Opening the Black Box: Agreement and Reliability of a Situational Judgment Test Across Multiple Institutions

OBJECTIVE

The primary objective of this study was to examine the levels of agreement and reliability of a situational judgment test (SJT) using a diverse pool of pharmacy practice faculty as subject matter experts. Secondary aims included analyses to build support for test validity and fairness.

METHODS

An SJT containing 18 scenarios and 118 responses assessing empathy, integrity, and teamwork was developed and delivered to pharmacy practice faculty at 5 schools of pharmacy across the United States. Reliability was assessed by examining internal consistency, inter-rater reliability, and split-half reliability. Only responses which attained an inter-rater agreement>0.7 were included in the final version of the SJT. All responses were scored using a near-miss system, allowing higher scores for answers more closely aligned with the key, which was determined by the faculty who completed the SJT. Test fairness was reported using descriptive statistics.

RESULTS

Thirty-nine faculty across the 5 participating institutions completed the SJT. The final version of the SJT included 105 responses, achieving an inter-rater agreement of>0.7 (inter-rater reliability of 0.98). Split-half reliability was 0.72. The average score was 85.7%, and no differences in performance were observed based on demographic characteristics.

CONCLUSION

An SJT designed to assess empathy, integrity, and teamwork achieved reasonable levels of reliability among pharmacy practice faculty across the United States, and the results provided initial support for test validity and fairness. These results support a pilot to assess this SJT among students representing multiple institutions.

The AACP Academic Affairs Committee's Final 2022 Curricular Outcomes and Entrustable Professional Activities (COEPA) for Pharmacy Graduates to Replace 2013 CAPE and 2016 EPAs

The American Association of Colleges of Pharmacy (AACP) Academic Affairs Committee was charged with revising both the 2013 Center for the Advancement of Pharmacy Education (CAPE) Educational Outcomes (EOs) and the 2016 Entrustable Professional Activities (EPAs). The Committee changed the document name from the CAPE outcomes to COEPA, (Curricular Outcomes and Entrustable Professional Activities) since the EOs and EPAs would now be housed together. A draft of the COEPA EOs and EPAs was released at the AACP July 2022 Annual meeting. After receiving additional stakeholder feedback during and after the meeting, the Committee made additional revisions. The final COEPA document was submitted to and approved by the AACP Board of Directors in November 2022. This COEPA document contains the final version of the 2022 EOs and EPAs. The revised EOs have been reduced to 3 domains and 12 subdomains (from 4 domains and 15 subdomains previously in CAPE 2013) and the revised EPAs have been reduced from 15 to 13 activities.

The AACP Academic Affairs Committee's Guidance for Use of the Curricular Outcomes and Entrustable Professional Activities (COEPA) for Pharmacy Graduates

The 2021-2023 American Association of Colleges of Pharmacy Academic Affairs Committee (AAC) was charged with and completed the revision of the 2013 Center for the Advancement of Pharmacy Education Outcomes and the 2016 Entrustable Professional Activity (EPA) statements for new pharmacy graduates. This work resulted in a new combined document, the Curricular Outcomes and Entrustable Professional Activities (COEPA) that was unanimously approved by the American Association of Colleges of Pharmacy Board of Directors and was published in the Journal. The AAC was also charged with providing stakeholders with guidance about how to use the new COEPA document. To achieve this charge, the AAC created example objectives for all 12 Educational Outcomes (EOs) and example tasks for all 13 EPAs. Although programs are asked to retain the EO domains, subdomains, one-word descriptors, and descriptions, unless they are adding more EOs or increasing the taxonomy level of a description, colleges and schools of pharmacy can expand or edit the example objectives and example tasks to meet local needs, as these are not designed to be prescriptive. This guidance document is published separately from the COEPA EOs and EPAs to reinforce the message that the example objectives and tasks are modifiable.

