Background: Mentors often provide advice to students regarding selection of Advanced Pharmacy Practice Experience (APPE) rotations to strengthen their candidacy for a residency position. However, the impact of APPE characteristics on the chances of matching is unknown. Objective: To determine the impact of APPE characteristics on Post Graduate Year-1 (PGY1) residency match rates at a Midwest US college of pharmacy. Methods: Graduates from a single college of pharmacy who participated in the PGY1 match in 2015 or 2016 were included. Match data were obtained from National Matching Services. APPE characteristics (e.g., rotation timing relative to the Midyear Clinical Meeting [MCM], rotation type, and setting) were stratified by matched status. Independent predictors were identified using multivariate logistic regression and tree-based models. Results: Ninety-nine students were included with 57 matching (57.6%). Students completing an infectious diseases rotation (75 vs. 51%; p = 0.028), a hospital rotation before the MCM (67 vs. 47%; p = 0.039), or a rotation in an ambulatory care clinic (67 vs. 47%; p = 0.045) were more likely to match. Students completing an independent community pharmacy rotation were less likely to match (8.3 vs. 64%; p < 0.001). After multivariate adjustment, all of these factors were associated with the likelihood of matching except completion of an infectious diseases ( p = 0.077) or ambulatory care rotation ( p = 0.073). Conclusion: A hospital rotation prior to the MCM was positively associated with matching while completion of an independent community pharmacy rotation was associated with non-matched status. The utility of these findings in guiding APPE selections for students pursing residency should be explored.
Changes to the U.S. health care landscape have increased the focus on the quality and use of alternative payment models, with a growing focus on value. As health care costs continue to rise, clinical pharmacists will increasingly engage in roles to expand the breadth and depth of clinical services in providing comprehensive medication management (CMM) to improve patient outcomes. The roles of pharmacy technicians and other support personnel must evolve to meet the needs created by this practice change and allow pharmacists to focus their services on activities that use their expertise to improve medication outcomes. Support personnel, including pharmacy technicians, should be identified to assist with clinical pharmacy tasks on the basis of their skills. To ensure competence, support personnel should be adequately trained and (if applicable) certified. Moreover, support personnel should be optimally incorporated into appropriate components of the clinical pharmacist's process of care to expand the reach and depth of clinical pharmacy services. When supervised by the pharmacist or others as defined in state practice acts, support personnel may be able to assist in the clinical pharmacist's provision of CMM. Finally, research should be conducted and disseminated on the utility and outcomes achieved using support personnel in the clinical pharmacist's process of care.
Competency standards in pharmacy education and training have been formulated by different organizations to focus on various stages in the development of students, residents, and clinical pharmacists. This commentary advocates a deliberate alignment of educational outcomes, goals, and competencies across the developmental continuum of students, residents, and pharmacy practitioners. Consistent use of terminology and appropriate sequencing of expectations will help develop pharmacists who can meet the demands of the profession in the changing health care landscape.Progressive development is needed for the pharmacist's abilities, from student to resident to new practitioner to experienced professional. Consistency will ensure that educational and training programs optimally prepare individuals for board certification and professional roles. Specific recommendations include developing a common taxonomy that aligns within the pharmacy profession and across health care professions. K E Y W O R D Sclinical pharmacist, pharmacist competency, pharmacy education
BackgroundPatient online drug reviews are a resource for other patients seeking information about the practical benefits and drawbacks of drug therapies. Patient reviews may also serve as a source of postmarketing safety data that are more user-friendly than regulatory databases. However, the reliability of online reviews has been questioned, because they do not undergo professional review and lack means of verification.ObjectiveWe evaluated online reviews of hypnotic medications, because they are commonly used and their therapeutic efficacy is particularly amenable to patient self-evaluation. Our primary objective was to compare the types and frequencies of adverse events reported to the Food and Drug Administration Adverse Event Reporting System (FAERS) with analogous information in patient reviews on the consumer health website Drugs.com. The secondary objectives were to describe patient reports of efficacy and adverse events and assess the influence of medication cost, effectiveness, and adverse events on user ratings of hypnotic medications.MethodsPatient ratings and narratives were retrieved from 1407 reviews on Drugs.com between February 2007 and March 2018 for eszopiclone, ramelteon, suvorexant, zaleplon, and zolpidem. Reviews were coded to preferred terms in the Medical Dictionary for Regulatory Activities. These reviews were compared to 5916 cases in the FAERS database from January 2015 to September 2017.ResultsSimilar adverse events were reported to both Drugs.com and FAERS. Both resources identified a lack of efficacy as a common complaint for all five drugs. Both resources revealed that amnesia commonly occurs with eszopiclone, zaleplon, and zolpidem, while nightmares commonly occur with suvorexant. Compared to FAERS, online reviews of zolpidem reported a much higher frequency of amnesia and partial sleep activities. User ratings were highest for zolpidem and lowest for suvorexant. Statistical analyses showed that patient ratings are influenced by considerations of efficacy and adverse events, while drug cost is unimportant.ConclusionsFor hypnotic medications, online patient reviews and FAERS emphasized similar adverse events. Online reviewers rated drugs based on perception of efficacy and adverse events. We conclude that online patient reviews of hypnotics are a valid source that can supplement traditional adverse event reporting systems.
Introduction Inpatient clinical pharmacists' roles and contributions to team‐based care are well established; however, there is limited evidence describing the activities and processes for the delivery of care by ambulatory care clinical pharmacists. Objectives The primary objective was to measure time spent on daily activities that comprise the workload of clinical pharmacists providing direct patient care services in an integrated ambulatory care setting. Methods A prospective, ethnographic, and observational pilot study was conducted at six pharmacist‐integrated multidisciplinary ambulatory care clinics. Clinical pharmacist participants were observed for up to three nonconsecutive clinic workdays. Participant demographics, site characteristics, and self‐reported engagement in direct patient care activities were collected. Workload was evaluated through direct observation of time spent on daily clinical and administrative activities. Time allocated, visit type, number of disease states assessed, and use of clinical support staff were collected for each visit. Results were stratified based on participant engagement in targeted, dual, or comprehensive medication management (CMM) visits, in which one, two, or three or more disease states were assessed, respectively. The primary outcome was analyzed using descriptive statistics. Results Ten clinical pharmacists were observed for a total of 26 clinic workdays. Of prespecified activities, clinical pharmacist participants spent the most time documenting care activities, spending a mean (SD) of 6.6 (6.7), 8.0 (8.2), and 7.6 (7.7) minutes after targeted, dual, and CMM visits, respectively. There was a large variation in the distribution of prespecified clinical and administrative activities among participants. Years of practice experience, postgraduate training, board certification(s), duration of practice at the site, and site characteristics did not affect the distribution of time spent on activities (P > .05). Conclusions This evaluation articulates the daily activities that contribute to the work of ambulatory care clinical pharmacists and may serve as the foundation to perform more comprehensive evaluations of their contributions to patient outcomes.
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