics (n = 40, 83%), acquiring patient information for prospective audit with feedback (n = 39, 81%), intravenous to oral conversion (n = 37, 77%), and pharmacokinetic services (n = 36, 75%). Anti-infective subcommittee participation (n = 3, 6%) was uncommon. Respondent perceptions were overall favorable regarding student participation in antimicrobial stewardship activities. Conclusion: With supervision from pharmacist preceptors, APPE students from 2 Florida colleges of pharmacy were reported to participate in each element and activity of antimicrobial stewardship as set forth by current guidelines. The role and value of such involvement is not fully understood. Future research investigating activity-specific outcomes and policy creation are needed to guide appropriate use of APPE students as a resource for optimizing antimicrobial use in hospitals.

Engaging Pharmacy Students, Residents, and Fellows in Antimicrobial Stewardship

Antimicrobial stewardship programs are mainly established by infectious diseases physicians and infectious diseases-trained clinical pharmacists with the goal of optimizing patients’ outcomes while halting antimicrobial resistance, decreasing adverse events, and controlling health care cost. The role of the infectious diseases-trained clinical pharmacist in antimicrobial stewardship is well established; however, there are not enough formally trained pharmacists to assume the challenging responsibilities of the steward coordinator. The purpose of this article was to review the available literature and resources and propose a model to engage introductory pharmacy practice experience students, advanced pharmacy practice experience students, postgraduate year (PGY) 1 pharmacy residents, PGY2 infectious diseases pharmacy residents, and PGY2 or PGY3 infectious diseases pharmacy fellows in antimicrobial stewardship. Further studies are needed to assess and document the impact of pharmacy students and postgraduate trainees on antimicrobial stewardship programs.

Making pharmacogenetic testing a reality in a community pharmacy

ObjectiveTo provide information for community pharmacies considering implementation of a pharmacogenetic testing service. SettingA single community pharmacy from a regional chain. Practice descriptionCommunity pharmacists at the study site routinely provide pharmacy services including medication therapy management, immunizations, point-of-care testing, blood pressure monitoring, and diabetes education. The pharmacy is a training site for post-graduate year 1 and 2community-pharmacy residents and for introductory and advanced pharmacy practice experience students. Practice innovationImplementation of a pharmacogenetics testing service in a community pharmacy. Main outcome measuresFeasibility of offering a pharmacogenetics testing service in a community pharmacy. ResultsStudy investigators identified several internal and external barriers to the community pharmacy when initiating a pharmacogenetics service. This article shares experiences of the study team and solutions to the identified barriers. ConclusionCommunity pharmacies interested in providing pharmacogenetic testing can overcome barriers by identifying practice partners and planning appropriately.

Planning a Pharmacy-Led Medical Mission Trip, Part 3: Development and Implementation of an Elective Medical Missions Advanced Pharmacy Practice Experience (APPE) Rotation

With an increasing number of new pharmacy schools/colleges and expansion of existing ones, pharmacy schools/colleges are often in need of elective rotation experiences as part of the final year advanced pharmacy practice experience (APPE) program. Offering a medical missions elective APPE in either a domestic or international setting is a unique opportunity to expose pharmacy students to direct patient care. APPE students can be involved in triaging patients, compounding and dispensing medications, and providing patient education. As part of this APPE, pharmacy students are expected to complete projects such as formulary development, case presentations, book club discussions, journal reflections, manuscript preparations, and trip logistics planning. An elective APPE focused on medical missions facilitates the learning process and promotes the emergence of team leaders and leadership skills in general.

Efficacy of an over-the-counter intervention follow-up program in community pharmacies

To evaluate whether patient adherence to appropriate self-care advice from a pharmacist or professional year 4 (PY4) advanced pharmacy practice experience (APPE) student provides satisfactory symptom relief. Two community pharmacies in the same chain in Massachusetts from mid-December 2009 to June 2010. Pharmacists and PY4 APPE students offered a follow-up phone call to patients who were seeking or had accepted the offer for self-care advice for themselves or others for whom they are primary caregivers. Patients were provided detailed counseling documented on an over-the-counter (OTC) intervention document, administered a point-of-care survey, offered a follow-up phone call(s), and then administered a follow-up survey. Patient demographics, point-of-care survey assessing current use and perceived benefit from a pharmacist's consultation, intervention document assessing potential medication-related problems, and follow-up telephone survey assessing patient adherence to advice, symptom relief, and satisfaction with the service. Of the 207 patients offered a follow-up phone call, 83 accepted. Of these, 54 completed one call and 9 completed two calls. Of those who completed one phone call and claimed complete adherence to advice provided, 38 (82.6%) experienced great symptom relief. Three patients followed advice only partially and experienced the same level of improvement. More than 75% of patients classified the follow-up as "very helpful," felt that it led to greater symptom improvement, and would like to see this service offered all of the time. Pharmacist intervention in OTC therapy is widely accepted and can lead to improved patient outcomes.

