Community pharmacists are highly accessible health care professionals, with many opportunities to increase patient access to health services. As local health departments continue to reduce clinical services, community pharmacies are well positioned to provide access to many of these services, including tobacco use cessation. The Kentucky Board of Pharmacy authorized protocol on tobacco use disorder allows for pharmacists to manage patients’ smoking cessation treatment. In partnership with an authorizing practitioner, pharmacists can dispense nicotine replacement therapy, bupropion SR, varenicline, and other FDA-approved medication listed in the most current USPHS clinical practice guideline for treating tobacco use for a maximum duration of six months. The Center for Health & Wellness (CHW) is a licensed pharmacy within the Sullivan University College of Pharmacy and Health Sciences. In 2018, the CHW and Louisville Metro Department of Public Health and Wellness (LMPHW) partnered to develop a pharmacist-driven tobacco cessation therapy service, with the LMPHW Medical Director as the authorizing protocol practitioner. This planning process included the development of pharmacist education, training modules, and patient education materials, as well as clinical documentation, referral, and notification procedures. Under this partnership, the CHW will 1) serve as a community referral site for LMPHW tobacco cessation inquiries; 2) educate student pharmacists in tobacco use disorder and cessation therapies; and 3) develop an implementation model for practicing pharmacists to offer this service in their communities. This partnership model is not limited to tobacco cessation, as it is also applicable to tuberculin skin testing, opioid use disorder, and other services.

Background: Traditionally, individuals with chronic conditions do not leave jail with a supply of discharge medications. This contributes to making re-entry from the criminal justice system a time of high morbidity and mortality, with a 12.7x increased risk of death within the first two weeks. Practically, results in many clinical challenges, such as psychiatric decompensation, diabetic ketoacidosis, and seizures. Additionally, this also leads to unnecessary emergency department visits and inpatient hospitalizations.

Methods: Given the challenges individuals returning from the criminal justice system have accessing care as they work to obtain healthcare coverage, the Whole Person Care Program (WPC) in the Los Angeles County Jails, the nation’s largest jail system, developed a system for discharging high-risk individuals with a 30 day supply of medications. The team also developed a framework or billing those who are Medicaid eligible for the medications received at discharge. This included the discussions with the state, thinking through the process for discharge medications, obtaining the proper licensing, and negotiating with the Medicaid managed care plans.

Results: Over 90% of individuals with chronic conditions eligible for medications in the WPC Program are being discharged with a 30 day supply of all of their medications. The billing process is currently being implemented.

Conclusion: This project demonstrates the ability to bring together custody, pharmacy, and transitions of care teams to create a way to provide and pay for discharge medications from the correctional health setting to high-risk individuals as they re-enter the community.

Objective

Report of adverse drug reaction (ADR) is one the most important services in clinical pharmacology. A good ADR report and propaganda, a complete establishment of allergic history, a comprehensive ADR monitoring, analysis and prevention and a well-designed ADR follow-up are all critical to prevent ADR in order to increase patient medication safety.

Methods

This study analyzed and explored the adverse reaction types of ADR events through a descriptive method, targeting reported cases of adverse reactions of drugs from 2017 to 2018. Based on data obtained from Type A/Type B, whether different age groups produced different values was analyzed to further analyze causes.

Results

Of the 139 ADR cases tallied in this study, minors (under 18 years old) Type A accounted for four cases and Type B accounted for 11 cases. The ratio of Type A and Type B is about 0.36; among adults (18-65 years old) Type A accounted for 21 cases and Type B accounted for 49 cases. The ratio of Type A/Type B is about 0.43; among the elderly (more than 65 years old), Type A accounted for 25 cases and Type B accounted for 29 cases. The ratio of Type A/Type B is about 0.86.

Conclusions

After the analysis, it was found that the ratios of Type A/Type B obtained from different age groups varied. The higher the age, the greater the likelihood for ADRs under Type A to occur. It appeared underestimation of patient compliance and medication accuracy may be the source of ADR.

Background: With increasing diversity in the US population, pharmacists have to deliver care to persons from diverse cultures. To help students develop required competencies, an annual Cultural Competency Case Competition was adapted to an elective course. Learning objectives included:

• acquiring knowledge of cultural identity and cultural difference;
• developing cultural awareness and skills to interrogate one’s beliefs and assumptions; and
• application of relevant knowledge and skills to patient care delivery

Methods: In addition to three workshops, students were grouped into teams of 3–4 students; a mix of PD1-PD3 students. A patient case detailing cross-cultural provider-patient interactions was provided. Each group was required to (1.) write appropriate SOAP notes; (2.) write a group reflective essay identifying provider stereotypical assumptions/biases; and (3.) make a video recreating the pharmacist-patient care encounter to reflect a more culturally-responsive approach. Teams were evaluated for clinical and cultural competencies using pre-set criteria. Individual reflection papers helped students interrogate their own beliefs and assumptions. A post-course survey was administered for student self-assessment.

Outcomes: Most students indicated moderate to high levels of (a.) self-awareness of stereotypical assumptions/biases; (b.) confidence in ability to effectively engage and communicate with patients of diverse cultural background; and (c.) self-efficacy to deliver culturally-responsive care . Reflection papers and videos demonstrated intermediate knowledge and skill levels in relevant competencies

Conclusion: Using multiple strategies to build relevant competencies is a promising approach that should be further explored. Ability of pharmacists to provide culturally-responsive care to diverse patient groups can help reduce health disparities.

