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Objective: To assess pharmacy participation in and accessibility of pharmacist-prescribed contraception after legislation effective in the state of Utah in 2019., Methods: A secret-shopper telephone survey was used to assess participation in pharmacist-prescribed contraception. Geospatial analysis was used to map the distribution of participating pharmacies by population characteristics., Results: Of all operating Class A retail pharmacies in Utah, 127 (27%) were providing pharmacist-prescribed contraception 1 year after implementation of the Utah standing order. Oral contraceptive pills were widely accessible (100%); however, other allowed methods were not (vaginal ring 14%; contraceptive patch 2%). Consultation fees and medication costs varied widely. Participating pharmacies were mainly concentrated in population centers. Assuming access to a personal vehicle, urban areas with a high percentage of Hispanic people (Utah's largest minority race or ethnicity group) have access to a participating pharmacy within a 20-minute driving distance. However, access in rural areas with a high percentage Hispanic or other minority were limited. We identified 235 (40%) census tracts with a high proportion of Utah's residents living below the poverty line or of minority race or ethnicity who also had low access to pharmacist-prescribed contraception., Conclusions: Although the pharmacy-based model is intended to increase access to contraception, practical availability 1 year after the authorization of pharmacist-prescribed contraception in Utah suggests that this service does not adequately serve rural areas, particularly rural areas with a high proportion of minorities and those living below the federal poverty line., Competing Interests: Financial Disclosure The authors did not report any potential conflicts of interest., (Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc.)

Background: States have passed legislation to expand the scope of pharmacists to directly prescribe contraception. It is thought that pharmacist prescription of contraception may promote correct and consistent use of contraception by reducing barriers to access. However, it is not known how this may impact ongoing contraceptive use., Objective: This study aimed to determine whether 12-month rates of continuation of an effective form of contraception or perfect use of contraception differ by prescribing provider (pharmacist or clinician)., Study Design: We conducted a 1-year prospective cohort study of 388 women seeking contraception in 139 pharmacies across 4 states (California, Colorado, Hawaii, and Oregon). Our study was powered to detect a 10% difference in 12-month continuation of an effective form of contraception. We clarified women's pregnancy intention at baseline and subsequent follow-ups. Women received a prescription directly from a pharmacist (n=149) or were filling a prescription from a clinician, our comparison group (n=239). We used multivariable logistic regression to measure the association between pharmacist prescriber and use of any effective contraceptive method or perfect use at 12 months. Model covariates included age, race, education, side effects experienced, payor, and contraceptive supply dispensed at baseline., Results: Of the study cohort, 88% (n=340) completed 12 months of follow-up. Among women not planning to become pregnant, 7 women in the clinic-prescribed group vs 1 woman in the pharmacy-prescribed group (3.4% vs 0.8%; P>.05) reported a positive pregnancy test during the study period. The majority of the cohort was continuing to use an effective method of contraception at 12 months (clinician 89.3% vs pharmacist 90.4%; P=.86). Among women receiving a prescription from a clinician, 53.9% reported perfect use (no missed days) at 12 months, compared with 47% of the pharmacist-prescribed group (P=.69). Pharmacist prescriber type was not associated with continuation of an effective contraceptive method at 12 months (adjusted odds ratio, 0.70; confidence interval, 0.28-1.71) or with perfect use of contraception (adjusted odds ratio, 0.87; confidence interval, 0.51-1.48), controlling for other woman-level characteristics., Conclusion: We found no difference in use of any effective contraception, perfect use, or switching at 12 months among those who received their baseline prescription from a pharmacist vs a clinician. This study is limited by not examining information on safety outcomes., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Objectives: Persons living with Alzheimer's disease (AD) may be at increased risk for prescribing cascades due to greater multimorbidity, polypharmacy, and the need for more complex care. Our objective was to assess the proportion of the antidopaminergic-antiparkinsonian medication prescribing cascades among persons living with Alzheimer's disease., Setting: Two large administrative claims databases in the United States., Participants: We identified patients aged ≥50 on January 1, 2017, who were dispensed a drug used to treat Alzheimer's disease for at least 1 day in the 365 days prior to or on cohort entry date and who had medical and pharmacy coverage in the 365 days prior to the cohort entry date. We excluded individuals with a recent institutional stay. We identified incident antidopaminergic (antipsychotic/metoclopramide) use in the 183 days following cohort entry and identified subsequent incident antiparkinsonian drug use within 8 to 365 days., Results: There were 121,538 patients with Alzheimer's disease eligible for inclusion. Approximately 62% were women with a mean age of 79.5 (SD ± 8.6). The mean number of drugs dispensed was 9.2 (SD ± 4.9). There were 36 incident antiparkinsonian users among 4,534 incident antipsychotic/metoclopramide users (0.8%)., Conclusion: We determined that the proportion of antidopaminergic-antiparkinsonian medication prescribing cascades, widely considered as high-priority, was low. Our approach can be used to assess the proportion of prescribing cascades in populations considered to be at high risk and to prioritize system-level interventional efforts to improve medication safety in these patients., (© 2021 The American Geriatrics Society.)

Preventive and control measures implemented by many countries to mitigate the spread of COVID-19 may negatively impact medication and chronic disease management, which can interfere with achieving patients' therapeutic goals. This study aims to evaluate the effect of the COVID-19 lockdown on these aspects, while exploring the role of community pharmacists. A cross-sectional study was conducted via a web-based questionnaire that targeted individuals who suffer from chronic diseases in Jordan. Participants were recruited by convenience sampling and were asked to self-report their ability to access medication, and the perceived role of community pharmacists. Among the 431 participants, the mean age ± SD (years) was 53.8 ± 13.7 and 60.1% (n= 259) were females. Participants mainly reported difficulties in accessing medication (n=198, 45.9%), reduced supplies or unavailability of medications (n=213, 49.4%), nonadherence to medications due to lack of access (n=98, 22.7%) and high costs (n=85, 19.7%). Participants avoided follow-ups due to a fear of infection (n=367, 82.5%) or prolonged waiting time in clinics (n=322, 74.7%). An increased reliance on the community pharmacy for medical advice was reported by 39.9% (n=172) of the participants, with half of them (n=217, 50.3%) depending on the pharmacists for advice regarding over-the-counter medications and COVID-19-related information (n=119, 27.6%). There is an urgent need to involve community pharmacists in medication and chronic disease management with a focus on patient adherence to ensure the optimal management of such vulnerable patient groups. Future studies to assess the effect of pharmacists' contributions towards enhancing medication/disease management are warranted.

Background: The term "doctor and pharmacy shopping" colloquially describes patients with high multiple provider episodes (MPEs)-a threshold count of distinct prescribers and/or pharmacies involved in prescription fulfillment. Opioid-related MPEs are implicated in the global opioid crisis and heavily monitored by government databases such as U.S. state prescription drug monitoring programs (PDMPs). We applied a widely-used MPE definition to examine U.S. trends from a large, commercially-insured population from 2010 to 2017. Further, we examined the proportion of enrollees identified as "doctor shoppers" with evidence of a cancer diagnosis to examine the risk of false positives., Methods: Using a large, commercially-insured population, we identified patients with opioid-related MPEs: opioid prescriptions (Schedule II-V, no buprenorphine) filled from ≥5 prescribers AND ≥ 5 pharmacies within the past 90 days ("5x5x90d"). Quarterly rates per 100,000 enrollees (two specifications) were calculated between 2010 and 2017. We examined the trend in a recently published all-payer, 7 state cohort from the U.S. Centers for Disease Control and Prevention for comparison. Cancer-related ICD-9/10-CM codes were used., Results: Quarterly MPE rates declined by approximately 73 % from 18.2-4.9 per 100,000 enrollee population with controlled substance prescriptions. In 2017, nearly one fifth of these commercially-insured enrollees identified by the 5x5x90d algorithm were diagnosed with cancer. Approximately 8% of this sample included patients with ≥ 1 buprenorphine prescriptions., Conclusions: Opioid "shopping" flags are a long-standing but rapidly fading PDMP signal. To avoid unintended consequences, such as identifying legitimate medical encounters requiring high healthcare utilization or opioid treatment, while maintaining vigilance, more nuanced and sophisticated approaches are needed., (Copyright © 2021 Elsevier B.V. All rights reserved.)

