A Different Way of Writing

Throughout pharmacy school, the PharmD curriculum has encouraged a critical, systematic way of thinking. Naturally, our documentation skills, whether it be patient care plans or position papers, is structured and almost formulaic by design.

Before arriving at RxBriefCase, I dove into the wild and wonderful world of research at St. Michael’s Hospital. Within the first few days, I realized that this rotation was an immense literary feat, and my first real exposure to writing abstracts, manuscripts and a scientific protocol. Each project had its stylistic quirks, including strict word limits, required headings and specifications for formatting, defined by research journals and scientific bodies. As an example, the study protocol I created needed to follow evidence-based criteria outlined by SPIRIT, an international organization that aims to enhance the quality of clinical trial protocols. 

Now that I have settled in at RxBriefCase, I have been tasked with the creation of an eNewsletter, a critical appraisal of an eCME, a module for MedSchoolForYou and periodic updates on the pharmacy student blog. So far, these have been excellent opportunities to reflect on my writing skills (and that of others), to refine the ability to communicate succinctly and to develop patient/provider-friendly education, albeit challenging at times.

Regardless of the type of writing I encounter, a few things remain tried and true: 

1.     Landscape- know what information is out there; your work should be novel or inform change

2.     Assess- review samples of published work to identify how your piece should be written

3.     Target- be mindful of your audience and select words appropriately

4.     Edit- constantly revise, as this guides your development

5.     Reference- always cite your sources!

Have a safe and happy holiday!

Vivian

Pinky and the Brain

In response to a rising number of deaths, the U.S. Drug Enforcement Administration (DEA) has labelled U-47700, also known by its street name ‘Pink’, as a Schedule I product under the Controlled Substances Act.¹ As of November 2016, at least 46 deaths around the U.S. have been associated with the use of Pink. This includes two 13 year-old boys, who tragically overdosed on Pink obtained from teens who had ordered it online.²

Pink was previously developed in the 1970s as a potential analgesic alternative to morphine. Today, amidst a global opioid abuse crisis, it has concerningly re-surfaced as a new synthetic opioid. With principal manufacturing occurring overseas, Pink’s composition, purity and exact effects are unknown, and it is often encountered with other illicit substances, such as heroin and fentanyl. Furthermore, it can appear in a number of different forms (e.g. powders, tablets), or may be marketed as other prescription products by producers. Evidently, any quantity of Pink could be fatal.

Reports indicate that Pink’s potency is up to 8-fold that of another highly abused opioid, heroin.² As a class, opioids bind to the mu-opioid receptors in the brain, which mediate biochemical responses associated with pleasure and reward. In the event of an opiate overdose, the body’s central nervous system is unable to regulate basic bodily functions. This can lead to slowed breathing, a decline in body temperature and a loss of consciousness. Overdosed persons may also become cyanotic, myoclonic and develop seizures. 

Naloxone, an opioid antagonist, can be used to reverse the effects of various opiates. As of June 24, 2016, naloxone was designated as a Schedule II product, enabling individuals to obtain this potentially life-saving drug from their local pharmacy without a prescription.³ Despite its proven ability to prevent opioid-related deaths, the efficacy of naloxone for Pink overdoses remains unclear. 

In light of the above, where do pharmacists fit in? As one of the most accessible, front-line health practitioners, pharmacists have the ability to recognize the signs of opioid addiction, monitor safe opioid use and refer patients for help. Now, with the advent of naloxone availability in community pharmacies, pharmacists also have a valued role in the safe distribution of and training for naloxone. For more information, please visit the following sites: CAMH, the Drug and Alcohol Helpline and The Works.

Vivian

References

1.    United States of America Drug Enforcement Administration. DEA Schedules Deadly Synthetic Drug U-47700. November 2016. Available: https://www.dea.gov/divisions/hq/2016/hq111016.shtml (accessed December 12, 2016).

2.    CBS News. Police: 2 Utah 13 year-old boys died from dangerous, new synthetic drug ‘pink’. October 2016. Available: http://www.cbsnews.com/news/police-2-utah-13-year-old-boys-died-from-dangerous-new-synthetic-drug-pink/ (accessed December 12, 2016).