Finalizing the Work Related to the Curriculum Outcomes and Example Objectives and Entrustable Professional Activities (COEPA) Document: The Report of the 2022-2023 Academic Affairs Standing Committee

The 2022-2023 Academic Affairs Committee (AAC) was charged to (1) complete the Center for the Advancement of Pharmacy Education Outcomes and Entrustable Professional Activities (EPAs) revisions (now renamed as COEPA - Curriculum Outcomes and Entrustable Professional Activities) after receiving feedback at the 2022 American Association of Colleges of Pharmacy (AACP) Annual Meeting; (2) offer guidance on how the revised COEPA education outcomes and EPA statements should be used by member institutions, faculty, preceptor, and students; (3) guide input into the ongoing revision of the Accreditation Council for Pharmacy Education (ACPE) standards for the Doctor of Pharmacy program. The published report of the 2021-2022 AAC outlines the work of the Committee through the spring of 2022.1 This 2022-2023 AAC report focuses on the work related to finalizing the COEPA educational outcomes, EPAs, preamble, and glossary and formally receiving approval from the AACP Board of Directors.2 This report also describes the creation of a COEPA guidance document, including educational outcomes example learning objectives, and EPA example tasks for the Academy, however, the actual guidance document will be published separately. Finally, this current report outlines the feedback the AAC sought, received, synthesized, summarized, and prioritized from key interested and affected parties about the ACPE 2016 standards revisions for the ACPE 2025 draft standards.3 The Committee offers revisions for 1 AACP policy statement pertaining to diversity, equity, inclusion, accessibility, justice, and anti-racism. One new policy statement is also offered that urges ACPE to create accreditation standards for pharmacy education that support diversity, equity, inclusion, accessibility, justice, and anti-racism, despite presence of laws, executive orders, and policies that oppose these concepts.

Revising the Center for the Advancement of Pharmacy Education (CAPE) Educational Outcomes and Entrustable Professional Activities (EPAs): The Report of the 2021-2022 Academic Affairs Standing Committee

EXECUTIVE SUMMARY. The 2021-22 Academic Affairs Committee was charged to 1) Update the Center for the Advancement of Pharmacy Education (CAPE) Outcomes and Entrustable Professional Activity (EPA) statements for new pharmacy graduates; 2) Nominate at least one person for an elected AACP or Council Office; and 3) Consider ways that AACP can improve its financial health. This report primarily focuses on the process undertaken by the committee to revise the CAPE Educational Outcomes and EPAs. Proposed changes to the current outcomes are discussed and the reasoning behind these revisions are described. AACP members will have the opportunity to provide feedback prior to the final document being approved and published later this year.

Student Performance on Graded Versus Ungraded Readiness Assurance Tests in a Team-Based Learning Elective

Objective. Team-based learning is widely used in pharmacy education. In this context, students need to be incentivized to do preclass preparation, thus ensuring they are ready for team-based learning, via graded readiness assurance tests (RATs). The purpose of this study was to determine the effect of graded versus ungraded RATs on examination performance in an ambulatory care elective course for third-year student pharmacists.Methods. For the course offered in spring 2020 and 2021, a standard team-based learning framework was employed. In 2020 the RATs were graded and contributed to the overall course grade (graded RAT cohort), but in 2021 RAT grades did not contribute to the course grade (ungraded RAT cohort). For the ungraded RAT cohort, at the end of the course students completed an online anonymous survey regarding class preparation and perceived team accountability.Results. No significant difference was found between the graded RAT (n=47) and ungraded RAT cohorts (n=36) in the overall mean percentage score on individual RATs (76% vs 74%) and individual examinations (82% vs 80%). Most students (69%-91%) in the ungraded RAT cohort reported completing preclass preparation assignments. In the postcourse survey, 94% of students agreed or strongly agreed that RATs contributed to team members' learning, and 86% agreed or strongly agreed that they were proud of their ability to assist in the team's learning.Conclusion. Ungraded RATs did not significantly impact students' examination performance in an elective course. Removing the grading of this test, whereby grading promotes the performance approach to learning, may have shifted the students' motivation to the mastery approach in the context of preclass preparation. This challenges a widely held belief that grades are necessary incentives for preclass preparation within team-based learning.

Pharmacy student self-assessment of strength of residency candidacy compared to clinical faculty

INTRODUCTION

The purpose of this study was to compare student and faculty perceptions of strength of residency candidacy and to identify student preferences and perceptions that influence the process of being selected by a residency program beyond standard application materials.

METHODS

A 31-item questionnaire was administered to third-year and fourth-year pharmacy students to collect information regarding factors deemed important for successful residency program candidacy. Global assessment of strength of residency candidacy was self-rated by students and a group of clinical faculty blinded to student responses. Interrater reliability for student-to-faculty and faculty-to-faculty perceptions of strength of residency candidacy was determined.

