Essential 2 Didactic

Behavior change models

Frameworks explaining how and why individuals adopt or change health behaviors

Purpose of behavior change models

Predict behavior, design interventions, evaluate programs, improve patient outcomes

Common factors influencing behavior change

Readiness to change, motivation, environment, social factors

Health Belief Model (HBM)

Model explaining behavior change based on perceived threat and evaluation of actions

Perceived susceptibility

Belief about personal risk of a condition

Perceived severity

Belief about seriousness of a condition and consequences

Perceived benefits

Belief that action will reduce risk or severity

Perceived barriers

Belief about obstacles or costs of action

Cues to action

Triggers that prompt behavior change (education, reminders, symptoms)

Self-efficacy

Confidence in ability to perform behavior

Transtheoretical Model (TTM)

Stage-based model describing readiness to change behavior

Precontemplation

Not considering change

Contemplation

Thinking about change

Preparation

Planning for change

Action

Actively making behavior change

Maintenance

Sustaining behavior change

Decisional balance

Weighing pros and cons of change

Processes of change

Strategies used to progress through stages

Self-efficacy in TTM

Confidence to maintain change despite barriers

5 A's Model

Patient-centered framework for behavior change counseling

Ask

Identify current behavior

Advise

Provide clear, personalized recommendations

Assess

Determine readiness to change

Assist

Help set goals and overcome barriers

Arrange

Follow-up and monitor progress

Motivational Interviewing (MI)

Collaborative counseling style to strengthen motivation for change

Righting reflex

Provider urge to correct patient behavior (should be avoided)

MI focus

Understanding the patient's "why" and readiness for change

Clinical service

Service provided by pharmacists to improve patient care beyond dispensing

Importance of clinical services

Improves outcomes, adapts to declining product reimbursement

Common community pharmacy clinical services

Immunizations, MTM, medication synchronization

Immunizations in pharmacy

Vaccines administered by pharmacists under state authority

Pharmacist immunization authority

Varies by state; governed by law and protocols

PREP Act

Federal law expanding pharmacist authority during public health emergencies

Medication Therapy Management (MTM)

Services optimizing therapeutic outcomes for patients

Purpose of MTM

Improve outcomes, reduce costs, enhance adherence

MTM eligibility criteria

Multiple chronic conditions, multiple medications, high drug costs

Comprehensive Medication Review (CMR)

Systematic review of all patient medications

Targeted Medication Review

Focused review of a specific issue or drug

MTM Core Elements

MTR, PMR, MAP, intervention/referral, documentation, follow-up

Medication synchronization (Med Sync)

Aligning refill dates for monthly medication pickup

Benefit of Med Sync

Improves adherence and convenience

Difference between Med Sync and auto-refill

Med Sync is appointment-based with pharmacist interaction

Cultural competency

Ability to provide effective care across cultural differences

Why cultural competency matters

Improves trust, communication, adherence

Key influences on patient care

Beliefs, attitudes, language, family involvement

Key elements of cultural competency

Knowledge, attitudes, skills

Common cultural competency pitfalls

Stereotyping, overemphasis on culture, false assumptions

Cultural relativism

No culture is superior or inferior

Ethnocentrism

Belief that one's own culture is superior

Legal basis for cultural competency

Title VI Civil Rights Act, CLAS Standards, OBRA '90

Cross-cultural communication

Patient-centered dialogue respecting beliefs and values

Examples of cross-cultural questions

What do you call this problem? What do you believe caused it?

Hospital pharmacy

Pharmacy practice within institutional healthcare systems

Types of hospitals

Community, academic, specialty, critical access

Hospital pharmacy departments

Procurement, distribution, clinical services, informatics

ASHP hospital practice standards

Define acceptable pharmacy practice standards

Role of hospital pharmacist

Ensure safe, effective medication use and therapy quality

Regulatory bodies in hospitals

State Boards of Pharmacy, Joint Commission, CMS

Joint Commission (TJC)

Accredits healthcare organizations with focus on safety

National Patient Safety Goals

Standards to prevent medical errors

Hospital reimbursement model

Diagnosis-Related Groups (DRGs)

DRG payment

Fixed payment per hospital admission

Value-Based Purchasing

Links reimbursement to quality and outcomes

Drug distribution systems

Centralized, decentralized, automated dispensing

Automated dispensing cabinets

Secure medication storage on patient care units

Pharmacy practice models

Distribution-centered, clinical-centered, patient-centered integrated

Insurance BIN

Routes claim to correct PBM

Insurance PCN

Identifies patient profile under PBM

Group number

Routes claim to correct plan

Pharmacy discount cards

Non-insurance price-reduction programs

Patient assistance cards

Manufacturer programs lowering brand-name copays

PPO insurance

Greater provider flexibility, higher cost

HMO insurance

Lower cost, restricted provider network

Medicare Part A

Hospital inpatient coverage

Medicare Part B

Outpatient medical services and some medications

Medicare Part C

Medicare Advantage plans

Medicare Part D

Prescription drug coverage

Georgia Medicaid eligibility

Income-based with age, disability, pregnancy, or dependent criteria

Common insurance rejections

Incorrect BIN/PCN, refill too soon, non-covered prescriber

DAW code 0

No substitution indicated

DAW code 1

Brand medically necessary

Leadership

Ability to guide teams toward shared goals

Four leadership domains

Executing, influencing, relationship building, strategic thinking

Five Practices of Exemplary Leaders

Model the way, inspire vision, challenge process, enable others, encourage the heart

Model the Way

Set example and clarify values

Inspire a Shared Vision

Motivate others with future goals

Challenge the Process

Seek innovation and improvement

Enable Others to Act

Build trust and empower team members

Encourage the Heart

Recognize and celebrate contributions

Collective intelligence

Team performance depends on collaboration more than individual IQ

UGA College of Pharmacy founded

1903

First UGA pharmacy degree

Pharmacy Graduate (Ph.G.)

First graduating class at UGA COP

1908

First African American graduate at UGA COP

William Robie III (1970)

Transition to PharmD

Expanded clinical education and patient-centered care