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Clinical reasoning is a vital skill for student pharmacists in the provision of patient-centered care, but these skills are often difficult to assess in the didactic curriculum. A script concordance test (SCT) is an innovative assessment method that can be used to assess clinical reasoning skills. The objective of this study was to develop and refine an SCT to assess clinical reasoning skills of third year student pharmacists (P3s).An SCT was written and administered to P3s. Pharmacy practice faculty members served as the expert group. The SCT was scored and Rasch analysis was performed.The SCT included 20 case vignettes and 60 questions. Test reliability was 0.34 with mean square values for all items between 0.7 and 1.3. Forty-two questions had a difficulty score between 0 and - 1 logits, indicating there were multiple questions with similar difficulty levels. Two case vignettes and 43.3% of questions (n = 26) were revised to enhance clarity and decrease ambiguity.The SCT is a tool to assess clinical reasoning in the didactic curriculum. Faculty can create the SCT and use statistical methods such as Rasch analysis to assess validity and reliability of the SCT.

Health care organizations face the challenge of reducing costs while improving health outcomes. Currently, more than 39 million seniors are enrolled in a Medicare Part D prescription benefit plan, many of whom also qualify for medication therapy management (MTM) services. MTM programs provide valuable services designed to prevent or resolve medication-related problems (MRPs). Two core components of all MTM programs include comprehensive medication reviews (CMRs) with followup interventions and focused non-CMR interventions. Currently, there is limited research comparing the rate of MRPs resolved by CMR and non-CMR interventions.To determine whether CMRs versus non-CMR interventions resulted in more pharmacist-initiated intervention recommendations and positive medication changes.This retrospective, cross-sectional quality improvement project evaluated outcomes for individuals who received interventions following a CMR compared with those who received non-CMR interventions as part of a comprehensive MTM program. For this project, eligible individuals qualified for an MTM program. A positive medication change was defined as the addition of an appropriate medication or the removal of an inappropriate medication within 120 days of a pharmacist recommendation. Differences between the groups were calculated using the Wilcoxon rank sum test.During the 2-year period (2012 and 2013), 788,756 beneficiaries were enrolled in the MTM program and evaluated for potential MRPs. In both years, pharmacists recommended more medication changes per member for those receiving a CMR (0.81 in 2012 and 0.82 in 2013) compared with the non-CMR group (0.68 in 2012 and 0.61 in 2013; P value0.001 for both years). However, recommendations made via non-CMR interventions (representing the vast majority of all medication reviews) were more likely to result in a positive medication change (OR = 1.24, 95% CI = 1.21-1.28 for 2012; OR = 1.26, 95% CI = 1.22-1.30 for 2013).These quality improvement project results suggest that Medicare Part D beneficiaries participating in a university-based MTM program who received non-CMR interventions had a higher likelihood of having positive medication changes than those receiving CMRs. These results are enlightening and may provide initial evidence to support inclusion of a non-CMR performance metric for the Centers for MedicareMedicaid Service's star ratings for MTM programs.No outside funding supported this study. The University of Arizona Medication Management Center (UAMMC)/SinfoniaRx provides grant funding to the University of Arizona for research. Augustine reports support from the UAMMC and ownership of Pfizer stock and was a graduate student at the University of Arizona College of Pharmacy at the time of this study. The authors report no other potential conflicts of interest. Buhl and Augustine contributed study concept and design, collected the data, and wrote the manuscript. Data interpretation was performed by all the authors. Taylor, Warholak, Augustine, and Martin revised the manuscript.