RESULTS

Students generally reported good academic metrics and participation in a wide variety of scholarly activities deemed important in attaining a residency position. Students rated overall strength of residency candidacy as "above average" (n = 54, 37.2%), "average" (n = 60, 41.4%), and "below average" (n = 31, 21.3%), and self-perception increased with matriculation. Student self-assessment of strength of residency candidacy compared to faculty assessment showed poor agreement (mean [SD] kappa = 0.27 [0.08]). Faculty concordance in assessment of strength of residency candidacy was moderate (α = 0.55).

CONCLUSIONS

Concordance in self-assessment of strength of residency candidacy of students compared to faculty was poor. In contrast, agreement among faculty was moderate with generally lower ratings compared to student self-rating, suggesting that students are overconfident in this regard. These findings support residency preparedness training in pharmacy curricula which should include formal assessment of strength of residency candidacy to identify gaps.

Assessing professionalism in health profession degree programs: A scoping review

BACKGROUND

To identify and classify methods for assessing professionalism across health profession degree programs and identify gaps in the literature regarding types of assessments.

METHODS

The authors conducted a scoping review of articles published from database inception through 24 January 2020. Included articles described an assessment approach for professionalism in health profession degree programs available in full-text in the English language. Articles were classified based on profession, timing of assessment, feedback type, assessment type, professionalism dimension, and Barr's modified Kirkpatrick hierarchy.

RESULTS

Authors classified 277 articles meeting inclusion criteria. Most articles were from medical education (62.5%) conducted during didactic (62.1%) or experiential/clinical curriculum (49.8%). Few articles (15.5%) described longitudinal assessment. Feedback type was formative (32.2%) or summative (35%), with only 8.3% using both. Assessment types frequently reported included self-administered rating scales (30%), reflections (18.8%), observed clinical encounters (17.3%), and knowledge-based tests (13.4%). Ethical practice principles (65%) and effective interactions with patients (48.4%) were the most frequently assessed dimensions of professionalism. Authors observed balanced distribution among Barr's modified Kirkpatrick model at levels of reaction (38.3%), modification of perceptions and attitudes (33.6%), acquisition of knowledge and skills (39%), and behavioral change (36.1%).

IMPLICATIONS

The classification scheme identified in current literature on professionalism assessment does not align with International Ottawa Conference Working Group on the Assessment of Professionalism recommendations. Gaps identified were limited description of professionalism assessment during admissions, infrequent longitudinal assessment, limited use of methods for both formative and summative assessment, and limited reports of assessments applicable to interprofessional education settings.

Stop tempting your students to cheat

INTRODUCTION

Maintaining academic integrity is paramount for educators, and even more so for health science educators, where the health of patients is potentially at stake. However, as more content and assessments are pushed into an online forum, more hurdles are being placed in the path of keeping everyone honest without requiring significant financial resources for online proctoring of every assessment. This commentary explores the suggestion of re-evaluating the need for graded course assessments as a way to uphold academic integrity.

COMMENTARY

One reason pharmacy students participate in academic dishonesty is the nature of the assessments employed, with students more likely to cheat on higher stakes assessments (i.e. graded assessments). There is an established difference between learning and performance, where a learning environment encourages mistakes and graded assessments lead more to performance. While the use of retrieval practice can facilitate learning, this can be done with ungraded formative assessments without decline in summative assessment scores.

IMPLICATIONS

Transitioning formative assessments from graded to ungraded while keeping them closed-book and at an appropriate level of difficulty allows for learners to make mistakes, utilize retrieval practice, and ultimately, learn. This transition also allows the pharmacy program to spend their financial resources on proctoring summative assessments only. Making this change strikes a balance between learning and performance while still making strides to maintain academic integrity.

Ferric Maltol: A New Oral Iron Formulation for the Treatment of Iron Deficiency in Adults

OBJECTIVE

To review the pharmacology, efficacy, and safety of ferric maltol (FM), an oral iron formulation, for iron deficiency anemia (IDA).

DATA SOURCES

A MEDLINE/PubMed and EMBASE (January 1, 1985, to June 19, 2020) literature search was performed using the terms ferric maltol, accrufer, feraccru, iron maltol, ferric trimaltol, iron deficiency, iron deficiency anemia, inflammatory bowel disease, and chronic kidney disease. Additional data sources included prescribing information, abstracts, and the National Institutes of Health Clinical Trials Registry.

STUDY SELECTION/DATA EXTRACTION

English language literature evaluating FM pharmacology, pharmacokinetics, efficacy, or safety in the treatment of IDA were reviewed.

