My First Patient Program Student acts as own first patient – to care for others, 1st need to understand your own health

2016 Great Lakes Residency Conference Heather Folz, PharmD PGY2 Ambulatory Care Resident Butler University College of Pharmacy & Health Sciences . . . Tracy Sprunger, PharmD, BCPS Jane Gervasio, PharmD, BCNSP, FCCP Objectives 1. Identify the areas of self-assessment analyzed in this course redesign 2. Describe the design of the My First Patient Program The speaker has no actual or potential Conflict of Interest in relation to this presentation

By Show of Hands . . . Knew what ADA stood for P1 year Had cholesterol checked in pharmacy school Know current A1C Have implemented a SMART goal Specific, measurable, achievable, results-focused (realistic), time-bound

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 Response to Healthy People 2010 and the Center for the Advancement of Pharmaceutical Education (CAPE) 2004 Educational Outcomes and the Accreditation Council for Pharmacy Education (ACPE) Standards to increase health promotion and disease prevention in the education of health care professionals Originally incorporated into the Introduction to Pharmaceutical Care I course taught fall semester of the first professional pharmacy year. Included didactic lectures centered around health promotion, disease prevention, behavioral change, and personal responsibility scheduled appointment for a comprehensive health screening at the Health Education Center, the university’s employee health clinic. At this visit each student would be provided with a fasting lipid panel and blood glucose, blood pressure measurement, weight measurement, body composition, and calculation of body mass index. From this screening, students would develop a personal health portfolio, create individualized health goals, and identify strategies to obtain or maintain these goals, essentially serving as their own “first patient.” Since the inception of MFP, the program’s chief creator has been granted the Innovative Pharmacy Practice Award from the Indiana Pharmacists Alliance. An evaluation of MFP was published in the American Journal of Pharmaceutical Education Cited as the inspiration for health self-awareness and prevention education programs at other institutions Maffeo C, et al. Am J Pharm Educ. 2009 Oct 1;73(6):97.

ACPE 2016 Standards emphasis health and wellness and self awareness 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 Coordinator for clinical assessment lab 

Change in confidence after MFP P2-P4 Study Design P1 Pre survey Post survey Change in confidence after MFP P2-P4 Confidence comparison throughout curriculum Null hypothesis would be that there is no change

Survey Design Self Assessment Physical activity Diet Weight Readiness and confidence to change Patient Assessment Confidence assessing primary disease states SMART goals Self reported empathy Reflection Post assessment only Free response This is the prime time to make healthy life changes Free Response List one thing you would change about the My First Patient Program. List what about the My First Patient Program that was most beneficial to you

Course Design Pre survey Health portfolio results (skills lab) Post survey Self assessment note (SOA) and SMART goal reflection Goals and guidelines discussion (large group) Health portfolio results (skills lab) Pre survey Discuss pre-lab Moodle assignment and class assignment questions

Walk through content

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 P1

Self Assessment P1

Pre-Survey vs Post-Survey Confidence to implement change Assessment Topic P1 Self Assessment Pre-Survey vs Post-Survey (1) (2) (3) (4) Mean (Standard Deviation) Physical activity Very active Active Somewhat Inactive 2.62 (0.78) 2.55 (0.81) 6% 9% 41% 40% 39% 12% 13% Diet Very healthy Healthy Unhealthy 2.77 (0.55) 2.75 (0.65) 1% 0% 28% 38% 65% 51% 11% Body weight Underweight Normal Overweight Obese 2.34 (0.63) 2.37 (0.75) 5% 63% 64% 27% 20% Overall health Excellent Good Fair Poor 2.41 (0.66) 2.32 (0.65) 4% 53% 61% 30% Confidence to implement change Not at all Confident Very confident 2.47 (0.73) 2.48 (0.71) 46% 49% 42% 7% Readiness to change Not interested Contemplating Making change Maintaining 2.41 (0.61) 2.42 (0.63) 3% 58% 50% 36% 44% P1 N=93 No meaningful difference in average scores

Patient Assessment P1

Pre-Survey vs Post-Survey Assessment Topic P1 Patient Assessment Pre-Survey vs Post-Survey Not at all confident (1) Somewhat confident (2) Confident (3) Very confident (4) Mean (Standard Deviation) Diet 54% 2% 34% 43% 12% 42% 0% 13% 1.53 (0.69) 2.67 (0.71) Weight and BF% 55% 1% 33% 10% 60% 29% 3.20 (0.64) Physical activity 45% 37 % 16% 14 % 52% 4% 32% 1.73 (0.81) 3.17 (0.67) A1C 76% 17% 11% 5% 1.29 (0.56) 3.30 (0.75) Blood pressure 63% 6% 40% 50% 1.39 (0.59) 3.41 (0.66) Lipids 86% 23% 3% 49% 26% 1.17 (0.46) 2.99 (0.76) Vaccines 56 % 31% 48% 1.55 (0.71) 3.03 (0.83) P1 Post = 55% Pre = 12% Post = 89% Pre = 12% Pre = 18% Post = 84% Post = 87% Pre = 7% All statically significant increases Alpha = 0.05 Null Hypothesis = 0 (no difference) Post = 90% Pre = 8% Post = 75% Pre = 5% Post = 79% Pre = 13%

P1 Assessment Topic P1 Patient Assessment Pre-Survey vs Post-Survey (1) (2) (3) (4) Mean (SD) Confidence to help patients create SMART goals Not at all Somewhat Confident Very 1.63 (0.73) 3.30 (0.72) 48% 1% 40% 11% 8% 44% 4% 45% Empathy to help them meet goals None Some Moderate High 3.27 (0.69) 3.43 (0.65) 3% 6% 5% 54% 38% 51% P1

A1C Blood Pressure Lipids Empathy P1 Pre-survey

A1C Blood Pressure Lipids Empathy P1 Post-survey P1

MFP Results P1-P4

Patient Assessment P1-P4

Curriculum Trend

Curriculum Trend

Curriculum Trend

Reflection P1-P4

“One thing you would change” P1 “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” Spirometry, A1C, like the placement in Clinical Assessment, more time

“What was most beneficial” P1 “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, A1C 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 A1C d. All of the above

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

Impact Create self health awareness Develop assessment skills Make lifestyle changes Promote patient empathy Introduce guidelines Coordinate curriculum Impact Medicare wellness visits! (billing upward to $200/visit) -follow up throughout the curriculum (capstone? . . . P3 or P4 screening?, e-portfolio?) -fit bits -welcome the opportunity to initiate collaborative employee wellness program -AACP Report published in the American Journal of Pharmaceutical Education - mentioned HH and supported innovative new practice models for preparing “practice ready” pharmacists. Charging pharmacy institutions to be initiators of innovation.

Questions?

2016 Great Lakes Residency Conference Heather Folz, PharmD PGY2 Ambulatory Care Resident Butler University College of Pharmacy & Health Sciences . . . Tracy Sprunger, PharmD, BCPS Jane Gervasio, PharmD, BCNSP, FCCP Objectives 1. Identify the areas of self-assessment analyzed in this course redesign 2. Describe the design of the My First Patient Program The speaker has no actual or potential Conflict of Interest in relation to this presentation