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Opioid misuse and mismanagement has been a public health crisis for several years. Pharmacogenomics (PGx) has been proposed as another tool to enhance opioid selection and optimization, with recent studies demonstrating successful implementation and outcomes. However, broad engagement with PGx for opioid management is presently limited. The purpose of this article is to highlight a series of barriers to PGx implementation within the specific context of opioid management. Areas of advancement needed for more robust pharmacogenomic engagement with opioids will be discussed, including clinical and economic research needs, education and training needs, policy and public health considerations, as well as legal and ethical issues. Continuing efforts to address these issues may help to further operationalize PGx toward improving opioid use.

Pharmacogenomics (PGx) is expanding across health-care practice settings, including the community pharmacy. In the United States, models of implementation of PGx in the community pharmacy have described independent services and those layered on to medication therapy management. The drug–gene pair of clopidogrel-CYP2C19 has been a focus of implementation of PGx in community pharmacy and serves as an example of the evolution of the application of drug–gene interaction information to help optimize drug therapy. Expanded information related to this drug–gene pair has been provided by the US Food and Drug Administration and clinical PGx guidelines have and continue to be updated to support clinical decision-making. Most recently direct-to-consumer (DTC) PGx has resulted in patient generated sample collection and submission to a genetic testing-related company for analysis, with reporting of genotype and related phenotype information directly to the patient without a health-care professional guiding or even being involved in the process. The DTC testing approach needs to be considered in the development or modification of PGx service models in the community pharmacy setting. The example of clopidogrel-CYP2C19 is discussed and current models of PGx implementation in the community pharmacy in the United States are presented. New approaches to PGx services are offered as implementation continues to evolve and may now include DTC information.

Objectives Certain prescription medications should be avoided during pregnancy to reduce the risk of fetal harm. Identification of these medications to minimize exposure may be achieved through the integration of preconception care recommendations into medication therapy management (MTM) services. The primary objective of this study was to identify missed opportunities for pharmacists to provide preconception care support related to medications associated with adverse pregnancy outcomes for reproductive-aged women who received MTM consultations at a regional supermarket pharmacy chain. Secondary objectives examined the concurrent use of prenatal vitamins, folic acid, or hormonal contraception in patients receiving medications associated with adverse pregnancy outcomes. Methods The study examined all MTM and prescription drug claims submitted by a regional chain of supermarket pharmacies from January 1, 2018 to June 30, 2019, to identify female patients aged 15-45 years who received MTM services. Prescription claims were cross-referenced to determine which of these patients also received medications associated with adverse pregnancy outcomes. To identify patients with long-term use of opioids and nonsteroidal anti-inflammatory drugs, a restriction based on days supplied was then applied. Results Of the 2020 female patients who received MTM services and filled at least 1 prescription during the study period, 731 (36.2%) were found to have received at least 1 medication associated with adverse pregnancy outcomes for the minimal days’ threshold. Of these, 509 (69.6%) lacked evidence of concurrent prescription contraception, and 74 (10.1%) had a concurrent prescription for folic acid or prenatal vitamins. Conclusion The use of medications associated with adverse pregnancy outcomes was widespread in this sample of reproductive-aged women. The findings of this study indicate the need for additional research to investigate the implementation of targeted MTM interventions to build standard workflow processes and facilitate pharmacists’ management of this critical clinical issue.

Background and purpose With a prevalence of about one million d/Deaf and Hard of Hearing (HOH) patients that utilize American Sign Language (ASL) and the strong potential for communication barriers to adversely influence patient care outcomes, strategies must be developed to support health care professionals and students in learning to better care for d/Deaf and HOH patients. The primary objective of this project was to implement and assess a co-curricular course focused on helping student pharmacists become more confident and comfortable in communicating with d/Deaf and HOH patients. Educational activity and setting The co-curricular course (ASL for the Pharmacy Professional) consisted of four 90-min classes, each covering different words/phrases and Deaf cultural competence. Students were taught basic ASL including the alphabet, numbers, vocabulary, and sentence structure. Deaf culture and d/Deaf patient interaction was also covered. Students interacted with a Deaf physician over Skype and with d/Deaf and HOH individuals from the local community. Findings Pre- and post-surveys that contained an identical set of questions were administered before and after course completion. Surveys assessed confidence and level of comfort of first- and second-professional year student pharmacists surrounding Deaf culture and interacting with d/Deaf and HOH patients. Following the course, students reported significantly improved confidence in communicating with d/Deaf patients directly and with a translator. Summary Following completion of a co-curricular ASL course, doctor of pharmacy students perceived an increase in confidence in working with d/Deaf and HOH patients. Program logistics were simplified through collaboration with an outside entity.

