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COMMUNITY PHARMACY
Engaging Students in Wellness and Disease Prevention Services
Audra S. Anderson, PharmD* and Jean-Venable R. Goode,
PharmD
School of Pharmacy, Virginia Commonwealth University
Pharmacy education has traditionally focused on medications
and treatment of disease. However, as an
accessible health care professional, pharmacists can influence
healthy behaviors in their patients. En-
couraging/promoting healthier lifestyles in the United States is
essential because the leading causes of
mortality are tobacco use, poor nutrition, and inactivity. In
order to prepare pharmacists for this role,
student pharmacists must be taught how to implement and
deliver wellness and prevention services.
Community advanced pharmacy practice experiences (APPEs)
occur at an ideal point in the curriculum
to engage students in these activities. This article provides
preceptors with guidance and tools for
restructuring the community APPE at their sites to incorporate
wellness and disease prevention activities.
Keywords: wellness, disease prevention, health promotion,
advanced pharmacy practice experiences, community
pharmacy
INTRODUCTION
Much of the morbidity and mortality associated with
chronic disease in the United States could be prevented
though lifestyle and behavioral changes. Although the
leading causes of death in the United States are heart
disease and cancer, the actual leading causes of mortality
are tobacco use, poor nutrition, and inactivity.1 Tradition-
ally, pharmacy education has focused on medications and
the treatment of disease. However, as accessible health-
care professionals, pharmacists are in an ideal position to
make an impact on patients’ behaviors. Furthermore,
pharmacists have been identified as key healthcare pro-
fessionals to help the nation meet the goals of Healthy
People 2010.
2-4 Healthy People 2010 is a document re-
flecting the nation’s health goals for reducing significant
preventable threats to public health. There are 2 overarch-
ing goals, which are to increase the quality and years of
life of Americans and to eliminate health disparities.2 In
order to accomplish these goals, as a profession, pharma-
cists will need to be prepared to deliver wellness and
disease prevention services.
The Center for Advancement of Pharmaceutical Ed-
ucation (CAPE) recently revised the educational out-
comes for colleges and schools of pharmacy.
5 The
advisory panel identified public health as a major area
for improvement and expansion in pharmacy education,
including teaching students strategies for promoting
health improvement, wellness, and disease prevention
to patients, communities, and at-risk populations, in col-
laboration with other health care providers. Community
advanced pharmacy practice experiences (APPE’s) are
ideal areas of the curriculum for offering these learning
experiences for students. Therefore, preceptors may need
to restructure APPE learning activities to provide oppor -
tunities for students to gain knowledge about wellness and
disease prevention. This article will provide preceptors
with ideas for incorporating wellness and disease preven-
tion into student learning experiences.
ESTABLISHING A WELLNESS AND
DISEASE PREVENTION FOUNDATION
Community practitioners should prepare for teaching
wellness and disease prevention by building a basic foun-
dation. The basic foundation for preceptors recommended
by these authors includes the following:
(1) Creating a model of wellness and disease pre-
vention in the advanced practice setting. This
means being a role model for students by hav-
ing at least one active service relating to well-
ness or disease prevention in the practice.
(2) Providing students with pertinent literature
about wellness, disease prevention, and health
promotion and addressing these issues either
during daily activities or during discussion
sessions.2-4,6-9
From the foundation, preceptors can build on stu-
dent’s knowledge using several different approaches in
their practice. These include students actively participat-
ing in the practice’s wellness and disease prevention
Corresponding Author: Jean-Venable R. Goode, PharmD.
Address: VCU School of Pharmacy, PO Box 980533,
Richmond, VA 23298-0533. Tel: 804-828-3865.
Fax: 804-828-8359. E-mail: [email protected]
*Dr. Anderson’s current affiliation is Ukrop’s Pharmacy,
Richmond, Va.
American Journal of Pharmaceutical Education 2006; 70 (2)
Article 40.
1
activities, creating new wellness and disease prevention
activities for the practice, creating tools and educational
materials, discussing pertinent wellness and disease pre-
vention literature, writing newsletters or articles about
wellness and disease prevention, marketing wellness
and disease prevention services, and assessing outcomes
of the programs and services (Figure 1). Ideally, students
should be involved in a range of activities and discussions
about wellness and disease prevention throughout an ad-
vanced practice experience. Activities do not have to be
complicated; however, depending on the activity, it may
take more preceptor time, either through direct supervi-
sion or reviewing and revising the materials students cre-
ate. Preceptors will need to consider their ability to
supervise and provide guidance and teaching as they de-
sign activities and learning experiences around wellness
and disease prevention. The following sections will focus
on how to incorporate these approaches using several
wellness and disease prevention strategies.
STUDENT ACTIVITIES
Health Observances
The Office of Disease Prevention and Health Promo-
tion publishes a comprehensive calendar of national
health observances, eg, October is National Breast Cancer
Awareness Month.6 Most of the health observances have
websites with additional information and materials.
These materials are excellent resources for pharmacists
and students developing wellness and disease prevention
activities7 and can be used as a framework for many of
the student activities during an APPE. Students should
choose a health observance that interests them and that
will occur during their experience. The student should
develop an activity that can be accomplished during the
rotation and be incorporated into the practice site. For
example, during National Osteoporosis Awareness and
Prevention Month, when dispensing a prescription, the
student could counsel every female patient about the ap-
propriate amount of dietary calcium and/or supplemental
calcium. This would engage the student in health promo-
tion activities directly with the patient.
Another activity based on the national health observ-
ances includes the development of handouts and patient
education materials to be made available at the pharmacy.
For example, during National Stroke Awareness Month in
May, students could develop handouts and patient educa-
tion materials on the risk factors and signs and symptoms
of stroke, and measures patients can take to prevent strokes.
Students could also evaluate patient education materials
that could be used by the practice site. Evaluation should
Figure 1. Algorthim for engaging students in wellness and
prevention.
American Journal of Pharmaceutical Education 2006; 70 (2)
Article 40.
2
include assessing the handout’s literacy level. If the prac-
tice site has a population of patients whose primary lan-
guage is not English, students should research the available
educational materials in other languages.
If the pharmacy has space, students could develop
a bulletin board or display with educational messages
and handouts for a national health observance. The phar-
macy could use these materials each year. If the pharmacy
does not have space for a bulletin board or display, stu-
dents could be involved in developing shelf-talkers or
posters to convey a message about a national health ob-
servance. For example, students could develop a message
around National SAFE KIDS Week that could be put on
the shelves displaying children’s products, toys, etc.
Students could also be involved in developing a pre-
sentation about a national health observance. The presen-
tation could be given in a meeting room or similar space at
the pharmacy or at a community center, church, civic
building, or library for various groups or associations. If
the pharmacy has a newsletter or if other community pub-
lications exist, a student activity could include developing
an article about the national health observance.
National health observances can also be used as a plat-
form for more advanced pharmacy activities such as risk
assessments, screenings, lifestyle counseling, immuniza-
tions, and targeted interventions. These activities will be
discussed later in the article.
Students do not have to focus on a national health
observance. Any of these activities could also center on
other health-related issues including seasonal concerns
(eg, sunscreen protection, allergies, bug bites, influenza)
or disease prevention topics (eg, diabetes mellitus,
obesity, depression).
Risk Assessment
If the practice site or state laws do not allow pharma-
cists to conduct health screenings, risk assessments are
another way to increase patient interaction and provide
patients with valuable information.
10,11 Risk assessments
may also be used in combination with screenings, such as
the Framingham Risk Assessment for which obtaining
cholesterol and blood pressure values are necessary. As
mentioned previously, risk assessments may be an activ-
ity related to a national health observance or a standalone
activity that is offered in the pharmacy.
Student activities can be related to designing and
implementing a new risk assessment program. Part of this
activity should include researching different risk assess-
ment tools for a specific disease state and choosing a risk
assessment tool that will be appropriate for the practice
site. Table 1 contains some resources for locating risk
assessments on the Internet. Some risk assessment tools
are available in paper format and others are available for
completion via the Internet. Once a risk assessment tool is
chosen, students should design an educational handout
with the risk assessment score and how to interpret the
patient’s risk. Preceptors should have the students de-
velop policies and procedures for the new risk assessment
program.
After designing and implementing the program or if
a risk assessment service is already in place at the practice
site, student activities should center around identifying
patients who should complete the risk assessment, per-
forming and documenting the actual risk assessment, pro-
viding patient counseling and education, recommending
lifestyle changes or preventative measures, referring to
other healthcare providers, and providing follow -up. To
enhance this activity, preceptors should have the student
present 1-2 patient cases from the risk assessments. The
case presentations can be brief but should address patient
demographics, pertinent information about the risk assess-
ment, plan, education and/or counseling, and follow -up.
Health Screenings
If the practice site and state laws permit pharmacists
to conduct health screenings, this is another way for stu-
dents to become involved in wellness and direct patient
care. Providing various screenings within the pharmacy
allows students to have extensive patient contact and will
assist in the development of their communication skills as
well.
