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case study Preventive care program
1513Am J Health-Syst Pharm—Vol 69 Sep 1, 2012
c a s e s t u d y
Design and implementation of a pharmacist-directed
preventive care program
Bethany L. Murphy, MichaeL J. rush, and Karen L. Kier
Bethany L. Murphy, pharM.D., is Assistant Professor of Pharmacy
Practice, Union University, Jackson, TN; at the time research was
conducted she was Pharmacy Practice Resident, Ohio Northern
University (ONU) HealthWise, Raabe College of Pharmacy, ONU,
Ada. MichaeL J. rush, pharM.D., cDe, BCACP, is Director, ONU
HealthWise; and Karen L. Kier, M.sc., ph.D., Bcps, BCACP, is
Professor of Clinical Pharmacy and Director of Assessment, Raabe
College of Pharmacy, ONU.
Address correspondence to Dr. Rush at the Raabe College of Phar-
macy, 205B, Ohio Northern University, 525 South Main Street, Ada,
OH 45810 (m-rush@onu.edu).
The authors have declared no potential conflicts of interest.
Copyright © 2012, American Society of Health-System Pharma-
cists, Inc. All rights reserved. 1079-2082/12/0901-1513$06.00.
DOI 10.2146/ajhp110384
Though pharmacists currently
have well-established roles in
both acute and chronic care
settings through activities such as
medication monitoring, disease
management, and medication ther-
apy management (MTM), the role
of the pharmacist in the preventive
care setting is less defined.1,2 While
pharmacists may participate in com-
ponents of preventive care such as
immunizations and disease screen-
ings, involvement in comprehensive
preventive care programs has been
limited. Many organizations, both
outside and within the profession of
pharmacy, recognize that pharma-
cists can have an important effect on
public health through programs ad-
dressing topics such as health screen-
ings, health education, and disease
prevention.3-5 This article describes
an effort to reduce health care costs
by improving health and wellness of
individuals by implementing a dis-
ease state clinic and MTM clinic at a
small rural university.
Background
Ohio Northern University (ONU)
is a small, rural, private university
Purpose. The design and implementa-
tion of pharmacist-directed preventive
care services within a university-based,
employee health and wellness clinic are
described.
Summary. Ohio Northern University (ONU)
HealthWise is a multidisciplinary employee
health and wellness clinic located on the
campus of ONU that offers medication
therapy management, disease manage-
ment, nutrition counseling, and physical
wellness coaching services. A pharmacist-
directed preventive care program based on
recommendations from the U.S. Preventive
Services Task Force (USPSTF) was designed
for incorporation into the clinic. Using an
electronic search tool provided by USPSTF,
pharmacists are able to provide a review
of recommended preventive services that
are appropriate for each individual patient.
Whenever possible, pharmacists within the
clinic perform the screenings and other in-
terventions that are recommended by USP-
STF; when necessary, patients are referred
to other health care providers to receive
recommended interventions. To date, nine
patients have participated in the preventive
care program. For these nine patients 112
recommendations have been reviewed by
pharmacists in the clinic. Of these, 16 were
found to be inappropriate after further dis-
cussion with the patients and 36 were veri-
fied as already completed by the patient,
resulting in a total of 60 unmet recommen-
dations. Of these 60, 52 recommendations
were met through interventions by the
pharmacist in the clinic, while 5 possible
screenings were declined by patients and 3
unmet recommendations required referral
to a provider outside of the clinic.
Conclusion. A pharmacist-directed preven-
tive care service offered within an employee
health clinic helped ensure that employees
receive appropriate screenings and preven-
tive care according to current guidelines.
Am J Health-Syst Pharm. 2012; 69:1513-8
of approximately 3500 students that
employs approximately 675 fac-
ulty and staff. The university is a
self-insured employer, with over 900
covered lives, including retirees and
employees of ONU, as well as their
dependents.
The university-funded ONU
HealthWise clinic consists of an
interdisciplinary team of four phar-
macists, one nurse, two exercise
physiologists, and a nutrition coach.
Historically, the clinic has provided
pharmacist-led disease management
case study Preventive care program
1514 Am J Health-Syst Pharm—Vol 69 Sep 1, 2012
and MTM services for employees
and retirees who are members of the
university’s health insurance plan.
