Angelo_NMA Podium Presentation 20151215

1/7/2016
Year 1 Overview
Incorporation of Nonprescription Medication‐Related Problems into First‐Year Simulation Activities
Introduction to Pharmacy Practice Pharmaceutics I, II, and III
Microbiology & Immunology
Biochemical Principles for Pharmacy
Fundamentals in Physiology I and II
Foundations for Interprofessional Practice
Pharmacy Skills Lab I, II, and III
Introduction to Drug Information Resources
Introductory Pharmacy Practice Experience (IPPE)
Health Care Systems
Medicinal Chemistry
Self‐Care and Non‐Prescription Medications
Introduction to Bioethics & Health Law
Research & Statistics
Lauren B. Angelo, PharmD, MBA
Assistant Dean, Academic Affairs
Associate Professor
Community Pharmacy
Focus
1
2
Medication History Collection Form (2 pages)
Simulation Activities in Year 1
Medication Histories and Patient Counseling
Late Fall/Early Winter
•
•
•
•
•
Formative assessment
Uses standardized patients and a data collection form
Incorporates peer observation and feedback as well as large group reflection
Video‐captured for self‐reflections
One case per student, which includes at least one nonprescription medication‐related problem
Patient Counseling
Late Winter/Early Spring
•
•
•
•
Formative assessment
Uses faculty/residents
Incorporates small group feedback
One case per student, which is a new prescription
Patient Counseling
End of Spring
•
•
•
•
Summative, high‐stakes assessment
Uses standardized patients
Four cases per student with varying complexity
Several cases include at least one nonprescription medication‐related problem
3
4
The Education and Evaluation Center (EEC)
Entrance & Sign-In Desk
Observation Room
Proctor Desk
Outside Exam Room
Exam Room
Orientation Room
5
6
1
1/7/2016
Inclusion of Nonprescription Medication‐Related Problems
Inclusion of Nonprescription Medication‐Related Problems
Medication Histories and Patient Counseling with Standardized Patients (15 minutes per case)
Student is required to take a medication history and counsel the patient on a newly prescribed medication
Case 1: Patient with newly diagnosed
hypertension
•
•
•
Patient received a new prescription for lisinopril
Patient takes aspirin for “aches and pains”
During the encounter, patient states, “I read an article in a magazine that aspirin can cause bleeding. Is there something safer for the pain?”
Prescription Counseling with Standardized Patients (5 minutes per case)
Student encounters four cases and is required to counsel each patient on a newly prescribed medication
(9 cases used; 5 cases include an issue with a nonprescription medication)
Case 2: Patient with newly diagnosed hypercholesterolemia
•
•
•
•
Patient received a new prescription for atorvastatin
Patient takes fish oil to help lower cholesterol
Patient takes Benadryl for seasonal allergies
During the encounter, the patient asks if fish oil can be taken with the new medication and if there is something else for allergies that won’t “make me so sleepy”
Case Medication
Complexity
Nonprescription Medication Issue
1
Coumadin
High
Patient takes aspirin for pain
2
Risedronate
Medium
Patient taking calcium/vitamin D and a multivitamin
3
Azythromycin
suspension
Low
Child has been taking acetaminophen for ear pain; parent asks if child can take both*
4
Finasteride
High
Patient taking Tylenol PM (acetaminophen + diphenhydramine)
5
Hydrocodone + acetaminophen
Medium
Patient also taking acetaminophen
*Not included in analysis of MRP identification for classes of 2016 and 2018
7
8
9
10
Results
Nonprescription MRP
Safer alternatives for aspirin
Simulation
1, Class of Take fish oil with atorvastatin
2019
21% (8/38)
47% (18/38)
Non‐drowsy allergy medication
47% (18/38)
Aspirin and warfarin interaction
45% (10/22)
Risedronate with calcium/vitamin D and Simulation multivitamin
2, Class of 2018
BPH and antihistamine
Hydrocodone/APAP and OTC APAP
11
% Correct
27% (6/22)
18% (4/22)
67% (16/24)
12
2
1/7/2016
Improvements Made
A Special Thanks To:
• Incorporated the medications used within the cases in the skills labs
• Enhanced the SP checklists to better capture student responses and SP prompts
• Recorded an example video to demonstrate the medication history and counseling encounter
• Increased the time for the high‐stakes case encounters
• Added two opportunities for SP feedback during the high‐
stakes case encounters
Barbara L Eulenberg, BAJS
Director of Standardized Patient Education
and
Mary Launder, MFA
Standardized Patient Educator
Department of Healthcare Simulation
13
14
Questions?