Students can assist with implementing a specific type
of screening into the practice or they can improve and en-
hance an existing screening program. Screenings that can
be conducted within the community pharmacy include,
but are not limited to, blood pressure, blood glucose,
Table 1. Selected Patient Risk-Assessment Resources for Use in
a Community Advanced Pharmacy Practice Experience
Risk Assessment Web Site
Health Check Tools
www.nlm.nih.gov/medlineplus/interactivetools/
Interactive Health Tools
www.brighamandwomens.org/healthinfor/healthTools.asp
Framingham CHD Risk Calculator
hin.nhlbi.nih.gov/atpiii/calculator.asp?usertype5pub
Men’s Health www.ncpanet.org/knowyourscore/assessment.pdf
Breast Cancer bcra.nci.nih.gov/brc/q1.htm
American Journal of Pharmaceutical Education 2006; 70 (2)
Article 40.
3
cholesterol, osteoporosis, Alzheimer’s disease, depres-
sion, metabolic syndrome, and body fat analysis.12-22
For a practice site that does not already have established
screenings in place, several steps may need to be taken.
Conducting non-invasive tests that do not require
a human specimen, such as blood pressure or osteoporosis
screening, have few or no regulations. Student activities
for implementing these types of screenings include the
development of screening forms, patient education materi-
als, and a general policy and procedures guide for the site.
Tests that require human specimens, such as blood
samples, are considered invasive and there are more strin-
gent regulations and requirements for conducting those
tests.
23 The Clinical Laboratory Improvement Act
(CLIA) of 1988 was enacted to assist in the standar-
dization of laboratory screening, personnel, and quality
control. There are varying levels of laboratory testing
based on the complexity of the test being performed. Most
pharmacy-based screenings, such as blood glucose or
cholesterol testing, are waived tests and are less regulated.
These tests require the site to have a certificate of waiver
from a local or regional Centers for Medicare and Med-
icaid Services (CMS) office and to agree to follow good
laboratory practices. To enroll in the CLIA program
a pharmacy must complete and submit CMS Form 116
for a Certificate of Waiver. A CLIA waiver is required to
allow pharmacy-based laboratory screenings. If there are
multiple screening sites, each site must have its own
CLIA waiver. Complete information regarding CLIA and
the waiver process is available at www.cms.hhs.gov/clia. A
full list of waived tests can be found at www.cms.hhs.gov/
clia/waivetbl.pdf. Students can learn about maintaining
a pharmacy-based laboratory including good laboratory
procedures, standard operating procedures, and quality
control. Along with obtaining the CLIA waiver for per-
forming screenings, pharmacies must also comply with
the universal precautions for blood-borne pathogens
regulations from the Occupational Safety and Health
Administration (OSHA). OSHA regulates worksite
safety and provides guidelines for protection, exposure
actions, and proper policies and procedures. Complete
information is available on the OSHA website at www.
osha.gov.
Another activity for students is researching the vari-
ous instruments and devices to perform screenings. For
example, there are numerous lipid analyzers available for
cholesterol screening. The most commonl y used device is
the Cholestech LDX. Obtaining information such as cost,
supplies needed, and reliability of the instrument is im-
portant in selecting the appropriate device.
For practice sites that already have patient screenings
in place, students could assist with enhancing the current
program. Finding ways to increase the number of patients
that take advantage of the screening services is an impor-
tant task with which students could assist.
In addition to assisting with establishing and promot-
ing the screening program, students can participate in
administering the program, performing and documenting
screening tests, providing counseling and education, rec-
ommending lifestyle changes or preventative measures,
referring patients to other healthcare providers, and fol-
lowing up with patients to determine effectiveness/out-
comes of the program. Preceptors should have students
present 1-2 patient cases per week from the screening
program. Students should be able to justify the recom-
mendations made to their patients.
Involving students in planning and implementing
a screening service in a pharmacy practice provides them
with a unique and valuable experience, increased confi -
dence, and the skills and tools for developing their own
services and programs.
Specific Screenings
Students can be asked to lead a presentation and
discussion of particular diseases, prior to conducting
screenings. Providing appropriate and accurate patient
counseling requires knowledge of the current guidelines
and recommendations for the disease. For example,
reviewing the JNC 7 Guidelines and all available anti -
hypertensive medications with the student is a good
way to increase his/her knowledge and confidence rela-
ted to the screening and management of high blood
pressure. Also, instruction in the proper operation of
the equipment that will be used in the screening is impor-
tant prior to the students’ interaction with patients. For
example, prior to providing cholesterol screening, the
student should observe how to obtain the blood sample,
operate the lipid analyzer, and counsel the patient based
on the results. Patient education after a screening should
include discussing diet, exercise, and potential drug
therapy alternatives. Observing the preceptor screening
a patient and discussing the patient’s disease state will
help the student become confident in providing patient
care.
Immunizations
Immunizations are another area of wellness and dis-
ease prevention that pharmacists can implement at their
practice site. Pharmacists have the authority to administer
immunizations in 44 states.24 Additionally, many col-
leges and schools of pharmacy have incorporated vaccine
science and vaccines into the curriculum; therefore, APPE
students will usually have some knowledge of immuni za-
tions. In 1997, the American Pharmacists Association’s
Board of Trustees adopted guidelines for pharmacy-based
American Journal of Pharmaceutical Education 2006; 70 (2)
Article 40.
4
immunization advocacy.25 The guidelines include 3 lev-
els: advocacy, facilitation, and administration. Activities
for students should be designed around these levels.
In states that do not allow pharmacist or student phar-
macist administration of immunizations, students should
be involved in recommending immunizatio ns to at-risk
populations, educating patients about the vaccines, and
referring patients to an appropriate health care provider.
Additionally, students could research vaccine controver-
sies and create handouts for patients with the facts about
the vaccine controversy. Students could also research
anti-vaccine web sites so they have an understanding of
the information patients may be exposed to on the Inter-
net.
26 Students could be responsible for updating the phar-
macy’s staff on the frequently changing recommendations
regarding vaccines and for developing a vaccine record
card for patients.
If the pharmacy practice is active in the second level,
facilitation of immunizations (having another healthcare
professional administer vaccines at the site), students
could assist with screening patients for immunizations
and processing paperwork. Students could also be in-
volved with identifying at-risk patients, marketing the
service, and answering questions.
In states that allow pharmacists to administer immu-
nizations, students could assist with designing and imple-
menting a new program or enhancing an existing one.
For example, if the practice site offers only influenza
vaccinations during October and November, students
could design and implement a year-round immunization
program, identifying patients at risk for other diseases
for which immunizations are available such as tetanus-
diphtheria or pneumococcal vaccine. Students could
assist with the administration of vaccines if allowed by
state law.
Preventative Services
Another way to approach wellness and disease pre-
vention is to target patients based on their age. The US
Preventative Health Services Task Force has a guide to
preventative health services which is based on age and
gender.
27 In addition, several other organizations publish
preventative health checklists based on age and gender
including the American Academy of Family Physicians
(www.aafp.org), the American College of Physicians
(www.acponline.org), and the American College of
Obstetricians and Gynecologists (www.acog.com). Stu-
dents could use these checklists to design a preventative
services counseling program for the practice site. Ano-
ther exercise is to have the student assess the usability
of preventative health guidelines (ie, how difficult is it
to identify the services recommended and determine
how frequently they should be performed), and sug-
gest changes that would make the checklists easier to
use.
Lifestyle Counseling
Knowledge and training about educating patients on
proper lifestyle choices is one of the keys to actually
helping them make positive changes. Realizing each
patient’s specific situation and goals is essential in help-
ing them attain those goals. Additionally, it is important to
understand how patients make lifestyle changes. APPE
activities could include researching and learning about
the different theories addressing changing patient behav-
iors. Several models have been used by pharmacists in-
cluding the Health Belief Model, Fishbein-Ajzen Theory
of Reasoned Action, and the Transtheoretical Model.
28-30
Students should observe preceptors using these models
in patient counseling, and then employ them when
working with patients trying to make lifestyle changes.
Other techniques used for disease and wellness programs
that students should learn include conducting motiva-
tional interviewing and providing self-management
education.31
Smoking Cessation
Tobacco use is one of the leading causes of mortality
in the United States. Providing directed interventions to-
ward patients who use tobacco is another way pharmacists
and student pharmacists can become involved in wellness
and disease prevention in their practice.
Students could provide brief interventions with
patients, such as counseling them on the benefits of quit-
ting, or more detailed interventions as part of a com-
prehensive smoking cessation program that includes
conducting one-on-one counseling, making drug ther-
apy recommendations, and providing follow-up care/
counseling.32-34 Students could assist in the development
of forms describing the various nonprescription and pre-
scription smoking cessation products available and the
advantages and disadvantages, side effects, and cost of
each.35 Providing patients with detailed information re-
garding available pharmacotherapy can help them make
informed decisions. To assist in the implementation and
delivery of a smoking cessation program within the prac-
tice site, students could develop patient handouts, and
patient interview and documentation forms.32,33
Students could also participate in one-on-one patient
counseling sessions provided for patients. Additionally,
some smoking cessation programs may include group ed-
ucational sessions, students may be involved in creating
and/or teaching these sessions. Offering smoking cessation
therapy management and obtaining payment for the
services will give the student a valuable experience in the
American Journal of Pharmaceutical Education 2006; 70 (2)
Article 40.
5
delivery of wellness and disease prevention services within
a pharmacy practice.