Disease management services for
patients with hypertension, diabetes
mellitus, and hyperlipidemia have
been established and include the
monitoring of clinical symptoms
and laboratory test results, patient
education, and the provision of ther-
apeutic recommendations to the pa-
tient’s primary provider. A tobacco-
cessation clinic was also created to
provide education and to assist pa-
tients dependent on tobacco.
MTM services for patients tak-
ing multiple medications are of-
fered during disease management
appointments and are also provided
on request for employees or retirees
not participating in disease manage-
ment services. In addition, exercise
and nutrition coaching are provided
to these patients by other health care
professionals on the team. Participa-
tion in the ONU HealthWise clinic
is voluntary and free of charge to
employees, retirees, and dependents,
with patients being recruited via ad-
vertisements highlighting the various
services offered.
Problem
Though the traditional ONU
HealthWise clinic has had great suc-
cess in assisting patients with the
management of chronic diseases,
it was recognized that only a select
portion of the university population,
those with the specific chronic dis-
eases listed, would benefit from the
services offered.6
Analysis and resolution
In order to better assist the entire
patient population served by the
ONU HealthWise clinic, the decision
was made to incorporate a preventive
care program into the clinic, provid-
ing assistance to healthier members
who may not qualify for the disease
management and MTM services. By
focusing on optimizing treatment for
patients with chronic diseases as well
as preventing disease in healthy indi-
viduals, the ONU HealthWise clinic is
expected to further improve employee
health status and achieve additional
cost savings for the university.
Preventive tool. The preventive
care program was developed based
on guidelines from the U.S. Preven-
tive Services Task Force (USPSTF),
a panel of experts formed by the
Agency for Healthcare Research and
Quality that reviews evidence and
provides recommendations regard-
ing various preventive services. These
services are assigned a grade based on
the evidence available.7 Evidence rat-
ings of A and B represent preventive
services that should always be offered
to patients for whom the service is
indicated. An evidence rating of C
represents a service that could be
considered in certain individuals, a
rating of D indicates that the service
should be discouraged in patients,
and a rating of I indicates that there
is uncertainty regarding the balance
of risks and benefits for the recom-
mendation.8 The USPSTF then
makes recommendations about how
these services should be put into
practice based on the level of evi-
dence. In addition, because USPSTF
refers to guidelines from the Centers
for Disease Control and Prevention
(CDC) regarding adult immuniza-
tions, vaccination schedules pro-
vided by CDC are used to ensure that
patients are current with the recom-
mended immunizations.9
During the development of the
preventive care program, any recom-
mendation with an evidence rating
of A or B was chosen for inclusion
in the list of possible recommenda-
tions to be made to patients, with the
exception of those regarding sexually
transmitted diseases, which were not
included due to the sensitivity of the
relationship between the employee
and the self-insured employer. Al-
though several of the recommended
screenings may require referral to
another health care professional for
completion, the majority of screen-
ings are conducted by the pharmacist
at the clinic.
USPSTF provides an online search
tool that allows health care profes-
sionals to search for patient-specific
recommendations for screening,
education, and preventive medi-
cine using basic information about
patients, such as age, sex, sexual
activity status, pregnancy status,
and tobacco-use status.10 This tool
was chosen for use in the ONU
HealthWise clinic in order to ac-
quire a list of the most appropriate,
evidence-based recommendations
for discussion with each patient. In
addition to providing individualized
recommendations for patients, the
search tool provides the rationale
for the suggested interventions, as
well as information for both the
health care provider and the patient
regarding the specific screening
itself.
When developing the preven-
tive care program, it was recognized
that the services recommended by
the USPSTF guidelines could be
addressed in one of several ways, in-
cluding through (1) objective screen-
ing, (2) a screening questionnaire, (3)
patient education, (4) verification by
the pharmacist, and (5) referral to
an outside health care professional.
Each recommendation included in
the program was placed into one of
these categories.
Preventive recommendations.