To evaluate the effect of clinical pharmacy interventions on the unplanned rehospitalizations rates of elderly people admitted for fall to the elderly emergency medicine (EEM) unit in a teaching hospital., Design and Measures: This was a longitudinal, comparative pilot study. Patients aged at least 75 who were admitted to the EEM unit for a fall and who had at least two chronic diseases and who were being treated with two or more medications were included from February 1, 2018 to June 30, 2018 and followed by 90 days. The main outcomes were the unplanned rehospitalizations rate at Limoges Teaching Hospital within the 90 days (primary outcome), 30 days and 72 hrs. The estimated cost-saving was also assessed., Results: We included 252 patients. The mean age was 88.4 ± 5.8 years and the average baseline number of medications was 8.3 ± 3.4. In total, 158 pharmaceutical interventions were performed, reflecting an acceptance rate of 94.9%. We found a significant reduction of the rate of unplanned rehospitalizations at 90-day (OR = 0.45 (0.26-0.79) p = 0.005). These results were still consistent at 30-day (p = 0.035) and 72 hours (p = 0.041). We found a cost-saving of 37,770 euros related to 21 avoided rehospitalizations., Conclusions: Our results highly emphasize the positive effects of clinical pharmacy services on the prevention of unplanned rehospitalizations of old adults admitted for fall.

Objective: We conducted a quality improvement initiative to restrict fluoroquinolone prescribing on two inpatient units housing high-risk patients and applied a human factors approach to understanding the barriers and facilitators to success of this intervention by front-line providers., Methods: This was a mixed-methods, quasi-experimental study. This study was conducted on two inpatient units at a tertiary care academic medical center: the medical-surgical intensive care and abdominal solid organ transplant units. Unit-level data were collected retrospectively for 24 months pre- and post- fluoroquinolone restriction intervention, implemented in July 2016, for all admissions to the study units. Our restriction intervention required antimicrobial stewardship pre-approval for fluoroquinolone prescribing. We explored barriers and facilitators to optimal fluoroquinolone prescribing using semi-structured interviews attending, fellow and resident physicians, advanced practice providers and pharmacists on these units., Results: Hospital-onset C. difficile infection did not decrease significantly, but fluoroquinolone use declined significantly from 111.6 to 19.8 days of therapy per 1000 patient-days without negatively impacting length of stay, readmissions or mortality. Third generation cephalosporin and aminoglycoside use increased post-restriction. Providers identified our institution's strong antimicrobial stewardship program and pharmacy involvement in antimicrobial decision making as key facilitators of fluoroquinolone optimization and patient complexity, lack of provider education and organizational culture as barriers to optimal prescribing., Conclusions: Fluoroquinolones can be safely restricted even among high-risk patients without negatively impacting length of stay, readmissions or mortality. Our study provides a framework for successful antimicrobial stewardship interventions informed by perceptions of front line providers., Competing Interests: No authors have competing interests.

Objective. To measure Doctor of Pharmacy (PharmD) students' confidence and assess their performance when processing inpatient medication orders, and to determine students' opinions regarding electronic health record (EHR) technology. Methods. Using an EHR platform, students processed inpatient medication orders during two laboratory sessions and one assessment. Each student was assigned one unique patient per session and was given three inpatient orders to process. Medication errors were randomly imbedded in the medication orders. Students needed to determine if the order was acceptable or required flagging because of an identified error. Pre- and post-activity surveys were administered to assess students' level of confidence and perceptions regarding the simulated EHR activities. Aggregate performance scores were compared between a cohort of PharmD students that used an EHR for the activity versus those who completed the activity the previous year using a paper-based medication form. Results. One hundred eight of 158 students (68%) in the course had pre- and post-activity survey data that could be paired. Less than one quarter (24%) of students had prior work experience in a hospital setting. For the medication verification questions, the confidence levels of students who used the EHR doubled and in some cases tripled pre- and post-EHR implementation. In each of the areas surveyed, results for all medication order processing statements were significant. Student performance improved significantly compared with that of those who completed the activity the previous year using a paper-based medication form. Post-EHR implementation, a significantly lower number of students felt that learning to use EHR technology would prepare them for advanced pharmacy practice experiences. Conclusion. Exposure to EHR technology improved PharmD students' confidence and performance scores related to processing inpatient medication orders. These findings support the continued use of an EHR platform in skills-based activities., (© 2020 American Association of Colleges of Pharmacy.)

Objective. To develop, implement, and evaluate a co-curricular activity in which second-year Doctor of Pharmacy (PharmD) students developed an idea for a new clinical pharmacy service. Methods. A brief co-curricular activity based on the television series SharkTank was developed to encourage innovation and entrepreneurship. Second-year pharmacy students worked in assigned teams and were allowed one hour to develop an innovative clinical service to solve a pharmacy-related problem. Students then "pitched" their idea to a panel of four faculty members who served as the "sharks" and graded the teams using a rubric. The rubric which was employed was mapped to the Center for the Advancement of Pharmacy Education (CAPE) Educational Outcomes. A pre- and post-activity survey was administered to students to gather information about changes in their perceptions of innovation and entrepreneurship in pharmacy. Results. Student groups received higher scores on their ability to present background information and the need for their clinical service and lower scores in areas such as tracking outcomes and predicting challenges. On the post-activity survey, 96.7% of students agreed that the activity gave them a better understanding of pharmacists' roles in establishing new clinical services, and 86.7% stated they intend to actively seek out new clinical pharmacy service opportunities in their future career. Conclusion. Results of the survey demonstrate that students understand the importance of innovation and entrepreneurship in pharmacy practice, and almost all students felt that the activity gave them an even better understanding of the pharmacist's role in clinical service development. This activity can serve as a blueprint for schools of pharmacy looking to incorporate creative and fun methods of exposing PharmD students to innovation and entrepreneurship activities., (© 2020 American Association of Colleges of Pharmacy.)

Objective. To assess pharmacy residency match/placement rates and student perceptions of a program designed to enhance Doctor of Pharmacy (PharmD) student competitiveness for postgraduate residency positions. Methods. The Scholars Program was developed to provide advanced training to select PharmD students who had an interest in postgraduate residency training and was completed during the third and fourth professional years. The program consisted of mentoring; elective coursework encompassing clinical practice, teaching, and leadership; modified experiential education; journal club meetings; teaching assistant duties; conducting research and/or scholarship; and delivering professional presentations. Residency match/placement rates of students who had completed the program were compared to national data and to students in the school who were not enrolled in the program. Perceptions of the program were assessed using an online survey. Results. Sixty-four students enrolled in and completed the Scholars Program from 2013 to 2019. Of these, 58 (91%) pursued postgraduate residency training. Students enrolled in the program had a higher combined phase 1/phase 2 match rate (91.4% vs 67.4%) than students in other PharmD programs across the United States. Similarly, students enrolled in the Scholars Program had a higher combined phase 1/phase 2 match rate (91.4% vs 62.9%) and overall residency placement rate (96.6% vs 67.0%) compared to students in the school who were not enrolled in the program. More than 85% of students enrolled in the Scholars Program who pursued residency training agreed that the program prepared them for and helped them attain a postgraduate residency. Conclusion. Pharmacy students enrolled in the Scholars Program experienced high residency match/placement rates and viewed the program as valuable preparation for postgraduate training., (© 2020 American Association of Colleges of Pharmacy.)

Objective. To describe the landscape of teaching and learning curriculum (TLC) programs sponsored by US schools and colleges of pharmacy and evaluate their adoption of best practice recommendations. Methods. A 28-item electronic survey instrument was developed based on best practice recommendations published by the American Association of Colleges of Pharmacy (AACP), American Society of Health-System Pharmacists (ASHP), and American College of Clinical Pharmacy (ACCP) for the conduct of TLC programs. The survey instrument was electronically distributed to 137 accredited colleges and schools of pharmacy in the United States. Results. Eighty-eight institutions responded, resulting in a response rate of 64%. Sixty-one TLC programs were included in the final analysis. Seventy-five percent of TLC programs reported using best practice recommendations; however, 10% of respondents indicated they were not aware of the published recommendations. Inconsistencies among programs were noted in required teaching experiences, participant evaluation, and ongoing programmatic assessment. Conclusion. Most institutions offering TLC programs are aware of published best practice guidelines and have adopted a majority of the published best practices. However, considerable variability exists across the country. Development of a formal external validation process for TLC programs is necessary to ensure consistent quality., (© 2020 American Association of Colleges of Pharmacy.)