Opioid use and misuse are continued issues facing clinicians across all aspects of health care. As clinicians struggle to effectively manage opioid prescribing, pharmacogenomics (PGx) further offers the prescriber an improved ability to understand the potential for an individual patient's genetics to influence opioid efficacy and safety. When PGx data are available at the point of initial prescribing, clinicians can apply that data to drug therapy selection. However, barriers continue to exist relative to PGx data sharing and interpretation, which have created difficulties for widespread PGx implementation. This article briefly describes potential barriers to PGx data integration, strategies to overcome those barriers, and the potential positive effect of successful data sharing on opioid prescribing. Prescription drug monitoring programs (PDMPs) have been successfully operationalized to share controlled substance prescribing data across health care settings. Such data sharing enables clinicians to, among other things, better understand risks associated with misuse. Because a relatively limited volume of PGx data is currently pertinent to opioid prescribing, such PGx data could be added to PDMPs as a way to communicate genetic information within current technology platforms. Not only would this integrate into existing clinical workflow models where PDMP data are accessed at this point of prescribing and/or dispensing, but associated clinical guidance for PGx data interpretation in the context of opioids could be integrated into the workflow process. Such clinical decision support could be provided directly through the PDMP interface for uniformity or could be provided via systems that access PDMP data. Clinical, economic, and policy implications of the inclusion of PGx data within PDMPs are also discussed. Through harnessing PDMP for data sharing, multiple barriers to PGx implementation could be mitigated, and clinicians may have better access to PGx data to optimize opioid prescribing. DISCLOSURES: No outside funding supported this study. Bright has a patent pending related to opioid use disorder risk assessment that includes genetic information and was a collaborator on funded research projects with pharmacogenomics-related companies. Petry has been a consultant to the North Dakota Department of Health and has received grants from IGNITE I and IGNITE II (NIH), unrelated to this work. The other authors are aware of no financial conflicts of interest.

Background The clinical implementation of pharmacogenomics (PGx) has often involved teams that include pharmacists. PGx laboratories often provide baseline information within the laboratory report that is based on Food and Drug Administration and Clinical Pharmacogenomics Implementation Consortium guidance, but information is often provided independent of concurrent disease states or medication use, among other clinical factors. Major challenges to widescale implementation of PGx include lack of physician experience or confidence in interpreting the data. The purpose of this paper is to describe how pharmacists can help further personalize PGx information and identify clinical recommendations for a given patient. Methods This work was performed as a secondary objective of a study evaluating genetic biomarkers of opioid addiction risk. This portion of the study utilized a descriptive analysis of pharmacist consult reports that consist of individualized, patient-level clinical recommendations that take into account current medications, current health conditions, and PGx data. A panel of 60 common PGx targets were tested among patients being treated for chronic pain or opioid use disorder (OUD). A pharmacist consult report was generated and compared with standard laboratory reporting of general PGx information. Results Of the 252 patients, PGx reports for 198 (78.6%) contained red and/or yellow clinical decision support flags for medications with actionable or informative PGx guidance for currently prescribed medications. Pharmacists recommended modifications to current prescriptions for 31 (53%) of the patients with actionable flags and 17 (12%) of the patients with informative flags. Drug classes most commonly included medications for cardiology, depression and anxiety, pain (opioids) and gastrointestinal management. Taken together, 24.2% of the actionable and informative flags had immediate clinical value based on the pharmacist's review. An additional 217 (86%) received one or more clinical recommendations not related to PGx. Conclusion While PGx provides another opportunity for pharmacotherapy personalization, PGx data must be considered within the context of other patient-specific factors. Pharmacists were able to streamline the PGx report flags and identify other pharmacotherapy interventions following application of patient-specific data, thereby developing a brief report of recommendations for the patient's prescriber(s). Engaging clinical pharmacists in the PGx clinical decision process may help to facilitate more widespread PGx implementation.

