Expanded Patient Care Research Articles

Pharmacist certification of drug therapy modification: A survey of pharmacist‐reported practices, facilitators, and barriers in Georgia

AbstractIntroductionCollaborative drug therapy management (CDTM) allows pharmacists to assess patients, administer medications, manage and adjust medication regimens, and order laboratory tests within a defined protocol. Pharmacist CDTM may aid in preventative care and chronic condition management.ObjectivesThe primary objectives were to identify CDTM services provided by pharmacists in the state of Georgia, examine factors associated with the provision of CDTM services, and identify barriers and facilitators to CDTM service provision. The secondary objective was to assess differences in CDTM practice between pharmacists who completed a Registered Pharmacist (R.Ph.)/Doctor of Pharmacy (Pharm.D.), postgraduate year one (PGY1), or postgraduate year two (PGY2) residency.MethodsUsing the Dilman method, this cross‐sectional study invited all 134 CDTM‐licensed pharmacists in Georgia to complete a 30‐min electronic survey. Data included demographics, training, services offered, disease states managed, and perceptions regarding CDTM implementation. Descriptive statistics, Welchs analysis of variance (ANOVA), and chi‐square were conducted using SPSS v28.ResultsA total of 36 (26.9%) pharmacists completed the survey. Participants offered a median of three CDTM services. A majority offered medication therapy management (86.1%) and chronic care management (66.7%). A majority offered services for diabetes (58.3%), hyperlipidemia (55.6%), and hypertension (55.6%). There were differences in the mean ranked number of CDTM services offered between R.Ph./Pharm.D. and PGY2 groups (−11.667, p = 0.019), and the mean ranked number of disease states covered between R.Ph./Pharm.D. and PGY1 (−10.990, p = 0.029) and R.Ph./Pharm.D. and PGY2 (−12.640, p = 0.010, adjusted p‐value) groups. Reported CDTM facilitators were job requirements, expanding patient care, job satisfaction/personal advancement, and expanding professional practice. Reported challenges were continuing education, clinical/interprofessional concerns, administration issues with the board of pharmacy or individual practice site, and regulations differing from other states.ConclusionOf those with CDTM licensure, a majority offer medication therapy management and chronic care management services covering diabetes, hypertension, and hyperlipidemia. Postgraduate training may help prepare pharmacists to engage in CDTM services.

(373) Economic Benefits of Patient Care for Prostate Cancer Survivors with Stress Urinary Incontinence and/or Erectile Dysfunction: A Physician Reimbursement Analysis

Abstract Introduction Reconstructive urological procedures play a vital role in enhancing the satisfaction and quality of life of patients with prostate cancer (PCa) following radical prostatectomy (RP). Providing comprehensive postoperative care for common side effects of post-RP, including stress urinary incontinence (SUI) and erectile dysfunction (ED), may result in a greater number of patients with PCa receiving needed consultations and therapies. This analysis sought to explore the potential economic benefits of offering men’s health consultations and reconstructive care for PCa survivors. Objective This study quantified the relative value units (RVUs) generated from providing patient care to PCa survivors covered by Medicare Fee-for-Service who may experience SUI and/or ED due to RP. Methods This physician reimbursement analysis was based on typical patient care pathway scenarios for patients at risk of developing SUI or ED post-RP. Current Procedural Terminology (CPT) codes were utilized to identify and describe the care provided to patients in each scenario, leading to an artificial urinary sphincter (AUS) or male sling for SUI and/or an inflatable penile prosthesis (IPP) for ED. The 2023 CMS Physician and Clinical Laboratory Fee Schedule and Medicare reimbursement rates were used to obtain the most recent RVUs and reimbursement for each CPT. RVUs represent the value assigned to a service or procedure performed by a physician and are used to capture the relative cost values associated with patient care. For each scenario, we reported the total RVUs, which include work, non-facility or facility, and malpractice RVUs, and the total physician reimbursement. The 2023 Physician Conversion Factor was used to calculate the Medicare physician reimbursement. The Medicare physician reimbursement was used as a conservative estimate. Results The four clinical pathway scenarios were patients who did not experience recurrent SUI or ED (no recurrent SUI/ED), patients who only experienced SUI (only SUI), patients who only experienced ED (only ED), and patients who experienced both SUI and ED (SUI + ED). For the no SUI/ED scenario, the total RVUs from providing patient care were 5.26 RVUs, resulting in $205 in physician reimbursement. For the only SUI scenario, the total RVUs were 56.20 RVUs with an average of $1,996 in physician reimbursement for those receiving AUS and 55.54 RVUs with an average of $1,974 in physician reimbursement for those receiving male sling. For the only ED scenario, the total RVUs were 42.51 RVUs, resulting in $1,550 in physician reimbursement. For the SUI + ED scenario, the total RVUs were 98.71 RVUs with an average of $3,547 in physician reimbursement for those receiving AUS and 98.05 RVUs with an average of $3,524 in physician reimbursement for those receiving male sling. Conclusions This study justified the economic benefits of expanding patient care to men who underwent RP for PCa and provided urology practice insight into the potential physician reimbursement when PCa survivors were seen by reconstructive urologists. Disclosure Yes, this is sponsored by industry/sponsor: Boston Scientific. Clarification: Industry initiated, executed and funded study. Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific.