Basic Nutrition and Exercise Counseling
A fundamental component of wellness and disease
prevention is good nutrition and adequate exercise. Stu-
dents should learn the basic nutrition and exercise infor-
mation needed for pharmacists to appropriately and
effectively counsel their patients regarding either pre-
vention or management of disease.
8-9 This topic is usually
not stressed in pharmacy curriculums and APPE’s pro-
vide an excellent forum for students to learn about nutri-
tion and exercise and practice their patient counseling
skills.
Preceptors can assign readings and have a topic
discussion about nutrition and exercise.
8-9 Students can
research and learn about the differences between fad
diets and create a chart for the pharmacy staff. Stu-
dents could also do this for vitamins and dietary sup-
plements.
Nutrition and exercise counseling can be incorporated
into patient counseling during risk assessment, disease
screening, and targeted intervention programs. Students
could be involved in developing, implementing, and mar-
keting a new patient care service for weight management or
starting a body composition screening service. Possible
activities would be similar to activities discussed in pre-
vious sections.
Targeted Interventions
Targeted intervention programs are programs designed
to focus on promoting wellness, disease prevention, and
healthy living for patients who already have a chronic
disease. As with the other areas of wellness, student
activities could include developing and implementing
the target intervention program, including writing poli-
cies and procedures, creating monitoring forms, and de-
veloping or evaluating existing patient educational
materials. For example, a targeted intervention program
for patients with diabetes might center on ensuring that
patients who have diabetes are receiving appropriate
medications such as ACE inhibitors or aspirin therapy.
36
Even though this is not really wellness, it is prevention of
future problems related to diabetes mellitus. A targeted
intervention program for patients with diabetes mellitus
could also include ensuring that these patients have access
to appropriate preventative services, such as annual
check-ups with a podiatrist and ophthalmologist and
bi-annual check-ups with a dentist.
Conducting targeted intervention provides students
with lessons in communicating with patients and pro-
viders, and in managing chronic diseases. Other activities
could include the preceptor conducting topic discussions
with the student that reinforce the student’s knowledge of
the pathophysiology and the pharmacologic and non-
pharmacologic (lifestyle modifications and preventative
measures) treatment of the disease. Students could be re-
quired to create a patient case and present all of this in-
formation to the preceptor, or ideally, the preceptor and
the student could discuss specific patients in the targeted
intervention program.
Targeted intervention programs can be used to assess
the outcomes of the practices’ patient care activities.
These outcomes can be used by the pharmacists to market
patient care services to self-insured employers or other
payors. This gives the preceptor another opportunity for
teaching APPE students. Students can be involved in the
process of organizing the outcomes for presentation and
developing materials for the meeting. Additionally, the
preceptor can engage the student in discussions about
compensation for patient care services.
Marketing
Acquiring a basic knowledge of marketing is impor-
tant for APPE students since effectively marketing a phar-
macy’s services to the appropriate patient population not
only increases the site’s revenue stream, it ensures that
patients are aware of the valuable and potentially life-
saving services offered. Students should be involved with
the marketing of any of the previously mentioned health
promotion programs and preventative services. Students
should be able to design marketing materials (signs, shelf
talkers, brochures, and patient handouts) including a plan
for how to inform patients about any new service or pro-
gram. Students could also develop a marketing strategy
that targets others such as caregivers, third-party payors,
and family members. Preceptors could assign readings
for students to learn more about marketing pharmacy
services.
37-39 Another valuable activity is to have stu-
dents participate in marketing the program to patients
directly. Preceptors should use this activity to have
discussion with the student about marketing, including
the difference between product and service marketing.
As another component, students could visit local physi-
cians and their practices to market new programs and
services.
Outcomes Assessment
All pharmacy services should be evaluated to determine
the outcomes and success of the program and then this in-
formation should be used for continuous quality improve-
ment. A learning activity for students could be designing an
evaluation process for the risk-assessment program or per-
forming evaluation activities such as tallying numbers of
patients, number at risk, and number of referrals. Students
could be involved with designing or researching available
American Journal of Pharmaceutical Education 2006; 70 (2)
Article 40.
6
evaluation tools for the program (eg, patient satisfaction
instruments).40,41
CONCLUSION
A community APPE provides an excellent opportunity
for developing and implementing wellness and disease pre-
vention activities. Additionally, preceptor involvement
with these activities provides a positive role model for
students. In turn, teaching and practicing wellness and dis-
ease prevention for the benefit of patients and student phar -
macists will help improve the professions’ capability of
making an impact on the health of the nation.
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compared. Soc Sci Med. 1987;24:973-81.
29. Ajzen I, Fishbein M. Understanding Attitudes and
Predicting
Social Behavior. Englewood Cliffs, NJ: Prentice Hall; 1980
30. Hudmon KS, Berger BA. Pharmacy applications of the
transtheoretical model in smoking cessation. Am J Health-Syst
Pharm. 1995;52:282-7.
31. Lange N, Tigges BB. Influence positive change with
motivational
interviewing. Nurse Pract. 2005;30:44-53.
32. Kennedy DT, Small RE. Development and implementation
of
a smoking cessation clinic in a community pharmacy practice.
J Am Pharm Assoc. 2002;42:83-92.
33. Kennedy DT, Giles JT, Ghnag ZG, et al. Results of a
smoking
cessation clinic in a community pharmacy practice. J Am Pharm
Assoc. 2002;42:51-6.
34. A Clinical Practice Guideline for Treating Tobacco Use and
Dependence. US Public Health Service Report. JAMA.
2000;283:3244-54.
35. Rigotti NA. Treatment of Tobacco Use and Dependence.
N Engl J Med. 2002;346:506-12.
36. Haggerty SA, Cerulli J, Zeolla MM, Cottrell JS, Weck MB,
Faragon JJ. A Community pharmacy Target Intervention
Program
(TIP) to improve aspirin use in persons with diabetes. J Am
Pharm
Assoc. 2005;45:17-22.
American Journal of Pharmaceutical Education 2006; 70 (2)
Article 40.
7
37. Mc Donough RP, Doucette WR. Using personal selling
skills
to promote pharmacy services. J Am Pharm Assoc.
2003;43:363-72.
38. Holdford DA. Using buzz marketing to promote ideas,
services,
and products. J Am Pharm Assoc. 2004;44:387-96.
39. Holdford DA. Marketing for Pharmacists. Washington, DC:
American Pharmacists Association; 2003.
40. Kucukarslan S, Schommer JC. Patients’ expectations and
their
satisfaction with pharmacy services. J Am Pharm Assoc.
2002;42:489-95.
41. Larson LN, Rovers JP, Mackeigan LD. Patient satisfaction
with
pharmaceutical care: update of a validated instrument. J Am
Pharm
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American Journal of Pharmaceutical Education 2006; 70 (2)
Article 40.
8
© 2010 FIDM/ Fashion Institute of Design & Merchandising
1
MODULE #7 SCREENCAST TRANSCRIPT
Writing a Rough Draft, Integrating Quotes Effectively
& Formulating Your Group’s Recommendation
Reflect for a moment on your previous Outline & Sources
Integration Assignment.
It was highly structured and specific in its organization and
focus of supporting points
and sub-points.
Depending on how successful you were in completing this stage
of our assignment, the
creation of your rough draft should be logical and rewarding.
Many students and writers attempt to write full paragraphs and
reports before they
have outlined and formulated specific topics and points. Not so
for you as you’ve
already crafted a detailed and focused outline with proposed
quotes and sources that
are relevant and specific.
Writing a Rough Draft
By creating a detailed outline with proposed quotes and sources
for each point, you can
begin to craft paragraphs for each section of your report.
• Each paragraph should begin with a focused topic sentence
which gives an
overview of the main idea for the entire paragraph and its
connection to your
thesis.
• Following this topic sentence, each paragraph should supply
approximately 15
sentences of supporting details which include quotes, facts,
graphics or expert
opinions that use in-text documentation in MLA formats.
• Equally important, in each paragraph you must supply your
own insights and
opinion which synthesize and analyze this factual information
and connect
them to the thesis. In this way, you will avoid a copy-and-paste
report – a
common mistake in report writing in which the writer merely
assembles a variety
of quotes, with or without focus, fails to analyze or synthesize
them and offers
no insights or opinion.
Also, you must strive to organize your points and material
within each paragraph.
Consider time order, cause and effect, reasons, a range of
opinions, strengths vs.
weaknesses, or distinct categories of frameworks or sources.
In addition, you must establish authority, introduce and qualify
each source from which
you quote in your paragraphs.
2
Establish Authority & Qualify Sources
In addition, you must establish authority. Introduce and qualify
each source from which
you quote in your paragraphs. Consider this quote:
“Apple has unlimited growth potential, not only in sales of its
innovative
products, but also its business model of offering a lucrative
platform and
charging suppliers and providers of content and applications – a
brilliant source
of ongoing revenue and profits.” (Buffett 213)
Who is Warren Buffett? Why does his opinion matter? Now
look at this example of
qualifying and introducing an expert’s opinion or qualitative
quote:
World-renowned equity expert and billionaire Warren Buffet
believes,
“Apple has unlimited growth potential, not only in sales of its
innovative
products, but also its business model of offering a lucrative
platform and
charging suppliers and providers of content and applications – a
brilliant source
of ongoing revenue and profits.”