DATA SYNTHESIS

FM is a ferric, non-salt-based oral iron formulation demonstrating improved tolerance in patients with previous intolerance to other iron formulations. Phase 3 trials demonstrated significant improvements in anemia and serum iron parameters in patients with inflammatory bowel disease (IBD) and chronic kidney disease (CKD). Common adverse effects were gastrointestinal intolerance.

RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE

FM is an effective and well-tolerated alternative to oral iron salts for patients with IBD or CKD and IDA. Emerging data suggest that FM is noninferior to intravenous (IV) ferric carboxymaltose in patients with IBD and IDA. Prior to selecting FM over IV iron products, consideration should be given to time to normalization of Hb, ease of administration, cost, and tolerability.

CONCLUSION

FM is a relatively safe, effective oral iron therapy that may be better tolerated than other oral iron formulations. FM may be an effective alternative to IV iron in patients with IBD.

Development and Validation of a Situational Judgement Test to Assess Professionalism

Objective. The purpose of this study was to develop, pilot, and validate a situational judgement test (SJT) to assess professionalism in Doctor of Pharmacy (PharmD) students. Methods. Test specifications were developed and faculty members were educated on best practices in item writing for SJTs. The faculty members then developed 75 pilot scenarios. From those, two versions of the SJT, each containing 25 scenarios, were created. The pilot population for the SJT was student pharmacists in their third professional year, just prior to starting their advanced pharmacy practice experiences. The students completed the two versions of the test on different days, approximately 48 hours apart, with 50 minutes allowed to complete each. Subsequently, students completed a questionnaire regarding the SJT at the conclusion of the second test. Results. Version 1 of the SJT was completed by 228 students, and version 2 was completed by 225 students. Mean scores were 390 (SD=20, range 318-429) and 342 (SD=21, range 263-387) on test versions 1 and 2, respectively. The reliability of the tests was appropriate (test version 1, α=0.77; test version 2, α=0.79). Students felt that the content of the tests was realistic with respect to pharmacy practice (90.1%), and that the tests gave them an opportunity to reflect on how to approach challenging situations (82.6%). Conclusion. We developed a reliable SJT to assess professionalism in PharmD students. Future research should focus on creating a personalized learning plan for students who do not meet minimum performance standards on this SJT.

Collaborative Learning Teams to Longitudinally Teach and Assess Teamwork Behaviors and Attitudes

Objective. To create and assess the effectiveness of a model of continuous development of teamwork skills (CDTS), which used a longitudinal peer feedback process across multiple courses that incorporated collaborative team learning. Methods. Pharmacy students participated in collaborative learning teams across the first three years of the doctor of pharmacy (PharmD) curriculum, with team membership changing annually. Self, peer, and team evaluations were completed using the Comprehensive Assessment of Team Member Effectiveness (CATME) Smarter Teamwork system at four time points each year (three formative assessments and one summative assessment). Faculty members used peer and team evaluations to identify when additional coaching on teamwork behaviors, attitudes, and norms was needed. Results. Self, peer, and team evaluations of 261 unique learning teams were conducted between fall 2015 and spring 2018. The majority of students and teams performed highly on teamwork behaviors and attitudes. Individual students and teams were identified for additional development on teamwork behaviors and attitudes as follows: for the 2015-2016 academic year, 5 (2%) individual students and 8 (20%) teams; for the 2016-2017 academic year, 15 (3%) individual students and 19 (22%) teams; and for the 2017-2018 academic year: 15 (2%) individual students and 24 (18%) teams. Conclusion. The CDTS model, which incorporates formative and summative assessments, identified individual students and teams that met the teamwork standards established by the college as well as those students and teams that needed additional coaching to achieve the teamwork learning outcome.

Impact of Team Formation Method on Student Team Performance Across Multiple Courses Incorporating Team-based Learning

Objective. To assess the impact of forming student learning teams based on problem solving styles on team performance and student perceptions of team quality. Methods. This was a prospective observational study involving students in the first year of a Doctor of Pharmacy degree program. Collaborative learning teams (balanced, implementer, optimizer, and random assignment) were created based on students' results on the Basadur Creative Problem Solving Profile Inventory. The teams remained in place across all courses for the first academic year, and those courses that incorporated team-based learning (TBL) were included in the study. Team performance was assessed by administering team readiness assurance tests. The quality of team interactions was assessed using the team satisfaction domain in the Comprehensive Assessment of Team Member Effectiveness (CATME) Smarter Teamwork system and the Team Performance Scale. Results. Each of the 237 first-year pharmacy students enrolled was assigned to one of 41 teams. All teams participated in the study. A significant difference in team performance was observed in the Principles of Patient Centered Care course but not in any of the other courses. No significant differences were found in quality of team interactions. Conclusion. Neither team performance, nor team satisfaction, nor quality of team interactions was impacted by the method of team formation that was used. Given the existing evidence and the results of this study, team formation process, regardless of method used, may have negligible influence on the performance of collaborative learning teams in courses taught using TBL.

