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1.  Relationship Between Patients' Perceptions of Care Quality and Health Care Errors in 11 Countries: A Secondary Data Analysis 
Supplemental Digital Content is Available in the Text.
Patients may be the most reliable reporters of some aspects of the health care process; their perspectives should be considered when pursuing changes to improve patient safety. The authors evaluated the association between patients' perceived health care quality and self-reported medical, medication, and laboratory errors in a multinational sample. The analysis was conducted using the 2010 Commonwealth Fund International Health Policy Survey, a multinational consumer survey conducted in 11 countries. Quality of care was measured by a multifaceted construct developed using Rasch techniques. After adjusting for potentially important confounding variables, an increase in respondents' perceptions of care coordination decreased the odds of self-reporting medical errors, medication errors, and laboratory errors (P < .001). As health care stakeholders continue to search for initiatives that improve care experiences and outcomes, this study's results emphasize the importance of guaranteeing integrated care.
PMCID: PMC4721215  PMID: 26783863
laboratory error; medical error; medication error; quality of care
2.  Prevalence and Incidence of Epilepsy in an Elderly and Low-Income Population in the United States 
Background and Purpose
The purpose of this study was to estimate the incidence and prevalence of epilepsy among an elderly and poor population in the United States.
Arizona Medicaid claims data from January 1, 2008 to December 31, 2010 were used for this analysis. Subjects who were aged ≥65 years and were continuously enrolled in any Arizona Medicaid health plans (eligible to patients with low income) for ≥12 months between January 1, 2008 and December 31, 2009 were considered eligible for inclusion in the study cohort. In addition to meeting the aforementioned criteria, incident and prevalent cases must have had epilepsy-related healthcare claims. Furthermore, incident cases were required to have a 1-year "clean" period immediately preceding the index date. Negative binomial and logistic regression models were used to assess the factors associated with epilepsy incidence and prevalence.
The estimated epilepsy incidence and prevalence for this population in 2009 were 7.9 and 19.3 per 1,000 person-years, respectively. The incidence and prevalence rates were significantly higher for patients with comorbid conditions that were potential risk factors for epilepsy and were of younger age than for their non-comorbid and older counterparts (p<0.05). The prevalence rates were significantly higher for non-Hispanic Blacks and male beneficiaries than for non-Hispanic Whites and female beneficiaries, respectively (p<0.05).
This patient population had higher epilepsy incidence and prevalence compared with the general US population. These differences may be at least in part attributable to their low socioeconomic status.
PMCID: PMC4507380  PMID: 26022458
epilepsy; incidence; prevalence; poverty; elderly
3.  Healthcare Professional Students’ Knowledge of Drug-Drug Interactions 
Objectives. To evaluate changes in medical, pharmacy, and nurse practitioner students’ drug-drug interaction (DDI) knowledge after attending an educational program.
Design. A DDI knowledge assessment containing 15 different drug pairs was administered to participants before and after a 45-minute educational session.
Evaluation. Pharmacy, medical, and nursing students scored significantly higher on the posttest assessment for DDI recognition (median change 3, 9, and 8, respectively) and management strategy (median change 5, 9, 8, respectively), indicating a significant improvement in DDI knowledge as a result of the educational session. Pharmacy students scored significantly higher on the pretest; however, no difference was observed between the students’ posttest scores. Posttest scores for all student groups were significantly greater than their respective pretest scores (p < 0.001).
Conclusions. Significant improvement in healthcare professional students’ DDI knowledge was observed following participation in the educational session.
PMCID: PMC3279016  PMID: 22345718
drug-drug interaction; drug interaction knowledge; medical education; pharmacy education; nurse practitioner education
4.  Faculty Perceptions of the Educating Pharmacy Students to Improve Quality (EPIQ) Program 
Objective. To investigate users’ initial perceptions of and potential applications for the Educating Pharmacy Students and Pharmacists to Improve Quality (EPIQ) program, a 5-module education program designed to educate pharmacists and pharmacy students about quality improvement in pharmacy practice.
Methods. The 5-module EPIQ program was distributed to pharmacy faculty members, pharmacy practitioners, and other health professionals across the country upon request. A 6-item survey instrument was sent to the first 97 people who requested the program.
Results. Twenty-seven (56%) of the 55 respondents had reviewed the EPIQ program and 22 (82%) intended to use some or all of the content to teach about quality improvement or patient safety primarily in pharmacy management and medication safety courses.
Conclusion. Initial perceptions of the EPIQ program were positive; however, further evaluation is needed after more extensive implementation of the program in pharmacy colleges and schools and other settings.
PMCID: PMC3220344  PMID: 22102753
medication safety; qualitative research; science of safety; education; pharmacy curriculum
5.  Perspectives on Educating Pharmacy Students About the Science of Safety 
Objective. To identify opinions about pharmacy graduates’ science of safety (SoS) educational needs.
