My First Patient Program 2016 Great Lakes Residency

My First Patient Program

2016 Great Lakes Residency Conference Heather Folz, Pharm. D PGY 2 Ambulatory Care Resident Butler University College of Pharmacy & Health Sciences. . . Tracy Sprunger, Pharm. D, BCPS Jane Gervasio, Pharm. D, BCNSP, FCCP The speaker has no actual or potential Conflict of Interest in relation to this presentation

By Show of Hands. . . • Knew what ADA stood for P 1 year • Had cholesterol checked in pharmacy school • Know current A 1 C • Have implemented a SMART goal

My First Patient (MFP) Background Introduced Fall 2004 into Pharmaceutical Care Response to Healthy People initiative and CAPE/ACPE standards Comprised of 8 lecture hours and individual screening appointments Maffeo C, et al. Am J Pharm Educ. 2009 Oct 1; 73(6): 97.

MFP Background Curricular improvement efforts identified Clinical Assessment as a more effective placement for MFP ACPE 2016 Standards emphasis health and wellness and self awareness Integrated into Clinical Assessment Skills Lab with 2 hour large group discussion

Study Design P 1 P 2 -P 4 • Pre survey • Post survey • Change in confidence after MFP • Post survey • Confidence comparison throughout curriculum

Survey Design Self Assessment Patient Assessment • Physical activity • Diet • Weight • Readiness and confidence to change • Confidence assessing primary disease states • SMART goals • Self reported empathy Reflection • Post assessment only • Free response

Course Design Pre survey Health portfolio results (skills lab) Goals and guidelines discussion (large group) Self assessment note (SOA) and SMART goal reflection Post survey

Which of the following describes the design of the My First Patient Program? a. Student partners would act as each other's first patient b. Each student would act as their own first patient c. Students would be assigned a case example as their first patient d. Patient actors would be the students’ first patient

MFP Results P 1

Self Assessment P 1

Assessment Topic P 1 Self Assessment Pre-Survey vs Post-Survey P 1 Physical activity Diet Mean (Standard Deviation) (1) (2) (3) (4) Very active Active Somewhat Inactive 6% 9% Very healthy 1% 0% Body weight Underweight Overall health Excellent 5% 4% 5% 5% Confidence to implement change 6% Readiness Not interested Not at all 5% 41% 40% Healthy 28% 38% Normal 63% 64% Good 53% 61% Somewhat 46% 49% Contemplati ng 41% 39% Somewhat 65% 51% Overweight 27% 20% Fair 39% 30% Confident 42% 40% Making change 12% 13% Unhealthy 6% 11% Obese 5% 11% Poor 4% 4% Very confident 6% 7% Maintaining 2. 62 (0. 78) 2. 55 (0. 81) 2. 77 (0. 55) 2. 75 (0. 65) 2. 34 (0. 63) 2. 37 (0. 75) 2. 41 (0. 66) 2. 32 (0. 65) 2. 47 (0. 73) 2. 48 (0. 71) 2. 41 (0. 61)

Patient Assessment P 1

Assessment Topic P 1 Patient Assessment Pre-Survey vs Post-Survey Not at all confident (1) Somewhat confident (2) Confident (3) Very confident (4) Mean (Standard Deviation) 13% Pre ==12% Post 55% 1. 53 (0. 69) 2. 67 (0. 71) 60%= 2% 29% Pre Post =12% 89% 1. 53 (0. 69) 3. 20 (0. 64) 32% Pre ==18% Post 84% 1. 73 (0. 81) 3. 17 (0. 67) 42%= 87% 2% 45% Post Pre 7% 1. 29 (0. 56) 3. 30 (0. 75) 50% Post Pre = 90% 8% 1. 39 (0. 59) 3. 41 (0. 66) 49%= 75% 2% 26% Post Pre 5% 1. 17 (0. 46) 2. 99 (0. 76) Pre ==13% Post 79% 1. 55 (0. 71) 3. 03 (0. 83) Diet 54% 2% 34% 43% 12% Weight and BF% 55% 1% 33% 10% Physical activity 45% 0% 37 % 16% 14 % A 1 C 76% 2% 17% 11% 5% Blood pressure 63% 0% 29% 10% 6% Lipids 86% 2% 10% 23% 3% Vaccines 56 % 5% 31% 16% 11% 42% 52% 40% 48% 0% 4% 2% 2% 31%

Assessment Topic P 1 Confidence to help patients create SMART goals Empathy to help them meet goals P 1 Patient Assessment Pre-Survey vs Post-Survey (1) (2) (3) (4) Not at all Somewhat Confident Very 48% 1% 40% 11% 8% 44% 4% 45% None Some Moderate High 3% 1% 6% 5% 54% 44% 38% 51% Mean (SD) 1. 63 (0. 73) 3. 30 (0. 72) 3. 27 (0. 69) 3. 43 (0. 65)

A 1 C Blood Pressure Lipids Empathy P 1 Pre-

A 1 C Blood Pressure Lipids Empathy P 1 Post. P 1

MFP Results P 1 -P 4

Patient Assessment P 1 -P 4

Curriculum Trend Means by Pharmacy Class 4, 5 4 3, 5 3 2, 5 2 1, 5 1 0, 5 0 A 1 C Blood Pressure P 1 P 2 P 3 P 4 Lipids

Curriculum Trend Means by Pharmacy Class 3, 5 3 2, 5 2 1, 5 1 0, 5 0 Diet Weight P 1 Physical Activity P 2 P 3 P 4 Vaccines

Curriculum Trend Means by Pharmacy Class 4 3, 5 3 2, 5 2 1, 5 1 0, 5 0 SMART Goals Empathy P 1 P 2 P 3 P 4

Reflection P 1 -P 4

P 1 “One thing you would change” “More time for SMART goal implementation and reflection” “I would make a lab session where you could talk to your table about things you are implementing and ways that you could help patients come up with changes they can actually keep in their life” “I think it would be fun to do at the beginning of the semester and then again at the end of the semester to see what kind of improvements have been made” “It seemed somewhat choppy, so I felt I was focused more one finishing the right assignments at the right time than actually paying attention to what I was learning about myself and about assessing a patient's health with each assignment”

P 1 “What was most beneficial” “Relating all the values back to ourselves and having it not just be in a textbook” “Learning how to make lifestyle adjustments in a reasonable and maintainable manner” “Knowing my numbers for lipids, A 1 C and % body fat was nice because that's something I'd never had done before” “I now eat salad” “Assessing myself made me more interested in what all of the numbers meant, because it was affecting me”

Improvements More intentional orientation to MFP Longer period for SMART goal activity Small group discussion time

Changes in student confidence were assessed for which of the following health screenings? a. Blood pressure b. Body composition c. Hemoglobin A 1 C d. All of the above

Limitations Non validated survey instrument No true control group Self-reported confidence and empathy

Create self health awarenes s Coordinat e curriculu m Develop assessme nt skills Impact Introduce guideline s Make lifestyle changes Promote patient empathy

Questions?

2016 Great Lakes Residency Conference Heather Folz, Pharm. D PGY 2 Ambulatory Care Resident Butler University College of Pharmacy & Health Sciences. . . Tracy Sprunger, Pharm. D, BCPS Jane Gervasio, Pharm. D, BCNSP, FCCP The speaker has no actual or potential Conflict of Interest in relation to this presentation