Analyzing Analgesic Medications in Community-Dwelling Older Adults

Objectives

Analyzing medication data for research purposes is complex, and methods are rarely described in the literature. Our objective was to describe methods of quantifying opioid and nonopioid analgesics and to compare the utility of five different analgesic coding methods when analyzing relationships between pain, analgesic use, and clinical outcomes. In this study, we used physical function as the outcome variable for its clinical relevance and its relationship to pain in older adults.

Design

Secondary analyses of baseline cross-sectional data from the Advanced Cognitive Training Interventions for Vital Elders (ACTIVE) study.

Setting

Community settings in six regions of the United States.

Subjects

A total of 2,802 community-residing adults older than age 65 years.

Methods

A medication audit was conducted. Analgesics were coded as any pain medication, counts (total analgesics, number of opioids and nonopioids), equianalgesics (oral morphine equivalents, oral acetaminophen equivalents), and dose categories. Adjuvant medications used to treat pain (e.g., tricyclic antidepressants and anticonvulsants) and low-dose aspirin typically used for cardiovascular conditions were excluded from these analyses. To examine the utility of these various approaches, a series of hierarchical regression models were conducted with pain and analgesics as predictors and physical functioning as the dependent variable.

Results

Eighty-one point nine percent of participants reported experiencing recent pain, but 26% reported analgesic use. Nonopioids were the most common drug class used. Models revealed that pain was significantly associated with worse physical function (β = -0.45, P = 0.001), after controlling for demographic and analgesic variables. Two basic drug coding methods (e.g., any pain medication, number of pain medications) were equivalent in their explanatory power (β = -0.12, P = 0.001) and were slightly stronger predictors of function than the more complex coding procedures.

Conclusions

Analgesic medications are important variables to consider in community-based studies of older adults. We illustrate several methods of quantifying analgesic medications for research purposes. In this community-based sample, we found no advantage of complex equianalgesic coding methods over simple counts in predicting physical functioning. The results may differ depending on the research question or clinical outcome studied. Thus, methods of analyzing analgesic drug data warrant further research.

Pharmacy resident teaching and learning curriculum program outcomes: Student performance and quality assessment

INTRODUCTION

The purpose of this study was to assess: (1) student performance on topics taught by first and second year postgraduate pharmacy residents and (2) the quality of learning objectives and multiple choice questions prepared by pharmacy residents.

METHODS

Using a retrospective cohort design, residents and students who taught or were enrolled, respectively, in the Medication Therapy Management course in years 2010 to 2012 were participants in this study. Student performance was assessed using scores earned on the individual readiness assurance tests (iRATs), team readiness assurance tests (tRATs), and course examinations. To assess the quality of the learning objectives and multiple choice questions written by pharmacy residents, criteria were established by the authors. Each learning objective and multiple choice question was then evaluated independently by two authors to determine if these criteria were met.

RESULTS

Statistical differences were observed in student performance across all content areas among the three years for iRAT, tRAT, and course examination scores, with the exception of the heart failure course examination (p = 0.05; all other p-values < 0.05). A total of 20 (42%) learning objectives met all quality review criteria, while 73 (79%) of the multiple-choice questions met all quality review criteria.

DISCUSSION AND CONCLUSIONS

Student performance varied significantly depending on the content, but the overall impact of resident instructors on student course performance was not educationally significant. Teaching and learning curriculum programs should focus on teaching residents to create quality learning objectives that help students focus on learning the most important course content.