Background: With recent advances in pharmacogenomics (PGx) comes the potential to customize medication use based on genetic data. Support for PGx has found practical limitations in terms of workflow and turnaround time of a test. However, with the expansion of point-of-care testing (POCT) in pharmacy practice models comes opportunity for PGx testing in the pharmacy setting. Objective: The purpose of this study is to quantify the amount of time spent during each step of a PGx POCT encounter in a community pharmacy setting. Methods: A time and motion study was conducted using a mock community pharmacy space for a simulated PGx-focused encounter to manage antiplatelet therapy following hospital discharge. PGx POCT was conducted using the Spartan RX instrument. Simulated patient encounters were divided into 7 categories. Time spent in each step, as well as total time spent, was tracked. Results: A total of 54 simulated PGx POCT encounters took place with an average time of 9.49 minutes (SD ± 1.38 minutes). Instrument run time adds 60 minutes to the total time required to obtain a result. Duties that could be performed by an appropriately trained pharmacy technician totaled 6.86 minutes. Conclusions: PGx POCT would require 9.49 minutes of pharmacy staff hands-on time for the encounter, which could be reduced to 2.64 minutes of pharmacist time with appropriate pharmacy technician involvement. Time requirements for PGx POCT are similar to that of community pharmacy–based immunizations. Future studies could explore how practice could change if PGx testing were routinely performed in the pharmacy.

In October 2020, the U.S. Department of Health and Human Services (HHS) issued guidance authorizing trained pharmacy technicians in all states to administer immunizations. Given that this action is temporary, it will be necessary for states to adopt their own legislation or regulations to sustain these efforts beyond the coronavirus pandemic. At least 11 different immunization administration training programs have emerged for pharmacy technicians. An increasing number of publications have emerged on pharmacy technician immunization administration, demonstrating the ability to train technicians and have them safely administer immunizations in practice. Supervising pharmacists reported initial hesitancy but strong acceptance of delegating this task after experience in practice. States should look to expand and make permanent the authority of pharmacy technicians to ensure these benefits can continue to be realized after the HHS guidance expires.

Objectives To perform a needs assessment with the use of evidence-based core indicators developed by the Preconception Health and Heath Care (PCHHC) Initiative Clinical Workgroup and Centers for Disease Control and Prevention (CDC) to describe the preconception care needs among female patients of a community pharmacy. Methods Women of childbearing age received a paper survey in either English or Spanish containing questions about patient demographics, health status, and pregnancy considerations. On completion of the survey, patient medication history data were retrospectively gathered from the medication profile and vaccination status on select vaccines was determined using the Michigan vaccination reporting system. Results Ninety-nine surveys were completed. The median age was 30 years (range 18-44). Of survey participants, 77.8% indicated that they were sexually active, 70.7% had an abnormal body mass index, 78.8% were missing documentation of one or more recommended vaccinations, 66.7% were not taking any form of daily folic acid supplementation, and 49.5% were using at least 1 medication with potential teratogenic effects. Conclusion A preconception health needs assessment conducted in a community pharmacy with female patients of childbearing age found multiple opportunities for intervention such as improving daily folic acid supplementation and ensuring appropriate management of medications with potential teratogenic effects. Each of the preconception care needs assessed can be addressed through services provided by community pharmacists.

Precision pharmacotherapy encompasses the use of therapeutic drug monitoring; evaluation of liver and renal function, genomics, and environmental and lifestyle exposures; and analysis of other unique patient or disease characteristics to guide drug selection and dosing. This paper articulates real-world clinical applications of precision pharmacotherapy, focusing exclusively on the emerging field of clinical pharmacogenomics. This field is evolving rapidly, and clinical pharmacists now play an invaluable role in the clinical implementation, education, and research applications of pharmacogenomics. This paper provides an overview of the evolution of pharmacogenomics in clinical pharmacy practice, together with recommendations on how the American College of Clinical Pharmacy (ACCP) can support the advancement of clinical pharmacogenomics implementation, education, and research. Commonalities among successful clinical pharmacogenomics implementation and education programs are identified, with recommendations for how ACCP can leverage and advance these common themes. Opportunities are also provided to support the research needed to move the practice and application of pharmacogenomics forward.