750 Development of a Guideline for the Integration of Speech-Language Pathology into the Burn Multidisciplinary Team

Abstract Introduction Speech Language Pathology roles include assessment and treatment of communication, orofacial contractures and oral motor weaknesses, head and neck mobility, ventilator weaning, progression towards tracheostomy decannulation, and swallowing. Specific services may include augmentative and alternative communication, speaking valve implementation on and off the ventilator, advance instrumental assessment of swallowing, and innovative therapeutic interventions. The speech-language pathologists at a single verified burn center recognized a gap in knowledge regarding the scope services they provide resulting in underutilization by the multidisciplinary burn team. The purpose of this study was to develop and disseminate a proposed clinical guideline leading to the inclusion of the speech-language pathologist in the multidisciplinary burn team. Methods Two hospital-based Speech-Language Pathologists undertook an exploratory research approach with an extensive review of available literature describing and defining their professional role both within the hospital system, and, more specifically, as a member of the burn multidisciplinary team. Burn team members were queried regarding their knowledge of speech services and appropriate patient referrals. Interviews and discussions with fellow professionals at other verified burn centers provided practice examples for comparison and consideration. Results Results from the review of literature and interprofessional discussions within our institution and with other verified burn centers were synthesized into the development of a structured practice guideline. Speech-Language pathology was officially included in the burn multidisciplinary team at our institution. The guideline was shared with outside Speech-Language Pathologists who were not yet a part of their burn multidisciplinary teams to describe and validate the role. Conclusions This foundational study led to increased awareness of Speech-Language pathology and the potential benefits to the hospitalized adult burn population. Active participation in the burn multidisciplinary conference has expanded patient care planning and led to generation of appropriate new consultations. Dissemination of the guideline supports the inclusion of Speech-Language in the burn multidisciplinary team. Applicability of Research to Practice This guideline details the many specialty services provided by speech-language pathology and provides the foundation for future research to detail the impact on burn patient outcomes.

PMS21 Change and Opportunity: U.S. Community Rheumatologists' Perceptions of and Plans to Address Evolving Industry Dynamics

In the next decade, rheumatologists are expected to face several changes to their practice (e.g., increased workforce demand, expanded telehealth options, and the integration of value-based care) that have the potential to significantly influence patient care. This study surveyed rheumatologists’ perceptions of these changes and the strategies they are employing to prepare for healthcare delivery in the future. We sampled U.S.-based rheumatologists via a web-based survey. Physician characteristics and responses were summarized using descriptive statistics. 102 rheumatologists participated. Participants were in practice for an average of 18 years (median 16; range 4-39), and 91% practiced in the community setting. Participants reported spending an average of 92% (median 95%; range 35-100%) of their time in direct patient care. 33% of participants said that the largest challenge facing their practice was increasing administrative duties and practice-related management duties, and 29% cited value-based care and the changing reimbursement landscape. Top business priorities included increasing practice revenue (37%) and reducing time spent on administrative/practice management duties (29%). Top clinical priorities included increasing patient satisfaction (35%) and patient access to care (32%). In terms of the increasing demand for rheumatologists, participants expected to manage these changing dynamics by hiring more advanced practice providers (APPs; 57%), expanding patient care with telemedicine (34%), investing in technology and tools to enable providers to spend more time on patient care (34%), and postponing retirement (19%). 52% of participants indicated that they believe APPs will have the same responsibility at their practice in the next 3 years, whereas 43% indicated that APPs will take on more responsibility. Amid changing industry dynamics, rheumatologists continue to prioritize practice success and patient satisfaction. Increasing administrative duties are the greatest burden currently facing rheumatologists. Rheumatologists plan to manage upcoming challenges by further incorporating APPs and telehealth tools within their practices.