Monitoring tools. The first category
of preventive care recommendations
includes those that can be addressed
by the pharmacist using monitor-
ing tools that provide objective re-
sults.11-14 For example, in the ONU
HealthWise clinic, blood pressure
can be measured quickly using blood
pressure cuffs and stethoscopes or
automated blood pressure cuffs,
screening for obesity can be per-
formed by weighing and measuring
the patient to calculate a body mass
index, and point-of-care testing
machines can be used to screen for
lipid disorders and diabetes mellitus.
case study Preventive care program
1515Am J Health-Syst Pharm—Vol 69 Sep 1, 2012
These point-of-care tools require
little training and often can provide
rapid results in the clinic. In addition,
bone densitometry machines that use
ultrasound waves to screen for osteo-
porosis are available and helpful in
allowing the pharmacist to identify
women who may require more in-
depth screening.15 As results from
these objective measurements for
hypertension, obesity, lipid disorders,
diabetes mellitus, and osteoporosis
are obtained, pharmacists can use
them to make decisions regarding
the patient’s need for further inter-
ventions and follow up to address
any issues that may be found during
screening.
Screening questionnaire. The sec-
ond category of preventive care rec-
ommendations includes those that
can be assessed by the pharmacist
through a screening questionnaire.
For example, the Primary Care
Evaluation of Mental Disorders
Patient Health Questionnaire-2 is
recommended by USPSTF for use in
depression screening.16 Likewise, the
CAGE (Cutting down, Annoyance
by criticism, Guilty feeling, Eye-
openers) questionnaire is a simple,
four-question test that can assist
with screening for alcohol abuse.17
Within the ONU HealthWise clinic,
any problems found through the
use of these questionnaires result in
immediate referral of the patient
to another health care provider
for further assistance and support.
Similarly, there are simple work
sheets available to calculate the
Framingham 10-year risk score for
men and the 10-year stroke score for
women based on patient data, which
USPSTF recommends for screen-
ing for appropriate aspirin use for
the primary prevention of cardio-
vascular disease in each patient.18
After calculating the risk score, the
pharmacist can appropriately re-
fer to materials from the USPSTF
guidelines, indicating levels at which
aspirin use is or is not of greater
benefit than risk.19
Another preventive recommenda-
tion involves screening for the use of
folic acid in women of childbearing
age. Women for whom folic acid
supplementation is recommended
are asked whether they take a mul-
tivitamin that includes 400–800 mg
of folic acid or another form of folic
acid supplement. If the answer is yes,
this recommendation is considered
met. If the pharmacist identifies an
individual who is not receiving ap-
propriate supplementation, the phar-
macist provides information about
the rationale and importance of this
recommendation, encouraging the
patient to begin the appropriate use
of folic acid.20
Patient education. Another catego-
ry of possible preventive recommen-
dations includes those that require
the pharmacist to provide education
by discussing their recommenda-
tions with the patient. These include
making recommendations from the
USPSTF guidelines regarding the
importance of breast-feeding after
pregnancy,21 a healthy diet in the gen-
eral population,22 and tobacco cessa-
tion.23 During a preventive care ap-
pointment, the pharmacist provides
this education orally to the patient
and with an informational handout.
If needed, patients are referred to
additional programs. For example,
within the ONU HealthWise clinic,
all patients for whom diet counseling
is recommended are provided with
the opportunity to speak one-on-one
with a nutrition coach. Likewise, pa-
tients interested in tobacco cessation
are referred to this service within the
ONU HealthWise clinic.
Additional screenings. The last
category of preventive recommenda-
tions includes those screenings that
must be conducted by a health care
provider outside of the ONU Health-
Wise clinic. With these screenings, it
is still important that the pharmacist
verify the patient’s medical history.
For example, with screenings for
breast cancer, colorectal cancer, and
cervical cancer, the pharmacist asks
the patient when the screening was
last performed.24-26 Since screening
for an abdominal aortic aneurysm
is normally performed only once,
patients for whom this screening
is recommended are asked if it has
ever been performed.27 If the patient
is currently in compliance with the
recommended screening interval,
no further discussion is required, and
the patient is encouraged to continue
following the screening recommenda-
tions. If the patient has never received
the particular screening or is due to be
rescreened, the pharmacist discusses
the importance of that screening with
the patient and refers him or her to
the necessary health care provider to
receive the screening. The patient is
provided with a list of the screenings
that need outside follow-up, and this
list is faxed to the patient’s primary
health care provider.