Methods. Semi-structured interviews were performed with 25 educators and researchers at US pharmacy colleges and schools and 5 individuals from associations engaged in drug safety-related issues.
Results. Themes that emerged from the 30 interviews with key informants included: pharmacists should meet minimum SoS requirements; medication safety education is inconsistent; and barriers exist to improving SoS curricula. Student deficiencies noted included the lack of: student acceptance of a “culture of safety”: ability to effectively communicate verbally about medication safety; knowledge of the drug development process; and quality improvement skills. Key informants did not agree on how to address these gaps.
Conclusions. While educators, researchers, and other leaders in drug safety-related issues thought that US colleges and schools of pharmacy covered portions of SoS well, there were perceived deficiencies. Minimum standards should be set to assist with curricular adoption of SoS.
PMCID: PMC3175660  PMID: 21969728
medication safety; patient safety pharmacy education; science of safety; education
6.  Rasch Analysis of the Student Refractive Error and Eyeglass Questionnaire 
To evaluate and refine a newly developed instrument, the Student Refractive Error and Eyeglasses Questionnaire (SREEQ), designed to measure the impact of uncorrected and corrected refractive error on vision-related quality of life (VRQoL) in school-aged children. Methods. A 38 statement instrument consisting of two parts was developed: Part A relates to perceptions regarding uncorrected vision and Part B relates to perceptions regarding corrected vision and includes other statements regarding VRQoL with spectacle correction. The SREEQ was administered to 200 Native American 6th through 12th grade students known to have previously worn and who currently require eyeglasses. Rasch analysis was conducted to evaluate the functioning of the SREEQ. Statements on Part A and Part B were analyzed to examine the dimensionality and constructs of the questionnaire, how well the items functioned, and the appropriateness of the response scale used.
Rasch analysis suggested two items be eliminated and the measurement scale for matching items be reduced from a 4-point response scale to a 3-point response scale. With these modifications, categorical data were converted to interval level data, to conduct an item and person analysis. A shortened version of the SREEQ was constructed with these modifications, the SREEQ-R, which included the statements that were able to capture changes in VRQoL associated with spectacle wear for those with significant refractive error in our study population.
While the SREEQ Part B appears to be a have less than optimal reliability to assess the impact of spectacle correction on VRQoL in our student population, it is also able to detect statistically significant differences from pretest to posttest on both the group and individual levels to show that the instrument can assess the impact that glasses have on VRQoL. Further modifications to the questionnaire, such as those included in the SREEQ-R, could enhance its functionality.
PMCID: PMC4045236  PMID: 24811844
questionnaire development; vision–related quality of life; refractive error; psychometrics; Native American
7.  Preceptor Perceptions of Pharmacy Student Team Quality Assurance Projects 
To assess preceptors' opinions of the impact of quality assurance projects.
Students were given the opportunity to directly apply material learned in class in a “real world” environment by completing a quality assurance project in a community or health-system pharmacy. All preceptors (n = 38) were contacted via telephone and given the opportunity to respond to open-ended questions concerning their experience with student-team quality assurance projects.
Preceptors indicated the quality assurance projects benefited their practice sites by providing additional resources (53%, n = 19), decreased medication errors (22%, n = 8), and increased awareness of the importance of quality assurance (22%, n = 8). Ninety-four percent of respondents (n = 34) perceived the projects had a positive impact on patient care and 92% (n = 33) perceived a positive impact on themselves.
Preceptors felt that quality assurance projects performed by pharmacy-student teams were beneficial to patient care, the practice site, and themselves. The quality assurance projects have broad applications and can be added to a medication safety class or to the introductory pharmacy practice experience (IPPE) sequence.
PMCID: PMC2703284  PMID: 19564990
preceptor; quality assurance; curriculum
8.  Educating Pharmacy Students to Improve Quality (EPIQ) in Colleges and Schools of Pharmacy 
Objective. To assess course instructors’ and students’ perceptions of the Educating Pharmacy Students and Pharmacists to Improve Quality (EPIQ) curriculum.
Methods. Seven colleges and schools of pharmacy that were using the EPIQ program in their curricula agreed to participate in the study. Five of the 7 collected student retrospective pre- and post-intervention questionnaires. Changes in students’ perceptions were evaluated to assess their relationships with demographics and course variables. Instructors who implemented the EPIQ program at each of the 7 colleges and schools were also asked to complete a questionnaire.
Results. Scores on all questionnaire items indicated improvement in students’ perceived knowledge of quality improvement. The university the students attended, completion of a class project, and length of coverage of material were significantly related to improvement in the students’ scores. Instructors at all colleges and schools felt the EPIQ curriculum was a strong program that fulfilled the criteria for quality improvement and medication error reduction education.
