Transcript evidence-based pharmacy

Patient Safety Content in the COP
Curriculum
COP Departments –
Teaching Mission
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Medical Chemistry (Medicinal Chemistry Foundations I &II, Nucleotides,
Pharmacodynamics (Physiological Basis of Disease I&II, Microbiological
Basis for Therapy, Pharmacology, Pharmacological Basis of Therapeutics
I&II)
Pharmaceutics (Dosage Forms I&II, Dose Optimization I&II, Dosage Forms
and Contemporary Practice, Clinical Biochemistry, Herbal Medicines)
Pharmaceutical Outcomes and Policy (Quantitative Methods, Introduction
to Pharmacy Health Care, Professional Communications, Evidence-based
Pharmacy, Legal and Organizational Medicine Use, Pharmacoeconomics)
Pharmacy Practice (Practicum I-IV, Drug Therapy Monitoring,
Pharmacotherapy I-VI, Pharmaceutical Skills Lab I&II)
Total: 146 credits (including 8 elective credits)
INTRODUCTION
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TO
PHARMACISTS, PHARMACEUTICALS AND
THE HEALTHCARE SYSTEM
This course introduces the pharmacy student to the relationships of
patients, pharmacists, and other health care professionals with the
institutions that control medication use; tools and attitudes
necessary to provide patient care; the concepts of health and
illness, and patient behavior; legal issues of pharmacy practice; how
health care systems, of which pharmacy is a part, seek to meet the
goals of equitable access, reasonable cost, and high quality. These
areas of knowledge are essential to understanding pharmacy
practice, and will guide the student throughout their curriculum
towards the goal of becoming a practicing pharmacist.
Delivery: Lectures, Text Book: McCarthy RL & Schafermeyer KW.
(2007). Introduction to Health Care Delivery: A Primer for
Pharmacists, Cases, Group Discussions
Assessment: Cases (group work, essay); Multiple-choice
LEGAL
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ORGANIZATIONAL ENVIRONMENT
OF
MEDICINES
USE
This course describes the governmental framework within which
pharmacy is practiced. The legal and ethical basis of pharmacy
practice is emphasized. Best pharmacy practices and managed care
approaches are presented and discussed.
EVIDENCE-BASED PHARMACY –
OBJECTIVES
Methods for evaluation and improvement of drug therapy outcomes
including critical appraisal of drug and clinical service literature, and
quality assessment and improvement techniques with special focus on
patient and medication safety
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Find and evaluate published medical literature for clinical decisionmaking, understand scientific reasoning and the research process
Describe how clinical findings are summarized in evidence reports
Describe current evidence on the assessment and improvement of
patient safety, the epidemiology of medication errors & ADEs
Devise ways to assess the quality of pharmacotherapy in pharmacy
practice and its effect on patient outcomes and health care cost.
Identify options for change in practice that are feasible and effective
Describe how to design, establish, and evaluate quality improvement
programs.
EBP –
COURSE PHILOSOPHY
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IOM report on reinventing the healthcare system:
Consequent application of evidence to healthcare delivery
Full adoption of quality improvement through IT and systems that
reward quality
Transition from individual to population-based care
Students don't appreciate patient safety issues
They don't feel responsible
Students love to be smart and to be drug experts
COURSE STRUCTURE
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4 campuses, 300+ students
Lectures (online; 3/week)
Discussion groups (6 groups, weekly, 2 hours, with polling tools)
Quizzes (weekly, online or via "clickers")
Midterm (4 hours, article critique)
Final project ( groups of 5, QI project, background paper, formal
presentation with external judges)
EBP –
COURSE CONTENT
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Critical literature appraisal will address the following issues
Introduction to evidence-based medicine
Retrieval methods for primary medical literature, drug references
and other evidence sources
Methods for the critical literature appraisal
Study types and their relevance to study validity and application in
practice
Interpretation of epidemiologic measures of frequency and risk
Threats to validity (confounding, bias, random error), hypothesis
testing and scientific reasoning
Methods and resources for evidence summaries (meta-analysis,
evidence reports, clinical guidelines)
EBP –
CONTENT II
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Quality assessment and improvement
Definitions and elements of quality; quality deficits in healthcare
Means to measure quality and current applications; selection of highpriority areas for QI
Methods to explore and explain variation in quality, benchmarking
Selection of QI strategies and plans for implementation & evaluation
Patient and drug safety
Review of drug safety information, methodological issues related to
pharmacovigilance and post-marketing studies
Epidemiology of patient safety and medication errors, ascertainment
and analysis of medication error data
Examples of medication safety initiatives
INTERVIEW
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DATA ENTRY FORM
http://www.cop.ufl.edu/safezone/ned/formg
en/5213b.htm
Patient demographics
 Diabetes Outcomes (labs,
complications, healthcare utilization)
 Diabetes care (prevention, drug
therapy, monitoring)
 Diabetes-related quality of life
 Diabetes Knowledge
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Hba1c, %
HbA1c
<=7
Missing
23
19.0%
98
81.0%
121
100.0%
Count
Column %
Count
Column %
Count
Column %
>7
Total
Patient DM
Knowledge
summary score
>= 10
< 10
valuehba1c, %
60
50
40
30
Frequency
20
10
Std. Dev = 1.90
Mean = 8
N = 273.00
0
5
7
6
9
8
valuehba1c, %
11
10
13
12
15
14
17
16
18
LDL
<100
25
41.7%
35
58.3%
60
100.0%
BMI
N
Mean
>= 29.00
< 29.00
156
115
8.254
8.097
Std.
Std. Error
Deviation
Mean
1.962
.157
1.833
.171
Total
>=100
20
21.7%
72
78.3%
92
100.0%
68
24.9%
205
75.1%
273
100.0%
N
Mean
Std. Deviation
Std. Error Mean
121
152
7.901
8.402
1.861
1.912
.169
.155
FINAL PROJECT
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Problem statement
Selection of a QI target
Selection of process and outcomes measures
Selection / development of intervention
Study design, statistics
Study significance
FAMOUS STUDENT
Thus, there is a
great capacity to
reduce morbidity
and morality with
the use of ACE-I.
“The causal
association is
temporarily
seen in the
study.”
INSTRUCTOR QUOTES
Recall bias is unpredictable
because there were 19
countries participating and it is
hard to figure out whether there
were cases more likely to think
harder about whether exposed.
The strength of
an RCT is that
subjects are
human.
“Randomization
levels the playing
field and blinding
keeps the game
fair.”
AND
“The authors of the
study except of the
two associated with
Merck were wellpositioned and
educated.”
“Attrition bias was
minimized by
adding more
subjects to the
study after drop
out.”
The dose in the
placebo group was
not mentioned.
“The control
group received a
fair fight.”
Efficient use of highlighter
Study
subjects are
human and
random.”
“Attrition was
slightly
similar.”
“The bias renders
the findings
reconsiderable.”
All the authors
appear wellpositioned to conduct
the study, but they
were all from
different countries
and I wonder how
well they were able
to communicate with
each other.
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