Preparing Pharmacists for Collaborative/Integrated Health Settings

Training for Collaborative Care: How Hospital Team Members View Pharmacy Students

Background

Interprofessional education activities are prevalent across health professional curricula in Canada. Students develop collaborative roles through structured on-campus programming; however, the ways in which established teams engage learners in hospital settings are unknown.

Objective

To explore how mixed-discipline professionals describe expectations and experiences related to collaborating with pharmacy students who join their team for training.

Methods

Mixed-discipline team members of an acute medicine clinical teaching unit were interviewed according to a semistructured interview guide. Participants described encounters with pharmacy trainees and shared expectations of the students' collaborator roles in patient care. Audiorecordings of the interviews were transcribed and coded independently by 2 researchers, who synthesized the data and used the template analysis method to derive themes.

Results

Fourteen team members from various disciplines were recruited. Participants' descriptions of collaborative roles were organized into 2 main themes: pharmacy students as informants and pharmacy students as a bridge. A third integrative theme, engagement, encompassed how team members described pharmacy trainees enacting these roles. Team members sought pharmacy students' medication-oriented expertise (e.g., dosing, compatibilities), and physicians often relied on the students' familiarity with study data to guide treatment choices. Nonphysicians capitalized on pharmacy student proximity to physicians to understand such decision-making and inform their own patient care. Accounts of pharmacy students' consultations with team members for patient assessments or to access other multidisciplinary knowledge were infrequent.

Conclusions

Most team members' expectations of pharmacy students in terms of the collaborator role lacked routine engagement or shared decision-making. These views represent challenges to the development of skills in collaborative care in workplace-based learning, which might be addressed through intentional interprofessional exercises assigned by preceptors. Further study is required to understand the potential of practice-based interprofessional education initiatives.

The Benefits and Challenges of Precepting Pharmacy Students Virtually in Interprofessional Primary Care Teams

OBJECTIVE

The objective of this study was to identify pharmacists' perspectives on the benefits and challenges of precepting pharmacy students during circumstances that require using virtual care in team-based primary care practices.

METHODS

A cross-sectional online survey was disseminated through Qualtrics software from July 5, 2021, to October 13, 2021. We used a convenience sampling technique to recruit a sample of pharmacists working in primary care teams across Ontario, Canada, who were able to complete a web-based survey in English.

RESULTS

A total of 51 pharmacists participated in the survey and provided complete responses (response rate of 41%). Participants noted benefits at 3 levels of precepting pharmacy students in primary care during the COVID-19 pandemic: (1) benefits to pharmacists, (2) benefits to patients, and (3) benefits to students. Challenges of precepting pharmacy students were: (1) difficulty training students virtually, (2) students not being ideally prepared to begin a practicum training during a pandemic, and (3) reduced availability and new workload demands.

CONCLUSION

Pharmacists in team-based primary care highlighted substantial benefits and challenges for precepting students during a pandemic. Alternative mechanisms of experiential education delivery can provide new opportunities for pharmacy care yet can also restrict immersion into interprofessional team-based primary care and diminish pharmacist capacity. Additional support and resources to facilitate capacity are critical for pharmacy students to succeed in future practice in team-based primary care.

The specialized competency framework for community pharmacists (SCF-CP) in Lebanon: validation and evaluation of the revised version

BACKGROUND

In the absence of similar studies in Lebanon, this study aimed at upgrading and validating the Lebanese specialized competencies framework for community pharmacists (SCF-CP) as a tool to transform community practice and support the professional development and career progression of community pharmacists.

METHODS

Content validity was assessed and improved through a team of experts. After a thorough literature review and utilizing the Delphi technique, six domains were defined in the framework, with their respective competencies and behaviors. A cross-sectional study was then carried out from March to October 2022 using an online questionnaire created on Google Forms. The snowball technique was applied to reach community pharmacists across all the Lebanese governorates.

