Post stroke pain: Is there under-diagnosis in Black versus White patients?

Stroke incidence is higher and stroke outcomes are poorer in Black patients compared to White patients. Poststroke pain, however, is not a well understood stroke outcome. Using the National Institutes of Health All of Us Research Program database, we hypothesized that the dataset would demonstrate proportionately higher relative risk of poststroke pain in the Black poststroke patient population compared to the White poststroke patient population. However, our analysis showed that Black stroke patients were diagnosed with poststroke pain at a similar rate as White stroke patients. As our results are not consistent with other poststroke outcomes in the literature, this study identifies a potentially underdiagnosed patient population, highlighting the need for further research.

Central Application Service for Physician Assistants Fifteen-Year Data Report 2002-2016

PURPOSE

This study highlights trends in available physician assistant (PA) applicant and matriculant data over the first 15 years of the Central Application Service for Physician Assistants (CASPA) service (2002-2016). This study expands knowledge identified in the CASPA 10-year data report.

METHODS

This was a retrospective analysis of CASPA data from all CASPA-participating PA programs between 2002 and 2016. Central Application Service for Physician Assistants staff verified all applicant academic information. In addition, beginning in 2007, the online CASPA admissions portal linked matriculant data with applicant data.

RESULTS

During the first 15 years of the CASPA service, there was a 194% increase in the number of CASPA-participating programs (from 68 to 200) and a 409% increase in the number of total applicants. Several trends identified in the CASPA 10-year report persisted, including increasing grade point averages among applicants and matriculants and lower matriculation rates among underrepresented minority applicants and applicants who reported economic disadvantage.

CONCLUSION

This 15-year comprehensive analysis of the CASPA data will benefit the profession by providing historical information that faculty and policymakers can use as a basis for developing and evaluating future admissions policies and practices.

Physician Assistant Student Attitudes Toward Gamification of Cardiac Auscultation Instruction

INTRODUCTION

Current physician assistant (PA) learners have a clear preference for interactive learning that is vibrantly present in new media technologies. At present, there is a paucity of research regarding use or acceptability of gamification in PA education. The purpose of this study was to examine PA students' experience with, attitudes toward, and outcomes of a gamified cardiac auscultation curriculum.

METHODS

Faculty at one institution designed an interactive Mobile App Cardiac Auscultation Curriculum (MACAC). The MACAC incorporates independent and group learning using the Littmann Learning mobile app. Author-created surveys as well as knowledge and auscultation assessment tools were delivered to all students.

RESULTS

Most of the students recommended the use of the app for future cohorts and reported confidence to accurately identify normal and abnormal heart sounds. Knowledge and auscultation assessment scores demonstrated proficiency in identification of normal and abnormal heart sounds.

DISCUSSION

Gamification research is important because blended learning that incorporates new media technologies with traditional approaches can help overcome the limitations of passive learning environments. This study provides evidence that the use of a mobile app can be an effective and innovative method to teach cardiac auscultation to the 21st century PA learners.

Screening for post-traumatic stress disorder among Latinx immigrant children

ABSTRACT

Latinx children face psychosocial, linguistic, and economic challenges that put them at an increased risk of developing mental health conditions. Primary care providers should be equipped to recognize the complex mental health needs of this growing population. This article explores some of the barriers to mental health screenings in Latinx children and presents culturally sensitive, validated screening tools for primary care providers.

Opioid use disorder and motivational interviewing: Training physician assistants for the epidemic

OBJECTIVES

(1) To evaluate the effectiveness of a curriculum on physician assistant (PA) students' knowledge about opioid use disorder (OUD) treatment and management and (2) present student satisfaction with the curriculum.

METHODS

Three cohorts of PA students completed pre- and post-intervention questionnaires about their knowledge of motivational interviewing (MI) for OUD. One cohort of students completed the 11-item questionnaire without exposure to the intervention (control group). Students' satisfaction with the curriculum was assessed as was their pre- and post-intervention knowledge about using MI for OUD. Bivariate statistical tests were used to analyze the quantitative data.

RESULTS

Three hundred complete and usable responses were obtained from the four cohorts of PA students (n = 300, 87.7 percent response rate). The intervention groups answered a higher number of items correctly (median = 7) than the control group (median = 6, Wilcoxon sign test M = 31, p < 0.0001). Among the intervention group, there was not a statistically significant between cohort difference on: (1) the number of identical pre- and post-intervention questionnaire items answered correctly (Chi-square = 3.77, DF = 2, p = 0.15), and (2) the total number of items answered correctly on the post-intervention questionnaire (Chi-square = 0.32, DF = 2, p = 0.85). Student comments suggest students were supportive of the curriculum, with improvements noted on how to deliver the material.

CONCLUSIONS

An educational intervention using MI for PA students was found to be valuable, and students who completed the intervention had greater knowledge about using MI with OUD patients than those who did not complete the training. The size of the effect was small, and more research on the curriculum is necessary prior to widespread adoption.

Are Physician Assistants Able to Correctly Identify Prescribing Errors? A Cross-Sectional Study

PURPOSE

(1) To describe how often physician assistant (PA) students correctly identify prescribing errors and (2) examine between-cohort differences on ability to correctly identify prescribing errors.

METHODS

This was a cross-sectional study of 2 cohorts of PA students at one institution. Students were presented with 3 hypothetical prescriptions, 2 of which contained a prescribing error. For each prescription, students were asked to (1) identify whether an error occurred and (2) indicate the type of error. A simple Poisson regression model analyzed the data.

RESULTS

We received responses from 130 students (72.6% response rate). Approximately 12% (12.3%, n = 16) correctly identified whether all 3 prescriptions were correct. The median number of correctly identified prescriptions was 1 (interquartile range = 1). There was not a statistically significant between-cohort difference identifying the correct number of prescriptions (β = 0.27, P = .10).

CONCLUSION

Physician assistant students' prescribing error identification was similar to previous research in medical and nursing students. Efforts to improve prescribing training are critical to ensure patient safety.

A Discrete Choice Experiment to Assess Patient Preferences for Asthma Rescue Therapy and Disease Management

BACKGROUND

With the expanding treatment landscape for asthma, the process of identifying best-fit, individualized management options is becoming increasingly complicated. Understanding patients' preferences can inform shared decision-making between clinicians and patients.

OBJECTIVES

To examine preferences of adults with asthma for therapeutic and management attributes and determine how these preferences vary among patients.

METHODS

We conducted an online discrete choice experiment survey in US adults with asthma. Patient preferences were analyzed using logit models. Factors affecting patients' preferences were identified by least absolute shrinkage and selection operator analysis.

RESULTS

A total of 1,184 patients completed the survey (60% female; mean [SD] age, 49.2 [15.0] years). Patients most valued fewer asthma attacks requiring urgent health care professional visits, fewer exacerbations requiring oral corticosteroids, and a reduced risk for oral thrush. Higher value was placed on reducing the risk of short-term (oral thrush) versus long-term side effects (diabetes). Patients were willing to increase rescue medication use in exchange for decreasing exacerbations requiring oral corticosteroids and attacks requiring urgent health care professional visits. Patients preferred a single inhaler for rescue and maintenance and least valued asthma action plans. Demographic, socioeconomic, and clinical factors affected patient preferences.

CONCLUSIONS

Patients sought convenient management options that focused mainly on decreasing the short-term morbidity associated with asthma exacerbations and therapies. Preferences varied by demographics, clinical factors, and socioeconomics. It is important for shared decision-making discussions to include conversations about morbidity and how available therapeutic options align with individual patient preferences.