Notice that I have qualified and introduced who Warren Buffett
is and why his opinion is
of value. Also, I documented the quote in the introductory
material of the sentence
rather than at the end in parenthesis. As with every quote I use,
I would then ensure
that I have a Works Cited page entry that begins with Buffett,
Warren and supplies the
full information for the source of this quote.
An example of qualifying, introducing and integrating statistics,
facts or quantitative
quotes:
According to Apple’s Annual Report, “revenues have increased
by 30% for the
quarter ending December, 2009” (23).
Again, I have documented the statistics in the introductory
material of the sentence
rather than at the end in parenthesis. However, I have included
the page number in
parenthesis at the end of the sentence. I also need to confirm
that I have a Works Cited
page entry that begins with “Annual Report – Apple” and
supplies the full information
for the source of this quote.
If I have already introduced and qualified the source earlier in
the report, I would
document the quote in parenthesis at the end of the sentence:
“Revenues have increased by 30% for the quarter ending
December, 2009”
(“Annual Report – Apple” 23).
Notice where and how quotation marks, periods and parentheses
are specifically used
and placed.
3
Use Correct Documentation
Again refer to your book and the online sources previously
identified to compare your
writing and formats to the MLA models for integration of
quotes and sources, in-text
documentation and Work Cited formats.
In addition, be sure to follow models in your book and online
for correctly citing and
using in-text documentation for any images, charts or graphs
you use. As with quotes,
facts or statistics which use words or numbers, the in-text
documentation you use for
images, charts and graphs should track back directly to a
specific Works Cited entry.
Avoid First-person Writing
Finally, avoid the use of “I” or “we” when writing sentences in
each paragraph which
supply your analysis, synthesis, opinion and insights.
An example using first-person writing:
I think Apple’s a great company and even though they don’t
give any dividends, I
still would buy the stock!
By avoiding first person, the revised sentence below must
synthesize and provide valid
reasons for opinions:
Even though Apple does not pay dividends to its shareholders,
its stock price has
increased significantly during the last decade, offering massive
profits to those
who have held shares for the long-term.
Refer to your completed Outline & Sources Integration
assignment from our previous
module.
• The 4 sections of your report should have 3 subpoints each
• In other words, you should supply 12 paragraphs for the body
of your report. (4
sections with 3 paragraphs each.)
Each paragraph should include:
• A focused topic sentence, which gives an overview of the
main of the entire
paragraph and its connection to your thesis
• Approximately 15 sentences of supporting details, which
include quotes, facts,
graphics or expert opinions that use in-text documentation in
MLA formats.
• Your own insights and opinion, which synthesize and analyze
this factual
information and connect them to the thesis.
Group Recommendation
Once all your group members have completed these body
paragraphs, you are ready to
write your own recommendation section which synthesizes all
the frameworks, insights,
facts, details, quotes and opinions from the previous 4 sections
and formulates your
group’s collective opinion about the company’s stock – buy,
sell or hold.
4
You may find that this section is one long paragraph or a series
of shorter paragraphs,
but your group should discuss the logic and organization of this
section.
Remember the purpose of the Group Recommendation section:
Synthesize the
research and comment on whether your group would recommend
investing in this
company. Give specific reasons for your opinions. BUY / SELL
/ HOLD
You may discover there are advantages and disadvantages,
strengths and weaknesses,
3-5 reasons, or 3-5 frameworks that seem logical as separate
paragraphs which highlight
each distinct point you are making.
Regardless of how you organize this crucial section of your
report, you must provide 1 or
more substantial paragraphs with focused topic sentences,
compelling evidence and
support, valuable synthesis, insights and analysis and an
articulate recommendation.
Once you have completed all the required sections for your
rough draft, refer to the
Rough Draft Rubric for your Company Report and be sure you
have proofread and
revised all sections before submitting it for my evaluation.
Required Sections for Rough Draft:
• Company Background & Current Stage in Growth Lifecycle
• Detailed Financial Information -- Microeconomics
• Industry Landscape, Trends and Competitors --
Macroeconomics
• Recent Developments, Analyst Opinions and Wall Street
Consensus
• Group’s Recommendation
• Updated Works Cited
Questions to Ask
Does your rough draft:
• Include all required sections?
• Supply sufficient organization & content?
• Effectively integrate sources, MLA formats and include your
updated works
cited?
• Follow standards for grammar & mechanics?
Make sure you communicate regularly with your group
members, especially for the
group recommendation section.
Hopefully, you have created a masterpiece with your rough
draft. All that remains is
selecting an appropriate frame which we will construct and add
during our next module
in preparation for submitting your final draft in the future.
MODULE #7 SCREENCAST TRANSCRIPTWriting a Rough
DraftEstablish Authority & Qualify SourcesUse Correct
DocumentationAvoid First-person WritingGroup
RecommendationQuestions to Ask
© 2010 FIDM/ Fashion Institute of Design & Merchandising
Company Report “Rough Draft” Rubric
Writing Assignment
(10 points)
INCLUDES ALL REQUIRED SECTIONS (2.5 POINTS)
Rough draft follows guidelines for organization and includes all
required sections, including:
• Company Background & Current Stage in Growth Lifecycle
• Detailed Financial Information -- Microeconomics
• Industry Landscape, Trends and Competitors --
Macroeconomics
• Recent Developments, Analyst Opinions and Wall Street
Consensus
• Recommendations
• Works Cited
ORGANIZATION & CONTENT (2.5 POINTS)
Paragraphs in all sections include:
• A focused topic sentence with an overview of the main idea
for the entire paragraph and
its connection to thesis
• Approximately 15 sentences of supporting details which
include quotes, facts, graphics or
expert opinions
• Writers’ insights and opinions are provided, which synthesize
and analyze researched
quantitative, qualitative and responsive information, and
connect to the thesis
• Points and material within each paragraph are logically
organized. Consider time order,
cause and effect, reasons, a range of opinions, strengths vs.
weaknesses, or distinct
categories of frameworks or sources.
SOURCE INTEGRATION, MLA FORMATS & WORKS CITED
(2.5 POINTS)
• Sources are integrated effectively establishing authority,
introducing and qualifying each
source quoted in paragraphs
• In-text documentation follows MLA formats
• Works Cited page follows MLA formats
GRAMMAR & MECHANICS (2.5 POINTS)
• Writing follows standards for effective business writing,
avoiding first person and errors
in sentence skills, mechanics, grammar and spelling
TOTAL POINTS: __________________
Company Report “Rough Draft” Rubric
Now that you have fully researched your company, written a
detailed outline and source review, selected the specific quotes,
graphics, and details which are quantitative, qualitative and
responsive, and created a correctly formatted and accurately
detailed Works Cited page, you are ready to compile and begin
writing the first draft of your Company Report.
Contrary to the method you may have used in writing researched
reports in the past, we will not begin by writing the introduction
or first paragraph of your report. You must first fully
collaborate and cooperate with your team members and begin
compiling the specific sections of your report -- the body. After
you have ensured that these sections are all complete and fully
developed, then your group can begin to synthesize all the
research and analysis featured in these sections to formulate and
write your group’s own recommendation section and opinion --
buy, sell or hold. In our next module, after completing this and
all the body sections of your report, your group will write an
introduction, summary, and conclusion that unify and frame
your report.
Design and create your masterpiece first – the body sections of
your report – then add a frame and packaging after – the
introduction, summary, and conclusion.
(No Group)

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COMMUNITY PHARMACY ENGAGES STUDENTS IN WELLNESS

  • 1. COMMUNITY PHARMACY Engaging Students in Wellness and Disease Prevention Services Audra S. Anderson, PharmD* and Jean-Venable R. Goode, PharmD School of Pharmacy, Virginia Commonwealth University Pharmacy education has traditionally focused on medications and treatment of disease. However, as an accessible health care professional, pharmacists can influence healthy behaviors in their patients. En- couraging/promoting healthier lifestyles in the United States is essential because the leading causes of mortality are tobacco use, poor nutrition, and inactivity. In order to prepare pharmacists for this role, student pharmacists must be taught how to implement and deliver wellness and prevention services. Community advanced pharmacy practice experiences (APPEs) occur at an ideal point in the curriculum to engage students in these activities. This article provides preceptors with guidance and tools for restructuring the community APPE at their sites to incorporate wellness and disease prevention activities. Keywords: wellness, disease prevention, health promotion, advanced pharmacy practice experiences, community pharmacy INTRODUCTION Much of the morbidity and mortality associated with
  • 2. chronic disease in the United States could be prevented though lifestyle and behavioral changes. Although the leading causes of death in the United States are heart disease and cancer, the actual leading causes of mortality are tobacco use, poor nutrition, and inactivity.1 Tradition- ally, pharmacy education has focused on medications and the treatment of disease. However, as accessible health- care professionals, pharmacists are in an ideal position to make an impact on patients’ behaviors. Furthermore, pharmacists have been identified as key healthcare pro- fessionals to help the nation meet the goals of Healthy People 2010. 2-4 Healthy People 2010 is a document re- flecting the nation’s health goals for reducing significant preventable threats to public health. There are 2 overarch- ing goals, which are to increase the quality and years of life of Americans and to eliminate health disparities.2 In order to accomplish these goals, as a profession, pharma- cists will need to be prepared to deliver wellness and disease prevention services. The Center for Advancement of Pharmaceutical Ed- ucation (CAPE) recently revised the educational out- comes for colleges and schools of pharmacy. 5 The advisory panel identified public health as a major area for improvement and expansion in pharmacy education, including teaching students strategies for promoting health improvement, wellness, and disease prevention to patients, communities, and at-risk populations, in col- laboration with other health care providers. Community advanced pharmacy practice experiences (APPE’s) are
  • 3. ideal areas of the curriculum for offering these learning experiences for students. Therefore, preceptors may need to restructure APPE learning activities to provide oppor - tunities for students to gain knowledge about wellness and disease prevention. This article will provide preceptors with ideas for incorporating wellness and disease preven- tion into student learning experiences. ESTABLISHING A WELLNESS AND DISEASE PREVENTION FOUNDATION Community practitioners should prepare for teaching wellness and disease prevention by building a basic foun- dation. The basic foundation for preceptors recommended by these authors includes the following: (1) Creating a model of wellness and disease pre- vention in the advanced practice setting. This means being a role model for students by hav- ing at least one active service relating to well- ness or disease prevention in the practice. (2) Providing students with pertinent literature about wellness, disease prevention, and health promotion and addressing these issues either during daily activities or during discussion sessions.2-4,6-9 From the foundation, preceptors can build on stu- dent’s knowledge using several different approaches in their practice. These include students actively participat- ing in the practice’s wellness and disease prevention Corresponding Author: Jean-Venable R. Goode, PharmD. Address: VCU School of Pharmacy, PO Box 980533, Richmond, VA 23298-0533. Tel: 804-828-3865.