A Systematic Review of Assessment Tools Measuring Interprofessional Education Outcomes Relevant to Pharmacy Education

Objective. To identify and describe the available quantitative tools that assess interprofessional education (IPE) relevant to pharmacy education. Methods. A systematic approach was used to identify quantitative IPE assessment tools relevant to pharmacy education. The search strategy included the National Center for Interprofessional Practice and Education Resource Exchange (Nexus) website, a systematic search of the literature, and a manual search of journals deemed likely to include relevant tools. Results. The search identified a total of 44 tools from the Nexus website, 158 abstracts from the systematic literature search, and 570 abstracts from the manual search. A total of 36 assessment tools met the criteria to be included in the summary, and their application to IPE relevant to pharmacy education was discussed. Conclusion. Each of the tools has advantages and disadvantages. No single comprehensive tool exists to fulfill assessment needs. However, numerous tools are available that can be mapped to IPE-related accreditation standards for pharmacy education.

Comparison of Patients Receiving Long-Term Metformin Therapy and Vitamin B12 Monitoring

Background: Metformin may cause vitamin B₁₂ deficiency that can present with symptoms of peripheral neuropathy. Lack of vitamin B₁₂ serum concentration monitoring could result in vitamin B₁₂ deficiency progression, worsening of symptoms, and unnecessary medication. Objectives: The purpose of this study was to (a) compare the influence of the rate of symptoms consistent with vitamin B₁₂ deficiency on obtaining vitamin B₁₂ serum concentrations in patients using metformin; (b) assess if vitamin B₁₂ serum concentrations were ordered as a routine monitoring parameter. Methods: This retrospective case-control study evaluated patients receiving metformin. Patients in the case group had documented symptoms or diagnosis of peripheral neuropathy or macrocytic anemia, while those in the control group did not. The primary outcome was frequency of vitamin B₁₂ serum concentration assessment. The secondary outcomes included frequency of vitamin B₁₂ serum concentration assessment for patients presenting with symptoms or diagnosis of peripheral neuropathy or macrocytic anemia. Results: Analysis included 355 patients (116 cases, 239 controls). The cases were 5 times more likely to have a serum vitamin B₁₂ serum concentrations drawn versus controls (odds ratio [OR] = 5.83, 95% confidence interval [CI] = 3.47-9.77, P < .001). Patients with a diagnosis of peripheral neuropathy or macrocytic anemia were 4 times more likely to have a serum vitamin B₁₂ concentration drawn than those who did not (peripheral neuropathy: OR = 4.92, 95% CI = 2.95-8.21, P < .001; macrocytic anemia: OR = 5.41, 95% CI = 1.30-20.97, P = .007). Conclusions: Cases were more likely to have vitamin B₁₂ serum concentrations assessed than patients without symptoms. The majority of patients taking metformin did not have routine vitamin B₁₂ serum concentration assessments for medication adverse event monitoring.

A Pilot Study to Assess Patient Adherence to New Chronic Medications Following the Use of a Novel Adherence Tool and Individualized Counseling

Background: Medication nonadherence leads to an increase in morbidity and mortality. In the United States, it results in an annual estimated cost of $290 billion in patients with chronic diseases. Several adherence screening tools are available for use, but none have been adopted for widespread use. Objective: Examine the impact of using a novel 3-item adherence tool (The Adherence Estimator) and individualized patient counseling on medication adherence, as determined by rate of initial prescription fill. Methods: This prospective, descriptive study enrolled patients discharged home from an inpatient adult family medicine service who received a prescription for at least one new chronic medication. Patients completed the Adherence Estimator survey for each new medication prescribed. All patients received counseling from a pharmacist or student pharmacist. Date of initial fill was determined by contacting the dispensing pharmacy. Results: The survey was completed for 79 medications. The rate of first fill for medications identified as low, medium, and high risk for nonadherence was 76.5% (n = 28), 71.4% (n = 20), and 94% (n = 17), respectively. Conclusions: The brevity of The Adherence Estimator and the ease of scoring allow the possibility of adoption for widespread clinical use. The survey permits immediate results that allow the clinician to tailor medication counseling toward the 3 most common predictors of nonadherence. The rate of first fill for medications classified as high risk was improved following administration of the tool and targeted medication counseling, 94% in our population compared to predicted probability of adherence of <32%. Several factors, including targeted counseling or study/tool limitations, could account for these results. Consideration should be given to revising the statements in the tool to a lower reading level. This screening tool provides significant advantages over available tools; however, further research is needed to determine the most appropriate population and setting for use of this tool.

Comparison of answer-until-correct and full-credit assessments in a team-based learning course

OBJECTIVE

To assess the impact of awarding partial credit to team assessments on team performance and on quality of team interactions using an answer-until-correct method compared to traditional methods of grading (multiple-choice, full-credit).