Several preventive services that
have an evidence rating of A or B
apply only to specific subsets of the
population and therefore require
further information from the patient
before the service is recommended.
The recommendations for BRCA
mutation testing for breast and ovar-
ian cancer28 and chemoprevention
of breast cancer29 fall into this cat-
egory. For these services, additional
assessment of the patient’s risk and
family history allows the pharmacist
to identify whether testing or chemo-
prevention is necessary. Pharmacists
ask the necessary questions as rec-
ommended by USPSTF guidelines
and then advise the patient regarding
follow-up with a physician for testing
or treatment.
In addition to reviewing appro-
priate recommendations from the
USPSTF guidelines, patients occa-
sionally may have questions regard-
ing recommendations for various
screenings that may have been sug-
gested by others. In these instances,
the pharmacist involved in the ap-
pointment can review the level of
evidence of those recommendations
with the patient and provide infor-
case study Preventive care program
1516 Am J Health-Syst Pharm—Vol 69 Sep 1, 2012
mation about why the screening may
or may not be appropriate.
Development of a provider man-
ual. In order to ensure a standardized
process when making preventive rec-
ommendations, a provider manual
was developed. This manual details
the exact steps to take regarding each
recommendation, including any ad-
ditional questions that should be
asked and any specific information
that should be provided to the pa-
tient. Educational handouts for each
recommendation are also included in
the manual for easy access. This man-
ual ensures that all clinic pharmacists
have the appropriate tools and follow
the appropriate steps when conduct-
ing these appointments.
Figure 1 is an example of a visit
note prepared by a pharmacist dur-
ing an individual appointment in the
ONU HealthWise clinic. All records
of the preventive care appointment
are maintained in a patient chart that
includes visit notes from other por-
tions of the ONU HealthWise clinic.
Follow-up. Six months after the
initial preventive care appointment
with the pharmacist, a patient with re-
ferrals to outside health care providers
are contacted to verify that the patient
has made progress toward meeting the
recommendation. If not, additional
encouragement and education are
provided to patients at this time. Since
the USPSTF guidelines are updated
and changed periodically as evidence
changes, it is important that preventive
care appointments not be considered a
one-time occurrence. Yearly appoint-
ments may be appropriate to address
screenings that should be completed
annually, discuss updates to the guide-
lines, and perform new screenings for
the patient based on age.
Initial outcomes. To date, nine
patients have participated in the
preventive care program. For these
nine patients, 112 recommendations
have been reviewed by pharmacists
in the ONU HealthWise preventive
care program. Of these 112 potential
recommendations, 16 were found
to be inappropriate after further
discussion with the patients and 36
were verified as already completed by
the patient, resulting in a total of 60
unmet recommendations. Of these
60, 52 recommendations were met
through interventions by the phar-
macist in the clinic, while 5 possible
screenings were declined by patients.
Three unmet recommendations re-
quired referral to a provider outside
of the ONU HealthWise clinic. From
the 52 screenings performed within
the clinic, nine possible new health
issues were identified, including one
case of possible undiagnosed depres-
sion, one unmet recommendation
for aspirin use, one unmet recom-
mendation for folic acid supple-
mentation, and six cases of obesity.
An additional 4 screenings that had
been suggested to patients from an
outside source were discussed and
advised against, based on the level
of evidence from the USPSTF guide-
lines. Due to the success of the first 9
patients, preventive health screening
has been incorporated into the rou-
tine practice of the clinic.
Discussion
The HealthWise preventive servic-
es program represents an opportu-
nity for pharmacists to fulfill an im-
portant role in patient care. Although
many other health care practitioners
are capable of addressing preventive
care recommendations, pharmacists
are readily accessible to patients and
already participate in many patient
care activities into which preventive
services could easily be incorporated.
This case study highlights one setting
in which pharmacists can provide
such services, though similar pro-
grams could easily be designed for
incorporation into other settings. For
example, in the community phar-
macy setting, this program could be
modified to provide a review of the
USPSTF recommendations for an in-
dividual, with referral to other health
care providers for all required inter-
ventions. Such reviews can provide
a benefit in encouraging preventive
care and require very few resources.