Opioid use disorder (OUD) in women of child-bearing potential is problematic in the United States. This has resulted in increasing risk for adverse maternal outcomes, neonatal abstinence syndrome, fetal and neonatal harm, prolonged hospitalizations, and increased health care costs. Pharmacists in all practice settings have opportunities to provide preconception and pregnancy care to prevent and manage OUD. Given pharmacists’ scope of practice and expertise, key roles include assessing patients for OUD; mitigating exposure; educating patients regarding potential infant effects; recommending contraceptive methods and counseling on proper use; ensuring safe breastfeeding with concurrent medications; and linking patients to needed services. Through patient counseling, medication management, and harm reduction interventions, pharmacists can work to combat this public health crisis. To encourage increased uptake of pharmacists into these roles, more needs to be done to reimburse pharmacists for these important services and quantify their impact on patient and population health outcomes.

Objective. To evaluate faculty and student perceptions of and performance on virtual skills-based assessments focused on communication compared to in-person assessments. Methods. In spring 2020, virtual skills-based assessments were conducted. After all assessments were completed, two 12-item questionnaires, one for students and one for the faculty members who conducted the assessment, were designed to assess perceptions of virtual skills-based assessments. The surveys were distributed via an online platform to second- and third-year (P2 and P3) pharmacy students and to faculty who had participated in a virtual skills-based assessment. Scores from the spring 2020 virtual skills-based assessment were compared to scores on the in-person skills-based assessment that took place in spring 2019. Results. Of the 19 faculty and 279 students invited to participate, 18 (94.7%) faculty and 241 (86.4%) students responded. The majority of faculty (88.9%) and students (63.5%) perceived the virtual skills-based assessments to be effective at simulating an interaction. However, only 33.3% of faculty and 28.6% of students preferred the virtual environment. There was not a significant difference in student performance between in-person and virtual assessments for patient consultation and SOAP note skills. Conclusion. Providing sufficient formative and summative feedback to pharmacy students is a challenge, particularly in the context of skills-based assessments. Students and faculty reported that the virtual assessment provided an opportunity for an appropriate assessment of student communication skills. However, a strong preference for using virtual skills-based assessments in the future was not observed.

Objective. To determine the validity and reliability of the Pharmacist Interprofessional Competencies Tool (PICT). Methods. Faculty members at Ferris State University, College of Pharmacy developed the PICT, which has five interprofessional criterion (collaboration, ownership, respect, engagement, and application) and four competency levels (unacceptable, novice, competent, and proficient) to assess the interprofessional competencies of pharmacy students. Fourteen pharmacy faculty members were trained in how to use the PICT and then used it to assess students' behaviors in four to six video-recorded interprofessional education (IPE) learning activities. A subset of these faculty members evaluated the video-recorded IPE learning activities using two other previously validated interprofessional assessment tools. Psychometric analysis of the PICT, including internal consistency and inter-rater reliability, was conducted, along with a correlation analysis and factor analysis, and the results were compared to those from the other validated assessment tools. Results. The overall rating of the internal consistency of the PICT was excellent and item-total correlations of the individual criterion were fair to good, with the exception of the respect criterion. The PICT demonstrated excellent overall inter-rater reliability, and individual criterion rated as fair to excellent with the exception of the respect criterion. Specific dimensions of the PICT showed high convergence with previously validated interprofessional assessment tools. Conclusion. The PICT exhibited overall validity and reliability as an assessment tool for measuring the interprofessional competencies of pharmacy students. In establishing the overall validity and reliability of the assessment tool, the respect criterion was not proved to be reliable or valid. Additional training and slight modifications to the PICT and associated IPE learning activities are planned to assist with longitudinal assessment of student performance across the curriculum.