15
3
2/20/2016
Presentation Objectives
TEACHING THE GREY AREA OF
CLINICAL DECISIONS IN SELF-CARE
Presented by: Aimee Dietle, PharmD
Cheryl Abel, Sheila Seed, Kaelen Dunican
MCPHS University
School of Pharmacy- W/M
• Describe a teaching design for exclusions to
self-care
• Identify the successes and challenges of
teaching design
• Incorporate “Grey Areas” into teaching
NMA Conference
February 20, 2016
Background
Objectives
• Self-Care Therapeutics
Exclusion to SelfCare
– Stand-alone course
– Team taught
– Case-based learning
Pharmacologic
Treatment
• Definitions:
Non-Pharm
Treatment
– “Grey-area”
– Treatment with referral
Methods
Strategy:
• Use standardized tables
Goals:
• Improve student knowledge
• Improve ability to make clinical decisions
Textbook Exclusions to Self-Care
Within Figure 5-1: Self-care of headache.
• 3 Standardized Tables
– Table 1: Exclusions to Self-Care
– Table 2: Non-Pharmacologic Treatment with
Referral
– Table 3: Non-Prescription Treatment with Referral
Exclusions to Self-Care
Severe head pain
Headaches that persist for 10 days with or without treatment
Last trimester of pregnancy
<8 years old
High fever or signs of serious infection
History of liver disease or ≥3 alcoholic drinks per day
Headache associated with underlying pathology (secondary headache), except for
minor sinus headache
Symptoms consistent with migraine, but no formal diagnosis of migraine headaches
Wilkinson JJ. Chapter 5. Headache. Handbook of Nonprescription Drugs 2015.
Available at: http://www.pharmacylibrary.com/abstract/811522. Accessed January 4, 2016.
1
2/20/2016
N
N
Y
STAT
N
N
< 8 years of age
Y
STAT
N
N
High fever or signs of serious infection
Y
STAT
N
N
Headache associated with underlying
pathology
Y
STAT
N
N
Last trimester of pregnancy
Y
STAT
N
N
History of liver disease or ≥3 alcoholic drinks
per day
Non-Rx
Medication
Non-Pharm
(Y/N)
Establish that the patient is an
appropriate self care candidate
Referral to
provider/
when?
Table 3: Non-Prescription Treatment
with Referral
Symptoms consistent with migraine, but no
formal diagnosis of migraine headaches
Y
Y
Y
*Patients with uncontrolled high blood
pressure or diabetes
Y
Y
Y
Y
Y
Non-Rx
Medication
Y
STAT
Headaches that persist for 10 days with or
without treatment
Establish that the patient is an
appropriate self care candidate
Non-Pharm
(Y/N)
Severe Head Pain
Table 2: Non-Pharmacologic Treatment
with Referral
Referral to
provider/
when?
Non-Rx
Medication
Non-Pharm
(Y/N)
Establish that the patient is an
appropriate self care candidate
Referral to
provider/
when?
Table 1: Exclusions to Self-Care
N
Results
Challenges
• Student perception
– Critical course evaluations
• Consistency
– Clinical judgement
Successes
• Student perception
– IPPE rotation feedback
– Implementation of concept
– Comfortability
Neither exam grades nor overall course grades differed
Excerpts from Course Evaluations
Excerpts from IPPE Feedback
• “The exclusion criteria is absolutely horrible.
Very confusing and almost impossible to learn.