In recent years, comparative effectiveness tools and methods have evolved to assist health care decision makers in identifying optimal therapies. In-person training programs on comparative effectiveness research may be helpful in understanding and applying this information.To provide a follow-up assessment of the use of comparative effectiveness research (CER) in the pharmacy and therapeutics (PT) committee decision-making process, using information collected from participants 1 year after attending a live continuing education program, in which participants were taught about CER designs and how to access available CER resources through the Agency for Healthcare Research and Quality (AHRQ) Effective Health Care (EHC) Program.A retrospective, cross-sectional questionnaire was developed and mailed to 2 groups of individuals: CER workshop attendees and interested nonattendees (expressing an interest in attending a workshop but did not attend for unknown reasons). The questionnaire asked respondents to indicate personal and organizational use of CER in the decision-making process. Participants were asked to indicate whether their knowledge, ability, and use of CER studies increased since participating in the program. Data were analyzed using nonparametric tests to compare the responses of attendees and nonattendees, as well as overall reliability of the instrument.A total of 164 respondents completed the questionnaire (63 attendees and 101 nonattendees; overall response rate = 44%). The majority of respondents were pharmacists (n = 157, 95.7%) and were affiliated with a hospital (n = 106, 64.6%). Proportions of attendees and nonattendees differed significantly in the use of EHC research reviews/reports (45% and 28%, respectively; P = 0.02) and EHC executive summaries of research reviews/reports (48% and 29%, respectively; P = 0.01). At 1-year follow-up, the majority of attendees reported an increase ("somewhat" or "very much") in knowledge of CER (91.5%), ability to use CER (83.0%), and use of CER studies (58.7%).Health professionals attending a continuing education CER program reported higher use of EHC CER materials compared with nonattendees. Additionally, attendees reported increased use of CER in clinical decision making. A continuing education program such as this may provide an effective avenue for introducing CER methods and resources to the PT committee and clinical decision-making processes.This project was supported by grant number R18HS019220 from the Agency of Healthcare Research and Quality. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency of Healthcare Research and Quality. Augustine has stock in Pfizer. The authors declared no other potential conflicts of interest associated with this study. Study concept and design were primarily contributed by Malone, along with Warholak, Hines, Brown, Hurwitz, and Taylor. Warholak, Hines, Brown, Hurwitz, and Taylor collected the data, assisted by Malone, Brixner, Cobaugh, and Schlaifer. Data interpretation was performed by Malone and Augustine, with assistance from the other authors. The manuscript was written primarily by Augustine, with assistance from Malone, Sun, Warholak, Hines, Brown, Hurwitz, and Taylor. Malone revised the manuscript, assisted by Warholak, Hines, Brown, Hurwitz, Taylor, Brixner, Cobaugh, and Schlaifer.

Objectives Tobacco use is the nation's leading cause of preventable illness and death, causing a significant burden on the health care system. Many cessation pharmacotherapy treatment options are available to help smokers quit, including nicotine replacement therapies (NRTs) and prescription medications. Research indicates that pharmacists are able to provide a positive benefit to smokers who want to quit through pharmacologic and nonpharmacologic interventions. The aim of the present work was to examine the quit rates among participants who received smoking cessation pharmacotherapy and pharmacist-provided telephone-based quit counseling services. Design Retrospective database review of enrolled participants. Setting Telephone-based pharmacotherapy and medication counseling services offered from a medication management center. Participants State employees who voluntarily contacted a medication management center for smoking cessation services after receiving promotional flyers. Main outcome measures Long-term quit rates at 7 and 13 months were determined by means of patient self-report in response to questioning. Smoking cessation was considered to be a success if the patient reported not smoking for the past 30 days. Results A total of 238 participants were included in the review. Thirty-nine participants completed the program after the first treatment, 12 participants after the second treatment, and 4 participants after the third treatment. Two patients completed the program more than once. Eighty-five participants (36%) reported results at 7-month follow-up; of these, 43 (51%) were smoking free. A total of 44 participants (18%) reported results at 13-month follow-up; of these, 24 participants (55%) reported being smoking free. There were no significant differences in the percentages of smoking-free participants at 7 or 13 months, regardless of their first treatment ( P = 0.06 and 0.345, respectively). Conclusion Successful quit rates were higher than previously demonstrated with other telephone-based smoking cessation programs. Therefore, pharmacist-provided telephone-based counseling may be beneficial in helping patients to quit smoking. Future research is warranted to examine the benefits of these types of programs.

