Reliability of Online Simulation-Based Assessment to Measure Cognitive Performance and Its Acceptance Among Pharmacy Students

The majority of conventional evaluations of cognitive skills (CSs) utilise paper-based or online multiple-choice questions or single best-answer questions. However, examination that uses online simulation of real scenarios has the potential to complement medium-to-high level CSs that make use of the intellectual capabilities of applying, analysing and evaluating complex information. Nevertheless, the reliability of online simulation as an alternative learning and assessment tool for Malaysian pharmacy courses has never been investigated. This paper illustrates online remote simulation-based assessment, its psychometric properties and students’ feedback towards this new learning and assessment tool opportunity. A virtual web-based simulation examination consisting of three infectious disease scenarios was administered in an undergraduate pharmacy course to assess physically distanced students for medium-level clinical pharmacy CSs. Students responded through written typed communication to online enquiries from health professionals, patients or caretakers’ avatars. Rasch analysis and a feedback survey were employed to measure the reliability of online simulation and to understand students’ experiences with the new web-based tool. This study found that the remote simulation examination had good reliability (ir = 0.95, pr = 0.73) for measuring medium-level clinical pharmacy CSs. The students’ survey indicates that the web-based simulation activities improved knowledge, engagement and cognitive reasoning. This article contributes to the pharmacy education literature by illustrating how a different type of assessment is feasible and reliable for evaluating students’ CSs for final examinations and potentially has equitable opportunities for distance-learning students to enhance their learning capabilities and show their performances. Future research to investigate the potential of remote online simulation examinations for inter-professional learning and assessment is highly recommended.

Collaborative intervention between pharmacists and physicians on elderly patients: a randomized controlled trial

Background

The elderly population is the largest consumer of medications as this age group is at high risk for developing chronic diseases. However, medication use among elderly people is complicated by an increased risk of drug-related problems. Therefore, the present study was conducted to investigate the effects of collaborative interventions between pharmacists and physicians on health-related outcomes of elderly patients.

Patients and methods

This was a randomized controlled trial (RCT) conducted on elderly outpatients who sought treatment in the Medical Outpatient Department of a public tertiary hospital in Malaysia and who were taking at least five medications. The participants were randomly allocated to the intervention and control groups. The intervention group received pharmaceutical care from a pharmacist in collaboration with physicians and was followed-up for 6 months, while the control group received usual care in the outpatient pharmacy.

Results

A total of 73 participants in the intervention group and 79 participants in the control group completed the study. Participants in the intervention group had significantly better medication adherence (median =7.0 vs 5.0, U=1224.5, p<0.001, r=0.503) and better Medication Appropriateness Index (MAI) score (median =8.0 vs 20.0, U=749.5, p<0.001, r=0.639).

Conclusion

Collaborative interventions between pharmacists and physicians improved medication adherence and MAI scores of the elderly patients. Therefore, such services should be implemented in all hospitals, especially in countries where pharmacists are still not playing a substantial role in patient care.

Trial registration

NMRR-12-958-13020.

Prevalence, risk factors and health outcomes associated with polypharmacy among urban community-dwelling older adults in multi-ethnic Malaysia

BACKGROUND

Polypharmacy has been associated with increased morbidity and mortality in the older population.

OBJECTIVES

The aim of this study was to determine the prevalence, risk factors and health outcomes associated with polypharmacy in a cohort of urban community-dwelling older adults receiving chronic medications in Malaysia.

METHODS

This was a baseline study in the Malaysian Elders Longitudinal Research cohort. The inclusion criteria were individuals aged ≥55years and taking at least one medication chronically (≥3 months). Participants were interviewed using a structured questionnaire during home visits where medications taken were reviewed. Health outcomes assessed were frequency of falls, functional disability, potential inappropriate medication use (PIMs), potential drug-drug interactions (PDDIs), healthcare utilisation and quality of life (QoL). Risk factors and health outcomes associated with polypharmacy (≥5 medications including dietary supplements) were determined using multivariate regression models.

RESULTS

A total of 1256 participants were included with a median (interquartile range) age of 69(63-74) years. The prevalence of polypharmacy was 45.9% while supplement users made up 56.9% of the cohort. The risk factors associated with increasing medication use were increasing age, Indian ethnicity, male, having a higher number of comorbidities specifically those diagnosed with cardiovascular, endocrine and gastrointestinal disorders, as well as supplement use. Health outcomes significantly associated with polypharmacy were PIMS, PDDIs and increased healthcare utilisation.

CONCLUSION

A significant proportion of older adults on chronic medications were exposed to polypharmacy and use of dietary supplements contributed significantly to this. Medication reviews are warranted to reduce significant polypharmacy related issues in the older population.