Exploring the Professional Identity Formation of Racial/Ethnic Minoritized Physician Assistants

INTRODUCTION

The purpose of this article is to (1) describe how professional identity intersects with physician assistants' (PAs') and PA students' racial and ethnic identities and cultural backgrounds; (2) examine how sociohistorical contexts shape professional identity in racial/ethnic minoritized PAs and PA students; and (3) identify the role of PA program administrators and faculty to address the needs of racial/ethnic minoritized PAs and PA students.

METHODS

This study draws on elements of constructivist grounded theory to investigate the professional identity formation (PIF) experiences of 45 PA students and alumni from 3 institutions. Participants were recruited using a snowball method and identified as 23 Black/African American, 12 Hispanic/Latino, 6 mixed race, and 4 Native American/Indigenous. Interview data were analyzed using sociocultural theory as an analytic framework.

RESULTS

The results suggest that participants felt that their racial/ethnic identity was an important part of their identity, yet many indicated they experienced frequent micro- and macroaggressions from fellow students, faculty, lecturers, administrators, preceptors, patients, and supervisors. Additionally, they indicated that they need more support from their programs than what is currently provided.

DISCUSSION

The results of this study suggest that social experiences before, during, and after PA training strongly influence PIF development in racial/ethnic minoritized PAs. Administrators and professional PA organizations should evaluate methods to support those individuals who identify as a racial/ethnic minority throughout their careers.

What Physician Assistants Prefer in a Postprofessional Doctorate Program: A Cross-Sectional Rating and Rankings Study

PURPOSE

The physician assistant (PA) literature has focused on the implications of creating an entry-level doctoral degree; however, there is scant primary literature on postprofessional doctorates, which are becoming more popular as the number of institutions offering them increases. The purposes of this project were to: (1) describe interest and motivation of currently practicing PAs to enroll in a postprofessional doctorate program and (2) identify the most- and least-preferred attributes of a postprofessional doctorate program.

METHODS

This was a quantitative cross-sectional survey of recent alumni from one institution. Measures included interest in obtaining a postprofessional doctorate, a nonrandomized Best-Worst Scaling (BWS) exercise, and motivators for enrolling in a postprofessional doctorate. The main outcome of interest was the BWS standardized score for each attribute.

RESULTS

The research team received 172 eligible responses (n = 172, response rate = 25.83%). Results indicate that 47.67% of respondents (n = 82) expressed interest in a postprofessional doctorate. The most preferred doctorate program attribute was a clinically based program, ending with a residency, conferring a Doctor of Medical Science (DMSc) degree, with a hybrid course delivery.

DISCUSSION

This sample included various interests, motivations, and preferred program attributes. Understanding these factors may help inform the design and redesign of doctoral programs.

American Indian/Alaska Native men are less likely to receive prostate-specific antigen testing and digital rectal exams from primary care providers than White men: a secondary analysis of the National Ambulatory Medical Care Survey from 2012-2018

PURPOSE

(1) Identify the proportion of primary care visits in which American Indian/Alaska Native (AI/AN) men receive a prostate-specific antigen test (PSAT)and/or a digital rectal exam (DRE), (2) describe characteristics of primary care visits in which AI/AN receive PSA and/or DRE, and (3) identify whether AI/AN receive PSA and/or DRE less often than non-Hispanic White (nHW) men.

METHODS

This was a secondary analysis of the National Ambulatory Medical Care Survey (NAMCS) during 2013-2016 and 2018 and the NAMCS Community Health Center (CHC) datasets from 2012-2015. Weighted bivariate and multivariable tests analyzed the data to account for the complex survey design.

RESULTS

For AI/AN men, 1.67 per 100 visits (95% CI = 0-4.24) included a PSATs (or PSAT) and 0 visits included a DRE between 2013-2016 and 2018. The rate of PSA for non-AI/AN men was 9.35 per 100 visits (95% CI = 7.78-10.91) and 2.52 per 100 visits (95% CI = 1.61-3.42) for DRE. AI/AN men were significantly less likely to receive a PSA than nHW men (aOR = 0.09, 95% CI = 0.01-0.83). In CHCs, AI/AN men experienced 4.26 PSAT per 100 visits (95% CI = 0.96-7.57) compared to 5.00 PSAT per 100 visits (95% CI = 4.40-5.68) for non-AI/AN men. DRE rates for AI/AN men was 0.63 per 100 visits (95% CI = 0-1.61) compared to 1.05 per 100 (95% CI = 0.74-1.37) for non-AI/AN men. There was not a statistically significant disparity in the CHC data regarding PSA (OR = 0.91, 95% CI = 0.42-1.98) or DRE (OR = 0.75, 95% CI = 0.15-3.74), compared to nHW men.

CONCLUSION

Efforts are needed to better understand why providers may not use PSA and DRE with AI/AN men compared to nHW men.

Abstract P432: Statin Initiation for Primary Prevention and Dose Intensity According to Age in the Women’s Health Initiative

Introduction: Over 50% of US adults older than 75 live free of atherosclerotic cardiovascular disease (ASCVD) and diabetes (DM), yet data on incident statin use among this population are lacking. Our objective was to assess statin initiation by age among the Women’s Health Initiative cohort free of ASCVD and DM at baseline (1993).

Hypothesis: Statin initiation is higher at older ages and differs by race/ethnicity.

Methods: Exclusions were statin use at baseline, known ASCVD, DM, and no follow-up after baseline. Self-reported medication use was assessed in 1996 and 2008. Specific statin and dose prescribed at the time of initiation were identified using National Drug Codes and determined statin intensity, defined by the ACC/AHA guidelines. We estimated the adjusted association between age group (<65, 65-74, and ≥75) and statin initiation and assessed for heterogeneity by race/ethnicity. We also assessed statin dose at the time of initiation.

Results: Over 12 years of follow-up, 27% of 99,631 women free of ASCVD and DM at baseline initiated a statin; initiation was lower with older age (Table). This association remained after adjustment for ASCVD risk factors and did not differ by race/ethnicity (p for interaction >0.5). Moderate intensity dose was most common at statin initiation overall, and moderate and high intensity dose were both lower with older age.

Conclusion: Of women free of ASCVD and DM, women older than 75 were least likely to start a statin and most likely to start low intensity statin therapy at initiation than younger women. We identified a potential clinical gap for investigation: whether lower overall use of statins and lower intensity statin therapy among older women are associated with preventable ASCVD.

The Prevalence of Low-Value Prostate Cancer Screening in Primary Care Clinics: A Study Using the National Ambulatory Medical Care Survey

INTRODUCTION

There has been an increasing focus on improving value in health care and deimplementing the use of low-value services, such as prostate cancer (PC) screening for men aged >70 years. The objectives of this study are to (1) identify the proportion of primary care visits at which low-value PC screening is ordered, and (2) identify predisposing, enabling, and health care need characteristics associated with low-value PC screening in the United States. METHODS: This was a secondary analysis of the National Ambulatory Medicare Care Survey datasets from 2013 to 2016 and 2018. Andersen's Behavioral Model of Health Services Use guided independent variable selection. Weighted multivariable logit models were used to analyze data. RESULTS: There were 6.71 low-value prostate-specific antigens (PSAs) per 100 visits and 1.65 low-value digital rectal exams (DREs) per 100 visits. For each additional service ordered by primary care providers, the odds of ordering a low-value PSA increased by 49%, and the odds of performing a low-value DRE increased by 37%. CONCLUSIONS: The use of low-value PSAs and DREs was sizable during the observed time period. Organizations who want to reduce low-value PSAs and DREs may want to focus interventions on providers who order a high number of tests.