National guidelines and initiatives have promoted the use of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) for patients with diabetes. The University of Arizona Medication Management Center (UA-MMC) is contracted by Medicare health plans, pharmacy benefit managers (PBMs), and multiple commercial health insurance plans to provide medication therapy management (MTM) services for plan members. As part of the MTM program, recommendations have been made for those patients who may benefit from the addition of an ACEI/ARB. Although the intervention benefits and guidelines for using ACEIs/ARBs are clear, real-world evidence is needed to understand and potentially increase uptake of guideline interventions among eligible patients.To (a) identify patient characteristics that predict acceptance of guideline recommendations to add ACEI/ARB medications to diabetic treatment via MTM services and (b) examine how well different case characteristics (i.e., patient age and sex, type and number of recommendation attempts, type of health care plan) predict the odds of adding ACEI/ARB medications to diabetic regimens when recommended through an MTM call center.This was a retrospective analysis of secondary data provided by the UA-MMC. The de-identified national data included adult plan members with diabetes who the UA-MMC recommended adding an ACEI/ARB prescription based on 2012 national guidelines. The UA-MMC made recommendations by either patient letters, patient phone calls, physician faxes, or any combination thereof. We conducted a binary logistic regression analysis to assess the impact of case characteristics on the likelihood of accepting recommendations to add ACEI/ARB medications. The outcome variable was recommendation acceptance (yes/no), defined as new prescription claims for an ACEI/ARB within 120 days following the recommendation. Five predictor variables were assessed: (1) patient's age quartile; (2) method of communicating recommendations (letter, phone call, fax, or some combination thereof); (3) whether recommendations were made once or twice on separate dates; (4) patient's sex; and (5) type of health care plan.Recommendations were made for 31,495 members of health plans or PBMs that contracted with the UA-MMC. Patients' ages ranged from 19-90 (Mean =72.01; SD =10.21), with females comprising 56% of the sample. The recommendation to add ACEI/ARB medications was accepted for 14.5% (4,559) of patients. In most cases (73%), recommendations occurred via a letter to patients together with a fax to their providers. The fitted model, containing 3 predictor variables (age quartile, type of contact to communicate the recommendations, and whether recommendation contacts were made twice), was statistically significant, χ(2) (10; N = 31,495) = 112.82 (P0.001), indicating that the model was able to distinguish between those who did and did not accept UA-MMC's recommendations to add ACEI/ARB medications. The likelihood of recommendation acceptance decreased as patient age increased compared with patients in the first age quartile (ages 19-67; P ≤ 0.005 at all levels). Compared with sending only a provider fax, patients who received all 3 types of contact (provider fax with patient phone call and letter) were estimated to be 1.34 times more likely (34% increase) to have recommendation acceptance ( P = 0.004; 95% CI = 1.10-1.63). Similarly, patients who received only letters were also 1.32 times more likely (32% increase) than provider faxes alone to result in recommendation acceptance ( P = 0.003; 95% CI = 1.10-1.59). Patients for whom recommendations were made twice were less likely to have recommendation acceptance than for those contacted once, controlling for all other predictor variables in the model ( P0.001; OR = 0.77; 95% CI = 0.69-0.86).Recommendations to add an ACEI/ARB to diabetic regimens are more likely to be accepted for younger patients and those who receive recommendations through all 3 communication types (provider fax combined with patient phone call and letter) or just letters than provider faxes alone. Further research is needed to understand why prescribers are not accepting MTM recommendations.

Objective To assess concept learning and topic difficulty in a concept-based research methods course. Methods A pre–post exam was given to second professional year Doctor of Pharmacy students enrolled at the University of Arizona College of Pharmacy using 25 concept-based multiple choice questions. Rasch analysis was used to determine the change in student ability and to assess question difficulty. Results A total of 94 students completed both pre- and post-tests (response rate = 96.9%). As a group, student ability significantly increased from the pre- to post-test ( p p Conclusions Students learned the material over the semester as indicated by the overall increase in student ability. Changes in question difficulty provide evidence for the importance of practice when learning concepts.

Background The use of social media by students in professional health programs has led to concerns about social networking site (SNS) content, and colleges and universities are deciding whether they should provide guidance for students regarding professional online content. Objective The primary objective was to evaluate the validity of an instrument used to assess student pharmacists’ comfort level and concerns regarding SNS. A secondary objective was to describe students’ perceptions of and concerns about specific SNS behaviors at one college of pharmacy. Methods In 2009, a 24-item questionnaire was distributed to students enrolled at the University of Arizona College of Pharmacy. The first section of the questionnaire (nine questions) asked students to indicate their level of agreement with specific SNS behaviors. The second section (eight questions) requested students to state their level of concern with specific unprofessional SNS behaviors. Rasch analysis was performed to assess reliability and validity. Results A total of 292 students submitted completed questionnaires (74% response rate). Facebook was the primary SNS used. Respondents indicated that they would not send a friend request to or accept a friend request from a faculty member. Students were most concerned about online posting of profanity and least concerned with online posting of unprofessional content affiliated with the pharmacy profession. Conclusions Student pharmacists were uncomfortable networking with faculty or future employers, and their lack of concern with the potential unprofessional online posts could raise some legal and ethical issues for colleges of pharmacy, especially those without a social media policy.