Postgraduate Year One (PGY1) Managed Care Pharmacy Residency programs strive to train pharmacy graduates to improve population health by offering a broad range of clinical and operational services. A required competency for accredited programs is the completion of a practice-related project, yet it is up to each program to determine how best to incorporate this requirement. Residency directors and preceptors may not have the needed expertise to facilitate a research-intensive project. This submission describes lessons learned from a newly accredited residency program obtained from analysis of the accrediting organization’s feedback, interviews with current and past residents and preceptors, and personal reflection. First, it is important to plan and start the research project early since it involves several time-intensive steps (e.g., IRB approval). Second, select a practical and meaningful research topic. Resident interviews indicate that it is more rewarding if the research can potentially be implemented within the organization. Third, expose the resident to a diverse range of research activities and skip some nuances without sacrificing resident understanding. Fourth, provide training to preceptors, focusing on their ability to compare and contrast various study designs and different statistical techniques. Having additional expertise in data collection and cleaning is also important. Lastly, the residency director or preceptor should help the resident manage time, prioritize tasks and balance work and life. Research support to our resident has evolved from one preceptor to an interdisciplinary advisory group and as a result the outcome has improved from a "check the box requirement" to meaningful operationalized implementation.

The current healthcare environment has increased the demand for public health professionals in diverse career paths. The scope of practice is expanding for pharmacists as primary health providers, including recognition as health professionals whom consistently promote and implement public health initiatives with local, state, national and global impact. Pharmacy curriculum generally does not meet the competencies necessary for students to track into this interdisciplinary practice without the addition of post-graduate courses and training.

The development of a public health concentration was initially driven by student interest and regional community need over the past 15 years. A “Pharmacy Applications in Public Health Concentration” has been implemented utilizing available electives that engages pharmacy students in a 15 credit course sequence that tracks through the each year of the pharmacy curriculum. This includes opportunities to complete a public health research project during the advanced pharmacy practice experience. The core design of the concentration aligns closely with the Council on Education for Public Health accreditation.

The professional concentration focuses epidemiology, pharmacy in public health, social and behavioral determinants of health, environmental health and a capstone research project with both didactic and service learning. Students complete the concentration without additional cost or credit loading. The first cohort was 6 students, followed by the current cohort of 12 students. Enrollment demand has been increasing to the point where course caps are implemented for logistical reasons. Programmatic outcomes will be assessed both during implementation and post-graduation to determine increased professional involvement in public health initiatives and education.

In South Korea, community pharmacy experiential practice (CPEP) is very important because most pharmacists (71.8%) work in community pharmacies, which also employ the majority of students after graduation. The present study investigated student responses to the current CPEP status, suggestions for improvement, and changes in their competency after practice based on evaluation of Community Pharmacy Experiential Practice Model (CPEPM) outcomes.

A nationwide cross-sectional, self-administered online survey was conducted in 2017 for sixth grade pharmacy students who completed CPEP, using 50 survey items. Descriptive analysis was performed to identify the relations between demographics and perception. To identify factors affecting CPEPM outcomes, multivariate linear regression analysis was performed.

Initially, 1,138 students participated in the survey. Of these, 492 students were excluded due to missing data and eventually, data from 646 students were included in the analysis. 95% of students responded in the affirmative that practical training influenced their future career decision. In addition, 78.5% of students were satisfied with the training. Further, they responded in the affirmative that their ability improved based on CPEPM outcomes. The most positive capability change was in the subdomain “personal and professional development”, followed by “inter professional collaboration”.

The findings of the present study are valuable and represent the current student perception of CPEP nationwide. They provide a basis to improve the quality of CPEP-based education not only in Korea, but in other countries as well.

Pharmacists can play a significant role in assisting our patients and providers in curtailing the opioid epidemic. ONE Rx is a patient screening tool used by pharmacists to tailor opioid and naloxone patient education. Patient specific risk factors are collected using the tool and aid in developing an individualized plan. Risk factors are used to determine the potential for opioid misuse or overdose and include history of substance abuse, current medical conditions, and concurrent use of select medications.

Using the transtheoretical model we will examine ONE Rx implementation in community retail pharmacies in North Dakota. We will examine the five phases of the model which include pre-contemplation and contemplation phases of pharmacist decision making in choosing to participate in the ONE Rx program. Preparation phase will include reporting the number of pharmacists (N=242) having completed 3 hours of ONE Rx continuing education. The action phase will describe the number of pharmacy locations (N=55) committed to participating in screening procedures and individualized opioid consultation. Lastly, the maintenance phase will report the numbers of patient screenings (N=660) and pharmacy interventions that have been completed during the maintenance phase of the project. Interventions reported will include partial fill of opioid prescriptions 2.8%, naloxone dispensed 4.3%, medication take back discussed 85.5%, community support services 3.7%, average time spent with patient, and patients identified as ‘high-risk’ for accidental opioid overdose 29%. This presentation will inform attendees on the process of implementing pharmacy practice redesign to address the opioid epidemic.