Student-led educational outreach visits as a strategy to advance pharmacy education: A qualitative analysis of students' perspectives of a Brazilian study
DOI:
https://doi.org/10.46542/pe.2024.241.670677Keywords:
Access to medicine, Educational outreach visit, Focus group, Pharmacy educationAbstract
Background: Pharmacy education in Brazil has recently transformed to better prepare students for public health services, requiring mandatory experiential learning. Essential medicines lists (EML) are vital for improving access to medications, though their distribution is limited. As part of a community outreach initiative, pharmacy students carried out Educational Outreach Visits (EOV) to healthcare professionals and engaged with users of primary healthcare units to promote the EML. This paper discusses the students' perceptions of leading these EOV in a municipality in southeastern Brazil.
Methods: Eight students involved in EOV participated in a focus group discussion. The session was recorded and transcribed, followed by content analysis. Three thematic categories were established: 1) importance for the training of the future pharmacist, 2) relevance of the initiative, and 3) challenges of the experience.
Results: The students expressed that their involvement in EOV allowed them to gain insights into the reality of the healthcare system and contributed to improving their understanding of pharmaceutical services. Additionally, the initiative was viewed as a method to advance access to medicines in the public health system. Regarding the challenges, the students were apprehensive about not answering some questions and interacting with physicians.
Conclusion: In the view of undergraduate pharmacy students, EOV is relevant to training pharmacists to work in Sistema Único de Saúde (SUS) and improving access to medicines in the public system. The lack of confidence to deliver EOV, particularly in communicating with physicians, should be considered when preparing students to participate in similar initiatives.
References
Abdu-Aguye, S. N., Yusuf, H., Agbale, E. O., Auwal, F. I., & Ma’aji, H. U. (2019). Connections between classroom theory & real world practice: Exploring the perspectives of undergraduate students at a Nigerian faculty of pharmacy. Pharmacy Education, 19(1), 185–189. https://pharmacyeducation.fip.org/pharmacyeducation/article/view/769
Adeola, A. T., Coetzee, R., Van Huyssteen, M., & Bheekie, A. (2021). Service learning in pharmacy: Implementation of tuberculosis screening by second-year pharmacy students in primary health care facilities in Cape Town, South Africa. Pharmacy Education, 21, 203–215. https://doi.org/10.46542/pe.2021.211.203215
Albassam, A., Almohammed, H., Alhujaili, M., Koshy, S., & Awad, A. (2020). Perspectives of primary care physicians and pharmacists on interprofessional collaboration in Kuwait: A quantitative study. PLOS ONE, 15(7), e0236114. https://doi.org/10.1371/journal.pone.0236114
Anderson, C., Bates, I., Beck, D., Brock, T. P., Futter, B., Mercer, H., Rouse, M., Whitmarsh, S., Wuliji, T., & Yonemura, A. (2009). The WHO UNESCO FIP pharmacy education taskforce. Human Resources for Health, 7(1), 45. https://doi.org/10.1186/1478-4491-7-45
Appaneal, H. J., Lesniak, K., LaPlante, K. L., & Feret, B. (2023). Student pharmacists delivering academic detailing on adult pneumococcal vaccination to community pharmacists. Journal of the American Pharmacists Association, 63(4), 1064-1069.e2. https://doi.org/10.1016/j.japh.2023.04.003
AtlasBR. (n.d.). Atlas do Desenvolvimento Humano no Brasil. http://www.atlasbrasil.org.br/perfil/municipio/330240#sec-saude
Baker, L., Egan-Lee, E., Martimianakis, M. A. (Tina), & Reeves, S. (2011). Relationships of power: Implications for interprofessional education. Journal of Interprofessional Care, 25(2), 98–104. https://doi.org/10.3109/13561820.2010.505350
Bardet, J.-D., Vo, T.-H., Bedouch, P., & Allenet, B. (2015). Physicians and community pharmacists collaboration in primary care: A review of specific models. Research in Social and Administrative Pharmacy, 11(5), 602–622. https://doi.org/10.1016/j.sapharm.2014.12.003
Bardin, L. (2011). Análise de conteúdo. Edições 70.