  • 4. Fax: 804-828-8359. E-mail: [email protected] *Dr. Anderson’s current affiliation is Ukrop’s Pharmacy, Richmond, Va. American Journal of Pharmaceutical Education 2006; 70 (2) Article 40. 1 activities, creating new wellness and disease prevention activities for the practice, creating tools and educational materials, discussing pertinent wellness and disease pre- vention literature, writing newsletters or articles about wellness and disease prevention, marketing wellness and disease prevention services, and assessing outcomes of the programs and services (Figure 1). Ideally, students should be involved in a range of activities and discussions about wellness and disease prevention throughout an ad- vanced practice experience. Activities do not have to be complicated; however, depending on the activity, it may take more preceptor time, either through direct supervi- sion or reviewing and revising the materials students cre- ate. Preceptors will need to consider their ability to supervise and provide guidance and teaching as they de- sign activities and learning experiences around wellness and disease prevention. The following sections will focus on how to incorporate these approaches using several wellness and disease prevention strategies. STUDENT ACTIVITIES Health Observances The Office of Disease Prevention and Health Promo- tion publishes a comprehensive calendar of national
  • 5. health observances, eg, October is National Breast Cancer Awareness Month.6 Most of the health observances have websites with additional information and materials. These materials are excellent resources for pharmacists and students developing wellness and disease prevention activities7 and can be used as a framework for many of the student activities during an APPE. Students should choose a health observance that interests them and that will occur during their experience. The student should develop an activity that can be accomplished during the rotation and be incorporated into the practice site. For example, during National Osteoporosis Awareness and Prevention Month, when dispensing a prescription, the student could counsel every female patient about the ap- propriate amount of dietary calcium and/or supplemental calcium. This would engage the student in health promo- tion activities directly with the patient. Another activity based on the national health observ- ances includes the development of handouts and patient education materials to be made available at the pharmacy. For example, during National Stroke Awareness Month in May, students could develop handouts and patient educa- tion materials on the risk factors and signs and symptoms of stroke, and measures patients can take to prevent strokes. Students could also evaluate patient education materials that could be used by the practice site. Evaluation should Figure 1. Algorthim for engaging students in wellness and prevention. American Journal of Pharmaceutical Education 2006; 70 (2) Article 40. 2
  • 6. include assessing the handout’s literacy level. If the prac- tice site has a population of patients whose primary lan- guage is not English, students should research the available educational materials in other languages. If the pharmacy has space, students could develop a bulletin board or display with educational messages and handouts for a national health observance. The phar- macy could use these materials each year. If the pharmacy does not have space for a bulletin board or display, stu- dents could be involved in developing shelf-talkers or posters to convey a message about a national health ob- servance. For example, students could develop a message around National SAFE KIDS Week that could be put on the shelves displaying children’s products, toys, etc. Students could also be involved in developing a pre- sentation about a national health observance. The presen- tation could be given in a meeting room or similar space at the pharmacy or at a community center, church, civic building, or library for various groups or associations. If the pharmacy has a newsletter or if other community pub- lications exist, a student activity could include developing an article about the national health observance. National health observances can also be used as a plat- form for more advanced pharmacy activities such as risk assessments, screenings, lifestyle counseling, immuniza- tions, and targeted interventions. These activities will be discussed later in the article. Students do not have to focus on a national health observance. Any of these activities could also center on
  • 7. other health-related issues including seasonal concerns (eg, sunscreen protection, allergies, bug bites, influenza) or disease prevention topics (eg, diabetes mellitus, obesity, depression). Risk Assessment If the practice site or state laws do not allow pharma- cists to conduct health screenings, risk assessments are another way to increase patient interaction and provide patients with valuable information. 10,11 Risk assessments may also be used in combination with screenings, such as the Framingham Risk Assessment for which obtaining cholesterol and blood pressure values are necessary. As mentioned previously, risk assessments may be an activ- ity related to a national health observance or a standalone activity that is offered in the pharmacy. Student activities can be related to designing and implementing a new risk assessment program. Part of this activity should include researching different risk assess- ment tools for a specific disease state and choosing a risk assessment tool that will be appropriate for the practice site. Table 1 contains some resources for locating risk assessments on the Internet. Some risk assessment tools are available in paper format and others are available for completion via the Internet. Once a risk assessment tool is chosen, students should design an educational handout with the risk assessment score and how to interpret the patient’s risk. Preceptors should have the students de- velop policies and procedures for the new risk assessment program.
  • 8. After designing and implementing the program or if a risk assessment service is already in place at the practice site, student activities should center around identifying patients who should complete the risk assessment, per- forming and documenting the actual risk assessment, pro- viding patient counseling and education, recommending lifestyle changes or preventative measures, referring to other healthcare providers, and providing follow -up. To enhance this activity, preceptors should have the student present 1-2 patient cases from the risk assessments. The case presentations can be brief but should address patient demographics, pertinent information about the risk assess- ment, plan, education and/or counseling, and follow -up. Health Screenings If the practice site and state laws permit pharmacists to conduct health screenings, this is another way for stu- dents to become involved in wellness and direct patient care. Providing various screenings within the pharmacy allows students to have extensive patient contact and will assist in the development of their communication skills as well. Students can assist with implementing a specific type of screening into the practice or they can improve and en- hance an existing screening program. Screenings that can be conducted within the community pharmacy include, but are not limited to, blood pressure, blood glucose, Table 1. Selected Patient Risk-Assessment Resources for Use in a Community Advanced Pharmacy Practice Experience Risk Assessment Web Site Health Check Tools
  • 9. www.nlm.nih.gov/medlineplus/interactivetools/ Interactive Health Tools www.brighamandwomens.org/healthinfor/healthTools.asp Framingham CHD Risk Calculator hin.nhlbi.nih.gov/atpiii/calculator.asp?usertype5pub Men’s Health www.ncpanet.org/knowyourscore/assessment.pdf Breast Cancer bcra.nci.nih.gov/brc/q1.htm American Journal of Pharmaceutical Education 2006; 70 (2) Article 40. 3 cholesterol, osteoporosis, Alzheimer’s disease, depres- sion, metabolic syndrome, and body fat analysis.12-22 For a practice site that does not already have established screenings in place, several steps may need to be taken. Conducting non-invasive tests that do not require a human specimen, such as blood pressure or osteoporosis screening, have few or no regulations. Student activities for implementing these types of screenings include the development of screening forms, patient education materi- als, and a general policy and procedures guide for the site. Tests that require human specimens, such as blood samples, are considered invasive and there are more strin- gent regulations and requirements for conducting those tests.