3.    Ministry of Health and Long Term Care. Ontario naloxone program for pharmacies. August 2016. Available: http://www.health.gov.on.ca/en/pro/programs/drugs/opdp_eo/notices/fq_exec_office_20160817.pdf (accessed December 12, 2016).

Shots, Shots, Shots!

On December 1, 2016, a great advancement was made to Ontario pharmacists’ scope of practice. Dr. Eric Hoskins, Minister of Health and Long-Term Care, announced that Ontarians will be able to access a broader range of vaccines through their community pharmacy.

Effective December 15, 2016, the amended regulations under the Pharmacy Act will permit pharmacists to vaccinate patients over five years of age against 13 more diseases. These include a number of travel vaccines, including hepatitis A and B, Japanese encephalitis, typhoid and yellow fever. Furthermore, pharmacists will be able to administer the herpes zoster (shingles), meningococcal, pneumococcal and rabies vaccines. A complete list of authorized vaccines can be found here.

Prior to this change in legislation, Ontario pharmacists were only able to administer the annual influenza vaccine, as part of the Universal Influenza Immunization Program (UIIP). Following the implementation of UIIP in 2012, over 1.8 million flu shots have been provided in Ontario pharmacies. This authority will now be expanded to trained pharmacy students and interns.

As demonstrated by the success of UIIP, leveraging the skills, training and knowledge of pharmacists through vaccination programs has benefited patients, and the Ontario healthcare system immensely. In addition to improving immunization rates, pharmacist involvement will increase patient access and convenience by minimizing the need to book vaccination appointments with their primary health provider. Moreover, due to the temperature-sensitive nature of many vaccines, on-site administration will minimize or eliminate stability-related safety issues.

All Ontarians are encouraged to ask their local pharmacist about the availability of various vaccines and any associated costs. Since the majority of vaccines are not publicly funded, patients may be required to pay out of pocket for both the product and its administration.

Vivian

For more information, please visit:

UIIP Program: http://www.health.gov.on.ca/en/pro/programs/publichealth/flu/uiip/

References

OPA Today. “Pharmacists to Provide Travel Vaccinations to Ontario Patients.” December 2016. Retrieved from <https://www.opatoday.com/Media/Default/Scope%20Of%20Practice/Travelvaccines_announcement_FINAL_Dec1.pdf> on December 7, 2016.

Ministry of Health and Long-Term Care. “Making More Vaccines Available in Pharmacies.” December 2016. Retrieved from <https://news.ontario.ca/mohltc/en/2016/12/making-more-vaccines-available-in-pharmacies.html> on December 7, 2016.

To my colleagues at RxBriefCase

Hello and welcome to my first blog entry as the newest member of the RxBriefCase team! As a 4th year pharmacy student at the Leslie Dan Faculty of Pharmacy, I am currently on my 7th block of advanced practice rotations. I currently work in both a community and a hospital pharmacy, and have a role as a teaching assistant for international pharmacy graduates at the Faculty.

Despite being on clinical placements, I have maintained my involvement in several extracurricular activities. These include the Seniors Outreach at the University of Toronto, acting as the Marketing Directors for both the Pediatric and Antimicrobial Stewardship Societies, and most recently, the Pharmasave Business Plan Competition.

From my previous clinical rotations, I have gleaned valuable insights into the areas of pharmacy operations, critical care and research. This research rotation enabled me to develop several quality improvement initiatives, a research protocol and a case series. In addition, I was able to refine my critical appraisal and scientific writing skills, which I aim to apply during this rotation.

Due to the unique nature of this placement, I am excited to learn more about the various CME platforms offered by RxBriefCase, the CCCEP accreditation process, and the opportunities to develop the eNewsletter for pharmacists and other healthcare professionals, the Expert Modules for patients, and the critical appraisal of an eCME.

Lastly, a big thank you for the warm introduction to the rest of the team by my preceptors Cassandra and Janet. I look forward to working closely with everyone over the next 5 weeks!

Vivian

Time flies

I can't believe that I've been at mdBriefCase for 5 weeks already!  My time here just flew by.  As I'm nearing the end of my rotation, I reflected on how rewarding the experience was because it provided me with more insight on what a pharmacist can do outside a community/hospital setting.

