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

2. 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

3. 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

4. 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 Oct 1;73(6):97.

5. 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 

6. 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

7. 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

8. 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

9. Walk through content

11. 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

12. MFP Results P1

13. Self Assessment P1

14. 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

15. Patient Assessment P1

16. 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%

17. 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

18. A1C
Blood Pressure
Lipids
Empathy
P1 Pre-survey

19. A1C
Blood Pressure
Lipids
Empathy
P1 Post-survey P1

20. MFP Results
P1-P4

21. Patient Assessment
P1-P4

22. Curriculum Trend

23. Curriculum Trend

24. Curriculum Trend

25. Reflection
P1-P4

26. “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

27. “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”

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

29. 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

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

31. 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.

32. Questions?

33. 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