Suboptimal Control of Asthma Among Diverse Patients: A US Mixed Methods Focus Group Study

Purpose

The US National Asthma Education and Prevention Program updates and Global Initiative for Asthma report encourage considering the patient perspective to improve asthma control. The objective of the present study was to collect data about the perceptions, experiences, and concerns of adult patients and caregivers of children with asthma regarding rescue, maintenance, and oral corticosteroid treatments.

Patients and Methods

In-person focus groups were conducted in three cities across the US. Participants also completed patient-reported outcome measures assessing asthma control and experiences.

Results

Focus groups were conducted in demographically and clinically diverse adults with asthma (five groups, n=34), caregivers of children with asthma (five groups, n=35), and adults with a dual diagnosis of asthma and chronic obstructive pulmonary disease (one group, n=5). Only 28% of patients were well-controlled by Asthma Control Test/Asthma Control Test-Caregiver Report and 18% by Asthma Impairment and Risk Questionnaire. Forty-four percent of participants reported not following their prescribed medical plan. Four key themes emerged from the focus groups: (1) asthma symptom control and monitoring are often inadequate; (2) treatments are often used incorrectly; (3) communication between health care professionals and patients or caregivers is often ineffective; and (4) concerns related to treatment and desires to improve treatment.

Conclusion

Control of asthma symptoms is suboptimal in the vast majority of patients and both patients and caregivers do not feel sufficiently informed about asthma. Health care providers should be encouraged to engage patients and caregivers in shared decision making for managing asthma and selecting treatments that integrate patient values, preferences, and lifestyles.

Didactic Physician Assistant Students' Perceptions of Evidence-Based Medicine Resources: A Preliminary Investigation

Evidence-Based Medicine (EBM) instruction is required for physician Assistant (PA) students. This pilot study surveyed didactic PA students at three geographically diverse PA programs at the end of their didactic EBM course to understand which attributes of EBM resources they find most and least useful, and their self-efficacy in searching and appraising medical literature. Thematic analysis identified the most important student-reported attributes of a resource. PA students in this sample preferred UpToDate and PubMed as their top EBM tools based on attribute ratings. However, each database included in this pilot study received positive feedback, despite a low usage rate across institutions. The most important attributes were ease of use/search, information presentation, and conclusion/critical appraisal skill. After one EBM course, on average, students rated their self-efficacy searching the literature and appraising the literature as "moderately confident." This suggests that instructors and librarians have an opportunity to expose students to more tools as well as encourage "the right tool for the right job."

Continuity of care among postmenopausal women with cardiometabolic diseases in the United States early during the COVID-19 pandemic: Findings from the Women's Health Initiative

BACKGROUND

In response to the COVID-19 pandemic, public health measures, including stay-at-home orders, were widely instituted in the United States (US) by March 2020. However, few studies have evaluated the impact of these measures on continuity of care among older adults living with chronic diseases.

METHODS

Beginning in June 2020, participants of the national Women's Health Initiative (WHI) (N=64,061) were surveyed on the impact of the pandemic on various aspects of their health and well-being since March 2020, including access to care appointments, medications, and caregivers. Responses received by November 2020 (response rate=77.6%) were tabulated and stratified by prevalent chronic diseases, including hypertension, type 2 diabetes, and cardiovascular disease (CVD).

RESULTS

Among 49,695 respondents (mean age=83.6 years), 70.2% had a history of hypertension, 21.8% had diabetes, and 18.9% had CVD. Half of respondents reported being very concerned about the pandemic and 24.5% decided against seeking medical care to avoid COVID-19 exposure. A quarter reported difficulties with getting routine care and 45.5% had in-person appointments converted to telemedicine formats; many reported cancelled (27.8%) or rescheduled (37.7%) appointments. Among those taking prescribed medication (88.0%), 9.7% reported changing their method of obtaining medications. Those living with and without chronic diseases generally reported similar changes in care and medication access.

CONCLUSIONS

Early in the pandemic, many older women avoided medical care or adapted to new ways of receiving care and medications. Therefore, optimizing alternative services, like telemedicine, should be prioritized to ensure that older women continue to receive quality care during public health emergencies.

Does Learner Self-Efficacy Influence Accurate Identification of Heart Sound Descriptions?

INTRODUCTION

Although physician assistant (PA) training includes cardiac instruction, there is a lack of theory-based research investigating skill and behavioral development in PA students. The objective of this study was to examine the relationship between self-efficacy and ability to correctly identify heart sounds.

METHODS

A cross-sectional study was conducted among 2 cohorts of PA students at one institution. Students answered self-efficacy items using 5-point Likert-type answers and identified specific heart sounds from text descriptions. Data from 154 students were analyzed using Cronbach's alpha and bivariate statistical tests.

RESULTS

Second-year students identified more heart sounds correctly than first-year students (8 v. 7, Z = -2.64, p = 0.01). Students with more confidence were more likely to correctly identify specific heart sounds.

DISCUSSION

Results are consistent with social cognitive theory showing that self-efficacy may be related to outcome performance in PA students. Educational processes that cultivate self-efficacy may increase proficiency in cardiac auscultation.

Impact of Patient-Specific Aminoglycoside Monitoring for Treatment of Pediatric Cystic Fibrosis Pulmonary Exacerbations

OBJECTIVE

Aminoglycosides are frequently used for empiric and definitive treatment of cystic fibrosis (CF) pulmonary exacerbations. Various methods have been described for aminoglycoside therapeutic drug monitoring. The objective of this study is to evaluate the effect of patient-specific pharmacokinetic calculations for aminoglycosides used to treat CF pulmonary exacerbations.

METHODS

Ambidirectional cohort study of patients admitted to a children's hospital from June 1, 2018, through February 28, 2019, and June 1, 2019, through February 8, 2021. The primary outcome was the occurrence of dosing changes after analysis of initial serum concentrations in either group. Secondary outcomes included occurrence of nephrotoxicity, duration of antibiotics, and length of stay.

RESULTS

Twenty-four patients (75%) in the intervention group versus zero in the control group required dosing adjustments after initial analysis of serum concentrations were completed (p &lt; 0.001). There was not a statistically significant between-group difference for duration of antibiotics in days (median, 14 vs 13.5; Z, 1.07; p = 0.29) or length of stay (median, 11 vs 11; Z, −0.31; p = 0.76). There was also not a statistically significant between-group difference in forced expiratory volume in one second (FEV1) change from admission to discharge (11.4% vs 13.9%; t, 0.61; Degrees of Freedom, 39; p = 0.55). Two patients (6.25%) in the intervention group experienced nephrotoxicity compared with zero patients in the control group (risk difference, 6.25%; 95% CI, −2.14 to 14.64; number needed to harm, 16).

CONCLUSIONS

Patient-specific pharmacokinetic monitoring led to significantly more dosing changes and was associated with similar patient outcomes as trough-only monitoring. Further studies are needed to identify methods to optimize aminoglycoside dosing and monitoring for these patients with the goal of reducing toxicities while maximizing efficacy.

Attitudes and Beliefs of Pediatric Residents and Physician Assistant Students Toward Screening Adolescents for Suicide in Primary Care

INTRODUCTION

The objectives of this study were to: (1) describe attitudes of health professional trainees for conducting routine screening for suicidal ideation with adolescents; (2) identify the relationship between intention to conduct suicide risk assessments and behavioral attitudes, norm referents, and behavioral control; and (3) investigate the relationship between intention to conduct these assessments and self-reported clinic behavior.

METHODS

Second-year physician assistant (PA) students and pediatric residents (MD) at 3 universities voluntarily completed an anonymous cross-sectional questionnaire. The questionnaire was guided by the Theory of Planned Behavior and included items about previous experience with suicide. Pearson correlation and multivariable linear regression were used to analyze the data.