PHARMACISTS FORGE AHEAD WITH POINT-OF-CARE TESTING, DESPITE BARRIERS

PHARMACISTS FORGE AHEAD WITH POINT-OF-CARE TESTING, DESPITE BARRIERS

Adventures in getting paid

Adventures in getting paid

Is Telemedicine Suited for Lower Extremity Pathologies? An Analysis of Non-Urgent Follow-Up in a Foot and Ankle Practice

Category:Other; Ankle; Hindfoot; Midfoot/ForefootIntroduction/Purpose:A lack of access to care is predictably associated with negative outcomes in foot and ankle surgery. Despite recent advances in telecommunication technologies, the field of orthopaedics has been slow to adopt these resources in offsetting barriers to care. The COVID-19 pandemic has forced departments to change their clinical approach, lending unprecedented opportunity to better understand how telehealth may bridge this care gap in foot and ankle practices. The purpose of this study was to assess patient-reported outcomes of telemedicine encounters, including comfort and patient satisfaction. Our hypothesis was that patients would be significantly less satisfied with telemedicine when compared to in-office appointments for all non-emergent visit types.Methods:Retrospective analysis of patients seen via telemedicine between April 13, 2020, to June 19, 2020, by one surgeon in the Emory Orthopedics Foot and Ankle department was conducted. Patients were contacted by one of the study authors via telephone to complete a questionnaire; satisfaction and other visit characteristics were assessed with a modified Likert scale from 1 to 5. Patients were designated as either ‘New’ or ‘Established’ based on whether or not they had completed an in-office clinic visit within the last year. Anatomy and pathology of disorder were determined by chief complaint and billing code. Patient demographics were recorded, and data were analyzed using paired and independent t-tests for parametric continuous data, Fisher’s exact and chi-square tests for non-continuous data.Results:338 eligible patients were contacted via telephone, with 216 (63.9%) completing the telemedicine questionnaire. The patient cohort had an average age of 50.6 (19-84) years old and was 73.6% female (n=159). Overall mean satisfaction for telemedicine visits (4.69) was significantly lower than in-office visits (4.86) (p<0.001). In a subgroup analysis of patient satisfaction, patients seeking fracture care had significantly higher telemedicine satisfaction when compared to those receiving non-fracture care (4.90 vs. 4.64, p=0.001). Telemedicine satisfaction was also significantly greater in patients traveling more than 50 miles from their home to clinic (4.96 vs. 4.67, p<0.001). Patients with median household income less than the Georgia state median ($55,679) were more satisfied with their telemedicine visits than those with greater income, though the difference was non-significant.Conclusion:our data suggest those with significantly hindered mobility such as increased distance from clinic, lower socioeconomic status, and those seeking care for fractures had higher telemedicine satisfaction than their peers. Further study is needed to detail the precise and safe use of telemedicine in practice, but these data illuminate the high ceiling telemedicine offers in expanding patient care. Our hope is that this study aids as a supportive rationale for the continued use of telehealth visits past the period of the pandemic and encourages a more nuanced view of what visit types may be best-suited for telehealthcare

Advancing the Adoption of Continuing Professional Development (CPD) in the United States.

Over the last four decades, the expanded patient care roles of pharmacists in the United States (U.S.) have increased focus on ensuring the implementation of processes to enhance continuing professional development within the profession. The transition from a model of continuing pharmacy education (CPE) to a model of continuing professional development (CPD) is still evolving. As pharmacists assume more complex roles in patient care delivery, particularly in community-based settings, the need to demonstrate and maintain professional competence becomes more critical. In addition, long-held processes for post-graduate education and licensure must also continue to adapt to meet these changing needs. Members of the pharmacy profession in the U.S. must adopt the concept of CPD and implement processes to support the thoughtful completion of professional development plans. Comprehensive, state-of-the-art technology solutions are available to assist pharmacists with understanding, implementing and applying CPD to their professional lives.

A tree with deep roots: 54th anniversary of nurse practitioners.

