Pharmacy Students' Perception of the Content and Delivery of Drug Information Training: A Mixed-Methods Study

OBJECTIVE

To explore the pharmacy students' perception of the content and pedagogical strategies used for the delivery of drug information (DI) training.

METHODS

An explanatory sequential mixed-methods study was conducted among BSc Pharmacy and PharmD students at the College of Pharmacy, Qatar University. The first phase consisted of a quantitative cross-sectional survey using a 34-item pretested questionnaire. The Donabedian framework guided the development of the questionnaire. This was followed by a phenomenological qualitative phase that was conducted based on the result of the first phase. Descriptive statistics and thematic content analysis were used for data analyses.

RESULTS

The completion and usable rates were 88.7% (102 of 115) and 91.2% (93 of 102) respectively. The online resources used for the delivery of DI and the progressive structuring from year 1 to 4 were reported to be adequate by a majority of the respondents (93.55%). Ninety percent of the students opined that the use of simulation-based assessments improved their integration of the theoretical and practical aspects, and their preparedness to apply the DI concepts in practice. However, 20% of the participants reported inconsistency of the DI curricular content with some practices encountered during their experiential learning exposures. The themes identified from the focus group discussion included the perceived value and skills acquired from the DI content, availability and currency of DI resources, students' preparedness, curricular structuring of DI content, and reflection on and recommendations to improve DI coverage and delivery.

CONCLUSION

The curricular structuring of the DI content across varieties of relevant undergraduate pharmacy courses from the lower to higher professional years and its focus on the progressive development of DI-related competencies appeared to have enhanced the students' perception of the relevance, appropriateness, and utility of the content, resources, and pedagogical strategies used for the delivery of DI education at the undergraduate level.

Interprofessional Medication Management in Patients With Multiple Morbidities

BACKGROUND

Medication reviews and medication management are being used more and more around the world to improve medication safety. Both of these tools were originally conceived as pharmaceutical care activities and have recently been developed into interdisciplinary approaches. We studied the efficacy of interprofessional medication management for multimorbid patients that takes their medical conditions, but also their general living situation into account.

METHODS

A comprehensive medication management was performed, which involved the collection of information on the drugs each patient took, the way they were stored, the patient's drug intake and handling, and any problems that arose with pharmacotherapy. The interventional approach was evaluated over a period of 15 months in a cluster-randomized controlled trial with a stepped wedge design. The primary endpoint was the quality of pharmacotherapy, as assessed with the Medication Appropriateness Index (MAI). A mixed model was used to analyze efficacy.

RESULTS

162 patients were enrolled in the study; 142 were included in the intention-to-treat analysis (53.3% women, mean age 76.8 ± 6.3 years). The mean total MAI score decreased significantly (p ≤ 0.001) from the control phase (29.21, 95% CI [26.09; 32.33]) to the intervention phase (22.27 [19.00; 25.54]), with an effect strength (Cohen's d) of -0.24 [-0.36; -0.13]. The number of drug-related problems declined as well.

CONCLUSION

In this study, interprofessional collaboration increased medication safety. Working across disciplinary boundaries allowed for a decrease in drugrelated problems and brought up aspects outside the purview of the primary care physician.

A literature review to identify interventions to improve the use of medicines in children

BACKGROUND

It is estimated that 200 million prescriptions for children and adolescents were issued in the UK during 2002. Therefore, it is important for the National Service Framework for Children (NSFC) to include advice on managing medicines effectively for children. This literature review was performed at the request of the NSFC Medicines External Working Group in order to provide underpinning evidence in the development of advice on managing medicines.

METHODS

Detabases, websites and conference abstracts were searched systematically to identify information on managing medicines in children in 2003. This article reported the results on medication review, concordance, enhanced medicines access through community pharmacy services and the use of medicines in schools.

RESULTS AND CONCLUSIONS

Although there is little evidence specific to paediatrics, the objectives and rationale of medication review could be expected to apply to chronic diseases in children. Issues such as polypharmacy, wastage, repeat prescriptions and medication problems could be similar. The benefits seen in adults may also occur in children, and medication review may possibly have a role in the management of medicines in children. There is an obvious role for pharmacists in ensuring the safety of over-the-counter medications and provision of information and education to parents, carers and adolescents. Evaluation and provision of necessary education and training to community pharmacists is needed, even in the most basic paediatric issues such as sugar-free medications. The evidence suggests that treatment compliance and adherence are generally lower in children than in adults, particularly in adolescents as they approach independence. Those with learning disabilities and infants are likely to be at risk of non-compliance, although little work has been done in these populations. Children and adolescents need appropriate parental and professional support in taking control of their medication and treatment. The management of medicines in school would appear to be far from ideal. Further research into school-based medicines education and outreach clinics would also be beneficial.

Outpatient prescription drug use by children enrolled in five drug benefit plans

This study examined prescription drug use among ambulatory children younger than 18 years of age enrolled in five drug benefit plans. Data for this study were obtained from the pharmacy benefit manager who administers the drug benefit plans. During the study period of December 29, 1992, through December 28, 1993, 3144 children younger than 18 years of age (34.0% of the total plan enrollment) were enrolled in the five drug benefit plans. A total of 8547 prescription drugs were dispensed to the study population. The mean prescription price was $16.38, and the mean duration of therapy was 11.7 days. The mean prescription price was $1.56 more for boys than for girls. The most frequently dispensed drugs were antibiotics (42.0%), followed by cold preparations (15.9%). The annual prevalence rate of prescription drug use was 59.1 cases per 100 children. The study population-based annual frequency rate was 3.2 prescriptions per child, and the drug user-based annual frequency rate was 5.5 prescriptions per child. The annual expenditures were $51.85 per child and $90.39 per drug users, with the out-of-pocket expenditures being $19.09 and $33.04, respectively. The prevalence rate varied little by sex. However, both frequency and expenditure rates differed by sex and decreased with age. Higher levels of cost sharing per prescription were associated with higher prevalence, frequency, and expenditure rates. Larger cost-sharing differentials between generic and brand name drugs were associated with higher rates of generic drug use but were not always associated with lower expenditure rates.