The opioid epidemic has had a devastating impact on our country, with wide-ranging effects on healthcare, corrections, employment, and social systems. Programs have been put in place for monitoring prescriptions, initiating and expanding medications for opioid use disorder, and harm reduction (i.e., naloxone distribution, needle exchanges). However, opportunities for personalization of opioid therapy based on addiction risk have been limited. The goal of the present study was to develop an objective risk assessment algorithm based on genetic markers that are correlated with opioid use disorder (OUD). A total of 180 single-nucleotide polymorphisms (SNPs) were tested in patients with and without OUD. SNPs selected for testing were associated with opioid metabolism and drug reward pathways based on previous studies. Of the 394 patients recruited, 200 had OUD and 194 served as controls without OUD but with prior opioid exposure. Logistic regression analyses stratified by sex identified ten unique SNPs in females and nine unique SNPs in males that were significantly associated with OUD. A Genetics Opioid Risk Score (GenORs) was calculated by counting the number of OUD risk-associated SNPs/genotypes for each patient. To evaluate the discrimination of the GenORs, a receiver operating characteristic (ROC) curve for each sex was generated and determined to be sensitive and specific. This represents the first published example of a sex-based genetic risk score with potential to predict OUD, and the first OUD algorithm to include opioid-associated pharmacokinetic genes.

A real-time, hourly updated, online graphical data product that displays the depth and strength of easterly gap flow in the Columbia River Gorge using a 915-MHz Doppler wind profiler is presented. During precipitation events, this data product also displays observed precipitation accumulation and diagnosed precipitation type using measurements provided by a collocated heated tipping-bucket rain gauge, an optical disdrometer, and temperature and relative humidity sensors. Automated algorithms that determine the existence and depth of the gap flow, as well as precipitation type, are described. The Columbia River Gorge is the only major gap in the Cascade Mountains of Oregon and Washington. Consequently, both easterly and westerly directed gap-flow events are common in this region. Especially during late autumn and winter, easterly gap flow can cause hazardous and damaging weather (e.g., snow, freezing rain, and strong winds) in the Portland, Oregon–Vancouver, Washington metropolitan area. The product described here was developed to help forecasters at the Portland National Weather Service Forecast Office monitor cool-season easterly gap-flow events in order to provide situational awareness and guide warnings to the public about potential weather-related hazards.

Introduction The Accreditation Council for Pharmacy Education (ACPE) Accreditation Standards suggest integration and inclusion of interprofessional education in doctor of pharmacy programs. Although not directly mentioned by these Standards, intraprofessional education between student pharmacists and student pharmacy technicians may provide valuable preparation for comradery in practice. Commentary Given the prevalence of collaboration between pharmacists and pharmacy technicians in pharmacy practice, lack of intraprofessional education could be a vital gap in current programs. There have been previous calls within academic pharmacy and from key stakeholder groups for greater involvement of the profession in the training and education of pharmacy technicians, yet literature is sparse on successful models. This commentary includes a discussion of why intraprofessional training is vital, a brief commentary on example intraprofessional activities, as well as strategies for collaboration. Implications A series of questions with the intention of evoking further conversations and awareness within academic pharmacy completes the commentary.

This study is an aviation-based application of NOAA’s second-generation medium-range Global Ensemble Forecast System Reforecast (GEFS/R; i.e., hindcast or retrospective forecast) dataset. The study produced a downscaled probabilistic prediction of instrument flight conditions at major U.S. airports using an analog approach. This represents an initial step toward applications of reforecast data to probabilistic aviation decision support services. Results from this study show that even at the very coarse resolution of the GEFS/R dataset, the analog approach yielded skillful probabilistic forecasts of flight conditions (i.e., instrument flight rules vs visual flight rules) at most of the Federal Aviation Administration (FAA)’s Core 30 airports. This was particularly true over the central and eastern United States, including the important Golden Triangle, where aircraft flow affects traffic flow management across the entire national airspace system. Additionally, the results suggest that reforecast systems utilizing better horizontal and vertical resolution, in both the modeling system and the reforecast archive, would be very useful for aviation forecasting applications.

