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Wopat M, Dunkerson F, Moss A, Moyer C, Pitterle A, Portillo E. Student Pharmacist Led Fish Oil Deprescribing Initiative at a Veterans Affairs Hospital and Rural Clinics. Innov Pharm 2023; 14:10.24926/iip.v14i3.5471. [PMID: 38487389 PMCID: PMC10936451 DOI: 10.24926/iip.v14i3.5471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2024] Open
Abstract
Background: Polypharmacy impacts one-third of older adults and has been shown to lead to adverse health effects. One contributor to polypharmacy includes omega-3 fatty acid (fish oil) due to the lack of evidence supporting clinical benefit. Pharmacists can identify and reduce polypharmacy, inspiring this student led deprescribing initiative to introduce a standard of care process for deprescribing fish oil. Purpose/Objectives: The overall objectives of this evaluation are to assess the need for a fish oil deprescribing process, to analyze the role of student pharmacists in deprescribing, and to evaluate the effectiveness of a fish oil deprescribing service. Methods: This project integrated three doctor of pharmacy students in their third year of pharmacy school who were enrolled in a yearlong class about improving healthcare for rural populations and the quality improvement research process. Four primary care clinic patient panels who were prescribed fish oil were assessed. Chart reviews were conducted, and patients were contacted to deprescribe their fish oil by the student and offer statin or lipid therapy modifications, if applicable. Results: A generated report identified 106 patients who had active prescriptions for fish oil. After application of exclusion criteria, 68 patients were included in the evaluation. A total of 76.2% of patients accepted at least one therapy modification offered by the pharmacy student. Conclusion: This evaluation demonstrates the positive impact of the integration of student pharmacists for deprescribing in a primary care setting. Opportunities exist to further explore student pharmacist roles within ambulatory care clinic models.
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Affiliation(s)
- Maria Wopat
- William S. Middleton Memorial Veterans Hospital, Madison, WI
| | | | - Alissa Moss
- University of Wisconsin-Madison School of Pharmacy, Madison, WI
| | - Chelsea Moyer
- University of Wisconsin-Madison School of Pharmacy, Madison, WI
| | - Alyssa Pitterle
- University of Wisconsin-Madison School of Pharmacy, Madison, WI
| | - Edward Portillo
- University of Wisconsin-Madison School of Pharmacy, Madison, WI
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Portillo EC, Rothbauer K, Meyer J, Look K, Wopat M, Gruber S, Dunkerson F, Lehmann M, Wagner E, Seckel E. Impact of a novel project management course sequence on innovative thinking in pharmacy students. Curr Pharm Teach Learn 2021; 13:982-991. [PMID: 34294264 DOI: 10.1016/j.cptl.2021.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 01/29/2021] [Accepted: 06/08/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND As healthcare continues to become more complex, pharmacist innovators have worked to advance the profession and expand the role of the pharmacist on the healthcare team. Accreditation standards for schools of pharmacy recognize the importance of developing future pharmacist innovators capable of making positive change in the profession, but there are limited resources available on how to best instill innovative thinking in student pharmacists. EDUCATIONAL ACTIVITY A two-semester elective course sequence was created for third-year doctor of pharmacy students requiring completion of a longitudinal quality improvement project at a partnering health system. Students collaborated with key stakeholders to design a project plan and charter, identify deliverables, and deliver project results. Innovative thinking was assessed using a mixed methods approach including questionnaires with forced choice and open response items, focus group data, and semi-structured interviews. Each questionnaire item mapped specifically to an element of a validated model for employee innovation. From the beginning to the end of the course sequence, there were significant improvements in student-perceived project management self-efficacy and innovative thinking. CRITICAL ANALYSIS OF THE EDUCATIONAL ACTIVITY Student learning outcomes and the course structure mapped closely with a validated model of innovative behavior, demonstrating the effectiveness of utilizing project management to instill innovative thinking in student pharmacists. These findings support the concept that innovative thinking can be taught in pharmacy didactic curricula by situating students in the environment of real-world pharmacy practice.