METHODS

Subjects were students from 3 different offerings of an ambulatory care elective course, taught using team-based learning. The control group (full-credit) consisted of those enrolled in the course when traditional methods of assessment were used (2 course offerings). The intervention group consisted of those enrolled in the course when answer-until-correct method was used for team assessments (1 course offering). Study outcomes included student performance on individual and team readiness assurance tests (iRATs and tRATs), individual and team final examinations, and student assessment of quality of team interactions using the Team Performance Scale.

RESULTS

Eighty-four students enrolled in the courses were included in the analysis (full-credit, n=54; answer-until-correct, n=30). Students who used traditional methods of assessment performed better on iRATs (full-credit mean 88.7 (5.9), answer-until-correct mean 82.8 (10.7), p<0.001). Students who used answer-until-correct method of assessment performed better on the team final examination (full-credit mean 45.8 (1.5), answer-until-correct 47.8 (1.4), p<0.001). There was no significant difference in performance on tRATs and the individual final examination. Students who used the answer-until-correct method had higher quality of team interaction ratings (full-credit 97.1 (9.1), answer-until-correct 103.0 (7.8), p=0.004).

CONCLUSION

Answer-until-correct assessment method compared to traditional, full-credit methods resulted in significantly lower scores for iRATs, similar scores on tRATs and individual final examinations, improved scores on team final examinations, and improved perceptions of the quality of team interactions.

Pharmacist-physician collaboration for diabetes care: cardiovascular outcomes

BACKGROUND

Only 23% of patients are meeting all goals for cardiovascular complications of diabetes.

OBJECTIVE

The purpose of our study is to evaluate the effect of a pharmacist-physician collaboration on attainment of cardiovascular-related goals in patients with type 2 diabetes.

METHODS

This prospective, multicenter cohort enrolled patients from 7 practice sites that were members of the University of Tennessee Pharmacist Practice Based Research Network (UT Pharm Net). Patients were included if they were diagnosed with type 2 diabetes, at least 18 years of age and English speaking. Pregnant patients were excluded. Patients were followed for 12 months after enrollment. Primary cardiovascular outcomes included reduction in systolic blood pressure, diastolic blood pressure, and low-density lipoprotein (LDL) as well as the proportion of patients achieving a blood pressure goal of <130/80 mm Hg and proportion of patients achieving an LDL goal of <100 mg/dL.

RESULTS

For the 206 patients enrolled, the average age was 59.7 years; the majority were male (59.7%) and white (66%). When compared with baseline, the postintervention mean systolic (P < .0001), diastolic blood pressure (P = .0003), and LDL (P < .0001) decreased significantly. The proportion of patients achieving a blood pressure of <130/80 mm Hg increased 21.8% (P < .0001), and the proportion of patients achieving an LDL of <100 mg/dL increased 12% (P = .0023).

CONCLUSIONS

The results of our study indicate that collaborative management has a positive impact on decreasing cardiovascular risk and assists patients in attaining national goals for blood pressure and cholesterol.

Hospital readmission and emergency department use based on prescribing patterns in patients with severely uncontrolled type 2 diabetes mellitus

BACKGROUND

Patients with uncontrolled diabetes are more likely to be readmitted to the hospital. The study objective was to determine the risk of hospital admission or emergency department (ED) use in patients with severely uncontrolled type 2 diabetes mellitus based on whether their diabetes medication regimen was intensified at discharge.

SUBJECTS AND METHODS

A retrospective cohort study of patients admitted to the medicine services at an academic medical center was conducted during a 9-month period. Medical records were reviewed to identify patients with type 2 diabetes mellitus and hemoglobin A1c >10% who were admitted for more than 24 h. Primary exclusion criteria included pregnancy, age >65 or <18 years, life expectancy of <12 months, hypoglycemia at admission, and new diagnosis of type 2 diabetes. Admission medication lists for patients were compared with discharge medications to determine whether the diabetes regimen was intensified. Patients whose regimen was intensified were then compared with patients whose regimen was not intensified for admissions and ED visits within 3 months after discharge. The primary end point was 90-day all-cause hospital and ED visits.

RESULTS

Patients who had their regimens intensified had significantly fewer average all-cause hospital and ED visits at 90 days (0.41 vs. 0.85; P=0.044). Statistical differences were also found in 30-day all-cause visits, readmissions within 90 days, and hospital-free time.