Bheekie, A., Adonis, T.-A., & Daniels, P. (2007). Contextualising undergraduate pharmacy training in service-learning at the University of the Western Cape. Education as Change, 11(3), 157–167. https://doi.org/10.1080/16823200709487186
Bollen, A., Harrison, R., Aslani, P., & Van Haastregt, J. C. M. (2019). Factors influencing interprofessional collaboration between community pharmacists and general practitioners—A systematic review. Health & Social Care in the Community, 27(4). https://doi.org/10.1111/hsc.12705
Brasil. Ministério da Educação, Conselho Nacional de Educação Superior, Câmara de Educação Superior. (2017). Resolução n. 6, de 19 de outubro de 2017. Institui as Diretrizes Curriculares Nacionais do Curso de Graduação em Farmácia e dá outras providências. https://abmes.org.br/arquivos/legislacoes/Res-CES-CNE-006-2017-10-19.pdf
DATASUS. (2024). Mortalidade geral. https://datasus.saude.gov.br/mortalidade-desde-1996-pela-cid-10
De Oliveira, V. F., Bittencourt, M. F., Navarro Pinto, Í. F., Lucchetti, A. L. G., Da Silva Ezequiel, O., & Lucchetti, G. (2018). Comparison of the readiness for interprofessional learning and the rate of contact among students from nine different healthcare courses. Nurse Education Today, 63, 64–68. https://doi.org/10.1016/j.nedt.2018.01.013
Eriksen, J., Gustafsson, L. L., Ateva, K., Bastholm-Rahmner, P., Ovesjö, M.-L., Jirlow, M., Juhasz-Haverinen, M., Lärfars, G., Malmström, R. E., Wettermark, B., & Andersén-Karlsson, E. (2017). High adherence to the ‘Wise List’ treatment recommendations in Stockholm: A 15-year retrospective review of a multifaceted approach promoting rational use of medicines. BMJ Open, 7(4), e014345. https://doi.org/10.1136/bmjopen-2016-014345
Etukakpan, A., Uzman, N., Ozer, O., Tofade, T., Leite, S. N., Joda, A., Choonara, Y., Mwila, C., Azzopardi, L. M., Mantel-Teeuwisse, A. K., Rahal, M., Darwish, R., Lee, B.-J., Shakya, R., Gallagher, P. J., Moreau, P., Lourenço, L., McKinnon, R. A., & Altiere, R. J. (2023). Transforming pharmaceutical education: A needs-based global analysis for policy development. Exploratory Research in Clinical and Social Pharmacy, 9, 100234. https://doi.org/10.1016/j.rcsop.2023.100234
Evoy, K. E., Groff, L., Hill, L. G., Godinez, W., Gandhi, R., & Reveles, K. R. (2020). Impact of student pharmacist–led naloxone academic detailing at community pharmacies in Texas. Journal of the American Pharmacists Association, 60(1), 81–86. https://doi.org/10.1016/j.japh.2019.09.007
Fang, K. M., Lau, G. C., Park, J. Y., & Tchen, P. (2022). Exploring factors that influence student engagement in community-engaged learning activities within a pharmacy context. American Journal of Pharmaceutical Education, 86(4), 8637. https://doi.org/10.5688/ajpe8637
Foppa, A. A., Oliveira Gomes, L., Raijche Mattozo Rover, M., Dos Santos, R. I., Rocha Farias, M., & Leite, S. N. (2021). Teaching and learning pharmacy services: A teaching method for developing competencies for patient-centered care through experiential learning in a real workplace. Journal of Pharmacy Practice, 34(1), 89–96. https://doi.org/10.1177/0897190019854573
Gondim, S. M. G. (2002). Grupos focais como técnica de investigação qualitativa: Desafios metodológicos. Paidéia (Ribeirão Preto), 12(24), 149–161. https://doi.org/10.1590/S0103-863X2002000300004
Gonzales, A. D., Harmon, K. S., & Fenn, N. E. (2020). Perceptions of service learning in pharmacy education: A systematic review. Currents in Pharmacy Teaching and Learning, 12(9), 1150–1161. https://doi.org/10.1016/j.cptl.2020.04.005
Governo do Estado do Rio de Janeiro. (2020). Diagnóstico de saúde da região norte. https://www.saude.rj.gov.br/planejamento-em-saude/regioes-de-saude/planejamento-regional-integrado
Instituto Brasileiro de Geografia e Estatística. (n.d.). IBGE Cidades. https://cidades.ibge.gov.br/brasil/rj/macae/panorama
International Pharmaceutical Federation. (2020). A Global Competency Framework for Services Provided by Pharmacy Workforce. International Pharmaceutical Federation. https://www.fip.org/file/5127
International Pharmaceutical Federation. (2022). The FIP Development Goals Report 2021: Setting goals for the decade ahead. International Pharmaceutical Federation. https://developmentgoals.fip.org/global-report-2021/
Kavanaugh, R., Yerks, M., Feldman, R., & Stanton, M. (2021). Combining simulated academic detailing with naloxone training to prepare student pharmacists for opioid risk mitigation strategies. Currents in Pharmacy Teaching and Learning, 13(12), 1679–1682. https://doi.org/10.1016/j.cptl.2021.09.030
Kolb, D. A. (2015). Experimental learning: Experience as the source of learning and development. Prentice-Hall.