I recommend taking out the nonpharmacologic treatment with referral
section.”
• “I do not think that putting exclusions to self
care and treatments with referral into tables
was a successful idea.”
• “This class I believe is one of the most helpful
classes not only for me working as an intern,
but as IPPE rotations”
• “We all noticed that there are grey areas and
we will have to figure out how to handle them
when we start working.”
2
2/20/2016
Implications
• Standardized approach
• Introduction to clinical judgement
• Flipped classroom
QUESTIONS?
3
1/12/2016
OBJECTIVES
EVERYONE WANTS TO
BE A MOVIE STAR
MELISSA MATTISON, PHARM D
• EXPLAIN ADDITIONAL WAYS TO ENGAGE STUDENTS THROUGH
ACTIVE LEARNING
• DEVELOP A PLAN FOR INSTITUTING VIDEO INTO THE CLASSROOM
• CREATE A VIDEOMMERCIAL USING SUGGESTED TOOLS
CLINICAL ASSISTANT PROFESSOR
WESTERN NEW ENGLAND UNIVERSITY
WHO, WHAT, WHERE, WHEN, AND
HOW
• 75 STUDENTS IN A REQUIRED 3 CREDIT SELF-CARE THERAPEUTICS
CLASS
• CREATE A COMMERCIAL FROM A LIST OF TOPICS PRESENTED IN CLASS
• IDEALLY 90 SECONDS OR LESS
• INCLUDE ACTIVE INGREDIENT(S), USES, WARNINGS, DIRECTIONS
• SHOULD BE CREATIVE, ENGAGING, FACTUAL
• DECIDE YOUR TARGET AUDIENCE
WILL I BE GRADED ON THIS?
TAKING RESPONSIBILITY FOR THE TOPIC
• YES! AND TESTED ON IT TOO!
1
1/12/2016
Dig a little deeper…
BENEFITS?
FUTURE PLANS…
• MOVE VIDEOMMERCIALS TO BEGINNING OF EACH CLASS OVER THE
ENTIRE SEMESTER
• CONTINUE TO WRITE SOME EXAM QUESTIONS FROM
VIDEOMMERCIALS
• HOLD EACH GROUP RESPONSIBLE FOR CHOSEN MATERIAL
• EXPLAIN ACTIVE LEARNING EARLY ON IN THE SEMESTER
2
Student Awareness of
Celebrity Endorsements
in Self-Care
Cortney M. Mospan, PharmD, BCACP
Nonprescription Medicines Academy
February 20th, 2016
Faculty Disclosure
• I have no relevant financial relationships or conflicts of interest
to disclose
Learning Objectives
• Describe an active learning/self-directed learning activity used
within a self-care course to create student awareness regarding
celebrity endorsements of OTC products and dietary
supplements
• Discuss opportunities for improvement and replication
• Examine student findings from review of celebrity
endorsements
Course Structure
• Nonprescription Pharmacotherapy, Natural Medicines, and
Self-Care I & II Management of Chronic Conditions
– Two semester series
• Spring P1 Year (2 credit hours)
• Fall P2 Year (3 credit hours)
– Class size ~80 students
– Activity incorporated as part of Current Topics lecture (1 hour)
• Second semester lecture
Kardashian Selfie
Isn’t the First
Celebrity Drug
Endorsement to
Endure Federal
Scrutiny
http://www.pharmacytimes.com/news/kardashian-selfieisnt-the-first-celebrity-drug-endorsement-to-endure-federalscrutiny
Lecture Objectives
Assignment Objectives
• Discuss new OTC products that have
been introduced to the market
• Assess emerging topics relating to
self-care and the role of the
pharmacist
• Identify potential sources of
information for patients interested
in using OTC products or
supplements
• Identify a celebrity endorsement for
an OTC product or dietary
supplement
• Determine the level of agreement
between the celebrity endorsement
and available evidence and data
• Determine if the celebrity
endorsement violates OTC and
dietary supplement regulations
Assignment Details
1.
2.
3.
4.