  • 10. 23 The Clinical Laboratory Improvement Act (CLIA) of 1988 was enacted to assist in the standar- dization of laboratory screening, personnel, and quality control. There are varying levels of laboratory testing based on the complexity of the test being performed. Most pharmacy-based screenings, such as blood glucose or cholesterol testing, are waived tests and are less regulated. These tests require the site to have a certificate of waiver from a local or regional Centers for Medicare and Med- icaid Services (CMS) office and to agree to follow good laboratory practices. To enroll in the CLIA program a pharmacy must complete and submit CMS Form 116 for a Certificate of Waiver. A CLIA waiver is required to allow pharmacy-based laboratory screenings. If there are multiple screening sites, each site must have its own CLIA waiver. Complete information regarding CLIA and the waiver process is available at www.cms.hhs.gov/clia. A full list of waived tests can be found at www.cms.hhs.gov/ clia/waivetbl.pdf. Students can learn about maintaining a pharmacy-based laboratory including good laboratory procedures, standard operating procedures, and quality control. Along with obtaining the CLIA waiver for per- forming screenings, pharmacies must also comply with the universal precautions for blood-borne pathogens regulations from the Occupational Safety and Health Administration (OSHA). OSHA regulates worksite safety and provides guidelines for protection, exposure actions, and proper policies and procedures. Complete information is available on the OSHA website at www. osha.gov. Another activity for students is researching the vari- ous instruments and devices to perform screenings. For example, there are numerous lipid analyzers available for cholesterol screening. The most commonl y used device is
  • 11. the Cholestech LDX. Obtaining information such as cost, supplies needed, and reliability of the instrument is im- portant in selecting the appropriate device. For practice sites that already have patient screenings in place, students could assist with enhancing the current program. Finding ways to increase the number of patients that take advantage of the screening services is an impor- tant task with which students could assist. In addition to assisting with establishing and promot- ing the screening program, students can participate in administering the program, performing and documenting screening tests, providing counseling and education, rec- ommending lifestyle changes or preventative measures, referring patients to other healthcare providers, and fol- lowing up with patients to determine effectiveness/out- comes of the program. Preceptors should have students present 1-2 patient cases per week from the screening program. Students should be able to justify the recom- mendations made to their patients. Involving students in planning and implementing a screening service in a pharmacy practice provides them with a unique and valuable experience, increased confi - dence, and the skills and tools for developing their own services and programs. Specific Screenings Students can be asked to lead a presentation and discussion of particular diseases, prior to conducting screenings. Providing appropriate and accurate patient counseling requires knowledge of the current guidelines and recommendations for the disease. For example,
  • 12. reviewing the JNC 7 Guidelines and all available anti - hypertensive medications with the student is a good way to increase his/her knowledge and confidence rela- ted to the screening and management of high blood pressure. Also, instruction in the proper operation of the equipment that will be used in the screening is impor- tant prior to the students’ interaction with patients. For example, prior to providing cholesterol screening, the student should observe how to obtain the blood sample, operate the lipid analyzer, and counsel the patient based on the results. Patient education after a screening should include discussing diet, exercise, and potential drug therapy alternatives. Observing the preceptor screening a patient and discussing the patient’s disease state will help the student become confident in providing patient care. Immunizations Immunizations are another area of wellness and dis- ease prevention that pharmacists can implement at their practice site. Pharmacists have the authority to administer immunizations in 44 states.24 Additionally, many col- leges and schools of pharmacy have incorporated vaccine science and vaccines into the curriculum; therefore, APPE students will usually have some knowledge of immuni za- tions. In 1997, the American Pharmacists Association’s Board of Trustees adopted guidelines for pharmacy-based American Journal of Pharmaceutical Education 2006; 70 (2) Article 40. 4
  • 13. immunization advocacy.25 The guidelines include 3 lev- els: advocacy, facilitation, and administration. Activities for students should be designed around these levels. In states that do not allow pharmacist or student phar- macist administration of immunizations, students should be involved in recommending immunizatio ns to at-risk populations, educating patients about the vaccines, and referring patients to an appropriate health care provider. Additionally, students could research vaccine controver- sies and create handouts for patients with the facts about the vaccine controversy. Students could also research anti-vaccine web sites so they have an understanding of the information patients may be exposed to on the Inter- net. 26 Students could be responsible for updating the phar- macy’s staff on the frequently changing recommendations regarding vaccines and for developing a vaccine record card for patients. If the pharmacy practice is active in the second level, facilitation of immunizations (having another healthcare professional administer vaccines at the site), students could assist with screening patients for immunizations and processing paperwork. Students could also be in- volved with identifying at-risk patients, marketing the service, and answering questions. In states that allow pharmacists to administer immu- nizations, students could assist with designing and imple- menting a new program or enhancing an existing one. For example, if the practice site offers only influenza vaccinations during October and November, students could design and implement a year-round immunization program, identifying patients at risk for other diseases
  • 14. for which immunizations are available such as tetanus- diphtheria or pneumococcal vaccine. Students could assist with the administration of vaccines if allowed by state law. Preventative Services Another way to approach wellness and disease pre- vention is to target patients based on their age. The US Preventative Health Services Task Force has a guide to preventative health services which is based on age and gender. 27 In addition, several other organizations publish preventative health checklists based on age and gender including the American Academy of Family Physicians (www.aafp.org), the American College of Physicians (www.acponline.org), and the American College of Obstetricians and Gynecologists (www.acog.com). Stu- dents could use these checklists to design a preventative services counseling program for the practice site. Ano- ther exercise is to have the student assess the usability of preventative health guidelines (ie, how difficult is it to identify the services recommended and determine how frequently they should be performed), and sug- gest changes that would make the checklists easier to use. Lifestyle Counseling Knowledge and training about educating patients on proper lifestyle choices is one of the keys to actually helping them make positive changes. Realizing each patient’s specific situation and goals is essential in help- ing them attain those goals. Additionally, it is important to
  • 15. understand how patients make lifestyle changes. APPE activities could include researching and learning about the different theories addressing changing patient behav- iors. Several models have been used by pharmacists in- cluding the Health Belief Model, Fishbein-Ajzen Theory of Reasoned Action, and the Transtheoretical Model. 28-30 Students should observe preceptors using these models in patient counseling, and then employ them when working with patients trying to make lifestyle changes. Other techniques used for disease and wellness programs that students should learn include conducting motiva- tional interviewing and providing self-management education.31 Smoking Cessation Tobacco use is one of the leading causes of mortality in the United States. Providing directed interventions to- ward patients who use tobacco is another way pharmacists and student pharmacists can become involved in wellness and disease prevention in their practice. Students could provide brief interventions with patients, such as counseling them on the benefits of quit- ting, or more detailed interventions as part of a com- prehensive smoking cessation program that includes conducting one-on-one counseling, making drug ther- apy recommendations, and providing follow-up care/ counseling.32-34 Students could assist in the development of forms describing the various nonprescription and pre- scription smoking cessation products available and the advantages and disadvantages, side effects, and cost of each.35 Providing patients with detailed information re-
  • 16. garding available pharmacotherapy can help them make informed decisions. To assist in the implementation and delivery of a smoking cessation program within the prac- tice site, students could develop patient handouts, and patient interview and documentation forms.32,33 Students could also participate in one-on-one patient counseling sessions provided for patients. Additionally, some smoking cessation programs may include group ed- ucational sessions, students may be involved in creating and/or teaching these sessions. Offering smoking cessation therapy management and obtaining payment for the services will give the student a valuable experience in the American Journal of Pharmaceutical Education 2006; 70 (2) Article 40. 5 delivery of wellness and disease prevention services within a pharmacy practice. Basic Nutrition and Exercise Counseling A fundamental component of wellness and disease prevention is good nutrition and adequate exercise. Stu- dents should learn the basic nutrition and exercise infor- mation needed for pharmacists to appropriately and effectively counsel their patients regarding either pre- vention or management of disease. 8-9 This topic is usually not stressed in pharmacy curriculums and APPE’s pro- vide an excellent forum for students to learn about nutri-
  • 17. tion and exercise and practice their patient counseling skills. Preceptors can assign readings and have a topic discussion about nutrition and exercise. 8-9 Students can research and learn about the differences between fad diets and create a chart for the pharmacy staff. Stu- dents could also do this for vitamins and dietary sup- plements. Nutrition and exercise counseling can be incorporated into patient counseling during risk assessment, disease screening, and targeted intervention programs. Students could be involved in developing, implementing, and mar- keting a new patient care service for weight management or starting a body composition screening service. Possible activities would be similar to activities discussed in pre- vious sections. Targeted Interventions Targeted intervention programs are programs designed to focus on promoting wellness, disease prevention, and healthy living for patients who already have a chronic disease. As with the other areas of wellness, student activities could include developing and implementing the target intervention program, including writing poli- cies and procedures, creating monitoring forms, and de- veloping or evaluating existing patient educational materials. For example, a targeted intervention program for patients with diabetes might center on ensuring that patients who have diabetes are receiving appropriate medications such as ACE inhibitors or aspirin therapy.