Objective. To quantify pharmacy faculty members' perceptions of the importance of entrustable professional activities (EPAs) and the expected level of entrustment that should be achieved to determine APPE readiness. Methods. Entrustable professional activities define the core skills and tasks expected of new pharmacy graduates and may serve as a logical framework for determining pharmacy student readiness to begin advanced pharmacy practice experiences (APPEs). A five-question survey was distributed to all faculty members, staff members, and administrators at Ferris State University College of Pharmacy. Respondents were asked to rate 18 statements mapped to 12 EPAs on the perceived importance of each statement and the expected level of entrustment students should achieve to determine readiness for APPEs. Thresholds were used to determine consensus for importance and level of entrustment for each statement. Results. Of the 44 faculty members surveyed, 28 (63.6%) responded. A strong consensus was reached on the level of importance for 16 of 18 statements (89%), while two statements demonstrated moderate consensus (11%). No strong consensus was identified on levels of entrustment. Seven (39%) of 18 statements demonstrated moderate entrustment consensus and 11 (61%) statements demonstrated little consensus. Conclusion. Strong consensus was identified regarding which EPAs are important to determine students' APPE readiness; however, no strong consensus was found when evaluating levels of entrustment. Lack of consensus regarding entrustment raises several questions that require further study and clarification as the implementation of EPAs continues throughout the Academy.

Introduction Standards 2016 require schools/colleges of pharmacy (s/cop) to assess students' readiness to enter advanced pharmacy practice experiences (APPEs). However, literature describing how schools are meeting this standard is limited. The purpose of this study was to conduct an environmental scan to describe how s/cop assess student readiness to enter APPEs. Methods A web-based survey was distributed to assessment leads at United States s/cop, regardless of accreditation status. Respondents answered questions related to their current approach to assessing student APPE readiness, existence of intentional assessment plans, competencies used, assessment methods, benchmarks, and remediation strategies. Aggregate data were analyzed using descriptive statistics. Results Fifty-two S/COP (36.1%) responded. The majority (90.1%) were fully accredited schools. Most respondents have an intentional APPE readiness plan (73.5%), although the duration since implementation varied. There was no consensus among schools on which competencies informed APPE readiness with 67.3% listing Center for the Advancement of Pharmacy Education (CAPE) 2013 outcomes, 61.2% Guidance for Standards 2016 Appendix A, 53.1% pre-APPE domains (Standards 2007), and 30.6% Entrustable Professional Activities. Twenty-eight S/COP (57.1%) reported having individual student-level data to assess student APPE readiness. The most common methods for validating student APPE readiness were preceptor (48.9%) and student (44.9%) surveys. Conclusions This environmental scan begins to identify trends in how S/COP is approaching the assessment of student readiness to begin APPEs. Further research is needed to identify best practices and practical methods to ensure compliance with current accreditation standards.

Background In order to optimize community pharmacist roles and patient outcomes, a better understanding of patient perceptions of pharmacogenomic (PGx) testing may be helpful for successful integration into community pharmacy practice. Objective The objective of this study was to identify patient perceptions related to PGx testing in the community pharmacy setting. Methods Semi-structured, face-to-face interviews were conducted with adults ≥18 years of age to gather their perceptions of PGx testing. Interview participants were taking either an antiplatelet agent or a selective serotonin reuptake inhibitor listed in Clinical Pharmacogenetics Implementation Consortium (CPIC) guidelines and were patients at one of two community pharmacies in West Michigan. Interview questions were designed to follow the Theory of Planned Behavior and to take into account existing literature on patient perceptions of PGx. Interviews were recorded, transcribed by a third party transcription service, coded by a team of three researchers to identify themes, and analyzed using nVivo qualitative analysis software. Results A total of 19 interviews were conducted over a period of 16 days in June 2016. Upon preliminary evaluation, four themes related to patient perceptions of PGx testing were consistently observed across multiple interviews: 1) trust, 2) experience, 3) risk/benefit, and 4) clarity. Conclusions Semi-structured patient interviews revealed four themes related to PGx testing in the community pharmacy setting. These themes may influence the desire to pursue PGx testing. Future research may seek to identify how community pharmacists can communicate with patients about PGx in the context of these themes to empower patients to make positive health care decisions.