5.
6.
7.
OTC/Supplement
Celebrity Endorsing
Location of Endorsement
Endorsement Claims
Is this in violation of any regulations/legislation?
Evidence from Professional Resources
Are these in agreement? How would you counsel a patient
referencing this resource?
Findings
• Media Searched: Instagram, YouTube, google, Dr. Oz Show
• Celebrities: Kardashian Family, Dr. Oz, Larry the Cable Guy,
Jimmy Johnson, Shaq
• Products: Prilosec, IcyHot products, ExtenZe Male
Enhancement, Proactiv, Garcinia Cambogia, Dr. Oz Green
Coffee Bean Extract Diet Pill
Findings
• 30% of students reported the endorsement violated
regulations affecting marketing of the OTC products/dietary
supplements
• 35% of students reported claims made in the endorsement
contradicted evidence-based literature
• Students selecting the same product/celebrity arrived at
different conclusions
STUDENT EVALUATIONS
QuickTrim®
• http://health.usnews.com/healthnews/dietfitness/articles/2012/03/05/thedangers-of-kardashian-endorsedquicktrim-2
• http://www.populardietpills.net/q
uicktrim-extreme-burn/
• http://www.lasplash.com/publish/
Los_Angeles_Reviews_142/Khloe_
Kardashian_Quick_Trim.php
QuickTrim®
• Student 1: “Yes, [this violates regulations] the Kardashian sisters
were all actually sued over the false claims they made about [Quick
Trim dietary supplements]… This violates DHSEA which means
supplements like this are limited to structure and function claims”
• Student 2: “Doesn’t seem to violate any of the regulations for OTC
supplements because it states that it hasn’t been evaluated by the
FDA, the manufacturer’s address is listed, and it doesn’t make any
therapeutic claims.”
• Student 3: “Yes, Khloe Kardashian is reported false information
about the product, including that there are absolutely no side
effects and that the product is safe since it is all-natural. There was
not sufficient evidence to support her claims for the weight loss
products, but only her personal experience.”
ExtenZe® All-Natural Male Enhancement
• https://www.youtube.com/w
atch?v=wiq93WjJzsg
• http://www.alux.com/mostbizarre-celebrityendorsements/10/
ExtenZe® All-Natural Male Enhancement
• Student 1: “Violated DSHEA in that it increases the size of your
penis and improves sexual performance. It also is in violated
when it says clinically tests as the research done has been a
small study that was underpowered and done by a
shareholder of the company”
• Student 2: “These claims were in violation of false advertising
and claims. Now they use this disclaimer: ‘These statements
have not been evaluated by the [FDA]. EztenZe® is not
intended to diagnosed, treat, cure, or prevent any disease”
• Student 3: “Yes, [it is in violation of regulation], ExtenZe® has
had to settle class action lawsuits in regards to false claims and
advertisements”
Prilosec OTC®
• http://www.prilosecotc.com/
en-us
• http://video.foxbusiness.com/
v/3632871613001/fightingheartburn-with-larry-thecable-guy/?#sp=show-clips
Prilosec OTC®
• Student 1: “…Although Prilosec or its commercials have not been
found of any violations, the drug does nothing for the problems
that cause the heartburn in the first place. These medications treat
the pain associated with heartburn and if the cause goes untreated,
it will just worsen over time.”
• Student 2: “No [the commercial and evidence are not in
agreement], none of the professional resources claim that Prilosec
OTC will result in zero heartburn, but it has been [shown] as safe
and effective for frequent heartburn for up to 14 days. Some
studies showed that it did reduce all heartburn for some of the
patients.”