RESULTS

There were usable and complete data for 105 respondents (n = 105). The sample included PA students (89.52%, n = 94) and pediatric residents (10.48%, n = 11). Trainees were significantly more likely to have higher intention to conduct suicide risk assessments when they reported greater behavioral control (Std. β = 0.34, p <0.001) and reported suicide being discussed during previous clinic visits as a student/resident (Std. β = 0.21, p = 0.03), controlling for profession, race, behavioral attitudes, and norm referents. Trainees were significantly more likely to report conducting suicide risk assessments when they had greater behavioral control (Std. β = 0.27, p = 0.01) and greater intention to conduct these assessments (Std. β = 0.21, p = 0.03), controlling for profession, race, behavioral attitudes, and norm referents.

DISCUSSION

Second-year PA students and pediatric residents support screening adolescents for suicide risk. Training on methods to increase behavioral control may increase rates of screenings.

A comparison of professional identity experiences among minoritized medical professionals

OBJECTIVE

Professional identity formation (PIF) is considered a fundamental process in the development of healthcare providers. In medical education, the PIF literature has historically centered on medicine's socialization practices involving white male physicians. However, recently researchers have begun to reveal how larger socio-historical contexts influence PIF in minoritized physicians. To better understand what influences Black/African American physicians' PIF, this study compares their PIF experiences to a group of minoritized physician assistants (PAs). In comparing Black physicians' experiences to another provider, this study explored what PIF experiences may be attributed to participants' minoritized status and what might be attributed to the culture of medicine.

METHODS

In this cross-case analysis, 45 minoritized PA students and practicing PAs were recruited from several Southeastern universities. The PA participants included 23 Black/African Americans, 12 Latinx, 4 Indigenous/Native, and 6 of mixed races/ethnicities. Interview data were then compared to previously collected data from 41 Black/African American medical trainees and physicians. Using constant comparative method, similarities and differences in PIF were explored.

RESULTS

Similarities between the two groups included the importance of participants' racial/ethnic identity to patient care, experiences on-going microaggressions from patients and peers, and a desire to engage in racial uplift. However, one marked difference was found, namely that PAs felt they could bring their entire selves to the profession, whereas physicians described feeling splintered early in their training.

CONCLUSIONS

Several possibilities that might explain why Black physicians and minoritized PAs have this one marked difference in their PIF experience, including identity threat, internalization of different discourses, and length of training for physicians. While this study was not designed to answer this question, it is clear that there is something in the culture of medicine and the training of physicians that signals to Black physicians that they cannot bring their whole selves to the profession.

COVID-19 and Physician Assistant Faculty Burnout: A Year into the Pandemic

PURPOSE

The psychological effects of COVID-19 have been extensive and have affected health care workers and educators alike. The aims of this study were to evaluate how the COVID-19 pandemic has impacted PA faculty and their attitudes toward work.

METHODS

Two quantitative, pre/post surveys were offered to 21 PA faculty at one institution prior to and then one year into the COVID-19 pandemic. PA faculty perceptions of workplace culture and burnout were included in the online surveys.

RESULTS

Data were collected on 17 PA faculty (81% response rate). There was a statistically nonsignificant decrease in faculty disengagement (2.1 v 2.1, p = 0.87) and a statistically significant increase in faculty exhaustion (2.2 v 2.5, p = 0.005). There were statistically significant increases in communication, value, job satisfaction, and wellbeing workplace items.

CONCLUSION

As many workplace protocols remain changed as a result of COVID-19, institutions should monitor and adjust processes to reduce the risk of burnout for faculty.

Dual Process Clinical Reasoning Assessment: Quantifying the Qualitative

PURPOSE

The objectives of this study were to: (1) describe a standardized clinical reasoning (CR) assessment process for preclinical physician assistant (PA) students; (2) describe student grades on a checklist by comparing clinical faculty members' judgment on a global rating scale (GRS) with judgments made by a faculty panel; and (3) evaluate interrater reliability between individual faculty members' grading and faculty panel grading.

METHODS

Three clinical faculty members created a checklist to assess preclinical PA students' CR on a standardized patient assessment. Individual faculty graders and a panel of faculty graders evaluated student performance. Interrater reliability between individual faculty members and the faculty panel was assessed with Cohen's kappa.

RESULTS

The study participants included 88 PA students (n = 88) and 12 faculty evaluators (n = 12). The faculty panel changed 11 grades (12.5%) from individual faculty members. Cohen's kappa indicated substantial agreement (k = 0.698, [95% CI: 0.54-0.85]) between the individual faculty members' grades and the faculty panel's grades.

CONCLUSIONS

The process of conducting a comparison of a checklist, the GRS, and a panel review improves the standardization of assessment and reduces grade inflation.

Can cardiac auscultation accuracy be improved with an additional app-based learning tool?

Introduction

Many institutions use simulation ‘events’ to instruct cardiac auscultation. Research shows that these ‘one and done’ events limit repetition, are costly and do not incorporate learning science techniques, such as spaced learning and retrieval practice. The Littmann Learning™ mobile app, which has unlimited access to a large library of real patient heart sounds, is a cost‐effective tool that we considered could be leveraged by educators to provide this training.

Methods

This was a quasi‐experimental pre‐ and post‐design consisting of an intervention group (PA22) and a non‐equivalent comparator group (PA21). The intervention group used a novel mobile app cardiac auscultation curriculum (MACAC), while the comparator group received standard didactic instruction. One‐way analyses of variance were used to analyse the data.

Results

A total of 174 PA students participated in the study. There was a significant (p < 0.001) difference in knowledge and auscultation scores between those who did and did not complete the MACAC. PA22 didactic year knowledge scores were 4.11 and 2.96 points higher than PA21 didactic and clinical year knowledge scores (p < 0.001, d = 1.61 and p < 0.001, d = 1.32), respectively. On average, PA22 didactic year auscultation scores were 0.83 points higher than PA21 clinical year scores (p < 0.001, d = 0.6).

Conclusion

Results indicate that students in their didactic year achieved proficiency in clinically identifying heart sounds, despite not having access to a mannequin simulator and not having an opportunity to identify these sounds bedside. Overall, a MACAC may be an effective method to teach cardiac auscultation to medical learners.

Impact of Peer-Assisted Learning on Ultrasound

PURPOSE

The aim of this study was to understand how peer-assisted learning (PAL) could be utilized by physician assistant (PA) students in an ultrasound student interest group (USIG) as a means of developing cognitive confidence and practical competence with the imaging modality.

METHODS

An observational study that included 3 USIG workshops was designed. Pre- and postworkshop surveys were administered. All first-year PA students, regardless of participation in the USIG workshops, were asked to complete the voluntary and anonymous surveys.

RESULTS

A statistically significant difference between those who attended at least one workshop and those who did not attend any workshops on their postworkshop scores (p = 0.02) was seen. There was a statistically significant association between the number of workshops attended and the postworkshop difference (p = 0.03).

CONCLUSION

Results show that, in the context of social cognitive theory, PAL is an efficacious learning modality that enhances learner and tutor performance in ultrasound.