Throughout my stay, I had several projects and these assignments helped me develop skills such as:

• Writing.  Over the past few weeks, most of you probably know that I've been struggling with writing.  I've worked on the eNewsletter and short summaries geared to patients.  At the end of my rotation, I can say that I have improved my writing significantly with help from my preceptor and pharmacy mentor.
• Presenting.  Presenting was something that I was relatively comfortable with, but this presentation had to be tailored to non-healthcare professionals.  This was a little more challenging for me, but in the end I think I portrayed the content well.  This is an important skill to have and to develop because in practice, you will be talking to patients in patient-friendly language.  It's important to learn how to speak in a way that is simple and concise so that you get the message across clearly.

I also wanted to take this time to thank everyone at mdBriefCase for being so friendly.  I've thoroughly enjoyed my rotation here and will definitely miss everyone.

There's More Out There

I can't believe I'm already at the halfway point of my rotation!  During my 3 weeks here, I've taken on a few projects and was constantly researching different therapeutic areas.  And that's when it hit me: learning is a lifelong thing and doesn't just stop after you graduate.

Love of Learning 
I got into pharmacy school a few years ago and was set on becoming a community pharmacist. Throughout my rotations, I've become less focused on becoming a community pharmacist, mainly because I want a career path that would allow me to constantly learn.  Don't get me wrong - community pharmacists are always learning.  It's just that I've come to appreciate a more concentrated learning experience.

While at Sick Kids, I was constantly reading articles and updating myself on guidelines.  I was learning something new everyday.  I find that learning in hospital is very different because you are learning about one specific topic, as opposed to community pharmacy where you're learning about a huge spectrum of therapeutic topics.  After experiencing both types of placements, I prefer the hospital setting more where you can become an expert in the field.

At mdBriefCase (non-direct patient care), I am working on an eNewsletter (cold sore management) and patient information sheets on various diseases.  These two projects require a lot of research and I'm learning something new everyday.

Over the next week and a half, I'll be working on more patient information summaries and a critical appraisal presentation, so stay tuned!

Writer's Block is Real

I've been at md/rxBriefCase for a week and a half now and I've  assigned several projects.  Some of the projects I am working on include:

1. Critical appraisal: Are you ready for subsequent entry biologic insulin?
• Throughout my rotation, I will be developing a critical appraisal of this program.  I will analyze and review the pros and cons of the program, as well as draft recommendations for improvement.
2. Content development: Cold sore management
• After some discussion with my pharmacy mentor (Mike), I decided to write an eNewsletter on cold sore management, as a program recently expired but is a hot topic since pharmacists want to learn more.
3. Patient information
• 150 to 200 word patient information summaries on a variety of therapeutic topics

As you can imagine, these projects require a lot of writing.  And, in the past week and a half, I've learned that writing is a huge challenge for me.  It seems I have the tendency to try and make one sentence perfect before I move on to the next. I've also learned that doing so would take too long to complete an assignment.  

I think the most important thing to do is to get ideas on the document and rearrange the format/sentences later.  Even so, getting something down is quite difficult.  

After discussing the issue with my preceptor, she recommended I take breaks and switch between projects.  If I can't think of something to write for one, then I work on a different project. After doing so, I found that I was more efficient. Hopefully, by the end of my rotation, my writing skills will have improved.

That's all for this week.  Tune in next time to see how I dealt with my writer's block!

Hi everyone!

My name is Toby and I am the new pharmacy student at the University of Toronto doing my 4^th Advanced Pharmacy Practice Experience (APPE) rotation at mdBriefCase Group Inc.   So far, I have done placements at Cancer Care Ontario, Sick Kids, and Shoppers Drug Mart.  Additionally, I work part-time at Shoppers just for extra community pharmacy experience. 

I haven’t done anything with Continuing Education (CE) before so this placement is a good opportunity to get some exposure.  During my five weeks here, I’ll be critically appraising a CE program, writing an eNewsletter, as well as keeping everyone updated on the blog.

Stay tuned next week for another post!

Applying my Education to Real Life

An update from Saliha Syeda:

It was my 2^nd last day at rxBriefCase. I was almost done my placement and I had completed all my projects.  So, I starting working on other projects related to Obesity, and suddenly I get a phone call from a family member.  This phone call made me very nervous and worried - a family member was admitted to the hospital due to chest pain.   I will call this family member "AT."  I left early that day from rxBriefCase to go see AT.  When I reached the hospital, AT's vitals were stable, and they were waiting on blood work and final diagnosis from the doctor.