Objective. To assess and characterize Doctor of Pharmacy (PharmD) students' well-being across the first professional year (P1) and determine the relationship between the number of examinations taken, student grade point average, and well-being scores. Methods. All P1 students (N=76) enrolled at one college of pharmacy self-reported their career, community, financial, physical, social, and overall well-being on a weekly basis during the fall and spring semesters. Parametric statistical tests were used to examine the extent to which students' well-being scores varied throughout the academic year, the extent to which their domain-specific well-being scores predicted overall well-being scores, and the association between their well-being scores and the number of examinations they had taken in a week and their grade point average. Results. Overall and domain-specific well-being scores significantly decreased from the beginning to the end of fall semester. Students' overall well-being across the academic year was most frequently predicted by their career well-being, physical well-being, and social well-being scores. Career, community, physical, and overall well-being scores were significantly negatively associated with the number of examinations the students completed during the week. Students' self-reported overall well-being during the fall semester was positively associated with their fall semester GPA. Conclusion. Significant variation was found in students' domain-specific and overall well-being across the P1 year. These findings can guide both the development and timing of school interventions to promote student well-being., (© 2020 American Association of Colleges of Pharmacy.)

Introduction: To evaluate the design of an interprofessional introductory pharmacy practice experience (IP-IPPE) designed to integrate third-year pharmacy students in patient care workflow under the direct supervision of non-pharmacist practitioners in a federally qualified health center., Methods: Data was gathered to evaluate the success of the IP-IPPE from the students', providers', and clinic's perspectives. Preceptors completed a mixed-methods survey to determine satisfaction and value of the IP-IPPE. Students completed the Interprofessional Collaborative Competencies Attainment Survey (ICCAS) post-IP-IPPE to assess change in interprofessional outcomes. Student performance and competency demonstration was assessed using a modified interprofessional professional assessment scoring tool. Finally, a retrospective patient chart review was conducted to determine student value to the clinic., Results: During a 12-week period at the studied clinic, 32 students were supervised by eight primary care providers (PCPs) and cared for 516 patients. Six providers (75%) endorsed students' ability to provide value-added interventions during clinical care. A chart review of 200 patient records indicated students provided medication education to 12% of patients engaged with, in addition to other contributions. Students' ICCAS self-assessments indicated significant improvement across all outcomes following the IP-IPPE. Qualitative provider responses indicated meaningful investment into the IP-IPPE and appreciation for pharmacy student's collaboration during patient care., Conclusion: All 32 students in this study were able to earn the trust of their assigned PCP preceptors. The IP-IPPE design created value for learners, patients, and providers., Competing Interests: Declaration of competing interest None., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Support of human immunodeficiency virus (HIV) and tuberculosis (TB) testing and treatment supported by President's Emergency Plan for AIDS Relief (PEPFAR) in Africa requires immense quantities of tests and medications. We sought to use central pharmacy supply data of Mozambique's rural Zambézia Province (2017 population ≈5.11 million persons; ≈12.6% adult HIV prevalence in 2016) to examine shortages, stockouts, and trends in availability. Using stock surveillance for 60 weeks in 2014-2015, we assessed availability of 36 medications [4 classes: adult antiretroviral (ARV) medications, pediatric ARVs, anti-TB medications, and antibiotics] and diagnostic test kits (2 rapid tests for HIV; 1 each for malaria and syphilis). We contrasted these to 2018-2019 data. We modeled pharmacy data using ordinal logistic regression, characterizing weekly product availability in four categories: good, adequate, shortage, or complete stockout. We found 166 (7 . 7%) stockouts and 150 (6.9%) shortages among 2,160 weekly records. Earlier calendar time was associated with reduced medication supplies ( p  < .001). Certain medication/test kit classes were associated with reduced supply ( p  < .001). We found an interaction between time and medication class on the odds of reduced supply ( p  < .001). Pediatric ARVs had a 17.4 (95% confidence interval: 8.8-34.4) times higher odds of reduced medication supply compared with adult ARVs at study midpoint. Trends comparing the first and last weeks showed adult ARVs having 67% and pediatric having 71% lower odds of reduced supplies. Only adult ARV shortages improved amid growing demand. Data from 2018 to 2019 suggest continuing inventory management challenges. Monitoring of drug (especially pediatric) and test kit shortages is vital to ensure quality improvement to guarantee adequate supplies to enable patients and care providers to achieve sustained viral suppression. A central Mozambican drug repository in the nation's second largest Province continues to experience drug and rapid test kit stockouts.

Objective. To explore how participation as a pharmacy camp counselor impacted pharmacy students' professional identity and views on professionalism. Methods. A pharmacy camp was developed to introduce rising high school juniors and seniors to the pharmacy profession. First- and second-year student pharmacists were invited to serve as counselors and, afterward, to participate in a focus group to share their experiences. Researchers used the focus group data to explore the impact of the camp experience on the student pharmacists. A direct interpretation approach was used to examine data as it allowed the research team to assess this single instance and draw meaning from focus group findings. Categories/themes were constructed through the interpretations of patterns and relationships discovered within the deconstructed results. Results. Ten student pharmacists participated in the focus group. The students provided their perspectives on the camp experience, including their role as camp counselors, the campers attending the camp, and the differences observed between student pharmacists and non-pharmacy camp counselors. Student pharmacists' comments gravitated toward the topic of professionalism. Student pharmacist counselors recognized positive and negative models of professionalism and made personal judgments concerning these concepts. Conclusion. Inclusion of student pharmacists in leadership roles such as this proved to be an effective means for further developing professional attributes. The focus group feedback provided novel insights into the professional mindset of student pharmacists. After serving as camp counselors, student pharmacists described their new perspectives on the importance of professionalism in their individual journeys, among their peers, and as future student pharmacists., (© 2020 American Association of Colleges of Pharmacy.)

Objective. To determine the factors, including a preparation test, that best predict pharmacy students' performance on the Pharmacy Curriculum Outcomes Assessment (PCOA). Methods. Two cohorts of third-year pharmacy students completed a 100-item locally created PCOA pre-test, the PCOA Prep. This PCOA Prep was a cumulative knowledge test that was administered in the fall semester. In the spring semester, the students completed the 200-item PCOA and a separate survey on study habits and confidence. A retrospective review of students' demographics data, pre-pharmacy admission variables, and pharmacy school factors were collected. Correlation and regression analyses were conducted to evaluate which factors predicted students' PCOA total scaled score as well as scores in areas 1-4. Results. One hundred seventy-nine students were included in the study. The majority were female (55%), white (54%), and 28 (SD=5.4) years old on average. Students' average score on the PCOA Prep test was 80.7% (SD=7.8). The stepwise multiple linear regression model for the PCOA total scaled score included the PCOA Prep test, cumulative GPA at the end of the didactic curriculum, race/ethnicity, Pharmacy College Admission Test (PCAT) Verbal, PCAT Biology, and a class identifier. Including the PCOA Prep test explained more variance than the model without the test. Conclusion. This study revealed that student performance on a locally created cumulative knowledge test best predicted the PCOA Total Scaled Score. These results offer insights into additional contributing factors that influence students' PCOA performance and how colleges and schools of pharmacy could identify at-risk students who may need knowledge remediation prior to beginning advanced pharmacy practice experiences., (© 2019 American Association of Colleges of Pharmacy.)

Objective. To identify work profile factors from the Career Pathway Evaluation Program, 2018 Pharmacist Profile Survey. Methods. Exploratory factor analysis was used to describe the underlying structures (factors) that best represented respondents' work profiles. Descriptive statistics and Analysis of Variance were used to describe the 17 different work categories listed in the survey. Results. Eleven underlying factors were identified for the respondents' work setting profiles. A description of these factors among the 17 different respondent career categories revealed variation that can be useful in describing the career categories in the APhA Career Pathway Evaluation Program for Pharmacy Professionals. Conclusion. The results revealed variation among pharmacist career types. The profiles constructed in this study describe the characteristics of various career paths and can be helpful for decisions regarding educational, experiential, residency, and certification training in pharmacist careers., (© 2019 American Association of Colleges of Pharmacy.)

Background: Infections of facial spaces in the maxillofacial region occur in most cases as a complication of odontogenic infections. It often results in substantial morbidity, with serious and potentially life threatening outcomes if allowed to progress without prompt medical attention., Objective: To identify factors that determine illness behaviour related to maxillofacial space infections., Method: This was a descriptive cross-sectional study of adult residents of pakoto community, Ifo local government area, Ogun state. The study was conducted using an interviewer administered questionnaire which included key information about respondents' awareness of predisposing factors of maxillofacial space infections; common actions taken with regards to treatment, and the factors that influenced their utilization of the available oral health care service., Results: A total of 187 individuals were sampled, mean age was 30.5(SD 11.7) years with majority being females (59.4%) The proportion of the total respondents who reported a history suggestive of orofacial space infection was 20.3% (n=38). Visiting a patent medicine dealer (26.3%) along with visiting a dentist (31.6%) were the illness behaviours most frequently engaged in by respondents who have had an orofacial swelling following a toothache, with majority (73.7%) indicating the action they took was based on what was most convenient., Conclusion: This study has revealed that engagement in unorthodox practises by individuals in a semi-urban community studied is prevalent, and influenced by factors such as age, gender, level of education and occupation., Funding: None., Competing Interests: Conflict of interest: None declared, (Copyright © The Author(s).)