Koster, E. S., & Philbert, D. (2023). Communication and relationship building in pharmacy education: Experiences from a student-patient buddy project. Currents in Pharmacy Teaching and Learning, 15(4), 393–399. https://doi.org/10.1016/j.cptl.2023.04.006
Kunstler, B. E., Lennox, A., & Bragge, P. (2019). Changing prescribing behaviours with educational outreach: An overview of evidence and practice. BMC Medical Education, 19(1), 311. https://doi.org/10.1186/s12909-019-1735-3
Lee, S. W. H. (2019). Pharmacy student-led health education campaign initiative. Currents in Pharmacy Teaching and Learning, 11(3), 292–295. https://doi.org/10.1016/j.cptl.2018.12.010
Linder, L., Pruitt, M., Ball, S., Wisniewski, C., & Weed, E. (2024). Utilising pharmacy students to extend academic detailing services focused on naloxone and opioid overdose education. Pharmacy Education, 24(1), 340–347. https://doi.org/10.46542/pe.2024.241.340347
Löffler, C., Koudmani, C., Böhmer, F., Paschka, S. D., Höck, J., Drewelow, E., Stremme, M., Stahlhacke, B., & Altiner, A. (2017). Perceptions of interprofessional collaboration of general practitioners and community pharmacists—A qualitative study. BMC Health Services Research, 17(1), 224. https://doi.org/10.1186/s12913-017-2157-8
Machado, F. L. da S., dos Santos, D. M. de S. S., & Lopes, L. C. (2021). Strategies to approach medicines litigation: An action research Study in Brazil. Frontiers in Pharmacology, 12, 612426. https://doi.org/10.3389/fphar.2021.612426
McCartney, J., & Boschmans, S.-A. (2018). South African pharmacy student perspectives of a hospital-based experiential learning programme. Pharmacy Education, 18, 29–40. https://pharmacyeducation.fip.org/pharmacyeducation/article/view/539
Magarinos-Torres, R., Esher, Â., Caetano, R., Pepe, V. L. E., & Osorio-de-Castro, C. G. S. (2014). Adesão às listas de medicamentos essenciais por médicos Brasileiros em atuação no sistema unico de saúde. Revista Brasileira de Educação Médica, 38(3), 323–330. https://doi.org/10.1590/S0100-55022014000300006
Miranda, V. I. A., Fassa, A. G., Meucci, R. D., & Lutz, B. H. (2016). Use of the Brazilian people’s pharmacy program by older adults. Revista de Saúde Pública, 50(0). https://doi.org/10.1590/S1518-8787.2016050006180
Monteguti, B. R., & Diehl, E. E. (2016). Pharmacy education in southern Brazil: Preparing pharmacists for the unified health system? Trabalho, Educação e Saúde, 14(1), 77–95. https://doi.org/10.1590/1981-7746-sol00008
Mureyi, D., Gwatidzo, S. D., & Matyanga, C. M. (2022). Consumers’ access to information about medicine prices and availability as an enabler of last mile medicine access: A scoping review. The Journal of Medicine Access, 6, 275508342210985. https://doi.org/10.1177/27550834221098598
Nicoline, C. B., & Vieira, R. D. C. P. A. (2011). Pharmaceutical assistance in the Brazilian National Health System (SUS): Pharmacy students' perceptions. Interface - Comunicação, Saúde, Educação, 15(39), 1127–1144. https://doi.org/10.1590/S1414-32832011005000026
O’Brien, M. A., Rogers, S., Jamtvedt, G., Oxman, A., Odgaard-Jensen, J., Kristoffersen, D. T., Forsetlund, L., Bainbridge, D., Freemantle, N., Davis, D., Haynes, R. B., & Harvey, E. (2007). Educational outreach visits: Effects on professional practice and health care outcomes. Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.CD000409.pub2