As we were waiting, I started to assess AT myself, and make my own conclusion about the incident.  When assessing AT, I realized AT's medications were not optimally managed. 

AT’s medical background: Diabetes, high blood pressure, and stent inserted due to previous heart blockage. 

I was thinking back to my rxBriefCase presentation which was on "Spotlight on SGLT2 inhibitors", and realized that AT should be on a SGLT2 inhibitor.  I wrote a letter to his family doctor mentioning the superior efficacy of this agent in those with diabetes and clinical cardiovascular disease.  

In terms of AT's chest pain, I mentioned:

1. Doctor will probably ask why did you stopped Ramipril (a very important medication for patients with diabetes for heart and kidney protection) (AT mentioned cardiologist asked them to stop it because they were feeling dizzy)
2. Rule in/out a mini stroke
3. Determine if there was any heart abnormalities through ECG

When the doctor came back 5 hours later, they mentioned the same points.

1. Doctor re-started ramipril at a lower dose for heart and kidney protection
2. Ruled out mini stroke
3. No heart abnormalities (both ECG and blood tests were normal)

In conclusion, due to normal blood test and ECG, they discharged AT with the diagnosis of chest pain.  In terms of the reason behind the incident, they were unable to find the cause.   The doctor did mention the importance of regularly taking medications, as AT’s medications are lifelong to help with his condition.  

The program that I took at rxBriefCase gave me knowledge about SGLT2 inhibitors as a class, as well as review the medical condition diabetes, and for that reason I was able to make an appropriate recommendation for AT.  

Goodbyes are never easy

Look at the time! It's already the end of my rotation at rxBriefCase.  I thoroughly enjoyed this rotation, and feel like I made the most use of my time here.

I started by set out goals for myself to be able to finish my projects ahead of the deadlines.  This is because I knew I worked in a team-based office.  This meant I had to give a few days for other people to edit my work, give me feedback, and make my work presentable.  

Overall, this was quite a different rotation, and I will take the following skills along with me:

• Critically appraise other people’s work (drafts of eCE and programs on rxBriefcase), and receive constructive criticism and feedback about my own work.  
• Develop an eNewsletter (using lots of tables and algorithms, which pharmacists love) 
•  Tailor my language to create patient-friendly material.  I realized this was quite an important skill to have and carry on for my future profession.  English may not be the patient's or the healthcare provider's 1^st language.   As my mentor mentioned, “A Grade 6 tone helps simplify the information and improves communication both ways.”
• Write in a concise, clear, accurate fashion.  I have told many people that writing is not my best skill, so when I first started this rotation, I was a little worried. However, I realized that with practice, your writing skills can develop.  Never let the fear of something steer you away from accomplishing something. 

Thank you to everyone here at rxBriefCase for an amazing journey. 

Don’t forget to check out my previous blogs:

•  Spotlight on patient-centered care vs. customer-service 
•  Update on my time at rxBriefCase 
•  Back to School Already! Tips to Make the Most of Your Time

Saliha

Back to School Already! Tips to Make the Most of Your Time

It is already mid-August, time is flying by, and many will be going back to school. 

Whenever I pass retail stores, all I see is back-to-school supplies.  This is bitter sweet for me, as I am currently in my last year of pharmacy school.  I won’t be returning to classes starting September, and it makes me a little sad (as I won’t be seeing my friends on a daily basis). I have been to University of Toronto for 8 years now.  I would like to share some words of wisdom to those returning to school (whether it’s high school, university, or higher-level education). 

1. Be organized and know your deadlines

Document your exam & assignment dates, volunteer & work schedule, extracurricular activities and meetings on either:

• big calendar
• agenda
• personal organizer
• laptop
• phone app

 2. Be punctual and do not procrastinate

This is actually easier said than done.  However, it is a very important skill to have which can be passed onto your work life.  Make sure you get to your classes on time, and start your projects ahead of time.  It is so easy to get distracted.   If the computer is a huge distraction for you, print your study notes and go to the library instead of studying on the laptop.  Furthermore, study or do your projects in a group, so you can motivate each other to finish.  

3. Ask for help

This is especially important when you are unsure of a problem, or you don’t understand the material.  Ask your professor, other students and your friends.  You do not have knowledge about everything.  Be aware of your weaknesses, and implement ways to improve them.  Asking for help is not a weakness; it’s actually a strength since it allows you to learn something new each day.  