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Affiliation(s)
- Edward C Portillo
- University of Wisconsin-Madison School of Pharmacy, 777 Highland Ave, Madison, WI 53705, United States.
| | - Katherine Rothbauer
- William S. Middleton Veterans Affairs Hospital, 2500 Overlook Terrace, Madison, WI 53705, United States.
| | - Jodi Meyer
- William S. Middleton Veterans Affairs Hospital, 2500 Overlook Terrace, Madison, WI 53705, United States.
| | - Kevin Look
- University of Wisconsin-Madison School of Pharmacy, 777 Highland Ave, Madison, WI 53705, United States.
| | - Maria Wopat
- William S. Middleton Veterans Affairs Hospital, 2500 Overlook Terrace, Madison, WI 53705, United States.
| | - Stephanie Gruber
- William S. Middleton Veterans Affairs Hospital, 2500 Overlook Terrace, Madison, WI 53705, United States.
| | - Frederick Dunkerson
- William S. Middleton Veterans Affairs Hospital, 2500 Overlook Terrace, Madison, WI 53705, United States.
| | - Molly Lehmann
- William S. Middleton Veterans Affairs Hospital, 2500 Overlook Terrace, Madison, WI 53705, United States.
| | - Erica Wagner
- William S. Middleton Veterans Affairs Hospital, 2500 Overlook Terrace, Madison, WI 53705, United States.
| | - Ellina Seckel
- William S. Middleton Veterans Affairs Hospital, 2500 Overlook Terrace, Madison, WI 53705, United States.
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Wopat M, Breslow R, Chesney K, McCauley M, Van Gysel R, Gray A, Hilsenhoff J, Edwardson G, Nachreiner J, Hoff L, Gruber S, Shattuck P, Portillo E. Implementation of a pharmacist and student pharmacist-led primary care service to identify and treat rural veterans at risk for osteoporotic fracture. J Am Pharm Assoc (2003) 2021; 61:e105-e112. [PMID: 34393078 DOI: 10.1016/j.japh.2021.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 06/03/2021] [Accepted: 07/15/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To develop and implement a pharmacist and student pharmacist-led osteoporosis service to increase dual-energy x-ray absorptiometry (DXA) screening rates among rural veterans and treat those at high risk of osteoporotic fractures. PRACTICE DESCRIPTION Pharmacists are uniquely positioned to provide direct patient care in the Department of Veterans Affairs ambulatory care setting owing to their broad scope of practice. Clinical Pharmacy Specialists (CPSs) have the authority to order laboratory tests and imaging, prescribe medications, refer patients to specialty services, and monitor patients along with the primary care team. PRACTICE INNOVATION The implementation of a pharmacist-led osteoporosis primary prevention service using student pharmacists to identify and treat patients has not been previously described in the literature to the authors' knowledge. EVALUATION METHODS Student pharmacists in their third year contacted veterans who met the inclusion criteria for osteoporosis screening. The veterans were offered DXA scans and provided education on the risk factors for osteoporosis. After the DXA scans were completed, the students and the CPS reviewed the results to determine treatment strategies. The primary objective was evaluated by comparing the pre- and post-implementation rates of DXA screening. The other process markers that were evaluated included (1) completed DXA scans, (2) new diagnoses of osteoporosis or osteopenia, (3) patients eligible for treatment on the basis of the DXA screening results, and (4) patients who started oral bisphosphonate therapy. RESULTS Of the 232 rural veterans evaluated, 36 had completed DXA scans before this service was implemented. After the service was implemented, 115 veterans completed DXA scans. A total of 57 patients received a new diagnosis, 33 were eligible for therapy, and 12 started oral bisphosphonate therapy after intervention by the CPS. CONCLUSION The implementation of a pharmacist-driven osteoporosis screening and treatment service demonstrated an increase in the rate of DXA screening among rural veterans.
