Enhancing Ambulatory Care APPEs by Incorporating Patient-Centered Medical Home Principles

Objective: Incorporation of various clinical activities during ambulatory care APPEs to achieve exposure to the five principals of a patient centered medical home (PCMH) provide Pharm.D. Candidates at the Wegmans School of Pharmacy with a strong foundation for a future practice in patient centered care. Methods: The APPE is designed to engage students in activities involving the five principals of a PCMH practice. Students that are assigned to complete their Ambulatory Care APPE at one of two Level 3 National Committee for Quality Assurance (NCQA) certified PCMH Family Medicine Residency Training Practices are directly involved in engaging patients in decision making and management of chronic disease states, improve communication directly between patients and providers through the use of an electronic medical record, coordinate care with other health professionals through care transitions, and contribute to the transparency of comprehensive evidence based care of patients through patient education. Results: A total of 26 Pharm.D. Candidates have completed the redesigned APPE that emphasizes the role of a pharmacist in delivering care in a PCMH practice. In the 2012-13 academic year three from a total 11 students pursued post-graduated training and acquired a residency to enhance their clinical and research skills. In the 2013-14 academic year a greater percentage of students pursued advanced training. Eight out of a total of 15 students acquired advanced training in a variety of settings including ambulatory care, managed care, and community pharmacy residency programs. One student intends to pursue an additional certification to enrich her future as community practitioner. Implications: The structured experiences at a certified PCMH practice site has displayed the potential to encourage Pharm.D. Candidates to pursue future careers in various settings to enhance their skills in delivering collaborative patient centered care

Aggressive Anesthetic Management of a Patient with Severely Dilated Cardiomyopathy for Non Cardiac Surgery

We report a case of a 37 year old man, with history of rhabdomyosarcoma as a child. Patient developed severe dilated cardiomyopathy secondary to the treatment of the cancer. He presented for resection of the small bowel. An intra-aortic balloon pump (IABP) was placed preoperatively for mechanical cardiac support. A combined general/epidural technique was used for the surgery. Transesophageal echocardiogram (TEE) was used to monitor patients cardiac status intraoperatively. Patient remained hemodynamically stable and tolerated the procedure well

SGLT-2 Inhibitors: A Novel Mechanism in Targeting Glycemic Control in Type 2 Diabetes Mellitus

OBJECTIVE: To review the chemistry, pharmacology, pharmacodynamics, pharmacokinetics, clinical efficacy, tolerability, dosing, drug interactions, and administration of canagliflozin, dapagliflozin, and empagliflozin, and comparing the benefit and risk aspects of using these agents in the older adult diabetes patient population. DATA SOURCES, STUDY SELECTION, DATA EXTRACTION, AND DATA SYNTHESIS: A search of PubMed using the terms SGLT-2 inhibitors, canagliflozin, dapagliflozin, empagliflozin, efficacy, and tolerability was performed to find relevant primary literature on each of the sodium/glucose cotransporter 2 (SGLT-2) inhibitors currently approved for use in type 2 diabetes. Phase III trials for all agents were included. All English-language articles from 2010 to 2015 appearing in these searches were reviewed for relevance to this paper. In addition, related articles suggested in the PubMed search were also reviewed. The SGLT-2 inhibitors have shown a reduction in hemoglobin A1c values and fasting plasma glucose levels with a low incidence of hypoglycemia. The incidence of mycotic infections is increased in patients taking an SGLT-2 inhibitor. CONCLUSION: SGLT-2 inhibitors may be a viable treatment option for patients not controlled on other oral agents. The risk of hypoglycemia is small. However, the clinical efficacy and tolerability of these agents has not been fully elucidated in older and frail patients

COPD: Optimizing Treatment

A guideline update and an expanded armamentarium have many physicians wondering how best to treat patients with COPD. Chronic obstructive pulmonary disease (COPD) carries a high disease burden. In 2012, it was the 4th leading cause of death worldwide.1,2 In 2015, the World Health Organization updated its Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines, classifying patients with COPD based on disease burden as determined by symptoms, airflow obstruction, and exacerbation history.3 These revisions, coupled with expanded therapeutic options within established classes of medications and new combination drugs to treat COPD (TABLE 1),3-6 have led to questions about interclass differences and the best treatment regimen for particular patients

Effective Use of Team Based Learning in a Flipped Classroom

This roundtable presentation highlighted the components of team based learning activities in a flipped classroom. The instructional techniques to maximize knowledge application and critical thinking are described. Additional student performance and level of satisfaction with this course design in comparison to lecture based course design in previous years is evaluated

Pharmacy Student-Led Evaluation of Patient Willingness for Smoking Cessation Utilizing Various Smoking Cessation Methods