Osorio-de-Castro, C. G. S., Azeredo, T. B., Pepe, V. L. E., Lopes, L. C., Yamauti, S., Godman, B., & Gustafsson, L. L. (2018). Policy change and the national essential medicines list development process in Brazil between 2000 and 2014: Has the essential medicine concept been abandoned? Basic & Clinical Pharmacology & Toxicology, 122(4), 402–412. https://doi.org/10.1111/bcpt.12932
Prado, F. O., Rocha, K. S., Araújo, D. C., Cunha, L. C., Marques, T. C., & Lyra, Jr, D. P. (2018). Evaluation of students’ attitudes towards pharmacist–physician collaboration in Brazil. Pharmacy Practice, 16(4), 1277. https://doi.org/10.18549/PharmPract.2018.04.1277
Ploylearmsang, C., Sookaneknun, P., Poophalee, T., & Pongruea, P. (2013). Diabetes and hypertension screening by pharmacy students in Thai communities. American Journal of Pharmaceutical Education, 77(3), 56. https://doi.org/10.5688/ajpe77356
Rawlinson, C., Carron, T., Cohidon, C., Arditi, C., Hong, Q. N., Pluye, P., Peytremann-Bridevaux, I., & Gilles, I. (2021). An overview of reviews on Interprofessional Collaboration in Primary Care: Barriers and Facilitators. International Journal of Integrated Care, 21(2), 32. https://doi.org/10.5334/ijic.5589
Reis, B. B., Borin, M. C., Da Costa, M. D., Dresch, R. L., Firmo, O. O. A., Guimarães, M. C., Alves, C. B. M., Junior, N. G. R., Gargano, L. P., Sarmento, T. T. R., Azevedo, P. S., De Figueiredo Zuppo, I., Dias, C. Z., Dos Santos, V. C. C., Alvares-Teodoro, J., De Assis Acurcio, F., & Guerra, A. A. (2022). A Strategy to improve knowledge about health policies and evidence based medicine for federal magistrates in health litigation. Journal of Law, Medicine & Ethics, 50(4), 807–817. https://doi.org/10.1017/jme.2023.22
Rover, M. R. M., Vargas-Peláez, C. M., Farias, M. R., & Leite, S. N. (2016). From the system's organization to the fragmentation of care: perception of users, doctors and pharmacists about the Specialized Component of Pharmaceutical Care. Physis: Revista de Saúde Coletiva, 26(2), 691–711. https://doi.org/10.1590/S0103-73312016000200017
Srinivas, S. C., Wrench, W., Bradshaw, K., & Dukhi, N. (2013). HIV/AIDS: Preliminary health promotion activity based on service-learning principles in Grahamstown, Eastern Cape, South Africa. Indian Journal of Pharmaceutical Education and Research, 47(1), 106–112. https://www.ijper.org/sites/default/files/ijper_47_1_16.pdf
Soumerai, S. B., & Avorn, J. (1990). Principles of educational outreach ('academic detailing’) to improve clinical decision making. JAMA, 263(4), 549–556.
Souza, L. B., & Bonamigo, A. W. (2019). Teaching-service integration in the training of professionals for public health systems. Trabalho, Educação e Saúde, 17(3), e0021747. https://doi.org/10.1590/1981-7746-sol00217
Wahl, K. R., Woolf, B. L., Hoch, M. A., Zillich, A. J., & Hudmon, K. S. (2015). Promoting pharmacy-based referrals to the tobacco quitline: A pilot study of academic Detailing Administered by Pharmacy Students. Journal of Pharmacy Practice, 28(2), 162–165. https://doi.org/10.1177/0897190013515711
World Health Organization. (2001). WHO medicines strategy
Revised procedure for updating WHO’s Model List of Essential Drugs. https://apps.who.int/gb/ebwha/pdf_files/EB109/eeb1098.pdf
Zielińska-Tomczak, Ł., Cerbin-Koczorowska, M., Przymuszała, P., Gałązka, N., & Marciniak, R. (2021). Pharmacists’ perspectives on interprofessional collaboration with physicians in Poland: A quantitative study. International Journal of Environmental Research and Public Health, 18(18), 9686. https://doi.org/10.3390/ijerph18189686