Psychometric properties of two instruments measuring self-efficacy and outcome expectations of providing inhaler technique education to patients

INTRODUCTION

Both the National Heart, Lung, and Blood Institute (NHLBI) and Global Initiative for Asthma (GINA) asthma practice guidelines recommend that providers routinely check inhaler technique and correct any mistakes that patients may make when using these devices. Providers, however, rarely check inhaler technique during asthma visits. The objectives of this study were to: (1) describe the development of an instrument to measure self-efficacy and outcome expectations regarding inhaler technique patient education, (2) evaluate the internal consistency reliability of the new scales, and (3) provide preliminary evidence of construct validity. Methods: First- and second-year physician assistant (PA) students at two institutions completed an anonymous and voluntary survey evaluating two new instruments, the Teaching Inhalers to Patients: Self-efficacy (TIP-SE) and the Teaching Inhalers to Patients: Outcome Expectations (TIP-OE) scales and sociodemographic characteristics. The data were analyzed using Principal Components Analysis (PCA), Cronbach's α, and multivariable logistic regression. Results: We had usable responses from 146 PA students (71.9% participation rate). The PCA identified one factor for the TIP-SE and TIP-OE, respectively. The internal consistency of the TIP-SE and TIP-OE was α = 0.96 and α = 0.92, respectively. The logistic regression found that second-year PA students who had higher mean TIP-SE scores were significantly more likely to report teaching patients to use inhalers during rotations (OR = 1.8, 95% CI = 1.1, 2.9). There was not a statistically significant relationship between reporting teaching patients to use inhalers during rotations and mean TIP-OE scores. Conclusion: The TIP-SE and TIP-OE show preliminary evidence of reliability and validity.

Supplemental data for this article is available online at https://doi.org/10.1080/02770903.2021.2008428 .

PAs' attitudes about adolescent suicide screening: The Theory of Planned Behavior

OBJECTIVE

Suicide is an increasing public health problem for adolescents and young adults. The purpose of this study was to identify the frequency of physician assistants' (PAs') self-reported adolescent suicide risk assessments and to elicit salient beliefs regarding behavioral attitudes, norm referents, control factors, and intention to conduct suicide risk assessment with adolescents.

METHODS

A convenience sample of PAs completed an anonymous cross-sectional questionnaire. Relationships were assessed using bivariate analyses and qualitative theme analysis.

RESULTS

Forty-three PAs completed the questionnaire. Many PAs supported suicide risk assessment screening as a strategy to identify adolescents who are suicidal at an earlier stage of their illness; lack of time during the visit and problematic parental involvement were identified as barriers.

CONCLUSIONS

PAs recognized that screening adolescents for suicide ideation may help prevent suicides. Their practice behaviors, however, did not correspond to this belief.

Dispensing of medications used in MAT for Medicare Part D beneficiaries: Impact of 2016 CARA

Objectives: (1) To describe dispensing of FDA-approved medications used in medication-assisted treatment (MAT) in Medicare Part D beneficiaries during 2013-2017; (2) to identify yearly dispensing associated with physician assistants (PAs) and nurse practitioners (NPs) during 2013-2017; and (3) to examine how Comprehensive Addiction and Recovery Act (CARA) of 2016 impacted dispensing of medications used in MAT in 2016-2017.Method: Retrospective secondary analysis of the Medicare Provider Utilization and Payment Data: Part D Prescriber datasets during the years 2013-2017. Generalized estimating equations (GEEs) were used to analyze the data.Participants: Providers whose national provider identifier is associated with at least one FDA-approved medication used in MAT during 2013-2017 and paid for by Medicare Part D.Main outcome measure: Per-prescriber population-adjusted number of claims for buprenorphine, buprenorphine/naloxone, and naltrexone.Results: There were 4,657,233 claims for medications used in MAT from 2013 to 2017 (mean = 2,374.48 per 100,000). PAs and NPs combined for 254,543 claims during 2013-2017 (mean = 127.58 per 100,000). In the first full year after CARA, prescriptions for medications used in MAT by PAs and NPs increased a population-adjusted 46.96 percent. In the GEE regression model, there were significantly fewer per-provider claims in the years 2013-2015 (pre-CARA) compared with 2017 (post-CARA) (all p 0.05).Conclusion: The year after CARA was passed, claims for medications used in MAT from PAs and NPs increased.

Impact of a Simulated Legislative Visit on Student Pharmacists' Political Skill Inventory Scores

Objective. To assess the impact of a simulated legislative visit on the Political Skill Inventory (PSI) scores of Doctor of Pharmacy (PharmD) students and assess their perceptions of their role as an advocate.Methods. Anonymous pre- and post-intervention surveys were administered online to third year student pharmacists at one school of pharmacy in North Carolina. Measures included gender, age, previous pharmacy experience, engagement in pharmacy organizations, legislative awareness and engagement, political skill inventory, and perceptions of the simulated legislative visit. Data are presented as medians or proportions, where appropriate. Paired t tests and Cohen d were used to analyze the data.Results. Thirty student pharmacists provided complete and matchable results for the pre- and post-intervention surveys (analysis response rate=36%). The mean PSI score was 5.4 before the intervention and increased to 5.7 after the intervention. The networking ability and interpersonal influence subscales showed significant and medium-to-large increases in effect size whereas the social astuteness and apparent sincerity subscales showed low-to-medium increases in effect size. Student pharmacists' agreement with advocacy skills or responsibilities increased overall from pre-to post-intervention.Conclusion. The political skill inventory scores of student pharmacists significantly improved following participation in a simulated legislative visit and listening to a corresponding advocacy lecture. Determining the effectiveness of educational interventions to develop advocacy skills in student pharmacists is essential to ensure efficacy and potential for PharmD students and graduates to make real-world impacts.

Spacer microbial contamination and asthma outcomes: case series

OBJECTIVE

The primary method of drug delivery to treat asthma is through pressurized metered dose inhalers (pMDI). Asthma guidelines recommend that providers prescribe a spacer for all patients using pMDI. The objective of this study was to examine whether microbial contamination of spacer devices is associated with poor asthma outcomes.

METHODS

This was a cross-sectional, single-center case series of seven pediatric patients with persistent asthma who had previously been prescribed a spacer. Spacers were swabbed with sterile cotton and samples assessed for bacterial/fungal growth. Parents completed a questionnaire including Asthma Control Test (ACT) and asthma control was assessed by an Allergist/Immunologist physician.

RESULTS

Two (n = 2) children's parent-completed ACT score indicated poorly controlled asthma and three (n = 3) patients were noted to be poorly controlled by the physician. All but one caregiver reported cleaning the spacer with most reporting (n = 5) that they cleaned their child's spacer monthly and one (n = 1) reporting cleaning it every two weeks. One spacer had detected Candida albicans. There was not a statistically significant association between ACT score and microbial growth (p > 0.05).

CONCLUSION

Most spacers in a pediatric sample were not contaminated, despite lack of consistent cleaning, as recommended by spacer manufacturers. Providers and pharmacists should discuss proper cleaning of spacers with caregivers of pediatric patients.

970. Transmitted Antiretroviral Drug Resistance Over a Period of 11 years at a Single Center in Southeast, USA

Background

In the United States, the prevalence of TDRMs is approximately 20%. As newer agents have become available, INSTI-based therapies have become the standard first-line treatment. The objectives of this study were to: (1) examine the incidence of TDRMs during 2008-2019 at a single institution and, (2) examine the association between TDRM and year as well as type of therapy.

Methods

A retrospective chart review was conducted at a single center in the Southeast United States. Resistance was defined on the basis of the International AIDS Society 2019 definition and Stanford University’s HIV Drug Resistance Database. Relative risk and multivariable logistic regression were used to analyze data.