Background: Medication adherence is an indicator of the quality of drug use, which is associated with better health outcomes and reduced health care expenditures. Drug cost sharing can be a barrier to adherence, especially for low-income individuals with chronic conditions. Most of the existing studies in a Medicaid population have evaluated the effects of increasing drug copayments, but few studies have evaluated the effects of reducing drug copayments on medication adherence. Medicaid coverage for low-income childless adults in Wisconsin was expanded on April 1, 2014, which included reductions in drug copayments and monthly caps on out-of-pocket spending., Objective: To evaluate changes in adherence to oral diabetes medications using proportion of days covered (PDC) among Medicaid childless adults with type 2 diabetes after the 2014 Medicaid drug copayment reduction., Methods: A difference-in-differences design was used to compare the changes in medication adherence between childless adults (treatment group) and parents/caretakers (control group). Wisconsin Medicaid's administrative enrollment records, pharmacy claims, and medical claims data were analyzed. Medication adherence was evaluated for 4 commonly used oral diabetes drug classes (i.e., biguanides, sulfonylureas, dipeptidyl peptidase-IV inhibitors, and thiazolidinediones) by adapting the medication adherence quality measures endorsed by the Pharmacy Quality Alliance. The PDC for all diabetes drugs was calculated among patients who filled ≥ 2 prescriptions for any of the 4 drug classes. PDC for each drug class was also measured among patients who had ≥ 2 drug fills for each drug class. The proportion of adherent patients was evaluated using a threshold of PDC ≥ 0.80., Results: Average PDC for all diabetes drugs was 0.87 in the childless adults at baseline and significantly increased by 0.02 ( P = 0.025) relative to the parents/caretakers after the copayment reduction. The baseline proportion of adherent patients (PDC ≥ 0.80) among the childless adults was 76% and significantly increased by 6.2 percentage points ( P = 0.003) relative to the control group. The odds of adherence to oral antidiabetic drugs increased by 47%, resulting in the proportion of adherent patients in the childless adults group reaching almost 80% after the coverage expansion. In the per class analyses, a significant effect was found for biguanides; the proportion of adherent patients increased by 5.5 percentage points in childless adults compared with the control group ( P = 0.022)., Conclusions: This program evaluation found that a reduction of drug copayments in Wisconsin Medicaid improved the quality of medication use by increasing adherence to oral antidiabetic drugs among childless adults., Disclosures: This study was conducted as part of a larger study funded by the Wisconsin Department of Health Services. The authors are solely responsible for the content of this study. The authors report an evaluation contract with the Wisconsin Department of Health Services, unrelated to this study. An earlier version of this paper was presented at the AcademyHealth Annual Research Meeting; June 23-24, 2018; Seattle, WA.

Objective. To design, implement, and assess a study abroad course in Ireland for pre-professional and Doctor of Pharmacy (PharmD) students. Methods. An elective study abroad course was created for pre-professional and PharmD students at North Dakota State University. The course included comparison of the US and Ireland's health care delivery systems and participation in history and cultural experiences in Ireland. Prior to the trip, students and preceptors attended seminars related to the culture of Ireland. The three-week trip to Ireland took place between the spring and summer semesters in 2016. Student assignments while abroad included completion of a self-reflection journal with daily entries describing what the student learned and how the experience impacted them, and completion and presentation of a term paper comparing Ireland's pharmacy system with that in the United States. Pre- and post-travel surveys were conducted to assess students' perceptions of and learning from the experience, and to identify areas for course improvement. Results. Students' evaluations of the course and travel experiences were positive. However, students' perceptions of their cultural awareness were largely unchanged. Conclusion. The course was well received by students. Other PharmD programs may benefit from implementing similar study abroad experiences., (© 2019 American Association of Colleges of Pharmacy.)

Objective. To evaluate the impact of a residency-focused introductory pharmacy practice experience (IPPE) on student perceived knowledge of and attitudes toward postgraduate residency training. Methods. Second- and third-year student pharmacists completed a required four-hour experience at a residency training site. Students completed a five-item survey before and after the experience, indicating their perceived knowledge of residency training components as well as their own postgraduate plans. Students also submitted a written reflection following the experience. Paired t tests were used to compare pre- and post-survey responses. Qualitative analysis was completed to identify common themes in student reflections and code for positive, neutral, or negative student experience. Results. A total of 276 students completed the Introduction to Postgraduate Residency Training IPPE in summer 2016. Post-experience survey responses indicated a significant increase in students' perceived knowledge of residency programs; however, plans to pursue residency training did not significantly change after completing the experience. Twenty-five independent themes were identified in reading student reflections, with the most common theme (included in 55% of reflections) being that the experience "clarified resident day-to-day responsibilities." The majority (95%) of students perceived the experience as valuable. Conclusion. A residency-focused IPPE increased student pharmacists' perceptions of knowledge about postgraduate residency training and was viewed by students as a beneficial experience., (© 2019 American Association of Colleges of Pharmacy.)

Objective. To compare performance outcomes of students completing a longitudinal pharmacy practice experience at a single site with those of students completing advanced pharmacy practice experiences (APPEs) at a variety of practice sites. Methods. Performance data and other meaningful outcomes from a cohort of students completing a six-month experience within a single health system (longitudinal group) were compared to data from a group of students completing six months of similar APPEs at multiple health systems (control group). Results. Motivators for participating in the longitudinal program varied, with students in the program identifying practice interest alignment, schedule simplification, and desire to do a residency; and students choosing to not participate in identifying schedule flexibility and experience at a variety of practice sites. The 16 longitudinal students differed from the 20 control students at baseline in grade point average and the number of scheduled community pharmacy APPEs. Performance measures for longitudinal students and control students did not differ significantly, but the difference between students' self-perceived effort and preceptor perception of student effort was significantly different for control students compared to longitudinal students. Residency match rates and number of students receiving recognition for high academic performance were similar in the two groups. Conclusion. Students participating in the longitudinal program had different motivators but comparable outcomes to students who completed similar APPEs at a variety of practice sites., (© 2019 American Association of Colleges of Pharmacy.)

Objective. To assess the impact of pharmacy school characteristics on the pass rates of students taking the North American Pharmacist Licensure Examination (NAPLEX) for the first time. Methods. A retrospective review of NAPLEX first-time pass rates, pharmacy school characteristics and percent of total graduating class who matched for a first postgraduate year (PGY1) residency was performed for 2014, 2015, and 2016. All US colleges of pharmacy accredited as of July 2017 were included. Independent samples t tests, paired samples t tests, correlational analysis, and multiple linear regression were conducted. Results. The first-time pass rates on the NAPLEX were significantly higher for the following: schools located within an academic health center; schools established before 2000, and public schools. The 2016 NAPLEX first-time pass rate was significantly higher for schools with a traditional four-year program structure versus an accelerated three-year structure. Also, a school's first-time pass rate on the NAPLEX was positively, significantly correlated with percentage of fourth-year students who matched for a PGY1 residency and being located within an academic health center. The NAPLEX first-time pass rate for the previous year and percent of the total graduating class that matched for a PGY1 residency were significant predictors in the final regression models for 2015 and 2016 NAPLEX first-time pass rates. Conclusion. While differences in certain program characteristics was coorelated with NAPLEX pass rate, many of these factors are not modifiable. Programs can proactively and critically evaluate their educational programs and the readiness of their students to sit for the NAPLEX.