In a future evaluation of the pre-
ventive care program in the ONU
HealthWise clinic, a determination
of specific cost savings will be benefi-
cial in determining the exact worth
of pharmacist involvement in this
area. Because it is often difficult to
determine the cost savings associated
with disease prevention, especially
in the short-term, literature dealing
with the cost of disease can provide
an estimation of the potential ben-
efit of prevention. For example, the
high initial direct costs of treatment
associated with myocardial infarc-
tion plus subsequent coronary ar-
tery bypass graft surgery (estimated
at $30,000 per patient in 2002)30
and ischemic stroke (estimated at
$15,000–$20,000 per patient in
1990)31 indicate that the appropri-
ate use of aspirin recommended
through the clinic has the potential
to decrease health care spending for
both the participant and the insurer
by assisting with the prevention of
these costly complications. Because
of the high cost associated with heart
disease and many other diseases,
proper prevention and education are
expected to lead to a reduction in
long-term expenditures.
In the future, the program will
gather data regarding the rate at
which patients choose to receive
follow-up from outside providers
and the rate at which these providers
accept referrals. In addition, patient
satisfaction regarding the preventive
care portion of the ONU HealthWise
clinic will be analyzed through the
semiannual survey that is sent to
all clinic patients. By continuing to
gather these data, a complete assess-
ment of the benefits of this program
will be made.
Conclusion
A pharmacist-directed preven-
tive care service offered within an
employee health clinic helped ensure
that employees receive appropriate
case study Preventive care program
1517Am J Health-Syst Pharm—Vol 69 Sep 1, 2012
Figure 1. Example of a visit note prepared by a pharmacist during an individual appointment in the HealthWise clinic. CAGE = Cutting
down, Annoyance at criticism, Guilty feeling, Eye-openers, PRIME-MED PHQ-2 = Primary Care Evaluation of Mental Disorders Patient
Health Questionnaire-2.
Patient demographic information
Age: 58 years
Sex: female
Pregnant: no
Tobacco use: no
Sexually active: yes
Recommendations retrieved from the search tool
1. Alcohol misuse: screening and behavioral counseling—men, women, and pregnant women
2. Aspirin to prevent cardiovascular disease: women age 55–79 years to prevent ischemic strokes
3. Breast cancer antigen mutation testing for breast and ovarian cancer: women, increased risk
4. Breast cancer preventive medication discussion: women, increased risk
5. Breast cancer screening with mammography: women 50–74 years
6. Cervical cancer: screening—women who are sexually active
7. Colorectal cancer: screening—adults, beginning at age 50 years and continuing until age 75 years
8. Depression: screening—adults age 18 years or older—when staff-assisted depression care supports are in place
9. Healthy diet: counseling—adults with hyperlipidemia and other risk factors for cardiovascular disease
10. High blood pressure: screening—adults 18 years or older
11. Lipid disorders in adults: screening—women 45 years or older, increased risk for coronary heart disease
12. Obesity: screening and intensive counseling—obese men and women
13. Osteoporosis: screening—women 65 years or older and younger women at increased risk
14. Type 2 diabetes mellitus: screening men and women—sustained blood pressure 135/80+ mm Hg
Select examples of additional information required for discussion of recommendations
1. Aspirin to prevent cardiovascular disease: information necessary to calculate the patient’s Framingham 10-year risk percentage is required
2. Breast cancer antigen mutation testing for breast and ovarian cancer: additional information regarding a family history of breast or ovarian
cancer is required
3. Cervical cancer: information regarding time of last screening, if ever, is required
4. Osteoporosis: additional information regarding risk factors for osteoporosis is required
Recommendations determined to be unnecessary for the patient and rationale
1. Aspirin to prevent cardiovascular disease: not recommended based on patient’s Framingham risk score
2. Breast cancer antigen mutation testing for breast and ovarian cancer: patient not at increased risk based on family history
3. Breast cancer preventive medication discussion: patient not at increased risk based on family history
4. Osteoporosis: patient not over age 65 years and not at increased risk
Recommendations determined to have already been met
1. Cervical cancer: patient was screened nine months prior
2. Colorectal cancer: patient screened with colonoscopy three years prior
Recommendations performed by the pharmacist
1. Alcohol misuse: CAGE questionnaire performed
2. Depression: PRIME-MED PHQ-2 question screen performed
3. Healthy diet: education regarding diet was provided by pharmacist, offer to speak further with nutrition coach was made
4. High blood pressure: screening performed
5. Lipid disorders in adults: screening performed using point-of-care testing
6. Obesity: weight, height, and body mass index obtained
7. Type 2 diabetes mellitus: screening performed using point-of-care testing
Recommendations referred to an outside health care provider
Breast cancer screening with mammography: patient has never been screened
Potential problems found through screening by the pharmacist
Depression: screening test was positive, referred to physician for further diagnosis
case study Preventive care program
1518 Am J Health-Syst Pharm—Vol 69 Sep 1, 2012
screenings and preventive care ac-
cording to current guidelines.