Results

Among 456 treatment-naïve patients who entered care 2008-2019 (80% male, 86% African American, mean CD4 count 359 cells/mm³), the cumulative incidence rate of >1 TDRM was 19.3% (n=88). There has been a steady increase in annual cumulative incidence in TDRMs since 2008, with the highest incidences in 2018 (46,667/100,000) and 2019 (36,585/100,000). Over the 11-year study period NNRTI resistance was most common (67/88; 76%), followed by NRTI (9/88; 10%), PI (4/88; 5%), and INSTI (2/88; 2%). Dual class resistance was noted in 6 (7%) patients, one of whom had TDRMs in the INSTI and NNRTI classes. The relative risk (RR) for TDRMs was 1.76 (95% CI=1.42-2.17). According to the regression model, compared to patients whose initial treatment was NNRTI-based, patients who started treatment on PI-based therapies (OR=5.34, 95% CI=2.17-13.11) or INSTI-based therapies (OR=4.00, 95% CI=1.43-11.20) had significantly greater odds of TDRMs, controlling for age, gender, race, baseline CD4+ count, HIV RNA, hepatitis B status, hepatitis C status, and time period of testing. The time period was not significantly related to TDRM incidence in this model.

TDRM Incidence 2008-2019

Conclusion

The overall incidence of TDRMs in our clinic mirrors national surveillance data, with notably higher incidences in the last 2 years. Prescribing of the newly available INSTI-based regimens reflects the continued increase in the incidence of NNRTI TDRMs.

Disclosures

All Authors: No reported disclosures

Student pharmacists' perceptions regarding pharmacist-prescribed hormonal contraceptives and their professional responsibility

BACKGROUND

Currently, 13 U.S. jurisdictions allow for pharmacist-prescribed contraception; however, pharmacists' intention to use and ultimate uptake of this patient care opportunity have been variable.

OBJECTIVES

The objectives of this study were to (1) identify student pharmacists' attitudes toward pharmacist-prescribed hormonal contraception (HC), (2) identify student pharmacist perceived barriers regarding pharmacist-prescribed HC, and (3) explore what factors affect student pharmacists' viewpoints.

METHODS

An anonymous survey was administered using Qualtrics among third-year student pharmacists in a public health course. The survey was developed using the Theory of Planned Behavior (TPB) and previously published literature. TPB was developed to predict an individuals' intention to engage in a behavior at a specific time and place. All responses were anonymous. Survey responses were summarized using descriptive statistics, and Wilcoxon Mann-Whitney test was used to compare differences based on student pharmacist gender and religion.

RESULTS

A total of 67 student pharmacists participated in the survey (response rate 80.7%). Most agreed-strongly agreed (n = 59, 88.1%) that pharmacists are capable of appropriately assessing and selecting HC therapies and believe it should be within a pharmacist's scope of practice (n = 53, 79.1%). Similarly, most agreed-strongly agreed that it is a professional responsibility for pharmacists to provide this service (n = 56, 83.6%). Potential barriers identified included limited access to patient medical records (n = 55, 82.1%), interruption to workflow (n = 51, 76.1%), and concerns for a decrease in well-women examinations (n = 51, 76.1%). Most identified with the Christian faith (n = 45, 67.2%) but said this did not influence their opinions (n = 40, 59.7%). Gender, age, and religion were not found to be associated with student pharmacists' attitudes. However, an increasing number of barriers were negatively associated with their attitudes.

CONCLUSION

Student pharmacists believe it is within a pharmacist's scope of practice and a professional responsibly to prescribe HC. Student pharmacists were less supportive of pharmacist-prescribed HC if they reported a greater number of barriers.

Evaluation of a Pharmacy Service to Lower BMI Prior to Total Joint Arthroplasty

Background:

Total joint arthroplasty (TJA) postsurgical complications are increased in patients with a body mass index (BMI) greater than 30 kg/m2. Reducing BMI prior to surgery can be complicated and it is important to find effective methods to achieve weight loss goals prior to surgery. Pharmacy services have proven to be effective models for weight loss in prior studies and may be an avenue for achieving BMI reduction prior to TJA surgeries.

Objective:

The purpose of this study was to examine the benefit of pharmacist-driven interventions in an ambulatory care setting to achieve weight loss goals prior to TJA orthopedic surgeries.

Methods:

A retrospective chart review was conducted on patients referred from an orthopedic surgeon’s office to a clinical pharmacist service providing chronic disease state management. Patients were referred based on need to decrease BMI prior to TJA orthopedic surgeries. Visits included evaluations of medications, education on weight loss management techniques, including therapeutic lifestyle changes, and recommendations for weight loss medications.

Results:

There was a statistically significant difference in post-BMI when compared with pre-BMI ( P = .007). Of 16 subjects who had complete pre- and post-BMI measurements, 4 (25%) subjects met their BMI goal. There was a statistically significant relationship between the number of appointments and difference in BMI (ρ = −0.71, P = .002).

Conclusion:

Pharmacists may be utilized in a collaborative health care model in the ambulatory care setting to assist patients with lifestyle or medication management to achieve weight loss prior to orthopedic surgeries.

Student Pharmacists' Attitudes Toward Suicide and the Perceived Role of Community Pharmacists in Suicidal Ideation Assessment

Objective. To determine first-year Doctor of Pharmacy students' attitudes toward suicide and perceptions of the role of the pharmacist in assessing patients for suicidal ideation, and whether their previous pharmacy work experience influences these attitudes and perceptions. Methods. An anonymous online survey was administered to first-year student pharmacists at one school of pharmacy in North Carolina. Measures included gender, previous community pharmacy work experience, personal contact with suicide, and score on the Attitudes Toward Suicide (ATTS) scale. Results. Seventy-three student pharmacists (75%) completed the survey. The vast majority (92%) agreed or strongly agreed that suicide was a real disease. Similarly, most students (79%) agreed or strongly agreed that pharmacists have a professional responsibility to assess for suicidal ideation. There was not a significant association between ATTS score and previous community pharmacy work experience nor the perceived pharmacist's role in assessing for suicidal ideation. Additionally, there was no association between ATTS score and personal contact with suicide. Conclusion. First-year student pharmacists, while undecided on their personal attitudes toward suicide, overwhelmingly agreed that suicide is a disease and that pharmacists have an important role in assessing patients for suicidal ideation. Pharmacy schools should implement training programs to prepare student pharmacists to identify suicidal ideation, design interventions to address student pharmacists' personal beliefs that may impact their ability to provide patient care, and provide students with adequate support skills to care for patients experiencing mental health crises.

Patient and prescriber perceptions of depression screening within a community pharmacy setting

OBJECTIVES

To determine patient and prescriber perceptions of depression screening within the community pharmacy setting and to assess the best strategies for patient engagement and care coordination.

DESIGN

Qualitative semistructured key informant interviews using the Consolidated Framework for Implementation Research as a theoretical framework.

SETTING AND PARTICIPANTS

A community pharmacy in the metropolitan Piedmont region of North Carolina from February 2019 to May 2019. Prescriber and patient interviews were audio recorded, transcribed, and independently coded by 2 investigators. A qualitative analysis was completed, with a selection of supporting quotations for each theme.

OUTCOME MEASURES

Qualitative analysis of prescriber and patient perceptions of depression screening provided in community pharmacies, strategies for patient engagement, and coordination of care for depression screenings.

RESULTS

Twelve patients and 4 prescribers participated in the study. The patient perceptions were categorized into 3 key themes: (1) private and confidential screenings; (2) disparate views regarding the potential interventions that pharmacists could offer; and (3) mental health stigma concerns. The prescriber perceptions were categorized into 3 key themes: (1) support for expanded access to depression screenings provided in community pharmacies; (2) necessity of referral algorithms for transitions of care; and (3) communication of full screening results for positive and negative screens. A mutual theme was identified among patients and prescribers: the view that mental health care provided at a community pharmacy was influenced by an established relationship with a community pharmacist.