Pharmacogenomics (PGx), the study of how an individual's genetic makeup affects his or her response to drugs, is a fast-growing field that gives health care providers a valuable tool to help safely and effectively manage medication. However, few providers have experience in applying the results of PGx tests to their practices, and this can lead to disregarding the data or unnecessarily modifying medication regimens. Pharmacists are uniquely positioned to become wellversed in the interpretation of PGx data, critically evaluating the "green-yellow-red" result categories that seemingly signal "go, caution, stop" regarding the use of a particular medication. Pharmacists also can evaluate genotype and phenotype information, commonly included in PGx laboratory reports, to optimize therapy. Using a case-based approach, this primer is intended to provide consultant pharmacists with practical direction to aid in PGx interpretation that will provide contextappropriate recommendations that contributes to positive patient outcomes.

Aim: The aim of this study was to evaluate a pharmacogenomics certificate training program relative to pharmacist competencies in basic genetic concepts, genetics and disease, pharmacogenetics/pharmacogenomics and ethical, legal and social implication. Methods: Participants, including pharmacists, pharmacy students and pharmacy educators completed a survey related to to the competency statements. Following the pre-program survey, participants completed a 6-week home self-study with subject matter including basic science (three chapters) and clinical application of pharmacogenomics (eight chapters). The participants completed a quiz for each of the self-study chapters. Following the self-study, participants completed a day-long, 7-h live program which included a review of the competency statements and counseling sessions with seven different simulated patients (primarily pharmacy students). Participants then completed a post-program survey which included the same items as the pre-program survey. Results: Specifically, for the pharmacist participants, the average score of the self-study quizzes was 91%. For the pharmacists specifically, there was a statistically significant increase in self-assessed perception of competence related to pharmacogenomics. Additionally, it was observed that recommendations related to specific drug–gene interactions for the simulated patients were addressed correctly 95% of the time across all participant–patient encounters. Conclusion: Self-study and a live, interactive component in the certificate training program led to increased self-understanding of defined pharmacogenomics competencies. Additionally, pharmacy students, in the role of simulated patients gained knowledge during the live component of the program. This type of program, especially if made available through electronic-based platforms can serve to educate pharmacists and increase the uptake of pharmacogenomics in various healthcare settings.

Pharmacy residency programs have become increasingly competitive in recent years, and changes to the residency search and application process have altered the process for matching with a residency. In this article, major residency topics, from the benefits of residency training to searching for and ranking programs, are summarized. A discussion of tips and tricks for applying for residencies and interviewing for positions is included along with specific suggestions developed with data following the implementation of the Pharmacy Online Residency Centralized Application Service (PhORCAS). The article is organized in a question and answer format to help facilitate understanding of key concepts and common questions that may arise from applicants. Many changes have taken place in the residency search and application process in recent years, and the process of obtaining a residency is complex. Residency applicants and those advising applicants may find value in the answers to commonly asked residency application questions to help ensure the greatest chance of a successful residency match.

Background Traditional interprofessional educational (IPE) exercises are those where learning exists “about, from, and with” trainees in two or more professions in order to prepare health sciences professionals to work on interprofessional teams. One emerging difficulty with IPE is the paucity of health profession students at single institutions, and the geographic and financial constraints of multi-institutional collaboration. Interprofessional education activity To circumvent these barriers, we developed a multi-institution telehealth team-based learning (TBL) event between medical and pharmacy students on the topic of pharmacogenomics (PGx). Using a validated pre-post survey design, student attitudes and perceptions were measured before and after an educational intervention designed to simulate interprofessional telehealth collaboration. The survey results showed significant improvement across all areas of student attitudes toward interprofessional collaboration. Also, medical student PGx confidence increased substantially during the exercise even though the only PGx instruction they received was from pharmacy students. Discussion These data demonstrate that learning exists “about, from, and with” trainees in other professions, even if they do not physically train in the same location. Free tools are available to create virtual interactions between students on different campuses, and telehealth exercises using these tools are a valid way to conduct IPE across different campuses. The instructional experience does not need to be identical for all participants in the IPE event; rather, tailoring the educational experience to each group of students provides opportunities for inter-student teaching.