Future Directions
• Revise lecture to only include Celebrity Endorsement analysis
– Students research PRIOR to lecture and come to class with evaluation
completed
• Students will submit to lecturer before lecture via survey celebrity and
product to allow discussion of students who research the same endorsement
– Students paired in learning groups to present findings (5-6 students)
– Enhance student reporting of evidence
• Students must provide citations and brief summary
• Students must provide legislation/regulation violated and support for decision
– Lecturer to provide a mini-lecture reviewing OTC and dietary
supplements regulation and legislation prior to assignment
• Could be incorporated into an introductory self-care lecture
Implications
• Designed to create awareness of endorsement claims made by
celebrities for OTC products and dietary supplements
• Enables student pharmacists to effectively counsel patients
regarding celebrity endorsement claims
• Students arrived at different conclusions highlighting the need
to re-emphasize legislation and regulation of OTC products and
dietary supplements
• Prevalence of regulation violations and false claims supports
relevance of social media impact on patient preferences
Questions
Cortney M. Mospan, PharmD, BCACP
mospan@etsu.edu
1/12/2016
Training Pharmacists of
Tomorrow to Provide Innovative
Clinical Patient Care Services
Jennifer D. Robinson, Pharm.D.
Kimberly McKeirnan, Pharm.D., BCACP
Washington State Pharmacy Association
Clinical Community Pharmacist (WSPA-CCP)
• Base Education
• CDTAs
• Set Up: Business plan and marketing plan,
documentation filing, CDTA template, etc.
• Diagnosis concepts
• Methods for documentation
• Evidence-Based Clinical Education
• Disease state specific
• Based on the Pharmacists’ Patient Care Process
• Differential diagnosis and when to refer
Used with permission from Washington State Pharamcists
Association
Creation of a Point of Care and Clinical
Services Course
Course Design
• Goals:
• Develop student pharmacists who are competent and confident in their
ability to provide advanced patient care services
• Provide an educational experience focused on specific clinical services that
can be provided in a community pharmacy setting
Pre-Course:
• Students independently complete 10
online modules with quiz prior to class
Live Seminar:
• 8-hour live skills seminar
Student
Assessment:
• Knowledge Assessment
• Patient Case Practical Exam
WSPA-CCP Modules in the Point of Care
Course
Post-Course Survey
• Fundamentals for the Clinical Community Pharmacist
• Allergic rhinitis treatment
Survey Question
N=126/132 students (95.5%)
Strongly
Agree
Agree
Disagree
Strongly
Disagree
• Anaphylaxis (treatment of acute condition, and refill epinephrine autoinjectors)
• Bronchospasm (treatment of acute conditions, and provision of fast acting beta agonist refill)
• Burns
1. I am comfortable providing the services
included in the Clinical Community Pharmacist
Training.
2. I am comfortable recommending
implementation of these services in a
community pharmacy.
3. If I owned a community pharmacy I would
implement these services.
25 (19.8%)
94 (74.6%) 6 (4.8%)
0
0
46 (36.5%)
63 (50%)
14 (11.1%)
4 (3.2%)
0
65 (51.6%)
43 (34.1%) 15 (11.9%)
2 (1.6%)
0
79 (62.7%) 12 (9.5%)
1 (0.8%)
0
• Headaches (including prescribing triptans)
• Human, canine and feline bite prophylaxis
• Insulin refills
• Oral fluoride
• Herpes zoster treatment
• Insect sting treatment
• Swimmer’s ear treatment
• Urinary Tract Infection (UTI) treatment
• Vaginal yeast Infection treatment
4. I am comfortable with knowing when to treat 34 (27%)
and when to refer patients for the services
included.
Neither Agree
or Disagree
1
1/12/2016
Next Steps
References
• Course modifications
• Washington State Pharmacy Association. Clinical Community Pharmacist. https://wsparx.siteym.com/?WSPA CCP. Accessed December 21, 2015.
• Refine cases and assessments
• More time for skills practice before assessment
• Research
• Joint Commission of Pharmacy Practitioners (JCPP). Pharmacists’ Patient Care Process. May 29,
2014. www.aWSPACCP.com/docs/positions/misc/JCPP_Pharmacists_Patient_Care_Process.pdf.
Accessed December 21, 2015.
• 5 chain community pharmacy organizations implementing CDTAs for these
services
• Feasibility and barriers for rural community pharmacies to implement
Questions?
2