Background: The central Appalachian region is at an elevated risk for HIV/HCV outbreaks, primarily due to injection drug use. Regional risk assessments highlight gaps in the evidence-based continuum of primary, secondary, and tertiary prevention strategies to minimize HIV/HCV transmission. One potential strategy for increasing the reach of HIV/HCV prevention efforts in rural areas is through provision of services at community pharmacies. Objective: To qualitatively describe community pharmacists' HIV/HCV-related prevention behaviors, attitudes, and beliefs in a 3-state central Appalachian region. Methods: Key informant interviews were conducted with 15 practicing community pharmacists. Theory of Planned Behavior-based questions probed for perceptions about the role of pharmacies in preventing and reducing HIV/HCV outbreaks in rural areas through activities such as syringe services, screening for HIV/HCV, and linking people to treatment when appropriate. Investigators applied thematic analysis to deductively and inductively generate themes from the interview transcripts. Results: Two overarching themes regarding pharmacist engagement in HIV/HCV-related prevention services were generated: 1) current approaches to primary prevention through nonprescription syringe sales (e.g., gatekeeping behaviors) and 2) potential for uptake of the continuum of HIV/HCV-related prevention services in community pharmacies. Future engagement of community pharmacists in the continuum of HIV/HCV-related prevention services comprised 2 subthemes as possible underlying factors: general and specific willingness to provide services and perceived fit within the pharmacy profession. Conclusions: Central Appalachian community pharmacists express a general willingness to help patients who may benefit from HIV/HCV-related prevention services, but current engagement, willingness, and perceived fit for offering specific prevention services in the community pharmacy setting is variable. This has potential immediate implications, such as prioritizing the introduction of more widely accepted services (e.g., provision of HIV/HCV-related prevention education) to community pharmacy practice, and longer-term implications, such as the integration and framing of HIV/HCV-related prevention services as helping behavior within the pharmacist professional identity.

BACKGROUND: Evidence supporting beta-lactam plus vancomycin synergy for methicillin-resistant (MRSA) continues to grow. Current evidence demonstrates that combination therapy is associated with shorter time to blood sterilization than vancomycin monotherapy. However, this combination has not been reported as salvage therapy for persistent MRSA bacteremia. CASE REPORT: We report a case of an 81-year-old male who was successfully treated with vancomycin plus nafcillin after failing vancomycin monotherapy, daptomycin monotherapy, and daptomycin plus gentamicin combination therapy. The patient originally presented with sepsis from a suspected urinary tract infection. Blood cultures drawn on days 1, 3, 5, 15, 19, 23, and 28 remained positive for MRSA despite multiple antimicrobial therapy changes. On day 29, therapy was changed to vancomycin plus nafcillin. Blood cultures drawn on day 32 remained negative. After 11 days, nafcillin was changed to piperacillin-tazobactam due to an infected decubitus ulcer. The combination was continued for 42 days after achieving blood sterility, 71 days after the patient originally presented. Evidence regarding salvage therapy for persistent bacteremia is sparse and is limited to case reports and case series. CONCLUSION: This case report supports that vancomycin plus an anti-staphylococcal beta-lactam combination should be further studied as salvage therapy for persistent MRSA bacteremia.

This paper details collaboration in elective global health Advanced Pharmacy Practice Experiences (APPEs) between six schools of pharmacy, four in the United States (U.S.) and two in Uganda. This collaboration was initiated to build capacity within Uganda to advance pharmacy practice by strengthening pharmaceutical care education and research, and to provide benefits in the global and public health education and research for U.S. students and each partner University. Makerere University and Mbarara University of Science and Technology in Uganda sought out collaborations to improve pharmacy education in Uganda and alleviate shortages in faculty they have experienced in expanding pharmacy training. In response to this need, Wilkes University, Binghamton University, the University of Minnesota, and East Tennessee State University developed faculty-led APPEs to help model and teach the principles of clinical pharmaceutical care. These faculty-led APPEs occur in various Ugandan locations throughout the year and incorporate Ugandan and U.S. students as co-learners. Ugandan and U.S. faculty act as co-facilitators of didactic, experiential, and research learning experiences. APPE activities include modeling the provision of pharmaceutical care, interprofessional patient care on inpatient wards, joint didactic lectures and case presentations, skills laboratory sessions, and research components. Developed to serve the needs of both the U.S. and Ugandan partners, the elective global health APPEs to Uganda have grown to be sustainable, mutually beneficial collaborations between the six schools of pharmacy and the Ugandan partners. Formal and informal communications between all of the entities involved have helped support continuity of these programs. We recommend such initiatives to other countries and institutions desiring to improve training for pharmaceutical care to advance pharmacy practice.