CONCLUSIONS

Patients whose home diabetes regimen was intensified at discharge were less likely to return to the hospital within 90 days compared with patients whose regimen was not intensified.

Impact of pharmacists' interventions and simvastatin dose restrictions

BACKGROUND

On June 8, 2011, the United States Food and Drug Administration (FDA) reported safety concerns regarding statin-related myopathies and advised further restrictions on simvastatin dosing. These restrictions reduced the maximum dose for specific patient characteristics, primarily certain concomitant medications.

OBJECTIVE

The purpose of this study was to compare the effectiveness of 2 different pharmacist-conducted educational interventions on appropriate simvastatin use in the primary care setting.

METHODS

This retrospective cohort analysis was conducted in 2 academic medical center clinics. Patients prescribed simvastatin before June 8, 2011, requiring dosage adjustment based on labeling changes were evaluated for study inclusion. The pharmacists' interventions included: 30-minute didactic session for prescribers or patient-specific recommendation communicated with the physician during the patient's follow-up visit. Primary outcomes were the number of patients prescribed FDA-recommended simvastatin doses after pharmacist intervention and the intervention's impact on low-density lipoprotein (LDL).

RESULTS

Medical record review identified 1173 patients prescribed simvastatin prior to June 8, 2011; 126 patients qualified for study inclusion. After controlling for baseline characteristics, the likelihood of patients being prescribed an appropriate dose postintervention increased if they were in the patient-specific recommendation group (odds ratio [OR] = 10.59; 95% CI = 3.43-32.69; P < .0001). LDL change occurred at a similar rate between intervention groups (P = .652).

CONCLUSION

Following FDA labeling changes for simvastatin, patient-specific recommendations made by pharmacists correlated with a greater likelihood of appropriate simvastatin dosing compared with a one-time didactic education session. Patient-specific recommendations positively affect prescribing habits and making steps to improve patient safety.

Best practices for implementing team-based learning in pharmacy education

Colleges and schools of pharmacy are incorporating more team-based learning (TBL) into their curriculum. Published resources are available to assist instructors with implementing TBL and describing it in the health professions literature. The 7 core elements include: team formation, readiness assurance, immediate feedback, sequencing of in-class problem solving, the 4 "S" structure for developing team application exercises (significant problem, same problem, specific answer choice, simultaneous reporting), incentive structure, and peer evaluation. This paper summarizes best practices related to implementation of TBL in pharmacy education, including courses taught using teaching teams.

β-Blocker Use and Incidence of Chronic Obstructive Pulmonary Disease Exacerbations

BACKGROUND

β-Adrenergic antagonist (β-blocker) use in patients with chronic obstructive pulmonary disease (COPD) has been avoided as a result of potential risk of pulmonary adverse effects. However, recent studies indicate that β-blocker use in patients with COPD can decrease outpatient visits and either decrease or have no effect on the number of hospitalizations. Long-term treatment with β-blockers has been shown to increase survival and decrease exacerbations in patients with COPD.

OBJECTIVE

To assess the impact of β-blocker use on the incidence of exacerbations in patients with COPD.

METHODS

In a retrospective cohort study of patients with COPD from 2 academic primary care practice sites who were seen in 2010, patients were identified using International Classification of Diseases, 9th revision, Clinical Modification codes for COPD and reviewing active medication lists for COPD-specific medications (tiotropium). Patients were classified as either a β-blocker user or a nonuser. Primary outcomes were incidence and severity of COPD exacerbations. Secondary outcomes included COPD exacerbations distinguished by β-blocker cardioselectivity and all-cause hospitalizations.

RESULTS

The study enrolled 412 patients. Of those, 166 patients were β-blocker users and 246 were β-blocker nonusers. β-Blocker users were less likely to have a COPD exacerbation (OR 0.61, 95% CI 0.40–0.93) and had fewer mild exacerbations (OR 0.56; 95% CI 0.34–0.89). There was no significant difference in COPD exacerbations based on β-blocker cardioselectivity (OR 0.84, 95% CI 0.38–1.83). When controlled for, using a backwards stepwise logistic regression, β-blocker use was a variable in the model that predicted exacerbations but alone was not statistically significant (adjusted OR 0.62, 95% CI 0.39–1.01).

CONCLUSIONS

Patients with COPD prescribed a β-blocker were significantly less likely to have a COPD exacerbation and had fewer mild COPD exacerbations.