References
1. Pedersen CA, Schneider PJ, Scheckelhoff
DJ. ASHP national survey of pharmacy
practice in hospital settings: monitor-
ing and patient education—2009. Am J
Health-Syst Pharm. 2010; 67:542-58.
2. McGivney MS, Meyer SM, Duncan-
Hewitt W et al. Medication therapy
management: its relationship to patient
counseling, disease management, and
pharmaceutical care. J Am Pharm Assoc.
2007; 47:620-8.
3. Promoting the pharmacist’s role in public
health. J Am Pharm Assoc. 2006; 46:311-2.
4. The role of the pharmacist in public
health. Washington, DC: American Pub-
lic Health Association; 2006.
5. American Society of Health-System
Pharmacists. ASHP statement on the role
of health-system pharmacists in public
health. Am J Health-Syst Pharm. 2008;
65:462-7.
6. Bright D, Rush M, Kroustos K et al. Pre-
liminary results from a university-based
disease state management program fo-
cused on hypertension, hyperlipidemia,
and diabetes. J Am Pharm Assoc. 2011;
51:264-5. Abstract.
7. U.S. Preventive Services Task Force. USP-
STF A-Z topic guide. www.uspreventive
servicestaskforce.org/uspstopics.htm
(accessed 2011 Aug 31).
8. U.S. Preventive Services Task Force.
USPSTF grade definitions. www.us
preventiveservicestaskforce.org/uspstf/
grades.htm (accessed 2011 May 11).
9. Centers for Disease Control and Preven-
tion. Recommended adult immunization
schedule—United States, 2011. MMWR.
2011; 60:1-4.
10. Agency for Healthcare Research and
Quality. Electronic Preventive Services
Selector (ePSS). http://epss.ahrq.gov/
ePSS/search.jsp (accessed 2011 May 16).
11. U.S. Preventive Services Task Force.
Screening for high blood pressure: U.S.
Preventive Services Task Force reaffirma-
tion recommendation statement. Ann
Intern Med. 2007; 147:783-6.
12. U.S. Preventive Services Task Force.
Screening for obesity in adults: recom-
mendations and rationale. Ann Intern
Med. 2003; 139:930-2.
13. U.S. Preventive Services Task Force.
Screening for lipid disorders in adults:
U.S. Preventive Services Task Force recom-
mendation statement. www.uspreventive
servicestaskforce.org/uspstf08/lipid/
lipidrs.htm (accessed 2011 May 16).
14. U.S. Preventive Services Task Force.
Screening for type 2 diabetes mellitus
in adults: U.S. Preventive Services Task
Force recommendation statement. Ann
Intern Med. 2008; 148:846-54.
15. U.S. Preventive Services Task Force.
Screening for osteoporosis: U.S. Preven-
tive Services Task Force recommenda-
tion statement. Ann Intern Med. 2011;
154:356-64.
16. U.S. Preventive Services Task Force.
Screening for depression in adults: U.S.
Preventive Services Task Force recom-
mendation statement. Ann Intern Med.
2009; 151:784-92.
17. U.S. Preventive Services Task Force.
Screening and behavioral counseling
interventions in primary care to reduce
alcohol misuse: recommendation state-
ment. Ann Intern Med. 2004; 140:554-6.
18. National Heart, Lung, and Blood Insti-
tute. ATP III guidelines at-a-glance quick
desk reference. Washington, DC: U.S. De-
partment of Health and Human Services;
2001.