CONCLUSION

This study describes patient and provider perceptions of depression screening within the community pharmacy setting. Prescribers were supportive of community pharmacists' ability to close the gaps in access to care for patients with mental health conditions, whereas patients had mixed feelings that may have been influenced by concerns of privacy, confidentiality, and stigma. This deeper understanding of prescriber and patient perceptions of how community pharmacies could expand access to depression screening may provide a roadmap for offering these interventions in community pharmacies.

Mixed Oil-Based Lipid Emulsions vs Soybean Oil-Based Lipid Emulsions on Incidence and Severity of Intestinal Failure-Associated Liver Disease in a Neonatal Intensive Care Unit

BACKGROUND

Neonates requiring long-term parenteral nutrition (PN) are at risk for developing intestinal failure-associated liver disease (IFALD). The purpose of this study was to compare the incidence and severity of IFALD in a highly surgical neonatal population receiving mixed oil-based lipid emulsions (MOLEs) vs soybean oil-based lipid emulsions (SOLEs) for long-term PN.

METHODS

This retrospective cohort study evaluated patients admitted to a neonatal intensive care nursery that received PN for ≥14 days. Patients were separated into 2 cohorts; those who received SOLE and those who received MOLE. The primary outcome of this study was the occurrence of IFALD. Secondary outcomes included time to IFALD, peak bilirubin level during therapy, incidence of hypertriglyceridemia, bronchopulmonary dysplasia, and retinopathy of prematurity.

RESULTS

A total of 107 patients were included in the study, IFALD occurred in 44.8% of patients receiving SOLE compared with 30% of patients receiving MOLE (relative risk, 0.67; 95% CI, 0.39-1.15). In the multivariable analysis, adjusting for the known confounders (prematurity, necrotizing enterocolitis, presence of ostomy, and duration of PN and lipids), the type of lipids was not a significant predictor for development of IFALD. Duration of PN and duration of lipids were determined to be significant risk factors for IFALD, regardless of type of lipid emulsion (odds ratio, 1.03; 95% CI, 1.01-1.05).

CONCLUSIONS

Use of MOLE resulted in no significant difference in the outcomes studied when compared with SOLE. Duration of PN and duration of lipids were significant risk factors for development of IFALD.

Using MyDispense to simulate validation of controlled substance prescriptions in a pharmacy law course

BACKGROUND AND PURPOSE

MyDispense is an innovative, web-based program which simulates a community pharmacy. Use of this software may assist students' comprehension of validating controlled substance prescriptions by determining if prescriptions contain errors or omissions.

EDUCATIONAL ACTIVITY AND SETTING

Fourteen MyDispense practice exercises were created and implemented into a required second-year pharmacy law course. Completion of the MyDispense exercises and performance on the pharmacy law midterm exam were recorded. A questionnaire was administered to students to receive feedback on the exercises.

FINDINGS

There were complete data on all 94 student pharmacists enrolled in the didactic course. Thirty-five students (37%) completed all MyDispense exercises, 15 students (16%) completed some of the exercises, and 44 (47%) did not complete any of the exercises. Linear regression results indicate that students who completed more MyDispense exercises were significantly more likely to score higher on the midterm than those who completed fewer exercises (β = 0.28, p = 0.02). Students reported moderate to high exercise value and a willingness to use the software in preparation for future pharmacy law examinations.

SUMMARY

MyDispense provided a platform for students to apply controlled substance laws to the prescription validation process in the community pharmacy setting. Completion of practice exercises in MyDispense was shown to positively impact student performance on a pharmacy law midterm. Students valued the innovative simulation tool and were willing to access the tool again to prepare for future examinations.

Predictors of performance on the North Carolina Multistate Pharmacy Jurisprudence Examination

INTRODUCTION

To evaluate an expanded set of variables and determine their association with Wingate University School of Pharmacy (WUSOP) graduates' scores on the North Carolina (NC) Multistate Pharmacy Jurisprudence Examination (MPJE).

METHODS

Demographic, pre-admission, pharmacy school, and licensing preparation variables were collected for WUSOP graduates who attempted the NC MPJE for the first time in 2017. Bivariate correlations between student-pharmacist characteristics and the MPJE score were performed.

RESULTS

Several variables were found to have a statistically significant association with the NC MPJE score, including prerequisite grade point average, pharmacy coursework, Pharmacy Curriculum Outcomes Assessment performance, and completion of MPJE practice questions. There were no significant associations between NC MPJE scores and demographic characteristics, previous paid pharmacy employment, receipt of undergraduate degree, or Pharmacy College Admission Test scores.

CONCLUSION

This exploratory analysis identified characteristics of WUSOP graduates that were associated with performance on the NC MPJE. The results of this study will be communicated with future graduates to enhance their success on the jurisprudence examination.

North Carolina community pharmacists' attitudes about suicide and willingness to conduct suicidal ideation assessment: A cross-sectional survey study

BACKGROUND

Suicide is a major and growing public health problem. Pharmacists are one of the most accessible members of the health care team. Due to their unique place in the health care system, pharmacists may be an ideal resource for monitoring patients at risk of suicide. The objectives of this study were to: (1) investigate community pharmacists' attitudes toward suicide; (2) identify pharmacist-reported barriers to suicidal ideation assessment; and (3) evaluate facilitators and barriers to pharmacists conducting suicidal ideation assessment.

METHODS

An anonymous questionnaire was distributed to North Carolina (NC) community pharmacists. Measures included contact with suicide, perceived role in suicidal ideation assessment, Attitudes Towards Suicide (ATTS), and barriers in suicidal ideation assessment. Multivariable logistic regression was used to analyze the data.

RESULTS

There were usable and complete data for 225 participants (3.52% response rate). The median ATTS score was 70 (IQR = 7). Community pharmacists were significantly more likely to perform a suicidal ideation assessment at least sometimes when (s)he reported a lower number of barriers (OR = 0.70, 99.5% CI = 0.51-0.98) and when (s)he agreed or strongly agreed that they knew how to help someone who was suicidal (OR = 6.63, 99.5% CI = 1.74, 25.23). The most common barrier to suicidal ideation assessment was lack of education in mental health screening (n = 176).

CONCLUSIONS

Suicide prevention education programs for pharmacists may need to address reducing barriers, increasing knowledge about suicide, and improving self-efficacy. Targeting these areas may lead more pharmacists conducting these assessments.

A semester-long critical thinking course in the first semester of pharmacy school: Impact on critical thinking skills

INTRODUCTION

To determine whether critical thinking improved after student-pharmacists participated in a semester-long critical thinking course in the first semester of pharmacy school.

METHODS

Students took the Health Sciences Reasoning Test-Numeracy (HSRT-N) on the first and last day of the course. The overall HSRT-N score, percentile ranking, and eight sub-categories within the HSRT-N (analysis, interpretation, inference, evaluation, explanation, induction, deduction, and numeracy) were evaluated. A multivariable quantile regression model evaluated the association between the post-test percentile and student age, at which campus the student was enrolled, and how many minutes the students required to take the test.

RESULTS

There were no significant differences in overall scores, percentile, or the sub-category scores with the exception of a significant increase in the analysis score and a significant decrease in the induction score. There was a greater increase for students in the lower quartiles on the pre-test compared to students in the higher quartiles on the pre-test. The largest percentile change occurred in students in the 25th-50th percentiles.

CONCLUSION

A statistically significant improvement in the analysis category of the HSRT-N and a greater increase for students in the lower quartiles on the pre-test to the post-test suggests students with the lowest quartiles on the HSRT-N would benefit the most from a critical thinking course.