  • 18. 36 Even though this is not really wellness, it is prevention of future problems related to diabetes mellitus. A targeted intervention program for patients with diabetes mellitus could also include ensuring that these patients have access to appropriate preventative services, such as annual check-ups with a podiatrist and ophthalmologist and bi-annual check-ups with a dentist. Conducting targeted intervention provides students with lessons in communicating with patients and pro- viders, and in managing chronic diseases. Other activities could include the preceptor conducting topic discussions with the student that reinforce the student’s knowledge of the pathophysiology and the pharmacologic and non- pharmacologic (lifestyle modifications and preventative measures) treatment of the disease. Students could be re- quired to create a patient case and present all of this in- formation to the preceptor, or ideally, the preceptor and the student could discuss specific patients in the targeted intervention program. Targeted intervention programs can be used to assess the outcomes of the practices’ patient care activities. These outcomes can be used by the pharmacists to market patient care services to self-insured employers or other payors. This gives the preceptor another opportunity for teaching APPE students. Students can be involved in the process of organizing the outcomes for presentation and developing materials for the meeting. Additionally, the preceptor can engage the student in discussions about compensation for patient care services. Marketing
  • 19. Acquiring a basic knowledge of marketing is impor- tant for APPE students since effectively marketing a phar- macy’s services to the appropriate patient population not only increases the site’s revenue stream, it ensures that patients are aware of the valuable and potentially life- saving services offered. Students should be involved with the marketing of any of the previously mentioned health promotion programs and preventative services. Students should be able to design marketing materials (signs, shelf talkers, brochures, and patient handouts) including a plan for how to inform patients about any new service or pro- gram. Students could also develop a marketing strategy that targets others such as caregivers, third-party payors, and family members. Preceptors could assign readings for students to learn more about marketing pharmacy services. 37-39 Another valuable activity is to have stu- dents participate in marketing the program to patients directly. Preceptors should use this activity to have discussion with the student about marketing, including the difference between product and service marketing. As another component, students could visit local physi- cians and their practices to market new programs and services. Outcomes Assessment All pharmacy services should be evaluated to determine the outcomes and success of the program and then this in- formation should be used for continuous quality improve- ment. A learning activity for students could be designing an evaluation process for the risk-assessment program or per- forming evaluation activities such as tallying numbers of patients, number at risk, and number of referrals. Students
  • 20. could be involved with designing or researching available American Journal of Pharmaceutical Education 2006; 70 (2) Article 40. 6 evaluation tools for the program (eg, patient satisfaction instruments).40,41 CONCLUSION A community APPE provides an excellent opportunity for developing and implementing wellness and disease pre- vention activities. Additionally, preceptor involvement with these activities provides a positive role model for students. In turn, teaching and practicing wellness and dis- ease prevention for the benefit of patients and student phar - macists will help improve the professions’ capability of making an impact on the health of the nation. REFERENCES 1. Mokdad AH, Marks JS, Stroup DF, Gerberding JL. Actual causes of death in the United States, 2000. JAMA 2004;291:1238-45. 2. U.S. Department of Health and Human Services. Healthy People 2010: Understanding and Improving Health. 2nd ed. 2 vols. Washington, DC: U.S. Government Printing Office;2000. Available at: www.healthypeople.gov. Accessed January 18, 2006. 3. Babb VJ, Babb J. Pharmacist involvement in Healthy People 2010. J Am Pharm Assoc. 2003;43:56-60. 4. Calis KA, Hutchinson LC, Elliott ME, Ives TJ, et al. Healthy
  • 21. People 2010: challenges, opportunities, and a call to action for America’s pharmacists. Pharmacotherapy. 2004;24:1241-94. 5. Educational Outcomes 2004. Center for Advancement of Pharmaceutical Education. American Association of Colleges of Pharmacy. 2004. Available at www.aacp.org/Docs/MainNavigation/ Resources/6075_CAPE2004.pdf. Accessed February 17, 2005. 6. 2005 National Health Observances. National Health Information Center, Office of Disease Prevention and Health Promotion, US Department of Health and Human Services, Washington, DC. Available at: www.healthfinder.gov/library/nho/nho.asp. Accessed July 11, 2005. 7. Ciardulli LM, Goode JR. Using health observances to promote wellness in community pharmacies. J Am Pharm Assoc. 2003;43:61-8. 8. Dombrowski SR. Pharmacist counseling on nutrition and physical activity – part 1 of 2: understanding current guidelines. J Am Pharm Assoc. 1999;39:479-91. 9. Dombrowski SR, Ferro LA. Pharmacist counseling on nutrition and physical activity – part 2 of 2: helping patients make changes. J Am Pharm Assoc. 1999;39:613-27. 10. Giles JT, Kennedy DT, Dunn EC, et al. Results of a community pharmacy-based breast cancer risk assessment and education program. Pharmacotherapy. 2001;21:243-53. 11. Boyle TC, Coffey J, Palmer T. Men’s health initiative risk assessment study: effect of community pharmacy-based screening. J Am Pharm Assoc. 2004;44:569-77. 12. DeHart RM, Gonzalez EH. Osteoporosis: Point-of-Care Testing. Ann Pharmacother. 2004;38:473-81. 13. Rosenthal WM. Implementing bone mineral density testing in the community pharmacy. J Am Pharm Assoc. 2000;40:737-
  • 22. 45. 14. Goode JV, Swiger K, Bluml BM. Regional osteoporosis screening, referral, and monitoring program in community pharmacies: findings from Project ImPACT Osteoporosis. J Am Pharm Assoc. 2004;152-60. 15. Elliot ME, Meek PD, Kanous NL, et al. Osteoporosis screening by community pharmacists: use of National Osteoporosis Foundation resources. J Am Pharm Assoc. 2002;42:101-10. 16. Tice B, Phillips CR. Implementation and evaluation of a lipid screening program in a large chain pharmacy. J Am Pharm Assoc. 2002;42:413-9. 17. Tsuyuki RT, Johnson JA, Teo KK, et al. A randomized trial of the effect of community pharmacist intervention on cholesterol risk management: the Study of Cardiovascular Risk Intervention by Pharmacists (SCRIP). Arch Intern Med. 2002;162:1149-55. 18. Carter BL. Pharmaceutical Care for Hypertensive patients. Am Pharm. 1994;NS34:54-61. 19. Park JJ, Kelly P, Carter BL, Buirgess PP. Comprehensive pharmaceutical care in the chain setting. J Am Pharm Assoc. 1996;36:443-51. 20. Carter BL, Barnette DJ, Chrischilles E, et al. Evaluation of hypertensive patients after care provided by community pharmacists in a rural setting. Pharmacotherapy. 1997;17: 1274-85. 21. Magnum SA, Kraenow KR, Narducci WA. Identifying at-risk patients through community pharmacy-based hypertension and stroke prevention screening projects. J Am Pharm Assoc.
  • 23. 2003;43:50-5. 22. Zerumsky K, Steinmetz KL, Handler SM, et al. Pharmacist detection of peripheral arterial disease through the use of a handheld Doppler. Pharmacotherapy. 2005;25:797-802. 23. Rosenthal WM. Establishing a pharmacy-based laboratory service. J Am Pharm Assoc. 2000;40:146-56. 24. States where pharmacists can provide immunizations. American Pharmacists Association. Available at: www.aphanet.org/ pharmcare/ImmunizationInformation.htm#States%20where. Accessed July 15, 2005. 25. Guidelines for pharmacy-based immunization advocacy. American Pharmacists Association. Available at: www.aphanet.org/ pharmcare/immguide.html. Accessed July 15, 2005. 26. Wolfe RM, Sharp LK, Lipsky MS. Content and design attributes of antivaccination web sites. JAMA. 2002;287:3245-8. 27. Guide to Clinical Preventative Services 2005. United States Preventative Health Services Task Force. Available at: www.ahrq.gov/clinic/pocketgd.htm. Accessed July 15, 2005. 28. Mullen PD, Hershey JC, Iverson DC. Health behavior models compared. Soc Sci Med. 1987;24:973-81. 29. Ajzen I, Fishbein M. Understanding Attitudes and Predicting Social Behavior. Englewood Cliffs, NJ: Prentice Hall; 1980 30. Hudmon KS, Berger BA. Pharmacy applications of the transtheoretical model in smoking cessation. Am J Health-Syst Pharm. 1995;52:282-7. 31. Lange N, Tigges BB. Influence positive change with motivational interviewing. Nurse Pract. 2005;30:44-53.
  • 24. 32. Kennedy DT, Small RE. Development and implementation of a smoking cessation clinic in a community pharmacy practice. J Am Pharm Assoc. 2002;42:83-92. 33. Kennedy DT, Giles JT, Ghnag ZG, et al. Results of a smoking cessation clinic in a community pharmacy practice. J Am Pharm Assoc. 2002;42:51-6. 34. A Clinical Practice Guideline for Treating Tobacco Use and Dependence. US Public Health Service Report. JAMA. 2000;283:3244-54. 35. Rigotti NA. Treatment of Tobacco Use and Dependence. N Engl J Med. 2002;346:506-12. 36. Haggerty SA, Cerulli J, Zeolla MM, Cottrell JS, Weck MB, Faragon JJ. A Community pharmacy Target Intervention Program (TIP) to improve aspirin use in persons with diabetes. J Am Pharm Assoc. 2005;45:17-22. American Journal of Pharmaceutical Education 2006; 70 (2) Article 40. 7 37. Mc Donough RP, Doucette WR. Using personal selling skills to promote pharmacy services. J Am Pharm Assoc. 2003;43:363-72. 38. Holdford DA. Using buzz marketing to promote ideas, services, and products. J Am Pharm Assoc. 2004;44:387-96.
  • 25. 39. Holdford DA. Marketing for Pharmacists. Washington, DC: American Pharmacists Association; 2003. 40. Kucukarslan S, Schommer JC. Patients’ expectations and their satisfaction with pharmacy services. J Am Pharm Assoc. 2002;42:489-95. 41. Larson LN, Rovers JP, Mackeigan LD. Patient satisfaction with pharmaceutical care: update of a validated instrument. J Am Pharm Assoc. 2002;42:44-50. American Journal of Pharmaceutical Education 2006; 70 (2) Article 40. 8 © 2010 FIDM/ Fashion Institute of Design & Merchandising 1 MODULE #7 SCREENCAST TRANSCRIPT Writing a Rough Draft, Integrating Quotes Effectively & Formulating Your Group’s Recommendation Reflect for a moment on your previous Outline & Sources Integration Assignment.