19. U.S. Preventive Services Task Force. As-
pirin for the prevention of cardiovascular
disease: U.S. Preventive Services Task
Force recommendation statement. Ann
Intern Med. 2009; 150:396-404.
20. U.S. Preventive Services Task Force. Folic
acid for the prevention of neural tube de-
fects: U.S. Preventive Services Task Force
recommendation statement. Ann Intern
Med. 2009; 150:626-31.
21. U.S. Preventive Services Task Force.
Primary care interventions to promote
breastfeeding: U.S. Preventive Services
Task Force recommendation statement.
Ann Intern Med. 2008; 149:560-4.
22. U.S. Preventive Services Task Force.
Behavioral counseling in primary care
to promote a healthy diet: recommenda-
tions and rationale. Am J Prev Med. 2003;
24:93-100.
23. U.S. Preventive Services Task Force.
Counseling and interventions to prevent
tobacco use and tobacco-caused disease
in adults and pregnant women: U.S. Pre-
ventive Services Task Force reaffirmation
recommendation statement. Ann Intern
Med. 2009; 150:551-5.
24. U.S. Preventive Services Task Force. Screen-
ing for breast cancer: U.S. Preventive Servic-
es Task Force recommendation statement.
Ann Intern Med. 2009; 151:716-26.
25. U.S. Preventive Services Task Force.
Screening for colorectal cancer: U.S. Pre-
ventive Services Task Force recommenda-
tion statement. Ann Intern Med. 2008;
149:627-37.
26. U.S. Preventive Services Task Force.
Screening for cervical cancer: recommen-
dations and rationale. www.uspreventive
servicestaskforce.org/3rduspstf/cervcan/
cervcanrr.htm (accessed 2011 May 16).
27. U.S. Preventive Services Task Force.
Screening for abdominal aortic aneu-
rysm: recommendation statement. Ann
Intern Med. 2005; 142:198-202.
28. U.S. Preventive Services Task Force.
Genetic risk assessment and BRCA muta-
tion testing for breast and ovarian cancer
susceptibility: recommendation state-
ment. Ann Intern Med. 2005; 143:355-61.
29. U.S. Preventive Services Task Force.
Chemoprevention of breast cancer: rec-
ommendations and rationale. Ann Intern
Med. 2002; 137:56-8.
30. Kauf TL, Velazquez EJ, Crosslin DR et al.
The cost of acute myocardial infarction
in the new millennium: evidence from a
multinational registry. Am Heart J. 2006;
151:206-12.
31. Taylor TN, Davis PH, Torner JC et al.
Lifetime cost of stroke in the United
States. Stroke. 1996; 27:1459-66.
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System Pharmacists and its content may not be copied or emailed to multiple sites or posted to a listserv without
the copyright holder’s express written permission. However, users may print, download, or email articles for
individual use.
IHP 670 Module Eight Program Critique Guidelines and Rubric
Overview
You will complete five program critique assignments in the course to support your work as you prepare for your final project. These assignments ask that you critique a program described
within an identified article located in the module’s resources. These articles were chosen because they relate to the module’s topics and demonstrate some common problems that programs
encounter. In each assignment, you will have the opportunity to critique certain program components, such as resources, activities, outcome measures, use of feedback loops, assumptions,
and external barriers. Once planners have identified the details for each of the program components, they must step back and assess how those components can best operate within the
program’s environment. That involves considering concepts such as cultural competency, systems thinking, ethical practice, and others. You will focus on these different concepts, in turn,
through the program critiques. As you develop your program critique skills, you will be asked to identify areas that could be or need to be improved and offer recommendations.
In this assignment, you will critique a health or healthcare program using the program critique reading in the Resources section of this module. The reading portrays example
program
decision-making relevant to module content. The selected program critique reading is the required reading for this assignment.
This assignment will help you predict the importance of a system-thinking approach in program planning. It will help you consider how to construct your program planning team. This activity
will also help you understand the role of adequate communication when developing a program plan, design, and evaluation.
Findings from this assignment will help you analyze and improve your program’s team development and communication aspects.
Prompt
Write a program critique that examines a health or healthcare program intended to meet a specific health need.