4. Communication is key

If you are running late on a project, unable to complete a task for a group project, or late for a meeting, let people know.  Send a quick email or text them right away, so people are aware of your actions.  People won’t be able to read your mind or your actions without you telling them.  

5. Enjoy your time!

School is only for a few more years, and then you will be working for the rest of your life.  Enjoy school life by participating in extra-curricular activities, making friends and taking the time to explore and try new things.  

I personally will miss the company of my friends and learning new information; however I will not miss the stress of my exams.  To actually survive school life, you need to find the perfect balance between school, work, family and friends. You also need to find ways to deal with stress.  Remember school will shape who you are in the future so take it as learning process and do your best!

Update on my time at rxBriefCase

Upon my arrival at rxBriefCase, two notes were waiting for me, one from Sara (my preceptor) and one from the past APPE student (Jennifer).  In the notes, they both welcomed me to rxBriefCase and the APPE manual 2016/2017 was waiting for me to read.  The manual was so helpful, and divided each task into weeks.  It mentioned all of the steps and requirements of my rotation.

These are my following tasks:

1. Critically appraise one of the rxBriefCase CCCEP-accrediated programs.

Chosen topic: Spotlight on SGLT2 inhibitors: thekidneys role in glucose control in type 2 diabetes.  

I will highlight both strengths and weakness of the program during my presentation in 3 weeks. Overall, on review of the participation, the results were quite positive.  

2. Write the eNewsletter on a topic that is of interest to me and would benefit my peers.

Chosen topic: Vaginal health.  Currently, there are no modules/eNewsletters on this topic.  Many people shy away from discussing this topic, as it is quite an intimate subject.  However, it is important to bring awareness to women’s health and know available treatment options.  It is also important to be aware that we are not allowed to diagnose patients with vaginal infections.  If patients are experiencing it for the first time, they need to be referred to their doctor.   

3. Develop content for medschoolforyou.ca (MSFY), the patient education portal

Chosen topic: Colic and teething. In terms of pediatrics, we usually do not get to see the baby in person.  It becomes very important to know the signs and symptoms of each condition and to be able to make a good recommendation.  Also, it is important to know the age range of each condition and when to refer.

Stay tuned for the completed versions of

Vaginal health: “I have an itch!  Down there!” and

Colic and Teething: “Irritable, crying, fussy baby, and it’s not a fever!”

---

Spotlight on patient-centered care vs. customer-service

From my experience working in a community pharmacy, I have seen many different patients.  Those that understand the role of a pharmacist providing medication therapy management compared to those who only see pharmacists as “pill counters.” 

I have heard lines like:

"It’s a packaged medication; you just have to put a sticker on it.” 

“Doctor prescribed it for me, so it must be right.”

"30 minute wait? I don’t get why it would take so long.”

  

In response to these, I always explain to the patient that at the pharmacy, we provide patient-centered care NOT customer service.  Customer service is the process of ensuring that the customer is satisfied with a product or service.¹ Patient-centered care defined by the Institute of Medicine is “care that is respectful of and responsive to individual patient preferences, needs, and values.²  

Once a person walks into the pharmacy and drops off their prescription, they become our patient.  We are responsible now for them to ensure that their medications are indicated, the most effective, safe and convenient for them (whether it’s timing of medication or cost).  For that reason, we need to take some time to ensure your antibiotic mediation does not interact with your cholesterol medication, and if there is, guide you on what to do.  We need to take some time to ensure the right medication is filled.  We need to take some time and fax your doctor with clarifications on your prescription, as all doctors are humans, and sometimes they can make mistakes.  We need to take some time as there are five other people also waiting for their prescription, and the process of checking needs to be done for each of them for all their prescriptions.  

We may not provide the best customer service (as medications may not be ready in 5 minutes, or it may not be ready at all as problems arose).  However, in the pharmacy, we strive to provide the best patient-centered care.  To ensure no mistakes are being made while filling your prescription.  To ensure that your medication is the most appropriate choice for you based on your age, your allergies, your conditions, your current medications and more.  

  

Pharmacists are more than just “pill-counters.”  I believe patient-centered care is also about respecting each other and developing a mutual relationship that puts the patent in the centre of care. 