More than 270,000 nurse practitioners (NPs) celebrate the profession's 54th anniversary this year. NPs have significantly expanded patient care options and availability. Many states now allow full practice authority for NPs, and all states now allow NPs to prescribe. Doctor of Nursing Practice-prepared NP enrollment is rising. The NP profession as an integral part of the US health care system has significantly strengthened our health care system, making the tree with deep roots even stronger and more substantial than ever.

Reflections on the early years of neonatology. William Oh: neonatal pioneer devoted his career to groundbreaking research, expanding patient care, and mentoring others.

Reflections on the early years of neonatology. William Oh: neonatal pioneer devoted his career to groundbreaking research, expanding patient care, and mentoring others.

Credentialing and privileging:Key to pharmacy’s expanding patient care role

Pharmacy Today is printed on 85% recycled paper. Credentialing and privileging: Key to pharmacy’s expanding patient care role The Council on Credentialing in Pharmacy (CCP), established in 1999, provides leadership, guidance, public information, and coordination for the profession’s credentialing programs. In 2014, CCP released Credentialing and Privileging of Pharmacists: A Resource Paper from the Council on Credentialing in Pharmacy. The purpose of this resource is to educate pharmacists about credentialing and privileging processes and to assist those who are introducing or enhancing a credentialing and privileging system for pharmacists within their health care setting. Health care providers are increasingly more accountable for the quality of the care delivered to patients. As efforts to provide and reward ef cient, affordable, and higher quality health care expand in the U.S. health care system, and pharmacists begin to function as part of health care teams, greater importance is being placed on credentialing and privileging of all health professionals. The Innovations article found on page 50 examines how credentialing and privileging processes are utilized in real-world practice settings—from the U.S. Public Health Service (USPHS) since the late 1990s to the U.S. Department of Veterans Affairs in the early 2000s, managed care as evidenced by Kaiser Permanente, and the independent community pharmacy setting as illustrated by Goodrich Pharmacy in Minnesota with former APhA President Steve Simenson, BSPharm, FAPhA, FACA. The article includes many strong arguments to establish a credentialing and privileging process for pharmacists. Lea Price, PharmD, BCPS, from Kaiser Permanente Colorado, noted something we often hear from Board of Pharmacy Specialties Board Certi ed Pharmacists: “Physicians and nurses can feel con dent that we perform at the highest level with the additional respect afforded by the credenitaling process.” However, I believe that RADM Pamela Schweitzer, PharmD, BCACP, U.S. Assistant Surgeon General and Chief Professional Of cer, Pharmacy, for the USPHS, said it best: “We realized at the time that if we expected to be reimbursed, we would have to have uniformity among credentials and competencies—similar to the medical staff.”

The effect of active learning methodologies on the teaching of pharmaceutical care in a Brazilian pharmacy faculty.

BackgroundIn recent years, pharmacists have been involved in expanded patient care responsibilities, for example patient counseling in self-medication, medication review and pharmaceutical care, which require graduates to develop the necessary competences. Consequently, reorientation of pharmacy education has become necessary. As such, active learning strategies have been introduced into classrooms to increase problem-solving and critical thinking skills of students. The objective of this study was to evaluate the performance and perceptions of competency of students in a new pharmaceutical care course that uses active learning methodologies.MethodsThis pharmaceutical care course was conducted in the first semester of 2014, in the Federal University of Sergipe. In the pharmaceutical care course, active learning methods were used, consisting of dialogic classroom expository, simulation and case studies. Student learning was evaluated using classroom tests and instruments that evaluated the perception of competency in pharmaceutical care practice. Furthermore, students' satisfaction with the course was evaluated.ResultsThirty-three students completed the four evaluations used in the course (i.e., a discursive written exam, seminars, OSCE, and virtual patient); 25 were female (75.75%), and the median age was 23.43 (SD 2.82) years. The overall mean of student scores, in all evaluation methods was 7.97 (SD 0.59) on a scale of 0 to 10 points, and student performance on the virtual patient method was statistically superior to other methods. With respect to the perception of competency in pharmaceutical care practice, a comparison of pre- and post-test scores revealed statistically significant improvement for all evaluated competences. At the end of the semester, the students presented positive opinions of the pharmaceutical care course.ConclusionsThe results suggest that an active learning course can enhance the learning of pharmaceutical care competences. In future studies it will be necessary to compare active learning to traditional methods.

APhA2015: You made it a success!

APhA2015: You made it a success!

