Lai Cindy J, Smith Amanda R, Stebbins Marilyn R, Cutler Timothy W, Lipton Helene L
UCSF School of Medicine, San Francisco, CA 94143, USA.
J Manag Care Pharm. 2011 Jul-Aug;17(6):439-48. doi: 10.18553/jmcp.2011.17.6.439.
Nearly all health professional students and prescribers, regardless of specialty, will care for older adults who are enrolled in or eligible for the Medicare Part D prescription drug benefit. Given the growing numbers of older adults, the increased burden of chronic disease, and the escalating costs of health care, health professional students and prescribers across disciplines should learn strategies to promote cost-effective prescribing and collaborate with pharmacists who are experts in medication use and costs.
To describe and evaluate the impact of a statewide peer education program in which selected students at 7 California schools of pharmacy delivered a clinically relevant lecture on Part D to a multidisciplinary audience of health professional students and prescribers.
Trained pharmacy students delivered a case-based lecture on Medicare Part D to other health professional students and prescribers throughout the state of California. An 11-item survey designed to evaluate (a) self-assessed Part D knowledge, (b) opinion of pharmacists' roles on the health care team, (c) intent to collaborate with pharmacists, and (d) awareness of cost-savings strategies to reduce patients' out-of-pocket drug costs was administered before and after the lecture. Pre-lecture versus post-lecture results were tested for statistical significance using the Wilcoxon signed-rank test with Bonferroni adjustment of alpha to 0.004 because of multiple comparisons.
From October 2008 through May 2010, trained students from 7 pharmacy schools gave 58 presentations to a total of 1,490 current or future prescribers, including 304 nurse practitioner students and 279 resident physicians. At baseline pre-lecture, self-rated knowledge of Medicare Part D was generally poor; only 4.9% of respondents strongly agreed that "I understand the Medicare Part D benefit," and 6.6% strongly agreed that they could "identify key Medicare Part D resources to help my patients." Nine of 11 survey items showed statistically significant improvement (P less than 0.001), including all 4 items in the Part D knowledge domain and all 5 items in the intent-to-collaborate domain (e.g., "I consult with pharmacists and/or pharmacy students about drug costs"). Outcomes were similar across the 7 schools.
At pre-lecture baseline, self-reported deficits in knowledge about Part D policy and drug cost-savings resources and strategies existed among medical, nursing and physician assistant students, resident physicians, and other health professionals. A pharmacy student-led peer education lecture can be used to bridge this gap, resulting in timely dissemination of geriatrics health policy information and increased awareness of pharmacists' roles and expertise in pharmaceutical health policy and patient care.
几乎所有健康专业的学生和开处方者，无论其专业如何，都会照顾参加或有资格参加医疗保险D部分处方药福利计划的老年人。鉴于老年人数量不断增加、慢性病负担加重以及医疗保健成本不断攀升，各学科的健康专业学生和开处方者都应学习促进成本效益开方的策略，并与药物使用和成本方面的专家药剂师合作。
描述并评估一项全州范围的同伴教育计划的影响，该计划中，加利福尼亚州7所药学院的部分学生向健康专业学生和开处方者的多学科听众发表了一场关于D部分的临床相关讲座。
经过培训的药学院学生在加利福尼亚州各地向其他健康专业学生和开处方者发表了一场基于案例的医疗保险D部分讲座。在讲座前后进行了一项包含11个项目的调查，旨在评估：（a）自我评估的D部分知识；（b）对药剂师在医疗团队中角色的看法；（c）与药剂师合作的意愿；（d）对降低患者自付药品费用的成本节约策略的认识。由于存在多次比较，使用Wilcoxon符号秩检验并将α值经Bonferroni校正调整为0.004，对讲座前和讲座后的结果进行统计学显著性检验。
从2008年10月到2010年5月，来自7所药学院的经过培训的学生进行了58场讲座，听众共有1490名现任或未来的开处方者，其中包括304名执业护士学生和279名住院医师。在讲座前的基线时，对医疗保险D部分的自我评估知识普遍较差；只有4.9%的受访者强烈同意“我了解医疗保险D部分福利”，6.6%的受访者强烈同意他们能够“识别关键的医疗保险D部分资源以帮助我的患者”。11项调查项目中有9项显示出统计学上的显著改善（P小于0.001），包括D部分知识领域的所有4项和合作意愿领域的所有5项（例如，“我就药品成本咨询药剂师和/或药学院学生”）。7所学校的结果相似。
在讲座前的基线时，医学、护理和医师助理专业的学生、住院医师以及其他健康专业人员在D部分政策以及药品成本节约资源和策略的知识方面自我报告存在不足。由药学院学生主导的同伴教育讲座可用于弥合这一差距，从而及时传播老年健康政策信息，并提高对药剂师在药品健康政策和患者护理方面的角色和专业知识的认识。