Objectives: A commercial barcode-assisted medication administration (BCMA) system was integrated to secure the medication process and particularly the dispensing stage by technicians and the administration stage with nurses. We aimed to assess the impact of this system on medication dispensing errors and barriers encountered during integration process., Methods: We conducted a controlled randomized study in a teaching hospital, during dispensing process at the pharmacy department. Four wards were randomized in the experimental group and control group, with two wards using the system during 3 days with dedicated pharmacy technicians. The system was a closed loop system without information return to the computerized physician order entry system. The two dedicated technicians had a 1-week training session. Observations were performed by one observer among the four potential observers previously trained. The main outcomes assessed were dispensing error rates and the identification of barriers encountered to expose lessons learned from this study., Results: There was no difference between the dispensing error rate of the control and experimental groups (7.9% for both, p  = 0.927). We identified 10 barriers to pharmacy barcode-assisted system technology deployment. They concerned technical (problems with semantic interoperability interfaces, bad user interface, false errors generated, lack of barcodes), structural (poor integration with local information technology), work force (short staff training period, insufficient workforce), and strategic issues (system performance problems, insufficient budget)., Conclusion: This study highlights the difficulties encountered in integrating a commercial system in current hospital information systems. Several issues need to be taken into consideration before the integration of a commercial barcode-assisted system in a teaching hospital. In our experience, interoperability of this system with the electronic health record is the key for the success of this process with an entire closed loop system from prescription to administration. BCMA system at the dispensing process remains essential to purchase securing medication administration process., Competing Interests: None declared., (Georg Thieme Verlag KG Stuttgart · New York.)

Objective. To assess the effectiveness of a required reflective writing assignment to document students' exposure to and experience with interprofessional collaborative practice (IPCP) during introductory pharmacy practice experiences (IPPEs). Methods. Pharmacy students completed the assignment during their community or institutional pharmacy IPPE and electronically submitted their written reflections. Twelve codes were created to indicate opportunities, barriers, and patient-centered care identified in the community pharmacy reflections. Fourteen codes were created to indicate interprofessional communication, roles, patient-centered care, and teamwork identified in the institutional pharmacy reflections. The reflections were then qualitatively analyzed to identify and code themes related to IPCP. Results. Two hundred twenty-eight reflections were submitted. Exposure to an observed IPCP was described in 51% of the community pharmacy reflections and in 100% of the institutional pharmacy reflections. Identified opportunities to improve IPCP in community pharmacy were extended pharmacy services, expanded networking and relationships, making more phone calls to other health professionals, and greater use of technology. The identified barriers to IPCP in community pharmacy were difficulty accessing patient health data, lack of direct access to prescribers, hierarchy, pharmacy workload, and lack of timely communication. The identified themes that impacted IPCP in institutional settings included dysfunctional communication, technology use, mutual respect, role overlap, teamwork, nonphysician leadership, and personal relationships. Conclusion. Implementing a reflective assignment during IPPEs was an effective way to document student exposure to and experience in IPCP in two types of pharmacy practice settings and helped to meet pharmacy accreditation standards of having IPE included in early experiential education settings.

Objective. To characterize Grit-S scores in pharmacy students, determine whether Grit-S scores change within individual pharmacy students and cohorts over time, and investigate the relationship between Grit-S scores, academic outcomes, and professional outcomes. Methods. A survey was conducted in fall 2016 and again in fall 2017 to determine Grit-S scores in first- through fourth-year pharmacy students. Participant demographic variables, grade point average (GPA), advanced pharmacy practice experience (APPE) ratings, and residency match results were collected. Results. Over the study period, 852 survey responses were completed by 85% of students surveyed. The mean Grit-S scores of each cohort ranged from 3.5 to 3.7 (on a 5-point scale with 5 representing the highest level of grit). Underrepresented minorities had slightly higher Grit-S scores and first-generation college students had slightly lower Grit-S scores. Two hundred eighty-seven students responded to both the 2016 and 2017 surveys. Among these paired responses, small but significant changes in individual Grit-S scores over time that varied in direction and magnitude by school year were noted. Higher Grit-S scores were not associated with higher GPA or superior APPE performance, nor were they predictive of a student matching to a postgraduate pharmacy residency. Conclusion. Significant associations between grit and measures of academic or professional achievement were not detected in this pharmacy student cohort. The presence of small but significant changes in Grit-S scores over time, in the absence of any intervention, has implications that further research should be conducted in this area.

Objective. To evaluate attitudes toward peer review of teaching and its impact on teaching practices and perceptions. Methods. The University of Waterloo School of Pharmacy implemented a peer-review process for its teaching program in 2015. Those reviewed were invited to complete an electronic survey that captured their attitudes toward teaching, attitudes toward peer review, and changes in teaching practices, and to participate in semi-structured follow-up interviews for more in-depth discussion of these issues. Results. Twenty-six (76%) instructors completed the survey. Instructors agreed that peer reviews of teaching are a development opportunity (96%), and 73% were comfortable with the idea of peer review. Over half (58%) indicated that the review made them feel more confident that their teaching strategies were effective, and the same percentage indicated that they planned to make changes to their teaching as a result of the feedback received from the peer review. Only a few instructors indicated that peer review changed their attitudes toward teaching (12%) or increased the value they placed on teaching (34%). Eight instructors (23.5%) participated in the semi-structured interviews. Themes that emerged included: attempts to make the reviewee comfortable during the peer review were successful; the feedback provided to instructors regarding their teaching was positive but not critical enough; there was lack of clarity as to the purpose of the feedback; and instructors planned to make only minor changes to their teaching as a result of the review. Conclusion. Peer review of teaching was well received and feedback was confirmatory in nature but had minimal impact on teaching practices as it was not deemed to be critical enough. Changes to the peer review program are needed to increase its impact on teaching practices.

Objectives: To measure and compare the perception of immunizations, immunization status, and recommendation sources in persons living with HIV (PLWHs) and persons without HIV and determine a strategy for improving immunization rates by increasing awareness of pharmacy services., Design: A 19-item survey based on the Health Belief Model assessed patients' perceptions and recommendation sources regarding immunization acceptance for specific vaccines: Tdap, pneumococcal, and hepatitis B (HepB). Survey items used a 5-point Likert-type scale assessing participants' perceptions, with questions identifying participants' most trusted sources of immunization information and patient demographics. Survey questions were designed to identify perceived susceptibility and severity of vaccine-preventable illness, barriers, benefits, and self-efficacy regarding immunization acceptance, and sources of patient-trusted immunization information., Setting and Participants: Survey recruitment occurred in Indiana and included any patient 18 years of age or older picking up medications at a specialty pharmacy predominantly serving PLWHs or a traditional community chain pharmacy., Main Outcome Measures: Primary outcomes included perceived barriers to immunization acceptance obtained from Likert-type scale questions, patient-reported immunization rates of selected vaccines (Tdap, pneumococcal pneumonia, and HepB), and trusted immunization recommendation sources. Logistic regression was performed to model association between perceived barriers, HIV status, and immunization recommendation sources., Results: A total of 142 participants (68 PLWHs, 74 persons without HIV) completed the survey. PLWHs were more likely to have immunization barriers, but this was not statistically significant (odds ratio 2.537, 95% confidence interval 0.585-10.996). Both participant groups reported "family doctor" as the most trusted source, with only 5% selecting "pharmacist." Significantly fewer PLWHs reported completing the HepB series (18% vs. 52%; P = 0.0224)., Conclusion: PLWHs possess barriers to immunization acceptance similar to persons without HIV yet report lower rates of HepB vaccine completion. Although pharmacists were less frequently selected as the most trusted source, additional studies on percptions of pharmacists' role in immunizing PLWHs should be considered., (Copyright © 2019 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.)

Objectives: The Code of Ethics of pharmacy practitioners in Australia recognises the obligation to provide care to patients in a culturally safe and responsive manner. The aim of this exploratory study was to examine how Australian community pharmacists understand and experience the concept of 'culture' in their everyday practice environment., Methods: Voluntary, semi-structured interviews were conducted at community pharmacy placement sites in South-East Queensland, Australia. Pharmacists were asked to recall an incident that evoked their cultural awareness during the course of their practice. The question stated, verbatim: "We are preparing our students to be pharmacists in a highly multicultural community. Can you think of an incident where you learnt something about another person's culture or it made you more aware of your own culture? Please briefly describe the incident." Reportable responses were collected from 59 of the 92 visited pharmacists. These responses were audio-recorded and transcribed. The data were collated and analysed through iterative, reflexive, thematic analysis using constant comparison., Results and Significance: The responses provided a rich selection of lived experiences within Australian multicultural pharmacy practice, describing professional dilemmas, fears and the strategies employed to overcome practice challenges. Six main response categories were identified: (i) Language/communication challenges, (ii) Cultural attitudes and behaviours, (iii) Exposure to culture due to pharmacy location, (iv) Religion, gender, and age, (v) Prejudiced/perceived racist attitudes and discrimination towards 'other' cultures, (vi) Perceived 'sameness' of different cultures. The study has provided valuable insights into community pharmacists' experiences of culture in their day-to-day professional practice, also highlighting the associated strategies used to maintain a high standard of practice. There is merit in ensuring that the pharmacy curriculum and professional development programs are designed to respond to the ethical obligation of pharmacists to practise in a culturally safe, responsive manner that acknowledges and incorporates the importance of culture, cultural differences and intercultural relations, while addressing culturally unique needs in a skilled and professional manner., Competing Interests: The authors have declared that no competing interests exist.

