Utilization of Pharmacists in Physical Therapy Didactic Curricula in the United States

By: Dr. Dustin Wilson, Dr. Brock Woodis, and Dr. Scot Sawyer

Introduction

Pharmacists have been recognized as ideal candidates for teaching the core concepts of pharmacology and pharmacotherapeutics in health sciences curricula.1-4 However, there is scarce data on pharmacists’ use in those curricula.3-5 A recent survey of US physician assistant (PA) programs reported that 83% of programs responding utilized pharmacists in their didactic curricula to deliver pharmacology and pharmacotherapeutics content.5 Pharmacists could ensure that health sciences students receive a solid foundation in pharmacology and pharmacotherapeutics to reduce serious ADEs and excessive healthcare costs.6 In addition, accreditation standards for some health sciences programs now require that curricula prepare students to work in interprofessional environments.7-9 Incorporating pharmacists early in the didactic curricula could enhance students’ knowledge of the role of the pharmacist on the healthcare team.

Currently, 277 US physical therapy (PT) programs are accredited by the Commission on Accreditation in Physical Therapy Education (CAPTE).10 The CAPTE standards require a program’s curriculum to include instruction in pharmacology to be accredited.7 They also state that PT program academic faculty (core and associated) can include medical practitioners from other healthcare disciplines as long as they have the expertise to meet specific curricular needs.7 Literature is not currently available on which medical practitioners are delivering the pharmacology content in these programs. The purpose of our study was to describe the scope of utilization of pharmacists to teach pharmacology/ pharmacotherapeutics in accredited PT programs in the United States.

Methods

This was an Institutional Review Board (IRB)-approved, prospective, cross-sectional, cohort survey. All accredited PT programs listed on the CAPTE website in which the email address of the Chair/Director was identified were recruited for the study. Programs were evaluated for inclusion from November 27, 2019, to December 11, 2019.

The primary objective of this study was to describe the percentage of PT programs that utilize pharmacists to lecture on pharmacology and pharmacotherapeutics content. Secondary objectives were to describe the percentage of pharmacology and pharmacotherapeutics lectures pharmacists deliver, the percentage of PT programs that employ a full-time pharmacist to coordinate the Pharmacology and Pharmacotherapeutics courses, and the inclusion of pharmacists in other courses in the curricula.

The investigators created an online survey (Qualtrics®, Provo, UT). The survey included twelve multiple-choice questions, with one question having a free text option if answered in the affirmative. Data collected in the survey included program characteristics (type of institution; first-year class size; length of graduate program; the presence of a school of pharmacy at the institution; years of establishment), how pharmacology and pharmacotherapeutics content was delivered, and if pharmacists were used elsewhere in the curriculum. The Director of Assessment of the investigators’ institution evaluated survey questions for ambiguity and readability. The survey link was emailed to programs that met inclusion criteria on February 19, 2020. A reminder email with a survey link was sent two weeks after the first email. The survey closed after four weeks on March 18, 2020. All data collected from the surveys were exported to Microsoft Excel (Version 2016, Redmond, WA). Descriptive statistics were used for all analyses.

Results

Of the 253 programs listed on the CAPTE website at the time of the study, the email addresses of the Chair/Director of 240 programs were identified (95%). Of these programs, the survey was delivered to 229 (11 emails were undeliverable). Of the 229 surveys delivered, 59 programs completed the survey for a 26% response rate. The majority of programs responding had been established for more than 15 years (76%). The type of institution was well balanced (public: 49% vs. private: 51%), as well as whether the university had a school of pharmacy (yes: 51% vs. no: 49%). Seventy-six percent reported that the pharmacology and pharmacotherapeutics content was delivered as individual courses. The individual courses totaled 1-4 credit hours in the didactic curricula, with most programs responding to 2 credit hours (67%). Program characteristics on class size and length of the program can be found in Table 1.

Forty-nine percent (29/59) of programs responding reported that pharmacists were utilized to deliver pharmacology and pharmacotherapeutics content. Of those programs that utilized pharmacists, 66% (19/29) reported pharmacists teaching more than 50% of the lectures. However, only five (8%) programs reported having a full-time pharmacist on faculty to coordinate these courses in the curriculum. Less than 10% (5/59) of respondents commented that pharmacists were involved in other courses in the PT curriculum, including biology of disease/pathophysiology and interprofessionalism.