The Accreditation Council for Pharmacy Education Standards 2016 state that colleges of pharmacy must assess student achievement and readiness to contribute as a member of an interprofessional collaborative patient care team. There are a limited number of assessment tools available to achieve this part of the Standards. The purpose of this Case Study Report is to describe the process that one college of pharmacy took to develop an interprofessional education (IPE) assessment tool to be used for their longitudinal assessment approach for IPE in the didactic portion of the curriculum. Strategies for the development of an assessment tool are provided through three themes: continuous refinement, collaboration and streamlining. Next steps for the implementation of the assessment tool, as well as evaluating its validity and reliability, are discussed. Type: Case Study

Purpose. To describe the potential role for pharmacy technicians in administering immunizations – limited for this discussion to specifically inserting the needle into the patient’s arm and pressing down on the plunger – at the discretion of a supervising pharmacist as a way to enhance patient care and workflow efficiency. Summary. Pharmacy technicians currently play an important role in facilitating pharmacy-based immunization programs. Technicians routinely perform non-clinical tasks related to pharmacy-based immunizations, though nearly all states prohibit technicians from administering vaccines. Several studies demonstrate that untrained laypersons can safely administer intranasal or intradermal vaccines, and laypersons routinely administer medications through intramuscular or subcutaneous routes (e.g., patients with diabetes or rheumatic conditions). It stands to reason that a trained pharmacy technician could perform comparably on these techniques that laypersons have mastered. One state has adopted rules to allow pharmacy technicians to administer immunizations if the technician has completed specific training on administration techniques and on basic life support. This task is performed at the discretion of the supervising pharmacist, and the pharmacist would still be responsible for clinical aspects of immunizing such as prescribing the right vaccine to the right patient. Additional considerations factoring into the decision as to whether or not to involve pharmacy technicians in immunization administration are also summarized. Conclusion. If safety can be reasonably assured through training and supervision, it may be appropriate to delegate vaccine administration to appropriately trained pharmacy technicians. Such delegation may enhance workflow efficiency, which may confer added value for patient care and potentially improve access to community pharmacy-based immunizations. Type: Commentary

Despite advances in technology and guidelines from the Clinical Pharmacogenetics Implementation Consortium (CPIC) that focus on how to use pharmacogene test results, hurdles remain that have delayed the widespread application of pharmacogenomics in clinical practice. These hurdles include a lack of prospective randomized controlled trials to address the utility of pharmacogenomics on clinical outcomes, what the clinical algorithm for pharmacogenomics should be, and whether pharmacogenomics is cost-effective. However, the implementation of clinical practice guidelines, such as those from professional organizations, is commonplace and often termed the application of evidence-based medicine. Here, we draw an analogy between the evidence supporting many commonly cited clinical practice guidelines and U.S. Food and Drug Administration-approved labeling recommendations and the evidence supporting recommendations from CPIC. Although many clinical practice guideline recommendations are supported by the results of randomized controlled clinical trials, we cite examples of common clinical practices that are supported by levels and types of evidence similar to the evidence supporting many of the CPIC recommendations. Specifically, we discuss clinical recommendations for guidance related to drug-drug interactions, drug-gene interactions, therapeutic range selection, and dosage adjustments based on patient-specific factors within the context of a select set of cardiovascular therapeutic topics.

The objective of this review is to provide an overview of the components, process and resources available to apply precision medicine strategies to drug therapy in cancer medicine, with an emphasis on oncology pharmacy practice. Precision medicine initiatives in oncology take into account individual variability in genes, environment and lifestyle factors. Genomic assays of patient tumors is now the standard of care in oncology and recommendations for targeted drug therapies are often formulated by interprofessional teams. Pharmacogenomics (PGx) is a component of precision medicine based on polymorphisms that impact medication selection and/or dosing. Several oncolytic agents used in the treatment of cancer and supportive care have pharmacogenomic-based dosing recommendations to minimize potential toxicities. Several resources are reviewed here to guide treatment options in oncology as they relate to somatic mutations and PGx. Examples include: OncoKB is a precision oncology knowledge base that offers evidence-based information for somatic mutations. The Clinical Pharmacogenetics Implementation Consortium provides PGx-based guidelines for several oncolytic therapies used to treat cancer and for supportive care. Pharmacists can be integral members of the interprofessional team in many practicesettings in precision medicine. Involvement can include membership in molecular tumor boards, PGx dosing services and provide patient education.Conclusion. Precision medicine is a rapidly evolving field in oncology that requires an interprofessional approach of drug therapy experts.