Introduction: There has been a significant increase in the volume of biosimilar medicines recently due to the expiries of patent protections of biologic medicines. Biosimilars are considered new medicines, and their usage in therapy is often associated with uncertainty from the perspectives of physicians, pharmacists and patients., Objectives: The purpose of this study was to identify hospital pharmacist opinions towards these new medicines and investigate their usage in practice., Methods: A paper-based, self-administered questionnaire was distributed to Polish hospital pharmacists., Results: Biosimilars were used in 77% of surveyed hospitals, whereas originator biologics were utilised within 90% of settings. The former medicines were found to consist of less than one-third of the entire course of biological pharmacotherapy used within Polish hospitals. A total of 88% of hospital pharmacists were concerned that the new drugs were not identical with the biologic versions, 48% with their immunogenicity and 44% with other pharmacokinetic properties. The majority of respondents (87%) stated that the most important advantage of biosimilars related to decreased costs. Furthermore, according to participants, pharmacist-led substitution is not appropriate., Conclusion: Due to the numerous concerns relating to the usage of biosimilars, their introduction into patient therapy requires special attention from healthcare providers. While pharmacists involved in the distribution of biosimilars are conscious of their impact in decreasing costs of therapy, they do not feel comfortable in recommending their substitution without a physician's permission. There is a need for more precise legal regulations relating to biosimilars, improved communication between physicians and pharmacists, as well as educational initiatives to improve the safe and effective usage of biosimilars.

Background: Inappropriate over-the-counter supply of antibiotics in pharmacies for common infections is recognised as a source of antibiotic misuse that can worsen the global burden of antibiotic resistance., Objectives: To assess responses of community pharmacy staff to pseudo-patients presenting with symptoms of common infections and factors associated with such behaviour., Methods: A cross-sectional pseudo-patient study was conducted from Jan-Sept 2017 among 242 community pharmacies in Sri Lanka. Each pharmacy was visited by one trained pseudo-patient who pretended to have a relative with clinical symptoms of one of four randomly selected clinical scenarios of common infections (three viral infections: acute sore throat, common cold, acute diarrhoea) and a bacterial uncomplicated urinary tract infection. Pseudo-patients requested an unspecified medicine for their condition. Interactions between the attending pharmacy staff and the pseudo-patients were audio recorded (with prior permission). Interaction data were also entered into a data collection form immediately after each visit., Results: In 41% (99/242) of the interactions, an antibiotic was supplied illegally without a prescription. Of these, 66% ( n  = 65) were inappropriately given for the viral infections. Antibiotics were provided for 55% of the urinary tract infections, 50% of the acute diarrhoea, 42% of the sore throat and 15% of the common cold cases. Patient history was obtained in less than a quarter of the interactions. In 18% (44/242) of the interactions staff recommended the pseudo-patient to visit a physician, however, in 25% (11/44) of these interactions an antibiotic was still dispensed. Pharmacy staff advised the pseudo-patient on how to take (in 60% of the interactions where an antibiotic was supplied), when to take (47%) and when to stop (22%) the antibiotics supplied. Availability of a pharmacist reduced the likelihood of unlawful antibiotic supply (OR = 0.53, 95% CI: 0.31-0.89; P  = 0.016) but not appropriate practice., Conclusions: Illegal and inappropriate dispensing of antibiotics was evident in the participating community pharmacies. This may be a public health threat to Sri Lanka and beyond. Strategies to improve the appropriate dispensing practice of antibiotics among community pharmacies should be considered seriously., Competing Interests: This study was approved by the local ethics review committee, faculty of medicine, University of Ruhuna Sri Lanka (Reference number 16.11.2016:3.1). Prior informed written consent was obtained for pseudo-patient visits and audio recording of the interaction during the self-reported survey phase of the research project. The processing of participants’ personal data was anonymised, and all data were kept confidential, including personal identifiers complied with local data protection legislations.Not applicable.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

The goal of this study was to evaluate the impact of socio-clinical factors on adherence to antiretroviral treatment in people living with HIV/AIDS in Koula-Moutou (a rural area of Gabon). Two adherence assessment methods based on patient declaration and compliance with pharmacy visits were used to determine qualitative and quantitative aspects of adherence to antiretroviral therapy (ART). The quantitative (82.2%) and qualitative (79.5%) adherences to ART declared by patients were higher than those obtained through pharmacy visit assessment methods (15.8% and 45.2%, respectively). Moreover, the declarative and pharmacy visit compliance methods showed fair agreement (quantitative Kappa = 0.317; qualitative Kappa = 0.311). A better quantitative or qualitative declarative adherence was associated with a lower level of education (P = 0.05 and P = 0.025 respectively). This study reported for the first time the factors influencing adherence to ART in a rural area of East Gabon. We recommend further investigations in a large cohort to better assess the impact of socio-clinical factors on ART adherence in a vulnerable group of patients.

Objectives: Excessive and inappropriate use of antibiotics increases antimicrobial resistance. The aim of this study was to determine the magnitude and determinants of antibiotic dispensing without prescription in Spain by the simulated patient technique., Methods: A cross-sectional study was conducted with all the pharmacies in a region of north-west Spain (n = 977), between December 2016 and January 2017. Four actors visited the pharmacies simulating a respiratory infection. Four incremental levels of pressure were used to obtain an antibiotic. The education and sex of the person who was dispensing and the area where the pharmacy was located were recorded. The effect of these independent variables on the dispensing of an antibiotic without prescription (1 = yes, 0 = no) was modelled by logistic regression., Results: An antibiotic was obtained in 18.83% (95% CI = 16.5%-21.41%) of the visits. The area influenced the dispensing of antibiotics without a medical prescription, with a greater likelihood of dispensing in rural (OR = 1.79; 95% CI = 1.20-2.68) or semi-rural (OR = 1.66; 95% CI = 1.13-2.44) areas than in urban areas. No association was found with the sex or the training of the person who dispensed the antibiotic. In the pharmacies in urban areas, a lower level of pressure was needed to obtain the antibiotic., Conclusions: This study shows that one-fifth of the pharmacies still dispense antibiotics without prescription, especially under patient pressure. A rural setting has been identified as a risk factor for dispensing without prescription, so it must be taken into account for future interventions.

Objectives: To compare the effects of a Geriatric Patient-Aligned Care Team (GeriPACT) on deprescribing of potentially inappropriate medications (PIMs) in individuals aged 80 and older with usual care (UC) in the Veterans Affairs setting., Design: Retrospective cohort study., Setting: Veterans Affairs Medical Center in Lexington, Kentucky., Participants: Individuals aged 80 and older who filled a PIM at least 90 days before a GeriPACT or primary care appointment between January 1, 2015, and September 6, 2017 (N = 568)., Measurements: The primary outcome was to determine whether an interdisciplinary team (IDT) including a clinical pharmacy specialist (CPS) resulted in greater deprescribing of PIMs for older adults than UC., Results: One hundred twenty-one (26.8%) PIMs were deprescribed in GeriPACT, compared with 73 (16.1%) in UC (p = <.001). Of PIMs not deprescribed, 9.7% (n = 32) were dose reduced in GeriPACT, versus 2.8% (n = 11) in UC (p < .001). Documentation of risk versus benefit discussion between a provider and participant or pharmacist and participant occurred with 65.2% (n = 215) of PIMs not deprescribed in GeriPACT and 0.003% (n = 1) in UC (p < .001)., Conclusion: An IDT that included a CPS led to significantly more deprescribing of PIMs in older veterans. Including a CPS on an IDT for the management of older adults can decrease PIM use in our rapidly growing aging population. J Am Geriatr Soc 67:115-118, 2019., (Published 2018. This article is a U.S. Government work and is in the public domain in the USA.)