Conclusion The EPIQ program is a viable, turnkey option for colleges and schools of pharmacy to use in teaching students about quality improvement.
PMCID: PMC3425924  PMID: 22919085
quality improvement; medication error; pharmacy education; pharmacy student; assessment; curriculum
9.  Physicians' opinions of a health information exchange 
Arizona Medicaid developed a Health Information Exchange (HIE) system called the Arizona Medical Information Exchange (AMIE).
To evaluate physicians' perceptions regarding AMIE's impact on health outcomes and healthcare costs.
A focus-group guide was developed and included five domains: perceived impact of AMIE on (1) quality of care; (2) workflow and efficiency; (3) healthcare costs; (4) system usability; and (5) AMIE data content. Qualitative data were analyzed using analytical coding.
A total of 29 clinicians participated in the study. The attendance rate was 66% (N=19) for the first and last month of focus-group meetings and 52% (N=15) for the focus group meetings conducted during the second month. The benefits most frequently mentioned during the focus groups included: (1) identification of “doctor shopping”; (2) averting duplicative testing; and (3) increased efficiency of clinical information gathering. The most frequent disadvantage mentioned was the limited availability of data in the AMIE system.
Respondents reported that AMIE had the potential to improve care, but they felt that AMIE impact was limited due to the data available.
PMCID: PMC3005874  PMID: 21106994
10.  Ability of pharmacy clinical decision-support software to alert users about clinically important drug–drug interactions 
Pharmacy clinical decision-support (CDS) software that contains drug–drug interaction (DDI) information may augment pharmacists' ability to detect clinically significant interactions. However, studies indicate these systems may miss some important interactions. The purpose of this study was to assess the performance of pharmacy CDS programs to detect clinically important DDIs.
Researchers made on-site visits to 64 participating Arizona pharmacies between December 2008 and November 2009 to analyze the ability of pharmacy information systems and associated CDS to detect DDIs. Software evaluation was conducted to determine whether DDI alerts arose from prescription orders entered into the pharmacy computer systems for a standardized fictitious patient. The fictitious patient's orders consisted of 18 different medications including 19 drug pairs—13 of which were clinically significant DDIs, and six were non-interacting drug pairs.
The sensitivity, specificity, positive predictive value, negative predictive value, and percentage of correct responses were measured for each of the pharmacy CDS systems.
Only 18 (28%) of the 64 pharmacies correctly identified eligible interactions and non-interactions. The median percentage of correct DDI responses was 89% (range 47–100%) for participating pharmacies. The median sensitivity to detect well-established interactions was 0.85 (range 0.23–1.0); median specificity was 1.0 (range 0.83–1.0); median positive predictive value was 1.0 (range 0.88–1.0); and median negative predictive value was 0.75 (range 0.38–1.0).
These study results indicate that many pharmacy clinical decision-support systems perform less than optimally with respect to identifying well-known, clinically relevant interactions. Comprehensive system improvements regarding the manner in which pharmacy information systems identify potential DDIs are warranted.
PMCID: PMC3005877  PMID: 21131607
11.  Science of Safety Topic Coverage in Experiential Education in US and Taiwan Colleges and Schools of Pharmacy 
Objective. To compare the science of safety (SoS) topic coverage and associated student competencies in the experiential education curricula of colleges and schools of pharmacy in the United States and Taiwan.
Methods. The experiential education director, assistant director, or coordinator at a random sample of 34 US colleges and schools of pharmacy and all 7 Taiwan schools of pharmacy were interviewed and then asked to complete an Internet-based survey instrument.
Results. Faculty members in both countries perceived that experiential curricula were focused on the postmarketing phase of the SoS, and that there is a need for the pharmacy experiential curricula to be standardized in order to fill SoS coverage gaps. Inter-country differences in experiential SoS coverage were noted in topics included for safety biomarkers that signal potential for drug-induced problems and pharmacogenomics.
Conclusions. Experiential SoS topic coverage and student ability gaps were perceived within and between US and Taiwan colleges and schools of pharmacy.
PMCID: PMC3279028  PMID: 22345721
science of safety; experiential education; survey research; international
12.  The Science of Safety Curriculum in US Colleges and Schools of Pharmacy 
Objective. To describe the integration of science of safety (SoS) topics in doctor of pharmacy (PharmD) curricula of US colleges and schools of pharmacy.
Methods. A questionnaire that contained items pertaining to what and how SoS topics are taught in PharmD curricula was e-mailed to representatives at 107 US colleges and schools of pharmacy.