Objectives To review concept theory and to describe a model for using concept theory so as to develop multiple-choice questions that can test more advanced cognitive skills in the area of study design. Theory Concepts are abstract categories containing information about objects, symbols, or events that share specific characteristics. Concepts serve as tools for identifying and categorizing objects, events, or situations, for instance, types of study designs, as examples or non-examples of a category. Application The process for developing questions to test concept learning in study design can be summarized as follows: (1) identify the learning objectives that require concept classification (e.g., use verbs such as identify, differentiate, or compare); (2) identify new case examples (cases not previously encountered by students) of the target concepts (e.g., an abstract for a randomized controlled trial); and (3) use information from the case examples to write multiple-choice questions. The questions use concept names (e.g., independent variable) and specific examples from the case (e.g., blood pressure) in the question stem or as response options. Conclusions By using concepts or specific examples from the case, multiple-choice questions that test concept skills critical to using the literature in clinical practice were developed. Use of a case example new to students assures answers cannot be memorized, and use of coordinate concepts as response options assures all options are viable choices. An advantage of using concept theory is that some questions can be reused with new case examples.

Objective To assess the knowledge and attitudes of Doctor of Pharmacy (PharmD) students regarding geriatric care and training. Methods The survey was administered to first, second, and third professional year PharmD students at a four-year public university during the fall semester of 2011. Groups were differentiated based on completion of a geriatrics-focused course, which is offered annually as a two-credit elective for a maximum of 100 health professional students. Results A total of 193 student pharmacists completed the survey, which resulted in a response rate of 66.55%. The second and third professional year PharmD students who took the geriatrics-focused course showed significantly higher knowledge of geriatric care (mean = 8.46 and 10.12, respectively) compared to their peers who did not take the course (mean = 7.45, p = 0.03; and mean=8.67, p = 0.02, respectively). Second and third professional year students who participated in the geriatrics-focused course were more likely to be interested in additional geriatric care training compared to their peers who had not taken the course ( p = 0.05 each). First professional year students who did not have the opportunity to take the geriatrics course yet placed high importance on participating in a geriatrics-focused course in the pharmacy curriculum. Conclusion Student pharmacists who took a geriatrics-focused course had stronger knowledge of geriatrics and more positive attitudes regarding geriatric care training. Therefore, schools and colleges of pharmacy should consider the positive impact of a geriatrics-focused course on students' geriatric knowledge and their attitudes toward geriatric care training.

The objective of this paper is to describe a method for using a logic model to guide program evaluation by detailing the steps used, providing diagrams that visually depict the process, and giving an example based on the evaluation of emergency preparedness nursing summits in Georgia. Developing a logic model is an ideal way to visually depict the inputs, activities, outputs, and outcomes of a program, thus providing a clear framework of the workings and functions of the program. In planning a comprehensive evaluation, being able to view all the elements in a program and how they interrelate makes it easier to determine the areas that should be addressed. When a survey is part of a program evaluation, determining that the goals, objectives, research questions, logic model, and survey questions maintain consistency in the way they relate and lead to each other can help document the completeness and symmetry of the assessment. By showing these linkages, the utility of the logic model is maximized and the stakeholders in the assessment of the program have clear evidence that their expectations and needs have been met for a valuable, useful evaluation product.

Crohn’s disease (CD) causes chronic inflammation of the gastrointestinal tract and leads to fluctuations between active disease and remission. Certolizumab pegol is one of the newer biological treatments for patients with moderate-to-severe CD. Certolizumab pegol was shown to be effective in CD patients achieving response and remission in both randomized and non-randomized studies, and is an alternative biological treatment for CD. The available data show that certolizumab pegol achieves similar therapeutic efficacy and health-related quality of life scores in CD patients as the other biological agents, but at a higher cost, if dose escalation of other biologics is not considered. Considering subcutaneous self-administration, and lower number and frequency of injections, patients may prefer certolizumab pegol over the other biological treatments.