patient safety content in the cop curriculum. cop departments – teaching mission medical chemistry...
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Patient Safety Content in the COP Curriculum
COP Departments –Teaching Mission
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 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 AND 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
Find and evaluate published medical literature for clinical decision-making, 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
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
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
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
Quality assessment and improvement Definitions and elements of quality; quality deficits in healthcare Means to measure quality and current applications; selection of high-
priority 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 AND DATA ENTRY FORM
http://www.cop.ufl.edu/safezone/ned/formgen/5213b.htm
Patient demographics Diabetes Outcomes (labs,
complications, healthcare utilization) Diabetes care (prevention, drug
therapy, monitoring) Diabetes-related quality of life Diabetes Knowledge
BMI N Mean Std. Deviation
Std. Error Mean
Hba1c, % >= 29.00 156 8.254 1.962 .157< 29.00 115 8.097 1.833 .171
HbA1c LDL TotalMissing <100 >=100
<=7 Count 23 25 20 68Column % 19.0% 41.7% 21.7% 24.9%
>7 Count 98 35 72 205Column % 81.0% 58.3% 78.3% 75.1%
Total Count 121 60 92 273Column % 100.0% 100.0% 100.0% 100.0%
Patient DM Knowledge
summary score
N Mean Std. Deviation Std. Error Mean
valuehba1c, % >= 10 121 7.901 1.861 .169 < 10 152 8.402 1.912 .155
valuehba1c, %
18
17
16
15
14
13
12
11
10
9
8
7
6
5
Fre
qu
en
cy
60
50
40
30
20
10
0
Std. Dev = 1.90
Mean = 8
N = 273.00
FINAL PROJECT
Problem statement Selection of a QI target Selection of process and outcomes measures Selection / development of intervention Study design, statistics Study significance
Thus, there is a great capacity to reduce morbidity and morality with the use of ACE-I.
“Randomization levels the
playing field and blinding keeps the game fair.”
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 authors of the study except of the two associated with
Merck were well-positioned and educated.”
“The causal association is temporarily seen in the
study.”
“Attrition bias was minimized by adding more
subjects to the study after drop out.”
The strength of an RCT is that subjects are
human.
The dose in the placebo group was
not mentioned.
FAMOUS STUDENT AND INSTRUCTOR QUOTES
“The control group received a fair fight.”
“Attrition was slightly
similar.”
“The bias renders the findings
reconsiderable.”
Study subjects are human and random.”
All the authors appear well-
positioned to conduct the study, but they
were all from different countries and I wonder how
well they were able to communicate with
each other.
Efficient use of highlighter