RESULTS

The final sample included 512 community pharmacists. The construct validity of the framework was confirmed by factor analysis. The Kaiser-Meyer-Olkin measures of sampling adequacy were satisfactory for all models ranging from 0.500 to 0.956 with a significant Bartlett's test of sphericity (P < 0.001). The internal consistency of all competency domains was confirmed by Cronbach's alpha, with values ranging from 0.803 to 0.953. All competencies were significantly correlated with their respective domains (P < 0.001), and all domains were significantly correlated with each other and with the framework (P < 0.001). The participants declared being competent in all domains relating to fundamental skills, safe and rational use of medicines, pharmacy management, professional skills, public health fundamentals, and emergency preparedness and response, with some exceptions, such as compounding, management, and emergency preparedness. A higher declared competency level was associated with having more experience and receiving more than 50 patients per day.

CONCLUSION

Our findings could demonstrate that the Lebanese specialized competency framework is a valid and reliable tool. This framework could help assess the minimum competencies that community pharmacists should possess or acquire and direct initial and continuing education for better practice. Hence, it could be adopted by the authorities and implemented in the Lebanese community pharmacy setting.

Medical and Pharmacy Students’ Attitudes Towards Physician-Pharmacist Collaboration in Indonesia: A Case Study Approach

Learning process evaluation of Interprofessional Education (IPE) was crucial to determine the implementation process’s success. The evaluation can be done by researching student attitudes in IPE activities. Research on students' attitudes in medical education and pharmacy study programs is expected to be a guideline for the IPE curriculum drafting team at the Faculty of Medicine, Universitas Islam Sultan Agung, Semarang, to develop future IPE learning activities. The study design was observational analytic with a cross-sectional method involving all medical and pharmacy students of the Faculty of Medicine, Universitas Islam Sultan Agung who had participated in a Small Group Discussion with TB management and met the inclusion criteria. Data collection was carried out in August 2020 using an online google form questionnaire. Data obtained through the Scale of Attitudes Toward Psychic-Pharmacist Collaboration questionnaire contains 16 questions tested for validity and reliability. Questions were answered using a 4-point Likert Scale. The statistical test analysis results on the total score of the collaboration attitude scale using the Mann Whitney Test was a p-value of 0.000. The median total score of medical and pharmacy students was 47.00 and 56.00, respectively. The p-value indicates a significant difference between the total scores of medical and pharmacy students. Based on the analysis results, the study shows significant differences in collaboration attitudes. Medical education students fall into the "moderate" category and pharmacy students in the "high" category. The pharmacy students have a more positive collaboration attitude than medical education students toward future collaborative relationships.

Integrating Behavioral Health into Primary Care: The Role of Psychiatric Nursing in the Development of the Interprofessional Team

BACKGROUND

Integrated behavioral health in a primary care setting is a paradigm shift that requires academic reconfiguration on how health care professionals are educated and trained in the clinical arena.

METHOD

An academic university was able to create interprofessional didactic and clinical learning experiences for students within the Schools of Nursing, Social Work, Health Professions-Rehabilitation Counseling Department and Pharmacy resulting in improved models for patient care delivery.

RESULTS

Interdisciplinary faculty developed the didactic, clinical and evaluative areas based on the HRSA grant work plan. Deliverables included 18 modules, case studies focused on population health, and team-focused standardized patient experiences to test their behavioral health and psychiatric skills in a primary care setting.

CONCLUSIONS

Faculty from the different disciplines were able to collaborate on the deliverables, take the opportunities to engage students and collaborate on scholarly presentations at a national, state and local professional organizations. Academic course for interprofessional practice has been developed and implemented as an outcome of this grant.