In conclusion, people should not expect the pharmacy to be like a fast food restaurant.  When you order your prescription, expect there to be a wait-time to ensure you are receiving the best care possible for you.   Similar to how you wait at a doctor’s office for diagnosis, you should be expected to wait at the pharmacy for medication therapy management

References:

1. Investopedia (2016).  Customer service.   Retrieved on July 25^, 2016 from http://www.investopedia.com/terms/c/customer-service.asp

2. Frampton, S. B., Guastello, S., & Lepore, M. (2013). Compassion as the foundation of patient-centered care: the importance of compassion in action. Journal of comparative effectiveness research, 2(5), 443-455.

The new girl here

Dear readers,

I just wanted to introduce myself, my name is Saliha Syeda.   Just like the previous bloggers, I am a fourth-year pharmacy student at the University of Toronto, completing my 3^rd APPE rotation.  In terms of experience, I have extensive community pharmacy experience that ranges from Shoppers Drug Mart, Walmart and Loblaws.  I am also still currently working at Shoppers Drug Mart as a student, where I sometimes leave rxBriefCase a little early (and do a shift from 6 to 11pm).   Last summer, I also had the opportunity to be an intern for the Ontario Pharmacists Association.  I was part of many amazing projects including an interactive tool for patients with diabetes, and a patient tip sheet regarding self-medication.

Feel free to read the patient tip sheet: https://www.opatoday.com/Self-medication-tips

I have always kept myself busy whether it is work, volunteer, or extracurricular activities.  I love learning new things and staying up to date on information.  I think CE courses are a great way to stay updated.  This is one of the reasons why I wanted to do a placement at rxBriefCase and I look forward to my time here.  Thank you everyone for welcoming me and making me feel comfortable. 

During the next 5 weeks, I will learn more about continuing education courses and how to critically appraise them, work on a newsletter and patient education module. 

Stay tuned for future blog posts about my experiences at rxBriefCase. 

When Less is More

It’s the last day of my time at mdBriefCase and I’m still learning!  I have really come to appreciate the different styles of writing – it all depends on your audience.  Preparing a newsletter for pharmacists was vastly different from preparing a document for patients.

However, there is one thing on which all audiences can agree: they like it brief.  Over the course of my education, I’ve heard time and time again “Be more concise! Only share the MOST important points!”  This is an incredibly difficult skill to master.  More often than not, everything feels important.

While I’m no expert (yet!), I’d like to offer some tips I’ve learned about being concise. 

1. When you begin writing, consider first “What do I want my audience to learn?”  This will help keep your focus on the purpose of the document, as well as your target audience.
2. Then organize your points in a logical order – these will become what we know as “the learning objectives”. From there, make sure each piece of writing contributes to a learning objective. 
3. Then write your heart out!  It is far quicker and easier to cut content than to add new content.  This is especially true when others are editing your document. As Antoine de Saint-Exupéry once said: “Perfection is not when there is no more to add, but no more to take away”.

Good luck!

A Refresher on Motivational Interviewing

Throughout our lives, we may often find ourselves trying to help someone make a change.  At times like these all of us hope to have a positive impact and support others in achieving their goals.

But how? What is the best way to show our support?

In 1991, Miller and Rollnick wrote the first of many books on a new way of talking to people about change:  Motivational Interviewing (MI).¹ MI involves techniques for discussion with those who are ambivalent, to elicit and strengthen their personal motivation for change. ²

To guide an interaction based on MI theory, the situation must first be assessed.  How does the person themselves feel about changing? For this assessment, Rollnick created the readiness ruler:  a simple method for determining readiness to change by asking where a person falls on a scale of 1 to 10.^3,4

Figure 1: Readiness rulers (adapted from Miller & Rollnick 1991; Keller & White 1997)

The readiness rulers are a useful tool to initiate any discussion surrounding change. With information on conviction and confidence, we can then apply appropriate strategies for different degrees of readiness.³

Keller and White (1997) found readiness involves two distinct scales: conviction and confidence.⁵

Figure 2: Factors influencing ambivalence (adapted from Keller & White 1997)

Is the person skeptical? 

Help them explore the pros and cons of change! 

Are they frustrated? 

Guide them to discover their personal strengths!   

Always tailor the discussion to the individual!