Pharmacist–Technician Teamwork in Hypertension Management Services in Community Pharmacies: Effects of Team Composition and Environmental Factors

Expanding patient care in community pharmacy necessitates effective pharmacy team efforts. This paper examines pharmacist-technician teams and examines whether team composition and environmental factors influenced team agreement and communication regarding a novel hypertension management program. Methods: Data were gathered via self-administered survey completed by each member of 12 pharmacist–technician pairs. Analysis used Fuzzy-set Qualitative Comparative Analysis (fsQCA). Outcome measures were: 1) team agreement on (a) technician tasks and (b) pharmacist tasks and 2) team communication. Two types of conditions (i.e., potential predictors) were examined: team composition (indicated by pharmacist experience and pharmacist experience relative to technician experience) and environmental factors (indicated by auxiliary support in the pharmacy, pharmacy workload, and economic status of the neighborhood). Outcomes and conditions were constructed in continuous fuzzy sets for analysis. A plausible causal configuration was deemed relevant if at least one case exhibited this particular configuration; a configurationwas considered a sufficient solution for an outcome it met the consistency benchmark (set at 0.9). Results: Team agreement on technician tasks was higher when: (1) a pharmacist was paired with a more senior technician in a pharmacy that had higher auxiliary support and (2) an experienced pharmacist worked in a low-workload pharmacy in a less affluent neighborhood. Agreement on pharmacist tasks was higher when: (1) a pharmacy had a low workload and higher auxiliary support and (2) an inexperienced pharmacist was in a low-workload pharmacy in a more affluent neighborhood. Only one configuration was associated with the two communication variables. The team had more discussion about tasks when the pharmacist was more senior than the technician. Greater communication was reported when the pharmacist was more senior and the pharmacy had greater auxiliary support. Conclusions: Results begin to identify team composition and pharmacy environment factors that promote (or impede) team agreement. They suggest ways to enhance pharmacy team-building.

Technology User's Training Is a Waif

BackgroundIn recent decades, health care systems has greatly influenced by the technology development. The technology is helpful to enhance quality of care, reduce costs and improve patient care if appropriate training be applied for technology users. Technology user’s training has been studied in some quantitative studies; however, a few investigators have studied the challenges which nurses’ experienced in this regard.ObjectivesThis qualitative study conducted to explain how nurses explain and perceive challenges in technology user’s training.Materials and MethodsThis qualitative study was conducted in 2012 by using the content analysis technique in which data were collected through interview. Twenty-four nurses who were occupied in hospitals affiliated to Isfahan University of Medical Sciences were selected by using purposive sampling and in-deep semi-structured interviews (focus-groups and individual interviews) were done. The content of data was analyzed by the Zhang and Wildmouth’s method.ResultsInitial concepts evolved after content analyzing and five main categories were emerged. Theses categories were “Everything and everyone teach” technology users but there are “No effective training”, “Uninformed resources”, and managers always “Rely on trial and error” and there are some “Learning Barriers”.ConclusionsThe result of this study outlined important concerns of nurses regarding biomedical technology user training, and determined the need for further education to modernized healthcare system for promoting and expanding patient care.

Win/Win: Creating Collaborative Training Opportunities for Behavioral Health Providers within Family Medicine Residency Programs

Integrating behavioral health into primary healthcare offers multiple advantages for patients and health professionals. This model requires a new skill set for all healthcare professionals that is not emphasized in current educational models. The new skills include interprofessional team-based care competencies and expanded patient care competencies. Health professionals must learn new ways to efficiently and effectively address health behavior change, and manage behavioral health issues such as depression and anxiety. Learning environments that co-train mental health and primary care professionals facilitate acquisition of both teamwork and patient care competencies for mental health and primary care professional trainees. Family Medicine Residency programs provide an excellent opportunity for co-training. This article serves as a "how to" guide for residency programs interested in developing a co-training program. Necessary steps to establish and maintain a program are reviewed, as well as goals and objectives for a co-training curriculum and strategies to overcome barriers and challenges in co-training models.