Work System and Process Designs for Community Pharmacy-Medical Clinic Partnerships to Improve Retention in Care, Antiretroviral Adherence, and Viral Suppression in Persons with HIV

The objective of this project was to collect and analyze information about work systems and processes that community pharmacy-medical clinic partnerships used for implementing the Patient-Centered HIV Care Model (PCHCM). Paired collaborations of 10 Walgreens community pharmacies and 10 medical clinics were formed in 10 cities located throughout the United States that had relatively high HIV prevalence rates and existing Walgreens HIV Centers of Excellence. Patient service provision data and most significant change stories were collected from key informants at each of the clinic and pharmacy sites over an 8 week period in 2016 and through in-depth phone interviews. Written notes were reviewed by two authors (J.C.S. and O.W.G.) and analyzed using the most significant change technique. The findings showed that half of the partnerships (n = 5) were unable to fully engage in service implementation due to external factors or severe staff turnover during the project period. The other half of the partnerships (n = 5) were able to engage in service implementation, with the most impactful changes being related to strong patient care systems, having a point person at the clinic who served as a connector between sites, and having pharmacists integrated fully into the health care team.

Pharmacist Segments Identified from 2009, 2014, and 2019 National Pharmacist Workforce Surveys: Implications for Pharmacy Organizations and Personnel

Background/Objective: Findings from the 2009 and 2014 National Pharmacist Workforce Surveys showed that approximately 40% of U.S. pharmacists devoted their time primarily to medication providing, 40% contributed a significant portion of their time to patient care service provision, and the remaining 20% contributed most of their time to other health-system improvement activities. The objective of this study was to characterize the U.S. pharmacist workforce into segments based on the proportion of time they spend in medication providing and patient care services and compare changes in these segments between 2009, 2014, and 2019. Methods: Data from 2009, 2014, and 2019 National Pharmacist Workforce Surveys were analyzed. Responses from 1200 pharmacists in 2009, 1382 in 2014, and 4766 in 2019 were used for analysis. Respondents working in the pharmacy or pharmacy-related fields reported both their percent time devoted to medication providing and to patient care services. Medication providing included preparing, distributing, and administering medication products, including associated professional services. Patient care services were professional services designed for assessing and evaluating medication-related needs, monitoring and adjusting patient's treatments, and other services designed for patient care. For each year of data, pharmacist segments were identified using a two-step cluster analysis. Descriptive statistics were used for describing the characteristics of the segments. Results: For each year, five segments of pharmacists were identified. The proportions of pharmacists in each segment for the three surveys (2009, 2014, 2019) were: (1) medication providers (41%, 40%, 34%), (2) medication providers who also provide patient care (25%, 22%, 25%), (3) other activity pharmacists (16%, 18%, 14%), (4) patient care providers who also provide medication (12%, 13%, 15%), and (5) patient care providers (6%, 7%, 12%). In 2019, other activity pharmacists worked over 45 hours per week, on average, with 12 of these hours worked remotely. Patient care providers worked 41 hours per week, on average, with six of these hours worked remotely. Medication providers worked less than 40 hours per week, on average, with just one of these hours worked remotely. Regarding the number of patients with whom a respondent interacted on a typical day, medication providers reported 18 per day, patient care providers reported 11 per day, and other activity pharmacists reported 6 per day. In 2009, 8% of patient care providers worked in a setting that was not licensed as a pharmacy. In 2019, this grew to 17%. Implications/Conclusions: The 2019 findings showed that 34% of U.S. pharmacists devoted their time primarily to medication providing (compared to 40% in 2009 and 2014), 52% contributed a significant portion of their time to patient care service provision (compared to 40% in 2009 and 2014), and the remaining 14% contributed most of their time to other health-system improvement activities. Distinguishing characteristics of the segments suggested that recent growth in the pharmacist workforce has been in the patient care services, with more being provided through remote means in organizations that are not licensed as pharmacies. The findings have implications for pharmacist training, continuing education, labor monitoring, regulations, work systems, and process designs. These changes will create new roles and tasks for pharmacy organizations and personnel that will be needed to support emerging patient care services provided by pharmacists.