  • 26. It was highly structured and specific in its organization and focus of supporting points and sub-points. Depending on how successful you were in completing this stage of our assignment, the creation of your rough draft should be logical and rewarding. Many students and writers attempt to write full paragraphs and reports before they have outlined and formulated specific topics and points. Not so for you as you’ve already crafted a detailed and focused outline with proposed quotes and sources that are relevant and specific. Writing a Rough Draft By creating a detailed outline with proposed quotes and sources for each point, you can begin to craft paragraphs for each section of your report. • Each paragraph should begin with a focused topic sentence which gives an overview of the main idea for the entire paragraph and its connection to your thesis. • Following this topic sentence, each paragraph should supply approximately 15 sentences of supporting details which include quotes, facts, graphics or expert opinions that use in-text documentation in MLA formats. • Equally important, in each paragraph you must supply your own insights and
  • 27. opinion which synthesize and analyze this factual information and connect them to the thesis. In this way, you will avoid a copy-and-paste report – a common mistake in report writing in which the writer merely assembles a variety of quotes, with or without focus, fails to analyze or synthesize them and offers no insights or opinion. Also, you must strive to organize your points and material within each paragraph. Consider time order, cause and effect, reasons, a range of opinions, strengths vs. weaknesses, or distinct categories of frameworks or sources. In addition, you must establish authority, introduce and qualify each source from which you quote in your paragraphs. 2 Establish Authority & Qualify Sources In addition, you must establish authority. Introduce and qualify each source from which you quote in your paragraphs. Consider this quote: “Apple has unlimited growth potential, not only in sales of its innovative products, but also its business model of offering a lucrative
  • 28. platform and charging suppliers and providers of content and applications – a brilliant source of ongoing revenue and profits.” (Buffett 213) Who is Warren Buffett? Why does his opinion matter? Now look at this example of qualifying and introducing an expert’s opinion or qualitative quote: World-renowned equity expert and billionaire Warren Buffet believes, “Apple has unlimited growth potential, not only in sales of its innovative products, but also its business model of offering a lucrative platform and charging suppliers and providers of content and applications – a brilliant source of ongoing revenue and profits.” Notice that I have qualified and introduced who Warren Buffett is and why his opinion is of value. Also, I documented the quote in the introductory material of the sentence rather than at the end in parenthesis. As with every quote I use, I would then ensure that I have a Works Cited page entry that begins with Buffett, Warren and supplies the full information for the source of this quote. An example of qualifying, introducing and integrating statistics, facts or quantitative quotes:
  • 29. According to Apple’s Annual Report, “revenues have increased by 30% for the quarter ending December, 2009” (23). Again, I have documented the statistics in the introductory material of the sentence rather than at the end in parenthesis. However, I have included the page number in parenthesis at the end of the sentence. I also need to confirm that I have a Works Cited page entry that begins with “Annual Report – Apple” and supplies the full information for the source of this quote. If I have already introduced and qualified the source earlier in the report, I would document the quote in parenthesis at the end of the sentence: “Revenues have increased by 30% for the quarter ending December, 2009” (“Annual Report – Apple” 23). Notice where and how quotation marks, periods and parentheses are specifically used and placed. 3
  • 30. Use Correct Documentation Again refer to your book and the online sources previously identified to compare your writing and formats to the MLA models for integration of quotes and sources, in-text documentation and Work Cited formats. In addition, be sure to follow models in your book and online for correctly citing and using in-text documentation for any images, charts or graphs you use. As with quotes, facts or statistics which use words or numbers, the in-text documentation you use for images, charts and graphs should track back directly to a specific Works Cited entry. Avoid First-person Writing Finally, avoid the use of “I” or “we” when writing sentences in each paragraph which supply your analysis, synthesis, opinion and insights. An example using first-person writing: I think Apple’s a great company and even though they don’t give any dividends, I still would buy the stock! By avoiding first person, the revised sentence below must synthesize and provide valid reasons for opinions:
  • 31. Even though Apple does not pay dividends to its shareholders, its stock price has increased significantly during the last decade, offering massive profits to those who have held shares for the long-term. Refer to your completed Outline & Sources Integration assignment from our previous module. • The 4 sections of your report should have 3 subpoints each • In other words, you should supply 12 paragraphs for the body of your report. (4 sections with 3 paragraphs each.) Each paragraph should include: • A focused topic sentence, which gives an overview of the main of the entire paragraph and its connection to your thesis • Approximately 15 sentences of supporting details, which include quotes, facts, graphics or expert opinions that use in-text documentation in MLA formats. • Your own insights and opinion, which synthesize and analyze this factual information and connect them to the thesis. Group Recommendation Once all your group members have completed these body
  • 32. paragraphs, you are ready to write your own recommendation section which synthesizes all the frameworks, insights, facts, details, quotes and opinions from the previous 4 sections and formulates your group’s collective opinion about the company’s stock – buy, sell or hold. 4 You may find that this section is one long paragraph or a series of shorter paragraphs, but your group should discuss the logic and organization of this section. Remember the purpose of the Group Recommendation section: Synthesize the research and comment on whether your group would recommend investing in this company. Give specific reasons for your opinions. BUY / SELL / HOLD You may discover there are advantages and disadvantages, strengths and weaknesses, 3-5 reasons, or 3-5 frameworks that seem logical as separate paragraphs which highlight each distinct point you are making. Regardless of how you organize this crucial section of your report, you must provide 1 or more substantial paragraphs with focused topic sentences, compelling evidence and
  • 33. support, valuable synthesis, insights and analysis and an articulate recommendation. Once you have completed all the required sections for your rough draft, refer to the Rough Draft Rubric for your Company Report and be sure you have proofread and revised all sections before submitting it for my evaluation. Required Sections for Rough Draft: • Company Background & Current Stage in Growth Lifecycle • Detailed Financial Information -- Microeconomics • Industry Landscape, Trends and Competitors -- Macroeconomics • Recent Developments, Analyst Opinions and Wall Street Consensus • Group’s Recommendation • Updated Works Cited Questions to Ask Does your rough draft: • Include all required sections? • Supply sufficient organization & content? • Effectively integrate sources, MLA formats and include your updated works cited? • Follow standards for grammar & mechanics? Make sure you communicate regularly with your group members, especially for the group recommendation section.
  • 34. Hopefully, you have created a masterpiece with your rough draft. All that remains is selecting an appropriate frame which we will construct and add during our next module in preparation for submitting your final draft in the future. MODULE #7 SCREENCAST TRANSCRIPTWriting a Rough DraftEstablish Authority & Qualify SourcesUse Correct DocumentationAvoid First-person WritingGroup RecommendationQuestions to Ask © 2010 FIDM/ Fashion Institute of Design & Merchandising Company Report “Rough Draft” Rubric Writing Assignment (10 points) INCLUDES ALL REQUIRED SECTIONS (2.5 POINTS) Rough draft follows guidelines for organization and includes all required sections, including: • Company Background & Current Stage in Growth Lifecycle • Detailed Financial Information -- Microeconomics • Industry Landscape, Trends and Competitors -- Macroeconomics • Recent Developments, Analyst Opinions and Wall Street Consensus • Recommendations • Works Cited ORGANIZATION & CONTENT (2.5 POINTS)
  • 35. Paragraphs in all sections include: • A focused topic sentence with an overview of the main idea for the entire paragraph and its connection to thesis • Approximately 15 sentences of supporting details which include quotes, facts, graphics or expert opinions • Writers’ insights and opinions are provided, which synthesize and analyze researched quantitative, qualitative and responsive information, and connect to the thesis • Points and material within each paragraph are logically organized. Consider time order, cause and effect, reasons, a range of opinions, strengths vs. weaknesses, or distinct categories of frameworks or sources. SOURCE INTEGRATION, MLA FORMATS & WORKS CITED (2.5 POINTS) • Sources are integrated effectively establishing authority, introducing and qualifying each source quoted in paragraphs • In-text documentation follows MLA formats • Works Cited page follows MLA formats GRAMMAR & MECHANICS (2.5 POINTS) • Writing follows standards for effective business writing, avoiding first person and errors in sentence skills, mechanics, grammar and spelling
  • 36. TOTAL POINTS: __________________ Company Report “Rough Draft” Rubric Now that you have fully researched your company, written a detailed outline and source review, selected the specific quotes, graphics, and details which are quantitative, qualitative and responsive, and created a correctly formatted and accurately detailed Works Cited page, you are ready to compile and begin writing the first draft of your Company Report. Contrary to the method you may have used in writing researched reports in the past, we will not begin by writing the introduction or first paragraph of your report. You must first fully collaborate and cooperate with your team members and begin compiling the specific sections of your report -- the body. After you have ensured that these sections are all complete and fully developed, then your group can begin to synthesize all the research and analysis featured in these sections to formulate and write your group’s own recommendation section and opinion -- buy, sell or hold. In our next module, after completing this and all the body sections of your report, your group will write an introduction, summary, and conclusion that unify and frame your report. Design and create your masterpiece first – the body sections of your report – then add a frame and packaging after – the introduction, summary, and conclusion. (No Group)