Our goal as healthcare professionals is to evoke change talk, to help others recognize the need for change and to help them believe it is possible. ¹  That being said, the most important point to remember is that MI is a partnership – two people working in a respectful, collaborative way.  

While there may be little time for pharmacists to have long discussion, we are still the most accessible health profession. As such it is imperative to communicate effectively in the time we have – I hope this helps!

References

1.           Miller, W. & Rollnick, S. Motivational interviewing: preparing people to change addictive behavior. (New York : Guilford Press, 1991).

2.           Foxcroft, D. & Al., E. Motivational interviewing for alcohol misuse in young adults. Cochrane Database Syst. Rev. 8, CD007025 (2014).

3.           Najavits, L. M. Treatment Improvement Protocol Series: Enhancing Motivation for Change in Substance Abuse Treatment. Subst. Abus. Ment. Heal. Serv. Adm. Cent. Subst. Abus. Treat. 1–27 (1999).

4.           Hesse, M. The Readiness Ruler as a measure of readiness to change poly-drug use in drug abusers. Harm Reduct. J. 3, 3 (2006).

5.           Keller, V. F. & White, M. K. Choices and changes: A new model for influencing patient health behavior. J. Clin. Outcomes Manag. 4, 33–36 (1997).

A Career of Lifelong Learning

Hello rxBriefCase! As a big fan of continuing education (CE) programs, I am grateful for this type of unique pharmacy experience.  The importance of continuing education is unquestionable; as healthcare professionals we are accountable to provide competent care to our patients throughout our careers.

To accomplish this, we must maintain and continuously develop our knowledge, skills and attitudes in the ever-changing healthcare system.¹

Over the next 5 weeks, I will be reviewing a current CE program available for pharmacists as well as producing an e-Newsletter for rxPassport and a mini-module in medSchool For You’s Pharmacy Corner. I hope they will be as enriching to read as they will be to create!  

It is pretty incredible to see all the various roles and components that contribute to the launch of a CE program.   Understanding the foundation upon which continuing education is based really helps you appreciate the time and effort that goes into building these modules. Learning to write continuing education content while simultaneously being a user of these programs enhances all aspects of the learning experience. 

In fact, practicing these different tasks – such as writing continuing education content and participating in continuing education - in a random order has been shown to result in better retention of concepts than practicing them in a blocked order: this is known as the contextual interference (CI) effect.²  Where blocking involves practicing one skill at a time, contextual interference mixes practice on several related skills together.³  This technique produces enhanced performance across disciplines, spanning from athletic training to problem solving in academia.^3,4

 

This approach to learning is increasingly applicable when noticing features among a list of competing alternatives is part of the task; contextual interference helps learners to more quickly estimate the impact of ideas on a case, which I know will absolutely be an asset in pharmacy practice! ^{4, 5}

Again, I am so fortunate for this rotation – good luck to all you lifelong learners!!

1.   Canadian Nurses Association. Professional Development. (2016). at https://www.cna-aiic.ca/en/professional-development. Accessed May 11, 2016.

2.   Lin, C.-H. J., Wu, A. D., Udompholkul, P. & Knowlton, B. J. Contextual interference effects in sequence learning for young and older adults. Psychol. Aging 25, 929–939 (2010).

3.   Pan, S. The Interleaving Effect: Mixing It Up Boosts Learning. Sci. Am. (2015). at http://www.scientificamerican.com/article/the-interleaving-effect-mixing-it-up-boosts-learning. Accessed May 11, 2016.

4.   Helsdingen, A. S., van Gog, T. & Merrie, Vannboer, J. J. G. The effects of practice schedule and critical thinking prompts on learning and transfer of a complex judgment task. J. Educ. Psychol. 103, 383–398 (2011).

5.   Hatala, R. M., Brooks, L. R. & Norman, G. R. Practice Makes Perfect: The Critical Role of Mixed Practice in the Acquisition of ECG Interpretation Skills. Adv. Heal. Sci. Educ. 8, 17–26 (2003).

School’s not out: The value of continuing education

My experience at mdBriefCase allowed me to explore and evaluate the importance of continuing the pursuit of professional knowledge, even after graduation. By investing in educational programs and opportunities, health professionals obtain up-to-date knowledge and skills, and are able to provide the best patient care.¹ Continuing education (CE) ensures that the best evidence is known, understood and practiced by health professionals.²  

CE is also effective at improving patient outcomes, which naturally leads to greater patient satisfaction.² Pharmacists can use the knowledge and skills acquired through participation in CE courses to expand their pharmacy practice and to enhance patient care.