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Weiner S, Schwartz A, Altman L, Ball S, Bartle B, Binns-Calvey A, Chan C, Falck-Ytter C, Frenchman M, Gee B, Jackson JL, Jordan N, Kass B, Kelly B, Safdar N, Scholcoff C, Sharma G, Weaver F, Wopat M. Evaluation of a Patient-Collected Audio Audit and Feedback Quality Improvement Program on Clinician Attention to Patient Life Context and Health Care Costs in the Veterans Affairs Health Care System. JAMA Netw Open 2020; 3:e209644. [PMID: 32735338 PMCID: PMC7395234 DOI: 10.1001/jamanetworkopen.2020.9644] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Evidence-based care plans can fail when they do not consider relevant patient life circumstances, termed contextual factors, such as a loss of social support or financial hardship. Preventing these contextual errors can reduce obstacles to effective care. OBJECTIVE To evaluate the effectiveness of a quality improvement program in which clinicians receive ongoing feedback on their attention to patient contextual factors. DESIGN, SETTING, AND PARTICIPANTS In this quality improvement study, patients at 6 Department of Veterans Affairs outpatient facilities audio recorded their primary care visits from May 2017 to May 2019. Encounters were analyzed using the Content Coding for Contextualization of Care (4C) method. A feedback intervention based on the 4C coded analysis was introduced using a stepped wedge design. In the 4C coding schema, clues that patients are struggling with contextual factors are termed contextual red flags (eg, sudden loss of control of a chronic condition), and a positive outcome is prospectively defined for each encounter as a quantifiable improvement of the contextual red flag. Data analysis was performed from May to October 2019. INTERVENTIONS Clinicians received feedback at 2 intensity levels on their attention to patient contextual factors and on predefined patient outcomes at 4 to 6 months. MAIN OUTCOMES AND MEASURES Contextual error rates, patient outcomes, and hospitalization rates and costs were measured. RESULTS The patients (mean age, 62.0 years; 92% male) recorded 4496 encounters with 666 clinicians. At baseline, clinicians addressed 413 of 618 contextual factors in their care plans (67%). After either standard or enhanced feedback, they addressed 1707 of 2367 contextual factors (72%), a significant difference (odds ratio, 1.3; 95% CI, 1.1-1.6; P = .01). In a mixed-effects logistic regression model, contextualized care planning was associated with a greater likelihood of improved outcomes (adjusted odds ratio, 2.5; 95% CI, 1.5-4.1; P < .001). In a budget analysis, estimated savings from avoided hospitalizations were $25.2 million (95% CI, $23.9-$26.6 million), at a cost of $337 242 for the intervention. CONCLUSIONS AND RELEVANCE These findings suggest that patient-collected audio recordings of the medical encounter with feedback may enhance clinician attention to contextual factors, improve outcomes, and reduce hospitalizations. In addition, the intervention is associated with substantial cost savings.
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Affiliation(s)
- Saul Weiner
- Department of Medicine, University of Illinois at Chicago, Chicago
- Center of Innovation for Complex Chronic Healthcare, Jesse Brown VA Chicago Health Care System, Chicago, Illinois
| | - Alan Schwartz
- Department of Medical Education, University of Illinois at Chicago, Chicago
| | - Lisa Altman
- Office of Healthcare Transformation, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Sherry Ball
- Research Services, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
| | - Brian Bartle
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr VA Hospital, Hines, Illinois
| | - Amy Binns-Calvey
- Department of Medicine, University of Illinois at Chicago, Chicago
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr VA Hospital, Hines, Illinois
| | - Carolyn Chan
- Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
| | | | - Meghana Frenchman
- Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Bryan Gee
- Department of Medicine, Edward Hines Jr VA Hospital, Hines, Illinois
| | - Jeffrey L. Jackson
- General Medicine Division, Clement J. Zablocki VA Medical Center, Milwaukee, Wisconsin
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Neil Jordan
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr VA Hospital, Hines, Illinois
- Department of Psychiatry and Behavioral Sciences and Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Benjamin Kass
- Department of Medicine, University of Illinois at Chicago, Chicago
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr VA Hospital, Hines, Illinois
| | - Brendan Kelly
- Department of Medicine, University of Illinois at Chicago, Chicago
- Center of Innovation for Complex Chronic Healthcare, Jesse Brown VA Chicago Health Care System, Chicago, Illinois
| | - Nasia Safdar
- Research Services, William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin
| | - Cecilia Scholcoff
- General Medicine Division, Clement J. Zablocki VA Medical Center, Milwaukee, Wisconsin
| | - Gunjan Sharma
- Department of Medicine, University of Illinois at Chicago, Chicago
- Center of Innovation for Complex Chronic Healthcare, Jesse Brown VA Chicago Health Care System, Chicago, Illinois
| | - Frances Weaver
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr VA Hospital, Hines, Illinois
- Department of Public Health Sciences, Loyola University Chicago, Chicago, Illinois
| | - Maria Wopat
- Pharmacy Services, William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin
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