Objective. To determine factors associated with advanced pharmacy practice experience (APPE) performance in the pre-pharmacy and Doctor of Pharmacy (PharmD) curriculum and establish whether performance on the multiple mini interview (MMI) independently predicts APPE evaluation scores. Methods. A multi-case MMI has been used in the admissions process since 2008. Students are scored anywhere from 1 to 7 (unsatisfactory to outstanding) on each interview. Traditional factors (GPA, PCAT, etc.) are also used in the admissions determination. Pearson product-moment correlation and ordinary least squares regression were used to explore the relationships between admissions data, pharmacy GPA, and APPE evaluation scores for the graduating classes of 2011-2014. These analyses identified which factors (pharmacy GPA, PCAT, MMI score, age, gender, rurality, resident status, degree, and underrepresented minority status) related to APPE performance. Results. Students (n=432) had a mean APPE score of 4.6; a mean MMI score of 5.5; mean pharmacy GPA, PCAT and age of 3.14, 73.2, 22.6 years, respectively. Pre-pharmacy GPA and pharmacy GPA positively correlated with mean APPE scores. MMI score demonstrated positive correlations with overall APPE score; including subcategories patient care, documentation, drug information/EBM, public health, and communication. MMI scores were positively related to overall APPE scores in the multivariable regression. Variables showing negative associations with APPE scores included a pre-pharmacy GPA of <3.0 (ref= GPA >3.5) and pharmacy school GPA of >3.0 - 3.5 and GPA 2.6 - 3.0 when compared to GPAs >3.5. Conclusion. GPA (pre-pharmacy and pharmacy) and MMI positively correlate with preceptor-rated performances in the APPE year.

Objective. To characterize informatics education opportunities in US colleges and schools of pharmacy curricula. Methods. Informatics curricular information online was catalogued via publicly available websites. Website content was searched via domain-specific keywords. Online course descriptions were reviewed. Website searches were also conducted for informatics-related opportunities. Results. Of 132 pharmacy curricula found online, 47 (36%) included an informatics course. Of those, 64% (n=30) were required while 47% (n=22) were elective courses. Additionally, 20% (n=26) provided informatics advanced and/or introductory pharmacy practice experiences, 20% (n=27) offered an informatics residency, and 17% (n=22) listed certificate and/or graduate degree programs in informatics. Conclusion. Over the past 10 years, little observable progress has been made in pharmacy school curricula in response to the increasing importance of informatics to the profession. Pharmacy programs can address this educational gap by internal (eg, course development) and external (eg, open source curriculum) solutions.

Objective. To evaluate perceived stress among postgraduate year 1 (PGY1) pharmacy residents and to examine relationships between perceived stress and certain demographic variables. Main stressors during residency training and coping mechanisms used were also determined. Methods. A link to a web-based survey was sent to 1128 pharmacy residency program directors who were asked to forward it to current PGY1 residents in their programs. The 22-item questionnaire included the 10-item Perceived Stress Scale (PSS-10), demographic information, number of working/sleeping hours, and major stressors and coping mechanisms. Results. There were 505 responses collected from PGY1 residents of community pharmacy, managed care, and pharmacy practice residency programs across the US. Females reported higher PSS-10 scores than males. Perceived stress scores were similar across age groups. Single residents and married residents exhibited similar PSS-10 scores. Residents with children had higher stress score compared to residents without children. Perceived stress scores were similar across types of PGY1 residency programs. A higher number of working hours was associated with a higher PSS-10 score. Time pressures, work overload, and fear of error were the top stressors reported. Spending time with family and friends, staying optimistic, and engaging in enjoyable activities were the top coping strategies employed by participants. Conclusion. Female gender, having children, working longer working hours, and desire to change residency program were associated with higher PSS-10 scores. Approximately a third of the participants associated perceived stress with activities related to residency training (time pressures, workload, fear of errors) and report the use of positive coping strategies to deal with stress.

Objectives: To characterize the most common medication-related problems and interventions and to evaluate the acceptance rates of pharmacist identification of medication-related problems through percent acceptance rates of interventions in a nontraditional long-term care pharmacy., Methods: A retrospective chart review of long-term care pharmacy patients 18 years of age or older was used to evaluate pharmacist interventions from January 2014 to August 2016. Data collection included the date and type of intervention, patient demographic information (age, sex), drug class involved, physician provider type (primary care or specialist), intervention outcome, and resolution type. Accepted and rejected interventions were reviewed and classified based on Hepler and Strand's 8 medication-related problems: untreated indications, improper drug selection, subtherapeutic dosage, failure to receive medication, overdosage, adverse drug reactions, drug interactions, and medication use without indication. Data were analyzed with the use of descriptive statistics., Results: Four hundred seventeen interventions were documented over 18 months, approximately 13 interventions per month. Prescribers accepted 47% of interventions and rejected 29%. The remaining 24% of interventions did not have a response from the prescriber. Of the medication-related problems, "untreated indication" and "overdosage" were the most commonly intervened with and accepted interventions. Regarding drug class, pharmacists made the most interventions regarding immunizations (41%), diabetes medications (11%), cholesterol medications (10%), and hypertension medications (7%)., Conclusion: Pharmacists are improving the care of patients living in small group homes through various types of recommendations regarding complex disease states, such as diabetes, hyperlipidemia, and hypertension, further complicated by mental illness. With almost one-half of all recommendations accepted by prescribers, pharmacists consistently provided recommendations to improve care., (Copyright © 2018 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.)

Objectives: To compare community pharmacists' comfort levels and knowledge prescribing hormonal contraception before and after a training session and to identify perceived barriers and resources needed to prescribe hormonal contraception., Methods: In this pre-post convenience sample survey study, all 350 pharmacists in the Mid-Atlantic Division of Kroger (which spans parts of Kentucky, North Carolina, Ohio, Tennessee, Virginia, and West Virginia) were surveyed before and after a training session. The survey consisted of several sections: 1) questions rating comfort, 2) knowledge-based multiple-choice assessment questions, 3) perceptions of barriers and resources needed to prescribe hormonal contraception, and 4) demographics. The training session was a 1-hour continuing education about hormonal contraception. Data were analyzed with the use of univariate and bivariate statistics to compare pre- and post-training survey information., Results: Seventy-eight pharmacists completed both surveys (22.3% response rate). Pharmacists averaged 14 years in pharmacy practice, and 66.6% were female. More pharmacists (31.8%) perceived liability concern as the greatest barrier to pharmacist-initiated contraception. Pharmacist knowledge about hormonal contraception increased in some domains after the training session (P < 0.001). If allowed as a scope of practice in their state, the comfort level of pharmacists in prescribing any type of hormonal contraceptive significantly increased after the training session (P < 0.004)., Conclusion: Pharmacists have an initial lack of knowledge and perceived lack of comfort with prescribing hormonal contraception if allowed in their state of practice. A training session was identified as an effective tool and intervention to increase pharmacists' comfort levels in prescribing hormonal contraception., (Copyright © 2018 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.)

Objective: To compare the impact of a whole-staff training strategy with a train-the-trainer strategy on 1) the number of influenza, pneumococcal, herpes zoster, and pertussis vaccines administered by community pharmacists to adults; 2) staff confidence; and 3) fidelity to the intervention., Setting: Eight Quality Food Centers (QFC) Pharmacies in Seattle, Washington., Practice Description: QFC Pharmacy is a grocery store division of The Kroger Co. with 30 pharmacies located in Washington State. QFC provides all routine and travel vaccines to adolescents and adults and has a culture of improving vaccine access to its community., Practice Innovation: Pharmacists and pharmacy technicians from 8 QFC pharmacies received training to enhance their immunization care for adults. The entire staff from 4 pharmacies received whole-staff training, and staff members from the other 4 pharmacies received a train-the-trainer approach. The whole-staff training group had all staff members attend a live, 2-hour training. The train-the-trainer group sent 1 pharmacist and 1 pharmacy technician champion to attend the live training and then return to their pharmacy to train the other staff members., Evaluation: The number of immunizations administered, staff confidence, and self-reported fidelity to the intervention were measured before and after training. All data were analyzed using descriptive statistics., Results: The number of total influenza, pneumococcal, herpes zoster, and pertussis vaccines administered increased 12.6% in the whole-staff training group and 15.2% in the train-the-trainer group. Both training strategies increased confidence in identifying patients eligible for vaccines, talking to patients about vaccine needs, and using the bidirectional immunization platform. Pharmacy staff members in both groups indicated fidelity to key steps in the intervention process., Conclusion: Both whole-staff training and train-the-trainer approaches were associated with an improvement in the number of vaccines administered, staff confidence, and fidelity to the intervention. Community pharmacy organizations could use either training strategy when implementing enhancements to an existing patient care service. The train-the-trainer strategy may be less resource intensive., (Copyright © 2018 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.)