Purpose: The ever-growing variety of methods available for smoking cessation have the potential to lead to confusion influencing a patient’s willingness to quit smoking. The aim of this study is to investigate if a change in patient motivation and product preference has occurred after receiving education on the various smoking cessation products Methods : An informative poster was created to highlight different smoking cessation methods .A questionnaire was developed to assess patient motivation to quit utilizing the ‘Readiness to Quit Ladder’ and patient experiences with or preference between various smoking cessation methods.1The poster was displayed in various pharmacy settings, including community pharmacies, ambulatory care clinics, and smoking cessation group visits. Motivation to quit was assessed prior to and following a brief educational discussion and presentation of the poster. Results and Discussion: Education on various methods of smoking cessation products did not significantly improve motivation to quit, likely due to the fact that patients included in the study presented high motivation at baseline. The majority of patients had made previous attempts to quit smoking in the past, and the nicotine replacement patch was used more often than other smoking cessation methods. Following education a greater number of patients were likely to use prescription smoking cessation methods. Patients were reluctant to discuss their smoking habits and previous attempts quitting. There was limited participation in the survey in the community pharmacy setting. This may be due to unease or aversion to discuss the topic in a public space or due to people’s limited experiences in having clinical conversations in a community pharmacy setting

Sitagliptin Associated Pancreatic Carcinoma: a Review of the FDA AERS Database

Purpose: Sitagliptin is a dipeptidyl peptidase-4 (DPP-4) inhibitor used in the treatment of type 2 diabetes mellitus in adults, as adjunct to diet and exercise to improve glycemic control. During phase III studies, sitagliptin was shown to cause toxicity to the pancreas, including pancreatitis. To date there is limited information available regarding its association with pancreatic carcinoma. Our goal was to qualitatively and quantitatively review available information in the AERS database in order to provide clinicians with a general understanding of the comparative occurrence of sitagliptin use and pancreatic carcinoma and any clinically relevant characteristics that may be useful in identifying patients at risk

Too Many Cooks in the Kitchen? Interdisciplinary Team Discharge Clinic Prevents Hospital Readmissions

Establishment of Interdisciplinary healthcare teams have shown to improve health outcomes and lower readmission rates in medically complex patients during hospitalization. Exploration of interventions has happened largely during the pre-discharge phase rather than post-discharge. To extend the team based approach, we implemented a pilot study of an interdisciplinary discharge clinic to determine what impact a biopsychosocial approach to care can have on hospital readmission rates. This work was conducted at a large family medicine residency-based practice, and facilitated by a physician, behavioral health clinicians, a clinical pharmacist, nurse care managers, and medical assistant. Patients were seen in the discharge clinic within 7 days of hospital discharge. In addition to patient demographics, data collected prior to visits included the calculation of a LACE score to identify risk of readmission, utilizing the BOOST (Better Outcomes for Older Adults Through Safe Transitions) risk assessment tool to identify high-risk medications. Additional data collected during the team visit included a CESD (Center for Epidemiologic Studies Depression Scale) score and MOCA (Montreal Cognitive Assessment) score to determine any psychosocial barriers to optimizing patient care; these standardized measures were conducted as part of a larger clinical interview. The total number of medications pre- and post-visit were collected along with the number of medication related problems identified following a comprehensive medication review. The primary outcome is the number of patients readmitted in 30 days. Secondary outcomes include average length of visits, total number of medications pre and post visit, number of medication related problems identified, existence of social support systems, and degree of patient satisfaction with the team visit. Future considerations include developing a sustainable, reproducible model for interdisciplinary discharge care that includes a component of inter-professional education

Path to Success: Development of the Pharmacist Through the Continuum of Pharmacy School and Beyond

Objective: To explore the processes and opportunities provided in the co-curriculum of the Wegmans School of Pharmacy (WSoP) that contribute to the development of successful pharmacy graduates. Methods: Pharmacy career preparation begins at orientation with workshops on emotional intelligence, leadership, and the APhA Career Pathway Evaluation Program. During the P1 through P4 years, the optional Student Development Workshop Series (SDW) offers seminars for students on a variety of topics including time management, exam taking strategies/anxiety management, learning styles, personal “brand” creation, CV/portfolio development, and interview soft skills. All students may participate in the annual WSoP Career Day, which offers networking and career opportunities, including post-graduate training options. During the P4 year, there is opportunity for a structured Residency/Fellowship Preparation Program (RPP). Additionally, local pharmacy residents/fellows participate in a Residency Teaching/Learning Curriculum Program (TLC) to develop academic teaching and precepting skills. Results: The SDW program has been successful and well attended with greater than 90% of students finding the topics relevant to their post-graduate success. After the RPP, ASHP residency match results in the 2016 class yielded an improvement from previous years, with 76 % of applied students and 94% of ranked students matching programs in Phase 1. Of the TLC participants, 90% documented an improvement in multiple types of teaching skills. Implications: Based on data and student/faculty input, career development is reassessed and improved continuously at WSoP. In the near future, a method for tracking graduates will be designed to further monitor the impact of programs on student success