My experience stretched beyond an appreciation of the continuing education materials produced at mdBriefCase. This placement was a learning experience in itself: learning about the broad range of opportunities, such as medical writing, that are available to pharmacists upon graduation. It emphasized the importance of searching available options, in whatever stage of your career, and pursuing the one or two (if not more!) in which you are interested. Regardless of the path we choose to pursue as pharmacists, one thing is certain: keeping up-to-date with new knowledge and skills is essential to enhance our level of patient care and excel as health care providers.

References

Continuing education for health professionals. WHO. (2016). Accessed March 28, 2016 http://www.who.int/genomics/professionals/education/en/

The Benefit of Continuing Education (CE) to Patients and the Public. Alliance for CE in the Health Professions. Accessed March 28, 2016. file:///C:/Documents%20and%20Settings/pharmacystudent/My%20Documents/Downloads/Focus_on_Benefit_of_CE.pdf

Enhancing Mental Health Management in the Community

Patients living with mental health conditions are frequently encountered in the community pharmacy.¹ Although supporting patients with a mental illness is crucial when providing patient care, this can be difficult. Given the current challenges in mental health care including accessibility, timeliness, and continuity of care, it comes as no surprise that patients with mental health conditions are prone to “falling through the cracks” while navigating the complex healthcare system.²

Pharmacists are ideally positioned to play a larger role
in supporting patients with a mental illness.1

Optimal medication management is essential in the care of patients with a mental illness. Pharmacists are a valuable resource to assess the appropriateness of therapy; detect and resolve or prevent drug related problems; provide comprehensive patient information; and address emerging side effects.1 Furthermore, community pharmacists are highly accessible to patients and can often be a first point of contact within the healthcare system, providing health system navigation support and facilitating referrals and triage.^{1, 2, 3}

However, challenges to providing mental health support and management may prevent patients from receiving this level of care. In a survey conducted by the National Alliance on Mental Health (NAMI), 75% of patients with a mental health condition reported seldom to never receiving safety and effectiveness monitoring assistance from community pharmacists.⁴ Barriers to optimal management include lack of privacy, lack of time, competing interests in community pharmacy, lack of awareness on services available to patients with mental illnesses and how the patients could access these services, and lack of therapeutic-based training.³

Pharmacists can make simple changes to improve
the care of people with a mental illness.⁵

Addressing medication adherence and follow-up, connecting with the prescribers of psychotropic medications, and performing regular medication reviews are all effective ways that pharmacists can increase the care they provide to patients with mental health conditions.5 As the pharmacy scope of practice continues to expand, pharmacists need to actively engage patients living with a mental illness and address their concerns to enhance patient care and improve patient outcomes.

References

1. Rubio-Valera, Maria, Timothy F. Chen, and Claire L. O’Reilly. “New Roles for Pharmacists in Community Mental Health Care: A Narrative Review.” Ed. Luis Salvador-Carulla, Alan Rosen, and Ana Fernandez Sanchez. International Journal of Environmental Research and Public Health 11.10 (2014): 10967–10990. PMC. Web. 16 Mar. 2016.
2. Murphy, Andrea L. et al. “Partnering to Enhance Mental Health Care Capacity in Communities: A Qualitative Study of the More Than Meds Program.”Canadian Pharmacists Journal: CPJ 148.6 (2015): 314–324. PMC. Web. 16 Mar. 2016.
3. Murphy, Andrea L. et al. “Community Pharmacists’ Experiences in Mental Illness and Addictions Care: A Qualitative Study.” Substance Abuse Treatment, Prevention, and Policy 11 (2016): 6. PMC. Web. 16 Mar. 2016.
4. “NAMI/CPNPF Survey Finds 75 Percent of Individuals with Mental Health Conditions and their Caregivers Don't Receive Medication Monitoring from Pharmacists.” National Alliance on Mental Illness. (2012)
5. Boivin, M. “Mental Health Champions.” Pharmacy Business. (2015). http://digitalmedia.pharmacyu.ca/PB2015November/index.html#p=1