Expanding pharmacists' roles in breastfeeding support: A pilot study of an online breastfeeding tutorial for student pharmacists

ObjectivesA 2011 report to the US Surgeon General by the US Public Health Service Chief Pharmacist provides rationale and a compelling discussion to support health reform through pharmacists delivering expanded patient care services. With their highly visible role in the community, frequent interactions with soon-to-be and new parents, and knowledge of medication safety, pharmacists can be a key component in the promotion and support of breastfeeding, an important, and underutilized health behavior. This expanded role in breastfeeding support would be consistent with the pharmaceutical care concept. Exposing student pharmacists to breastfeeding information beyond traditional medication and lactation information can facilitate the early shaping of their attitudes and understanding. MethodsWe created and pilot-tested an online tutorial that complements existing medication–lactation education at three schools of pharmacy. A survey was conducted to understand pharmacy students' attitudes regarding their roles in infant feeding. ResultsAfter the online tutorial, student pharmacists most commonly expressed moderate confidence in answering questions that parents have on breastfeeding (47% moderately confident, 39% extremely or very confident, and 14% not very or not at all confident) and on introducing solid foods (41% moderately confident, 35% extremely or very confident, and 24% not very or not at all confident). Almost all student pharmacists felt they had an important role in providing breastfeeding information and support. ConclusionsLeveraging pharmacists to address unmet preventive health needs is especially important in our current health care delivery environment. A short online tutorial is a feasible mechanism for expanding student pharmacist awareness about breastfeeding.

Evolution in Pharmacy Education: Developing Effective Patient Care Practitioners

Changes outlined in the Blueprint for Pharmacy emphasize the need to provide “[o]ptimal drug therapy outcomes for Canadians through patient-centred care”. This approach requires pharmacists to contribute to outcomes-focused patient care, while working within health care teams; pharmacists also need to be accountable and responsible for the safe and effective use of medications. There is an urgent need for all pharmacists to take on this responsibility. Almost half of patients visiting a community pharmacy or a clinic will have a drug therapy problem. Patients who have been admitted to hospital also experience a substantial number of preventable adverse drug events. Medication costs represent the fastest-rising expenditure within our health care system. Furthermore, with increased use of medications, there is potential for even more adverse drug events to occur. Also, the elderly population uses the most medications, exposing them to an even greater risk of drug therapy problems; in fact, by 2036, 1 in 4 Canadians will be over 65 years of age. Pharmacists are required to effectively manage drug therapy for all patients, and both faculties of pharmacy and the profession as a whole have obligations to prepare graduating pharmacists for this role. Education to prepare pharmacists for expanded patient care roles has started to change. For example, all pharmacy schools in Canada have made a commitment to have an entry-level PharmD curriculum in place by 2020. Some key components of new curricula include an expanded and integrated approach to teaching pharmacotherapy, management courses that include development of patient care services, incorporation of physical assessment and competencies related to the expanded scope of practice (e.g., training for administration of injections), and extensive clinical training in direct patient care. This expanded education is supported nationally by the 2010 educational outcomes of the Association of Faculties of Pharmacy of Canada, which call for pharmacy graduates to be “medication therapy experts”. Also, the Canadian Council for Accreditation of Pharmacy Programs (CCAPP) has now approved new standards for PharmD first professional degree programs, which will be implemented in early 2013. Each program must offer a total of 40 weeks (1600 h) of experiential education, with early and mid-program practice experiences lasting at least 8 weeks (320 h) and concluding practice experiences (at the end of the program) lasting at least 24 weeks (960 h). This level of clinical training is considered essential for graduates to become independent, competent patient care practitioners, who are responsible to both patients and colleagues within interprofessional teams. Current training, although effective, is demanding for the preceptor and the site and does not explicitly hold the student accountable to the patient and the rest of the health care team. There are many challenges and just as many opportunities as we consider a paradigm shift in how we train pharmacy students. At the June 2011 meeting of the American Society of Health-System Pharmacists, Ashby proposed a pharmacy student training model that would enable trainees to become more accountable and make them indispensable within the patient care team. He also emphasized the importance of students undertaking patient care activities that are known to improve patient outcomes. Additional recommendations included extension of rotational experiences and provision of support to students in their own desired career paths by matching training to interests. In this issue of the CJHP, Hall and others provide an insightful overview of current experiential training in hospital pharmacy and put forward 8 guiding principles that they consider as key factors for the success of future experiential models. Much of what they outline is akin to training within medical programs, including starting experiential education earlier in the program; providing a mix of hospital and community site experience early, with sustained practices in later years

To what Extent Would PBL be Best Incorporated into a Pharmacy Curriculum?