Yes / Pain experienced by many patients with advanced cancer is often not well controlled and community pharmacists are potentially well placed to provide support. The study objective was to explore the views and experiences of patients with advanced cancer about community pharmacies, their services and attitudes towards having a community pharmacist pain medicines consultation. Purposive sampling of GP clinical information systems was used to recruit patients with advanced cancer, living in the community and receiving opioid analgesics in one area of England, UK between January 2015 and July 2016. Thirteen patients had a semi-structured interview which was audio-recorded and transcribed verbatim. Data were analysed deductively and inductively using Framework Analysis and incorporating new themes as they emerged. The framework comprised Pain management, Experiences and expectations, Access to care and Communication. All patients reported using one regular community pharmacy citing convenience, service and staff friendliness as influential factors. The idea of a community pharmacy medicines consultation was acceptable to most patients. The idea of telephone consultations was positively received but electronic media such as Skype was not feasible or acceptable for most. Patients perceived a hierarchy of health professionals with specialist palliative care nurses at the top (due to their combined knowledge of their condition and medicines) followed by GPs then pharmacists. Patients receiving specialist palliative care described pain that was better controlled than those who were not. They thought medicines consultations with a pharmacist could be useful for patients before referral for palliative care. There is a need for pain medicines support for patients with advanced cancer, unmet need appears greater for those not under the care of specialist services. Medicines consultations, in principle, are acceptable to patients both in-person and by telephone, the latter was perceived to be of particular benefit to patients less able to leave the house. / National Institute of Health Research programme grant

<p><b>Background</b><br></p> <p>More than 90% of individuals aged 65 years or older in the United States (US) are taking at least one prescription medication, and more than 40% are taking five or more prescription medications. The potential for non-adherence and risk of medication therapy problems (MTPs) increases with the use of multiple medications. To enhance patient understanding of appropriate medication use, improve medication adherence, and reduce MTPs, the Centers for Medicare & Medicaid Services (CMS) launched Medication Therapy Management (MTM) services as part of Medicare Prescription Drug (Part D) policy; however, “best practices” for achieving positive MTM outcomes are not well understood.</p><p><br></p> <p> </p> <p><b>Objectives</b></p> <p>This study had two objectives. The first objective was to identify and explain reasons for concordance and discordance between a) consistently high, moderate, and low performing pharmacies and b) pharmacies that improve or worsen in performance overtime. The second objective was to generate hypotheses for strategies that contribute to community pharmacies’ ability to achieve high performance on widely accepted MTM quality measures. </p><p><br></p> <p> </p> <p><b>Methods</b></p> <p>This comparative mixed-methods, case study design incorporated two complementary conceptual models. First, an adaptation of the Positive Deviance (PD) model explains reasons for deviations in MTM quality measure performance among community pharmacies and informs study design. Second, the Chronic Care Model (CCM) guided data collection and analysis. Data consisted of pharmacy/staff demographics and staff interviews. When appropriate, quantitative and qualitative data were analyzed within and across pharmacy MTM performance (i.e., high, moderate, low) or change-in-performance (i.e., consistent, improved, worsened) categories using descriptive statistics and cross-tabulation respectively. MTM performance component measures used to evaluate and rank pharmacy MTM performance mirrored measures under Domain 4 (Drug Safety and Accuracy of Drug Pricing) of the 2017 CMS Medicare Part D Plan’ Star Rating measures. This study was approved by the Institutional Review Board for the Purdue University Human Research Protection Program. </p><p><br></p> <p> </p> <p><b>Results </b></p> <p>Across the sample of eligible pharmacies (N = 56), MTM performance composite scores varied by 21.3%. Of the five component scores, the <i>Comprehensive Medication Review (CMR)</i> component score had the highest percent variation (88.3%). Pharmacy staff at 13 pharmacies of the 18 pharmacies selected as case study sites participated in interviews, yielding a 72.2% case pharmacy participation rate. Of the 13 pharmacies, five were categorized as high performers, four were moderate performers, and four were low performers. Of the 39 pharmacy staff approached across all pharmacies, 25 participated in interviews, yielding a 64.1% participation rate. Interviewees included 11 pharmacists, 11 technicians and three student interns. Eight strategies were hypothesized as positively (7) or negatively (1) contributing to pharmacies’ MTM performance. Hypotheses generated were organized by CCM elements and included: <i>Delivery System Design (DSD)</i> – Having a high degree of technician involvement with MTM activities; Inability to meet cultural, linguistic, and socioeconomic needs of patients (negative); Having sufficient capacity to provide CMRs to patients in person compared to telephone alone; Pharmacy staff placing high priority on addressing MTM activities<i>; Clinical Information Systems (CIS) </i>– Faxing adherence-related MTP recommendations and calling providers on indication-related MTP recommendations; Technicians’ use of CISs to collect/document information for pharmacists; Using maximum number of available CISs to identify eligible MTM patients; <i>Health System Organizations (HSO) </i>– Strong pharmacist-provider relationships and trust. No hypotheses were generated for the remaining three CCM elements.</p><p><br></p> <p> </p> <p><b>Conclusions </b></p> <p></p>A total of eight strategies were hypothesized as contributing to community pharmacies’ ability to achieve high performance on MTM quality measures. Notable strategies were related to three of the six chronic care model elements. Future research should engage stakeholders to assist with prioritizing hypotheses to be statistically tested in a larger representative sample of pharmacies.