Further Development of Pharmacy Student-Facilitated Diabetes Management Clinics

To further develop and evaluate a diabetes disease state management (DSM) program that provided direct patient care responsibilities to advanced pharmacy practice experience (APPE) students as members of healthcare teams. Nine new clinics and 3 established sites that provide self-care management education to patients with diabetes were established and maintained in rural Colorado pharmacies and supported by students in APPE training for 48 weeks per year. The 12 clinics provided 120 APPE student placements in 2010-2011. Students' perceptions of their experiences were positive. Patients who completed the student-supported diabetes self-management education program had improvements in blood glucose, blood pressure, and lipid values. Twelve diabetes DSM clinics provided direct patient care opportunities to APPE students working as part of healthcare teams while expanding healthcare resources in underserved communities in Colorado.

Assessment of web-based training modules on learning facilitation for advanced pharmacy practice experiences in pediatrics.

To assess the effectiveness of web-based training (WBT) modules to enhance and facilitate student pharmacists' learning and their ability to provide pharmaceutical care to children during a pediatric advanced pharmacy practice experience (APPE). Pediatric-specific WBT modules were developed for completion by APPE students during a 4-week rotation. Pediatric modules covered developmental pharmacology; antimicrobial use and monitoring; fluids, electrolytes, and dehydration; and drug information. Students were responsible for completing all modules within the first week of the APPE. Preassessments and postassessments consisted of 8 to 10 multiple-choice questions, with scores ranging from 0 to 100 points. Data were analyzed using descriptive statistics and paired t tests. Statistically significant improvements in postassessment scores were achieved for 3 of the 4 modules. Significant improvements were not observed in the antimicrobial use and monitoring module. Most student pharmacists either somewhat or strongly agreed that the modules improved their understanding of pharmaceutical care for children. WBT modules, taken during an APPE rotation, may expand and improve student pharmacists' understanding of pharmaceutical care in pediatric patients.

A Guided Interview Process to Improve Student Pharmacists' Identification of Drug Therapy Problems

To measure agreement between advanced pharmacy practice experience students using a guided interview process and experienced clinical pharmacists using standard practices to identify drug therapy problems. Student pharmacists enrolled in an advanced pharmacy practice experience (APPE) and clinical pharmacists conducted medication therapy management interviews to identify drug therapy problems in elderly patients recruited from the community. Student pharmacists used a guided interview tool, while clinical pharmacists' interviews were conducted using their usual and customary practices. Student pharmacists also were surveyed to determine their perceptions of the interview tool. Fair to moderate agreement was observed on student and clinical pharmacists' identification of 4 of 7 drug therapy problems. Of those, agreement was significantly higher than chance for 3 drug therapy problems (adverse drug reaction, dosage too high, and needs additional drug therapy) and not significant for 1 (unnecessary drug therapy). Students strongly agreed that the interview tool was useful but agreed less strongly on recommending its use in practice. The guided interview process served as a useful teaching aid to assist student pharmacists to identify drug therapy problems.

Multi-site Heart Disease Risk Assessment Service Provided by Pharmacy Students

To evaluate a pharmacy student service focused on patient coronary heart disease (CHD) risk assessment. Fourth-year pharmacy students offered a CHD risk assessment service at 5 physicians' offices as part of ambulatory care advanced pharmacy practice experience (APPE). Patient acceptance of the service was assessed using a satisfaction survey instrument. Fifty-seven students educated 311 patients about CHD risk. Of the 258 patients who completed the satisfaction survey, 245 (95%) reported that the service was helpful in understanding CHD risk, and 79 (31%) learned of a personal CHD risk factor of which they were not previously aware. Student knowledge was assessed using a multiple-choice pretest and posttest focused on CHD knowledge recall. Students' test scores improved from pretest to posttest (mean 51.6 % +/- 1.1 vs. 64. 8% +/- 1.0. respectively; p = 0.01). A CHD risk assessment service provided by APPE students in ambulatory care settings was educational for both students and patients.