Discussion

To our knowledge, this is the first study to describe the scope of utilization of pharmacists in physical therapy didactic curricula. A similar study was conducted in PA programs throughout the US.5 The majority of published literature discusses the utilization of pharmacists on patient care teams and clinical training of mainly physicians and physician assistants.11-14 Considering physical therapists are often the first healthcare providers patients see after hospital discharge, having solid drug therapy knowledge to identify and monitor ADEs could prove invaluable in reducing healthcare costs and patient morbidity.15

Our study showed that of the 59 PT programs responding to the survey, 49% were utilizing pharmacists to deliver pharmacology and pharmacotherapeutics content. This observation is promising, considering the recent commentaries by Lerchenfeldt and Lloyd advocating that pharmacists should have a larger role in medical education.2,4 However, the percentage of programs utilizing pharmacists was much lower than what was recently reported in PA programs (49% vs. 83%).5 A possible explanation for this observation is the number of pharmacology and pharmacotherapeutics credit hours in each program. In the present study, most programs responding averaged two credit hours, while PA programs often have at least four or more credit hours. More credit hours in the PA programs are necessary since PAs have prescribing authority.

It is also encouraging to observe that in our study, pharmacists delivered more than 50% of the pharmacology and pharmacotherapeutics lectures in 19 of the 29 programs (66%). This is a similar finding as compared to PA programs (83%) which suggest that when pharmacists are utilized, they deliver most of the content. Only 8% of programs employed a pharmacist as a full-time faculty member. This is not surprising since most programs reported pharmacology and pharmacotherapeutics courses were two credit hours in their curriculum. Justifying the cost of a pharmacist to serve as a full-time faculty responsible for a two-credit hour course may not be feasible.

Another potential advantage of utilizing pharmacists to deliver pharmacology and pharmacotherapeutics content in the curricula is the early exposure to interprofessional education (IPE). The CAPTE standards state, “The didactic and clinical curriculum includes interprofessional education; learning activities are directed toward the development of interprofessional competencies including, but not limited to, values/ethics, communication, professional roles and responsibilities, and teamwork.”7 Theoretically, students could better understand pharmacists’ role on the healthcare team if pharmacists delivered pharmacology and pharmacotherapeutics lectures early in the curriculum. Whether this early exposure would translate to improved student attitudes and collaboration in practice is unknown and warrants further study.

There are limitations to our study worth noting. First, only 59 (26%) programs completed the survey, which is a lower response rate than the response rates of health professionals reported in a recent systematic review (51%).16 Several programs were excluded due to the inaccessibility of the email address Chair/Director. Targeting other faculty with broad knowledge of their respective program (e.g., didactic coordinator) may have led to a higher response rate. In addition, the title alone could have decreased the response rates for programs that do not utilize pharmacists. Second, we should have surveyed whether programs had access to or were affiliated with an academic medical center. Proximity and affiliation to an academic medical center could improve the program’s ability to recruit pharmacists to participate in the curriculum. Lastly, we did not evaluate the academic or clinical impact of pharmacists lecturing in the PT curricula. Whether PT curricula that utilize pharmacists have better National Physical Therapy Examination passage rates could be evaluated in future studies. However, considering drug therapy knowledge is likely a small portion of the exam, this endeavor may be futile.

Conclusions

In this study, nearly 50% of programs responding to the survey utilize pharmacists to deliver phar- macology and pharmacotherapeutics content in their curricula. Furthermore, 66% of programs using pharmacists reported that pharmacists deliver more than 50% of the lectures on pharmacology and pharmacotherapeutics. This study suggests that pharmacists are being used to teach the core concepts of pharmacology and pharmacotherapeutics in PT curricula. Pharmacists should consider pursuing opportunities to become involved in didactic teaching in PT programs.

Authors: Dustin Wilson, PharmD, BCPS, is an Associate Professor of Pharmacy Practice (dwilson@ campbell.edu) at the Campbell University College of Pharmacy & Health Sciences (CPHS) in Buies Creek, NC. C. Brock Woodis, PharmD, BCACP, BC-ADM, CDCES, and Scot Sawyer, PT, DPT, were affiliated with CPHS at the time of the study.

References

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Table 1. Program characteristics