Results. The majority of the colleges and schools responding indicated that they had integrated SoS topics into their curriculum, however, some gaps (eg, teaching students about communicating risk, Food and Drug Administration [FDA] Sentinel Initiative, utilizing patient databases) were identified that need to be addressed.
Conclusions. The FDA and the American Association of Colleges of Pharmacy (AACP) should continue to collaborate to develop resources needed to ensure that topics proposed by the FDA in their SoS framework are taught at all colleges and schools of pharmacy.
PMCID: PMC3175655  PMID: 21969727
medication safety; pharmacy education; curriculum; science of safety
13.  Pharmacy Students’ Retention of Knowledge of Drug-Drug Interactions 
Objectives. To evaluate pharmacy students' drug-drug interaction (DDI) knowledge retention over 1 year and to determine whether presenting DDI vignettes increased knowledge retention.
Methods. A knowledge assessment tool was distributed to fourth-year pharmacy students before and after completing a DDI educational session. The questionnaire was re-administered after 1 year to assess knowledge retention. During the intervening year, students had the option of presenting DDI case vignettes to preceptors and other health professionals as part of their advanced pharmacy practice experiences (APPEs).
Results. Thirty-four of 78 pharmacy students completed both the post-intervention and 1-year follow-up assessments. Students’ knowledge of 4 DDI pairs improved, knowledge of 3 DDI pairs did not change, and knowledge of the remainder of DDI pairs decreased. Average scores of the 18 students who completed all tests and presented at least 1 vignette during their APPEs were higher on the 1-year follow-up assessment than students who did not, suggesting greater DDI knowledge retention (p = 0.04).
Conclusion. Although pharmacy students’ overall DDI knowledge decreased in the year following an educational session, those who presented vignettes to health professionals retained more DDI knowledge, particularly on those DDIs for which they gave presentations. Other methods to enhance pharmacy students’ retention of DDI knowledge of clinically important DDIs are needed.
PMCID: PMC3175677  PMID: 21931448
drug-drug interaction; assessment
14.  Teaching the Science of Safety in US Colleges and Schools of Pharmacy 
This paper provides baseline information on integrating the science of safety into the professional degree curriculum at colleges and schools of pharmacy. A multi-method examination was conducted that included a literature review, key informant interviews of 30 individuals, and in-depth case studies of 5 colleges and schools of pharmacy. Educators believe that they are devoting adequate time to science of safety topics and doing a good job teaching students to identify, understand, report, manage, and communicate medication risk. Areas perceived to be in need of improvement include educating pharmacy students about the Food and Drug Administration's (FDA's) role in product safety, how to work with the FDA in post-marketing surveillance and other FDA safety initiatives, teaching students methods to improve safety, and educating students to practice in interprofessional teams. The report makes 10 recommendations to help pharmacy school graduates be more effective in protecting patients from preventable drug-related problems.
PMCID: PMC3138345  PMID: 21769153
safety; curriculum; pharmacy education; FDA; quality
15.  Medication Error Identification Rates by Pharmacy, Medical, and Nursing Students 
To assess and compare prescribing error-identification rates by health professional students.
Medical, pharmacy, and nursing students were asked to complete a questionnaire on which they evaluated the accuracy of 3 prescriptions and indicated the type of error found, if any. The number of correctly identified prescribing errors and the number of correct types of errors identified were compared and error identification rates for each group were calculated.
One hundred seventy-five questionnaires were returned (87% response rate). Pharmacy students had a significantly higher error-identification rate than medical and nursing students (p < 0.001). No significant differences were found between medical and nursing students (p = 0.88). Compared to medical students, pharmacy students more often were able to identify correctly the error type for each prescription (p < 0.001; p = 0.023; p = 0.001).
Of the 3 student groups, pharmacy students demonstrated a significantly higher error-identification rate, which may be associated with the greater number of pharmacology and pharmacotherapeutics course hours that pharmacy students complete.
PMCID: PMC3073098  PMID: 21519414
prescription; medication error; simulation
16.  Impact of the Career Explorers Program on High School Students' Perceptions of the Pharmacy Profession 
To determine the effect of a 5-week Career Explorers Program (CEP) on high school students' perceptions of pharmacists' characteristics, duties, and training.
A 16-item survey instrument with attitudinal, frequency, and relative quantity response options was completed by all CEP students on the first and last day of the program. The survey assessed students' attitudes concerning pharmacist characteristics, duties, and training.
All students who participated in the CEP in 2003 completed the survey instrument (n = 50). Seventy percent of respondents' answers to the attitudinal subscale questions significantly changed from preassessment to postassessment.
A 5-week CEP provided high school students with more realistic perceptions of pharmacists' roles, duties, and training before the students entered the pharmacy program.
PMCID: PMC2508715  PMID: 18698385
experiential learning; career choice; pharmacists; high school students

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