Purpose The purpose of the study was to identify current practice settings for Certified Diabetes Educators (CDEs) who are pharmacists. Following nurses and dietitians, pharmacists are the third largest group of health professionals who hold the CDE credential. The growing number of CDE pharmacists highlights the increasing involvement of pharmacists in diabetes care. What remains unknown is the specific settings in which pharmacist CDEs practice. Methods A cross-sectional, nationwide electronic survey was sent to all CDE pharmacists in the United States. Questions regarding demographics, practice setting characteristics, certification information, and common diabetes-related counseling topics were asked of all respondents. Survey items also sought to determine pharmacists' perceptions of the benefits and barriers to obtaining the CDE credential. The questions were dichotomous, Likert-scale response, or open-ended. Results A total of 462 survey responses were included in the analysis for a response rate of (462/1275) 36.2%. Respondents identified hospital or health system as the most common practice setting (n = 311), followed by academia (n = 100), community (n = 81), managed care (n = 44), and other settings. Conclusions Study findings provide important data that describe where CDE pharmacists are practicing to provide diabetes education. The continued steady growth of CDE pharmacists suggests a consistent increase of pharmacists practicing diabetes education. Diabetes educators should recognize that CDE pharmacists practice in a variety of different settings.

Objective: To evaluate the implementation of pharmacist-prescribed hormonal contraceptives in California after a recent expansion of pharmacists' scope of practice., Methods: A probability sample of 480 licensed California retail pharmacies (stratified by nonrural or rural location and independent or chain status) was included in a cross-sectional "secret shopper" telephone survey assessing the availability of pharmacist-prescribed hormonal contraceptives and service details. Survey data were analyzed using weighted descriptive statistics, CIs, and Wald tests., Results: Findings included data from 457 pharmacies (response rate 95.2%). Only 5.1% of pharmacies reported providing pharmacist-prescribed hormonal contraceptives (95% CI 2.9-7.2%). This proportion did not differ significantly between rural and nonrural pharmacies (P=.83) nor between independent and chain pharmacies (P=.40). Five of the 22 pharmacies that were providing pharmacist-prescribed hormonal contraceptives informed secret shoppers that all allowed hormonal methods were available; most of these pharmacies (77.3%) did proactively describe that a health history was required before receiving medications. Only half of pharmacies providing pharmacist-prescribed hormonal contraceptives would do so for minors although this was allowed by law., Conclusion: In the first year after statewide protocol implementation, only a small proportion of retail pharmacies across California has begun offering hormonal contraception services. In the absence of additional supportive legislation regarding reimbursement for pharmacist services, increases in scope of practice regulations to build a larger network of contraceptive providers may not be effective in increasing access to birth control.

We sought to examine whether pharmacy service quality was associated with parents' willingness to have immunizing pharmacists administer human papillomavirus (HPV) vaccine to their adolescent children. Participants were a national sample of 1504 US parents of adolescents ages 11 to 17 who completed an online survey in 2014. Analyses used structural equation modeling. Parents rated service quality and feelings of satisfaction with their pharmacies as moderate to high. Many (44%) were willing to get HPV vaccine from immunizing pharmacists for their adolescent children. Compared with parents who went to chain pharmacies, parents who went to independent pharmacies gave higher ratings of service quality (professionalism, confidentiality, milieu, all p < .001). Parents who went to clinic pharmacies, compared with parents who went to chain pharmacies gave lower ratings for milieu (p < .01). Parents who went to independent pharmacies had lower willingness to get HPV vaccine from pharmacists compared to parents who went to chain pharmacies (p = .001), but there was no difference in willingness for parents who went to clinic versus chain pharmacies. Service quality and satisfaction partially mediated the effect between independent pharmacies compared to chain pharmacies and willingness (p < .05). Parents who knew their pharmacists or expressed more confidence in HPV vaccine also had higher willingness to get their children HPV vaccine from pharmacist. Many parents were willing to go to immunizing pharmacists for their children's HPV vaccination. Pharmacies that are considering offering HPV vaccine may be able to improve vaccine uptake by increasing perception of service quality., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Objectives: This study was designed to identify the services provided by community pharmacists in Kuwait and their views regarding self-care in pregnancy and lactation. In addition, it determined the pharmacists' recommendations for treatment of pregnancy-related and breast feeding-related ailments., Design: Cross-sectional questionnaire-based survey., Setting: Community pharmacies in Kuwait., Participants: 207 pharmacies were randomly selected from the Ministry of Health database. One registered pharmacist was approached from each pharmacy. One hundred and ninety-two (92.8%) pharmacists agreed to participate and completed a self-administered questionnaire., Outcomes: The proportions of pharmacists offering particular advice for health conditions in pregnancy and lactation, pharmacists' recommendations for common and specific ailments during pregnancy and breast feeding, and pharmacists' views about self-care in pregnancy and breast feeding., Results: The top services provided to pregnant and lactating women were recommending vitamins and food supplements (89.8%) and contraception advice (83.4%), respectively. More than half of participants indicated that they would recommend medications for headache, constipation, cough, runny nose, sore throat, nausea/vomiting, indigestion, sore or cracked nipple and insufficient milk. Diarrhoea, haemorrhoids, insomnia, varicose vein, swelling of the feet and legs, vaginal itching, back pain, fever, mastitis and engorgement were frequently referred to the physician. Recommendations on medication use were occasionally inappropriate in terms of unneeded drug therapy, off-label use and safety. In relation to offering advice and solving medication and health problems of pregnant and lactating women, more than half of pharmacists indicated that they have sufficient knowledge (61.5%; 50.5%) and confidence (58.3%; 53.1%), respectively. Most of the respondents (88.5%) agreed that a continuing education programme on this topic would be of value for their practice., Conclusion: The present findings show that respondents had different recommendations for treatment of pregnancy-related and lactation-related ailments; and also highlight the need for interventions, including continuing professional development and revision of the undergraduate pharmacy curriculum., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Objectives: Residency programs may need to spend a large amount of time on the application review process in order to invite the best candidates for interviews. By using a different scoring strategy, this process could be made more efficient while still resulting in selection of the most appropriate candidates to interview. The objective of this study was to explore hypothetical scoring strategies for past residency applicants and to determine the percentage of these applicants that would have received an interview offer compared with the program's standard scoring strategy., Methods: Two years of residency applications to a postgraduate year 1 (PGY1) program providing the majority of clinical experience in ambulatory care were analyzed. Four models were explored: 1) standard model (original method); 2) simplified model (derived from statistical methods); 3) intuition model (criteria thought to best exemplify program success); and 4) objective model (criteria easy to objectively record, e.g., grade point average). All 3 new models were compared with the standard model to determine the percentage of candidates who would have received an interview if their applications had been scored according to the new model., Results: A total of 110 applications were reviewed (42 interviews offered). After a multivariable analysis, academics, leadership, interest in ambulatory care, and professionalism were included in the simplified model, which predicted 81% of the interviews offered through the standard model. The intuition and objective models predicted 71% and 48% of interviews offered through the standard model, respectively., Conclusion: Models scoring only 4 of the initial 12 criteria would have likely predicted 71% to 81% of original interview offers. Residency programs should consider periodically reviewing their application review processes to determine areas for improved efficiency., (Copyright © 2018 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.)

Objectives: To summarize the findings of a literature search on advancing the role of pharmacy technicians, including the types of training identified and the potential costs and benefits to both the technician and the pharmacy., Data Sources: A literature search of Scopus, Embase, and Medline was conducted on January 11, 2017., Study Selection: Original research, research reports, case studies, or association reports were included for review. Articles were considered to be relevant based on identification of an advanced pharmacy technician role or addressing additional training/education for technician functions., Data Extraction: A standard data extraction form was used to collect study authors, article title, year published, journal title, study design, brief description of methods, primary outcome measures, advanced technician roles identified, additional education or training addressed, and additional costs and benefits identified in each article., Results: A total of 33 articles were included for full review and data extraction. Study design varied, with 17 (52%) quantitative, 1 (3%) qualitative, 5 (15%) mixed-method, and 10 (30%) case study designs. Seventeen (52%) of the studies included were published after 2006. The mechanism of training was primarily through supervised on-the-job training, allowing technicians to assume administrative-based positions that facilitated a pharmacist-led clinical service, with either the pharmacist or the pharmacy receiving the greatest benefits., Conclusion: Although the literature supports technicians performing advanced roles in the pharmacy, resulting in either improved patient outcomes or opportunities for pharmacists to engage in additional clinical services, the benefits to the technician were primarily indirect, such as an increase in job satisfaction or a more desirable work schedule. If a technician is to take on additional roles that require completion of a formalized training or educational program, benefits that are more tangible may help to inspire technicians to pursue these roles., (Copyright © 2018 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.)