Abstract available through the Journal of the American Pharmacists Association.

Objectives: The objective was to determine the effect of podcasting, with resultant increased in-class active learning time, on student performance. Methods: In an effort to increase in-class active learning time and improve understanding of the material in a third-year pharmacotherapy course, podcasts were developed to cover specific topics and were made available outside-of-class for students in 2010. Students in the same course in the year 2009 had received identical in-class didactic instruction for these topics. End-of-course exam scores were adjusted using analysis of covariance and compared using the t-test. Results: The class averages on the end-of-course exams were significantly higher at 77.5 ± 1.2 (n = 65) for the class of 2009 compared to 72.9 ± 1.5 (n = 71) for the class of 2010 (p = 0.019). This difference remained significant after adjusting the 2009 and 2010 classes for the covariates. The difference between the classes was further magnified when using the covariate of GPA, 78.3 ± 1.2 compared to 72.2 ± 1.1 (p < 0.001) for the classes of 2009 and 2010, respectively. Rank ordering resulted in a significant difference in the exam grade in the lower 50th percentile 73.2 ± 1.6 (n = 34, 2009 class) compared to 65.8 ± 1.9 (n = 34, 2010 class), p = 0.004. No significant differences were noted between the two classes for those students in the upper 50th percentile. Conclusion: Increased in-class active learning time led to decreased examination scores for the lower 50th percentile of students in the 2010 cohort. One potential explanation is that students were not held accountable for completing the out-of-class preparatory exercises.

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

Objectives: 1) Describe personal finance (PF) perceptions of the East Tennessee State University (ETSU) Gatton College of Pharmacy Class of 2014 upon and 1-year post-graduation; 2) Examine the association between PF elective course completion during pharmacy school and post-graduation PF behaviors. Method: Students enrolled in the ETSU Class of 2014 completed a self-administered questionnaire that assessed student characteristics (e.g, participation in a PF elective during school), PF characteristics (e.g., student loan indebtedness), perceptions (e.g., confidence in ability to manage PF), and behaviors (e.g., monthly budgeting) one week prior to graduation and 18 months post-graduation. Paired and independent samples statistical analyses were conducted to examine changes in responses over time and PF course participation. Results: Sixty percent of the cohort completed both questionnaires. Students reported an average student loan debt balance of $155,571 (±$83,853) 18 months post-graduation and average loan term length of 17.3 (±8) years. Students’ concerns about their student loan debt were significantly higher prior to graduation as compared to 18 months post (p=0.01). No significant differences were noted for student loan debt amount or student loan term length across PF elective participation. Students who took the personal finance elective were significantly more likely to develop monthly budgets (p=0.01) and report positive career satisfaction as compared to students who did not (p=0.04) 18 months post-graduation. Implications: To our knowledge, this is the first study to track PF perceptions and behaviors of pharmacy graduates longitudinally. Continued tracking and analysis will inform PF curricular integration and alumni personal and professional development.

Objective. To use cognitive interviewing techniques to determine faculty and student interpretation of a subset of items from the AACP faculty and graduating student surveys. Methods. Students and faculty were interviewed individually in a private room. The interviewer asked each respondent for his/her interpretation of 15 randomly selected items from the graduating student survey or 20 items from the faculty survey. Results. While many items were interpreted consistently by respondents, the researchers identified several items that were either difficult to interpret or produced differing interpretations. Conclusion. Several interpretational inconsistencies and ambiguities were discovered that could compromise the usefulness of certain survey items.