Publication Type: Conference Paper/Unpublished Manuscript
Abstract: Current discussions of clinical trials in the developing world seldom focus on the individual motivations of local physicians and the impact upon clinical research. Using ethnographic fieldwork of a developing world HIV clinic, this paper focuses on the rationales given by clinic physicians to provide post-study care for patients in the form of a clinical trial. This paper demonstrates that local physicians express common logics of evidence based medicine, generalizability, and biological plausibility when evaluating clinical trials. In addition, institutional familiarity with the clinical trial and physician desire to maintain high status position drove the decision to use the clinical trial form. This has important implications for informed consent.

Publication Type: Poster
Review Method: Peer Reviewed
Abstract: This poster describes the results of a survey of clinical directors regarding the theoretical orientation, clinical practices and training and supervision needs within public-sector forensic mental health programs. The prevalence of various professional disciplines (psychology, psychiatry, social work, and master’s-level psychology professionals) employed in these sites is reported along with a detailed description of their clinical activities and duties, scope of practice, and supervisory and management function. Among the findings reported is that while doctoral professionals have migrated toward forensic assessment, sub-doctoral professionals have assumed primary clinical responsibility for the treatment and management of forensic patients

Publication Type: Abstract
Abstract: Objectives:
Evaluate patient satisfaction with clinical pharmacy services provided in the Family Medicine Pain Management Clinic (FMPAIN Clinic).
Methods:
Current services offered in the FMPAIN Clinic include pharmacy students collecting medication histories and providing follow-up counseling. A multidisciplinary team (consisting of physician, pharmacy faculty member and student) then meets with each patient to determine the most appropriate treatment option. A patient satisfaction survey was developed to assess patients' perceptions of clinical pharmacy services in the FMPAIN Clinic. This survey was administered to each patient seen in clinic over a two month period (N=131). 85 completed surveys (65%) were received. Patients were asked nine questions about understanding how to take their pain medications, potential side effects, helpfulness of pharmacy students, and satisfaction with overall care. They were also asked the same questions regarding other hospital clinics. Results to the questionnaire were rated on a Likert scale (1-10).
Results:
Student t tests were conducted to determine statistical significance. Statistically significant differences were found in patients' understanding of medication dosing (p=0.475) and side effects (p=0.0181). Significant differences were also detected in patients assessment of overall care received in the FMPAIN Clinic compared to other hospital clinics (p<0.0001). Internal reliability was assessed using Cronbach's alpha (α =088465).
Implications:
While our institution provides extensive in-patient clinical pharmacy services, this is the first out-patient pharmacy service established. These results demonstrate that pharmacy students and faculty provide well received and much needed services. We are currently adding pharmacy faculty in other Family Medicine clinics.

Publication Type: Conference Paper/Unpublished Manuscript
Review Method: Peer Reviewed
Abstract: Background: During the recent healthcare reform, clinical practice has been increasingly been rationalized. Measures have been implemented to standardize the context and process of clinical decision-making, and physician performance were quantified and evaluated with the intention of influencing the decision-making process. Clinical practice has traditionally been the exclusive domain of the medical profession. This paper therefore examines the relationship between rationalization of clinical practice and physician perception of clinical autonomy and how this relationship vary by physician cohorts and physicians’ elite status, and the organizational context in which they work.

Data: Two rounds of the Community Tracking Study Physician Survey, which is a nationally representative and longitudinal study of physicians, are used. The dependent variable is physicians’ assessment of their clinical autonomy at round two of the survey; the independent variables are changes in the impact of four rationalizing measures on physicians’ practice of medicine between two rounds.

Method: We use multivariable logistic regression models for binary responses that comprise a first-order Markov chain. Interaction terms are used to assess how the relationship between rationalization of clinical practice and physician perception of clinical autonomy vary by physician and organization characteristics.

Results: Our study shows that rationalizing measures that directly guide clinical decision-making are perceived as more restrictive on clinical autonomy than those measures that monitor and evaluate physician behavior. The knowledge elite, defined as medical school faculty, physicians whose practice is heavily influenced by electronic data entry, and those working in large practice are more likely to have a favorable view of the effect of guidelines on clinical autonomy.

Discussion: Not all rationalizing measures negatively influence physician assessment of their clinical autonomy. Improving the use of clinical information technology and implementing guidelines by physicians’ immediate organizations may facilitate the introduction of guidelines. Efforts are needed to minimize the gap between knowledge elites and rank-and-file physicians in their understanding of the implication of rationalization of clinical practice on clinical autonomy.

Publication Type: Abstract
Abstract: Introduction: The current standard at most schools of pharmacy to practice the application of the didactic information is to use a brief case summary as a springboard for case discussions and/or SOAP notes. However, case summaries do not offer the opportunity to learn how to review medical charts, which is how cases are presented during rotations and in practice.

Model: Western University’s College of Pharmacy, Pomona, CA, utilizes a block system in the 2nd and 3rd years. The last block prior to rotations is used for curricular review and evaluation of content and skills. Four faux medical charts were created by 4th yr rotation students and edited by a faculty member. Two cases each were inpatient and outpatient, and were designed to present realistic, multi-disease state patients. Student teams were offered an opportunity to do a focused review of the chart, and then each student individually wrote a chart note based upon additional information provided by the course facilitator.

Outcomes: Each student had an opportunity to write four chart notes, and each note was hand graded by the same faculty member (involving 40-45 hrs of time). Overall grades improved from chart 1 through 3 (91%, 92%, 95%, p<0.001) but decreased with chart 4, which involved a more complicated case (89%, p<0.001 compared to charts 1 – 3).

Future directions: Overall students found the exercises helpful and productive. Proper training of required chart note structure and a consistent rubric for grading is essential to ensure a productive learning exercise.