Specifically, you must address the following rubric criteria:
1. Systems Thinking: Explain how the program considers a systems-thinking approach in program planning. Consider the following questions to guide
your response:
What role does systems thinking play in making program planning more adaptive, transparent, and evidence based?
How does systems thinking help with team development and communication?
2. Stakeholders’ and Team Members’ Roles: Analyze the roles and responsibilities of stakeholders and team members in the program’s planning. Consider the following questions to guide
your response:
How did the inclusion of stakeholders help minimize the risks associated with the program?
What would you change in the given program’s team-building efforts to make it more collaborative?
3. Communication Tools and Techniques: Determine whether the program’s activities and resources use adequate communication tools and techniques to achieve the desired outcomes.
Consider the following questions to guide your response:
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How did ineffective communication negatively impact the given program and its stakeholders?
What would you change to improve the communication with the stakeholders?
4. Summary and Recommendations: Summarize your findings from the program analysis, and share at least two recommendations about the appropriate use of systems thinking and
inclusion of stakeholders in program planning. Consider the following question to guide your response:
How would you use systems thinking to plan the activities for the given program differently?
Note that all the claims in your deliverable should be evidence based. Your citations should be from your independent search for evidence (not from the scenario, textbook, or module
resources) of credible sources and be current within the last five years. You are required to cite a minimum of two sources overall. Refer to the Shapiro Library Guide: Nursing—Graduate
located in the Start Here section of the course for additional support. If you need writing support, access the Online Writing Center through the Academic Support module of your course.
What to Submit
Your submission should be a 2- to 3-page Word document. Also include a title page. Use 12-point Times New Roman font, double spacing, and one-inch margins. Sources should be cited
according to APA style.
Module Eight Program Critique Rubric
Criteria Exemplary (100%) Proficient (90%) Needs Improvement (70%) Not Evident (0%) Value
Systems Thinking
Exceeds proficiency in an
exceptionally clear and
insightful manner, using
industry-specific language
Explains how the program
considers a systems-thinking
approach in program
planning
Shows progress toward
proficiency, but with errors or
omissions
Does not attempt criterion 20
Stakeholders’ and Team
Members’ Roles
Exceeds proficiency in an
exceptionally clear and
insightful manner, using
industry-specific language
Analyzes the roles and
responsibilities of stakeholders
and team members when
planning and designing a
program
Shows progress toward
proficiency, but with errors or
omissions
Does not attempt criterion 20
Communication Tools and
Techniques
Exceeds proficiency in an
exceptionally clear and
insightful manner, using
industry-specific language
Determines whether the
program’s activities and
resources use adequate
communication tools and
techniques to achieve the
desired outcomes
Shows progress toward
proficiency, but with errors or
omissions
Does not attempt criterion 20
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Criteria Exemplary (100%) Proficient (90%) Needs Improvement (70%) Not Evident (0%) Value
Summary and
Recommendations
Exceeds proficiency in an
exceptionally clear and
insightful manner, using
industry-specific language
Summarizes the findings from
the program analysis and
shares at least two
recommendations on the
appropriate use of systems
thinking and inclusion of
stakeholders in program
planning
Shows progress toward
proficiency, but with errors or
omissions
Does not attempt criterion 1
5
Articulation of Response Exceeds proficiency in an
exceptionally clear and
insightful manner
Clearly conveys meaning with
correct grammar, sentence
structure, and spelling,
demonstrating an
understanding of audience and
purpose
Shows progress toward
proficiency, but with errors in
grammar, sentence structure,
and spelling, negatively
impacting readability
Submission has critical errors in
grammar, sentence structure,
and spelling, preventing
understanding of ideas
10
Professional Sources Incorporates more than two
professional, current (within
the last five years) sources, or
use of sources is exceptionally
insightful
Incorporates two professional,
current (within the last five
years) sources that support
claims
Incorporates fewer than two
professional, current (within
the last five years) sources, or
not all sources support claims
Does not incorporate sources 10
APA Style
Formats in-text citations and
reference list according to APA
style with no
errors
Formats in-text citations and
reference list according to APA
style with fewer than five
errors
Formats in-text citations and
reference list according to APA
style with five or more errors
Does not format in-text
citations and reference list
according to APA style
5
Total: 100%
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