Documentation of Student Pharmacists' Interventions from Medication Histories in a Primary Care Setting

Background: Medication safety is a major concern in primary care. Documented interventions by clinical pharmacists have shown positive clinical outcomes. In addition, it has been shown that student pharmacists have positive outcomes when participating in their advanced pharmacy practice experiences (APPEs). Most of this documentation has taken place in hospital settings. No data are available regarding interventions performed when APPE students record medication histories prior to a primary care provider (PCP) appointment. Objective: To describe the number and types of interventions made by APPE students in recording medication histories and to describe PCP acceptance rates. Methods: This prospective study documented the interventions from medication histories by 2 APPE students. With faculty supervision, the students recorded medication histories and vital signs prior to patient appointments with their PCPs. This was done approximately 1.5 days/week. Recommendations to the PCP were made verbally prior to the patient examination. Type of recommendation made, patient demographics, and PCP acceptance were documented. Descriptive statistics were employed. Results: Over 6 weeks, 109 interventions were documented. The mean ± SD patient age was 61.8 ± 14.94 years. The most common interventions documented were laboratory monitoring (22.0%), drug information (17.4%), and patient education (14.7%). Of the applicable interventions, 69% (49/71) were accepted by the PCP. Conclusions: APPE students in this clinic provided a variety of recommendations following completion of medication histories. A majority of the interventions were accepted. Such data demonstrate the benefit of including APPE students in patient care.

Women's health promotion within a community advanced pharmacy practice experience.

To establish low-cost easily conducted health promotion interventions for advanced pharmacy practice experience (APPE) students in community pharmacy settings that would increase women's awareness about health issues using Food and Drug Administration (FDA) educational materials. Students distributed fact sheets on medication use, heart disease, and diabetes to women over 45 years of age at 6 community pharmacy APPE sites. Interventions completed were either personal medication records (PMR) to identify medication-related problems (MRP) or heart health screenings followed by completion of an anonymous patient satisfaction survey instrument. Over 1500 fact sheets were distributed. Fifty-eight women (age 61 +/- 15 years) completed PMRs, which identified 57 MRPs in 42 patients. Twenty-four women indicated the screening was "useful/very useful" for increasing medication understanding. Sixty-three women completed heart health screenings. Thirty-one of the 40 who completed the survey instrument indicated the screening was "useful/very useful" for learning heart disease risk. Community pharmacy APPE students interventions identified MRPs and patients at risk for heart disease. These health promotion interventions enhanced women's awareness of these topics while guiding students to achieve the desired curricular outcomes.

A Strategy to Develop Advanced Pharmacy Practice Experiences

To establish statewide medication, disease management, and other clinical programs to serve as advanced pharmacy practice experience (APPE) training sites for the University of Colorado at Denver and Health Sciences Center School of Pharmacy, and to guarantee year-round support for the programs by providing pharmacy students with the necessary competencies to carry a significant proportion of each program's workload. Partnerships with pharmacies willing to use students to expand their scope of clinical practice or support existing programs were established. Partners were asked to choose the clinical program(s) they wished implemented or supported and were guaranteed that APPE students would contribute to carrying each program's clinical service workload for 48 week/year under the supervision of the partners' pharmacists. In addition, partners implementing new programs were offered other support, including equipment, supplies, and training and mentoring for their pharmacists. Twenty-two partnerships involving anticoagulation, diabetes, immunization, medication reconciliation, and other clinical programs were established with hospital, community, and community health center pharmacies. The partnerships provided 213 APPE placements in the 2006-2007 academic year. This work demonstrates that by using innovative approaches, a pharmacy school can form new partnerships with hospital, community health center, and community pharmacies, as well as work with existing clinical programs, to create a variety of medication, disease management, and other APPEs to meet its increasing placement needs and evolving accreditation standards.

Writing Skills of Advanced Pharmacy Practice Experience Students Whose First or Best Language Is Not English

Objective. To study the perceptions that advanced pharmacy practice experience (APPE) students whose first or best language is not English have regarding their writing skills and the APPE writing e...

ANY QUESTIONS

<b>Objective</b>. To evaluate a pharmacy student service focused on patient coronary heart disease (CHD) risk assessment. <b>Design</b>. Fourth-year pharmacy students offered a CHD risk assessment service at 5 physicians9 offices as part of ambulatory care advanced pharmacy practice experience (APPE). Patient acceptance of the service was assessed using a satisfaction survey instrument. <b>Assessment</b>. Fifty-seven students educated 311 patients about CHD risk. Of the 258 patients who completed the satisfaction survey, 245 (95%) reported that the service was helpful in understanding CHD risk, and 79 (31%) learned of a personal CHD risk factor of which they were not previously aware. Student knowledge was assessed using a multiple-choice pretest and posttest focused on CHD knowledge recall. Students9 test scores improved from pretest to posttest (mean 51.6 % ± 1.1 vs. 64. 8% ± 1.0. respectively; <i>p</i> = 0.01). <b>Conclusions</b>. A CHD risk assessment service provided by APPE students in ambulatory care settings was educational for both students and patients.