For the time being our pharmacy curriculum is in Iran mostly based on lecturing methods as instructional strategies. In this method of education a great deal of declarative knowledge as well as a large number of students could be covered at the same time. Indeed based on the job description of a pharmacist, pharmacy graduates should work in a relevant field in pharmacy retail, in order to be able to solve any health related problems, rather than having merely declarative knowledge. Colleges of pharmacy can utilize problem based learning (PBL) to aid anticipated learning outcomes and practice competencies of entry level pharmacists. Problem-based learning is an effective approach to enhance cognitive strategies and long-term memory as well. In this method pharmacists will be involved in expanded patient care responsibilities which require graduates to possess enhanced communication skills, greater problem-solving capabilities, effective critical thinking abilities and decision making skills. Moreover, PBL has the potential to integrate the basic sciences with clinical practice too. However, to achieve the PBL method of learning, curriculum modification and various instructional strategies will have to be considered to facilitate the learning outcomes needed for the practice of pharmaceutical care. Fortunately, already a number of pharmacy courses includeing, over the counter (OTC) medicines, pharmacotherapeutics, pharmacy administration, toxicology, pharmacy practice, pharmacology, clinical pharmacy and some other advanced courses, lend themselves to the PBL instructions. However, the use of the PBL learning method may in some basic courses such as pharmaceutical sciences, biochemistry, medicinal chemistry and so on face difficulties. For such courses is there another option close to PBL is called the problem-solving model. The differenc between then is that is in PBL the specific situation is defined as the problem and student should analyse the situation and provide a solution, whereas in the problem solving metod for student better understanding problems have been designed for students to solve together and find answers to them. Hence basic sciences in pharmacy education are best taught by conventional curriculum and problem solving method and advanced courses could be taught using the PBL model. In order to succeed, we need to change the pharmacy curriculum, by integrating the knowledge with practice. Conditions needed to make integration possible are as follows: 1) a well- developed national health policy; 2) a plan for the development and coordination of human resources for health; 3) a discussion and decision committee to review the curriculum; and 4) organization to consider financial aspects, compensation, maintenance of quality of the services and academic standards. Apart from the face that PBL strategy is valuable in helping students to learn team collaboration, listening, and participating in interdisciplinary discussion, students will be able to clarify for themselves the abilities they bring to a health care team. This will help them to obey their job responsibility as a good consultant for physicians, nurses, patients, and other health care professionals. PBL is directing the learning strategy to: keep the students engaged in active learning, hold students responsible for the entire knowledge base that applies to different courses of pharmacy, use a facilitator of knowledge (tutor) rather than presenter of knowledge, and design a variety of clinical scenarios that can be extended into chronic followed-up care and treatment. To achieve this situation it is highly recommended to revise pharmacy curriculum and develop methods of teaching and learning. Hossein Vatanpour is currently working as a professor at the Department of Toxicology and Pharmacology, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran. He could be reached at the following e-mail address: vatanpour.hossein@gmail.com.

Constructs underlying community pharmacy dispensing functions relative to Florida pharmacy technicians

ObjectivesTo assess pharmacist and pharmacy technician opinions on functions community pharmacy technicians should perform. DesignCross-sectional and descriptive. SettingFlorida community pharmacies during August and September 2004. ParticipantsRandom sample of Florida community pharmacists (n = 2, 000) and Certified Pharmacy Technicians (n = 2, 000). InterventionSelf-administered mail questionnaire. Main outcome measuresParticipant attitudes (6-point Likert-type scale:1, strongly disagree; 6, strongly agree) regarding whether pharmacy technicians should perform 26 community pharmacy dispensing functions. Chi-square difference tests and separate group exploratory factor analyses (EFAs) were conducted. ResultsPharmacists (n = 383) and technicians (n = 579) agreed that technicians should perform 17 of the 26 (65%) functions. The groups differed significantly on eight items that were focused on patient care and beyond technicians’ traditional involvement in processing prescriptions, with technicians having a more expansive view of their roles than did pharmacist respondents. Three similar factors were extracted in both groups from the EFAs: functions typical of pharmacy technicians in current practice, clinical pharmacy knowledge functions, and pharmacist-only functions as specified by law. Additionally, general drug knowledge (technician data only) and pharmacy information evaluation and management skills (pharmacist data only) factors were generated. ConclusionGenerally, pharmacists and technicians agreed on basic functions involving prescription and claims processing; however, technicians, as compared with pharmacists, supported a more expanded patient care role for themselves.