Assessment of factors that impact performance in a year-long Top 200 Drug course

BACKGROUND AND PURPOSE

Knowledge of commonly used medications ("Top 200") is a common component of pharmacy curricula. This study assessed the impact of pre-pharmacy grade point average (GPA), timing of students' community introductory pharmacy practice experience (C-IPPE), C-IPPE practice location, completion of practice quizzes (PQs), and campus attended on Top 200 performance.

EDUCATIONAL ACTIVITY AND SETTING

Top 200 Drugs is a two-part series offered during the first professional (P1) year of the program. Students concurrently complete their C-IPPE during either the fall or spring semester. A retrospective review was completed to assess factors associated with student performance during the 2016-2017 academic year.

FINDINGS

Higher fall course grades were associated with higher pre-pharmacy GPA, active C-IPPE enrollment, and completion of >80% of PQs. Higher spring course grades were associated with higher pre-pharmacy GPAs, completion of >80% of PQs, satellite campus attendance, C-IPPE completion at a grocery store/mass merchant, and higher fall semester performance.

SUMMARY

A retrospective review of factors associated with student performance allowed the course coordinator to create further learning opportunities based on the findings. Since practice quizzes were associated with higher performance, these self-directed learning opportunities were expanded in the subsequent course offering. Student completion of the C-IPPE in the fall improved performance in the fall, and C-IPPE location may have impacted performance as well. Further investigations are warranted to better understand the impact of C-IPPE semester and C-IPPE location on Top 200 performance so these can be maximized to support student performance.

Health professions students' attitudes and perceptions of interprofessional biases

OBJECTIVE

The purpose of this study was to examine attitudes toward interprofessional, team-based care in first-year health professions students.

METHODS

A cross-sectional questionnaire was administered to all first-year health professions students in their first semester at one university using the Interprofessional Attitudes Scale (IPAS). Kruskal-Wallis tests were used to analyze the data.

KEY FINDINGS

Results indicated only two significant differences among students in IPAS subdomains: teamwork (χ²  = 13.11, df = 3, P = 0.004) and patient-centredness (χ²  = 40.75, df = 3, P < 0.0001).

CONCLUSIONS

Not all health professions students come into their formal education with the same level of attitudes toward team-based care. Educators should consider this when designing IPE activities.

Do more opioid policies reduce opioid dispensing in traditional medicaid?: A national analysis

BACKGROUND

Several Medicaid programs have implemented approaches to ensure the appropriateness of opioid utilization and decrease opioid dispensing.

OBJECTIVE

To evaluate whether Medicaid opioid harm reduction strategies (OHRS) resulted in a decrease in opioid claims, costs, or units reimbursed per beneficiary.

METHODS

The number of OHRS was determined for each state's fee-for-service (FFS) Medicaid program according to previously published data. Publically available FFS Medicaid data were tabulated by state for opioid claims, costs, and units reimbursed in state fiscal years 2016 and 2017. Multivariable generalized estimating equation (GEE) models were utilized to analyze the data.

RESULTS

GEE results indicated that OHRS intensity or change in OHRS did not impact opioid claims or units reimbursed in Medicaid FFS programs. A significant finding on reduction in beneficiary-adjusted opioid costs was observed for states with two OHRS compared to states with no OHRS. There were no significant differences in opioid claims, units reimbursed, and costs based on states with 3 or fewer OHRS versus those with four or more. When examining the differential effect of each individual type of OHRS, there were no significant differences in opioid claims, units reimbursed, nor medication costs.

CONCLUSIONS

The number of OHRS may not be associated with opioid dispensing or utilization in FFS Medicaid programs. Other factors may have led to the decrease in opioid claims for Medicaid.

Association between the North Carolina Medical Board opioid guideline update and opioid prescriptions in Medicare Part D beneficiaries

OBJECTIVE

To examine if North Carolina (NC) opioid prescribing guidelines were associated with changes in opioid prescribing.

METHOD

Retrospective secondary analysis of the Medicare Provider Utilization and Payment Data: Part D Prescriber datasets from 2013 to 2015.

PARTICIPANTS

Providers who prescribed at least one opioid from 2013 to 2015 and paid by Medicare Part D.

MAIN OUTCOME MEASURE

Per-prescriber Medicare-population adjusted number of analgesic opioid claims and per-prescriber average day supply. Generalized estimating equations (GEE) were used to analyze the data.

RESULTS

There were significantly higher per-prescriber Medicare adjusted opioid claims in 2014 compared to 2015 (p < 0.001) but no difference between 2013 and 2015 (p = 0.584). GEE results also indicated that there was a significant increase in 2015 in per-prescriber average day supply, compared to 2013 and 2014 (both p < 0.0001).

CONCLUSIONS

State opioid prescribing guidelines published in mid-2014 may have slowed the escalation of numbers of opioid prescriptions in NC. Future research should examine whether the guidelines were associated with changes in morphine equivalent dosing in NC during the same timeframe.

Using Indian Health Service (IHS) counseling techniques in an independent community pharmacy to improve adherence rates among patients with diabetes, hypertension, or hyperlipidemia

OBJECTIVES

To 1) identify barriers to medication adherence and 2) examine the relationship between the Indian Health Service (IHS) 3 prime questions and medication adherence in patients with diabetes, hypertension, or hyperlipidemia before and 6 months after intervention.

METHODS

This quasi-experimental study evaluated the effectiveness of an adherence program at an independent community pharmacy. Patients who met inclusion criteria were telephoned monthly to answer questions related to their medications. Patients served as their own controls to show comparison between pre- and postintervention adherence rates calculated according to proportion of days covered over the previous 6 months. Mean medication adherences before and after intervention were assessed via paired t test. Linear regression was used to analyze predictors of average medication adherence. The Charlson Comorbidity Index was used to measure the impact of comorbid conditions on medication adherence.

RESULTS

Fifty-six of 354 patients met inclusion criteria, consented, and completed the study. The percentage of patients achieving an adherence rate of 80% or more increased from 9% initially to 59% at study completion. Each medication class showed improvement in adherence rates: diabetes from 66.24% to 80.06% (P = 0.0153), hypertension from 72.33% to 81.34% (P = 0.0192), and hyperlipidemia from 64.45% to 74.66% (P = 0.0103). Overall, average medication adherence increased by 11% (P < 0.0001). The top patient-reported barrier to adherence was convenience/forgetfulness (46.43%).

CONCLUSION

Pharmacist-led counseling sessions with the use of the 3 prime questions showed short-term improvement in adherence rates among patients participating in a medication adherence program. Future studies should assess if improved adherence is sustained long-term following active intervention.

A Meta-Analysis of Outcomes Comparing Flipped Classroom and Lecture

Objective. To examine the evidence of the effectiveness of flipped classroom compared to traditional lecture. Methods. Experimental and observational studies were included and obtained through searches of PubMed, Education Resources Information Center (ERIC), and Google Scholar. Publications from January 1, 2000 through July 1, 2017 were included. Studies were eligible for this research if: (a) the study compared student outcomes using flipped classroom versus lecture and (b) at least one outcome measure was final examination score or final course score. This analysis used a random effects model with weighted mean difference (WMD) as the outcome. Results. Six studies were included in the qualitative synthesis and five were included in the quantitative synthesis. To date, there has only been one prospective randomized comparison of flipped classroom to lecture in student pharmacist education. When comparing final examination scores, there was no significant difference between flipped classroom and lecture based instruction. Only two studies examined the effect of flipped classroom compared to lecture on final course score. This analysis also found no significant difference. Conclusion. Despite a lack of prospective randomized studies, findings from this meta-analysis suggest that flipped classroom may be associated with minimal gains in student knowledge compared to lecture. These findings are important because previous research has estimated that the flipped classroom requires more time to develop and implement. Future studies using prospective randomized designs need to be conducted before widespread adoption.