1
|
Pharmacist Intention to Provide Medication Therapy Management Services in Saudi Arabia: A Study Using the Theory of Planned Behaviour. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095279. [PMID: 35564673 PMCID: PMC9101803 DOI: 10.3390/ijerph19095279] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/11/2022] [Accepted: 04/19/2022] [Indexed: 12/10/2022]
Abstract
Medication therapy management (MTM) is provided by pharmacists and other healthcare providers, improves patient health status, and increases the collaboration of MTM providers with others. However, little is known about pharmacists’ intention to provide MTM services in Saudi Arabia. This study aimed to predict the pharmacists’ willingness in this nation to commit to providing MTM services there. This study used a cross-sectional questionnaire based on the theory of planned behaviour (TPB). The survey was distributed to 149 pharmacists working in hospital and community pharmacies. It included items measuring pharmacist attitudes, intentions, subjective norms, perceived behavioural control, knowledge about the provision of MTM services, and other sociodemographic and pharmacy practice-related items. The pharmacists had a positive attitude towards MTM services (mean = 6.15 ± 1.12) and strong intention (mean = 6.09 ± 1.15), highly perceived social pressure to provide those services (mean = 5.42 ± 1.03), strongly perceived control over providing those services (mean = 4.98 ± 1.05), and had good MTM knowledge (mean = 5.03 ± 1.00). Pharmacists who completed a pharmacy residency programme and had good knowledge of MTM services and a positive attitude towards them usually strongly intended to provide MTM services. Thus, encouraging pharmacists to complete pharmacy residency programmes and educating them about the importance and provision of MTM services will enhance their motivation to provide them.
Collapse
|
2
|
Witry MJ, Pham K, Viyyuri B, Doucette W, Kennelty K. The Initial Use of the Home Medication Experience Questionnaire (HOME-Q) in Community-Based Pharmacy. J Patient Exp 2020; 7:1658-1664. [PMID: 33457627 PMCID: PMC7786684 DOI: 10.1177/2374373520916015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The Home Medication Experience Questionnaire (HOME-Q) was developed to systematically gather information on the medication experience of patients. The objectives of this study were to (1) assess the frequencies of medication experience issues for a sample of patients and (2) report pharmacist recommendations to address issues and patient implementation of recommendations. This study used a single-group design with 3-month follow-up. A convenience sample of patients aged 55 years and older and taking 4 or more chronic medications self-administered the HOME-Q and discussed responses with a pharmacist from 2 community pharmacies. A researcher called or visited participants at 3 months to readminister the HOME-Q and inquire about recommendations. Thirty-three patients completed questionnaires, and 30 participated in the follow-up. At 3 months, the HOME-Q median did not decrease (4 at both administrations). There were 51 pharmacist interventions/recommendations, and 47% were reported adopted. The HOME-Q prompted pharmacists to respond to medication experience issues that may not have been identified otherwise. More work is needed to test the impact of the HOME-Q and better understand medication experience discussions between patients and pharmacists.
Collapse
Affiliation(s)
| | - Kassi Pham
- University of Iowa College of Pharmacy, Iowa City, IA, USA
| | | | - William Doucette
- Veale Professor in Healthcare Policy, University of Iowa College of Pharmacy, Iowa City, IA, USA
| | - Korey Kennelty
- University of Iowa College of Pharmacy, Iowa City, IA, USA
| |
Collapse
|
3
|
A Descriptive Quantitative Analysis on the Extent of Polypharmacy in Recipients of Ontario Primary Care Team Pharmacist-Led Medication Reviews. PHARMACY 2020; 8:pharmacy8030110. [PMID: 32630000 PMCID: PMC7558087 DOI: 10.3390/pharmacy8030110] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 06/23/2020] [Accepted: 06/25/2020] [Indexed: 01/29/2023] Open
Abstract
Pharmacist-led medication reviews have been shown to improve medication management, reducing the adverse effects of polypharmacy among older adults. This paper quantitatively examines the medications, medication discrepancies and drug therapy problems of recipients in primary care. A convenience sample of 16 primary care team pharmacists in Ontario, Canada contributed data for patients with whom they conducted a medication review over a prior four-week period. Data were uploaded using electronic data capture forms and descriptive analyses were completed. Two hundred and thirty-seven patients (on average, 67.9 years old) were included in the study, taking an average of 9.2 prescription medications ( ± 4.7). Majority of these patients (83.5%) were categorized as polypharmacy patients taking at least five or more prescribed drugs per day. Just over half of the patients were classified as having a low level of medication complexity (52.3%). Pharmacists identified 2.1 medication discrepancies ( ± 3.9) and 3.6 drug therapy problems per patient ( ± 2.8). Half these patients had more than one medication discrepancy and almost every patient had a drug therapy problem identified. Medication reviews conducted by pharmacists in primary care teams minimized medication discrepancies and addressed drug therapy problems to improve medication management and reduce adverse events that may result from polypharmacy.
Collapse
|
4
|
Fitzpatrick RM, Witry MJ, Doucette WR, Kent K, Deninger MJ, Mcdonough RP, Veach S. Retrospective analysis of drug therapy problems identified with a telephonic appointment-based model of medication synchronization. Pharm Pract (Granada) 2019; 17:1373. [PMID: 31275491 PMCID: PMC6594433 DOI: 10.18549/pharmpract.2019.2.1373] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Accepted: 04/08/2019] [Indexed: 02/07/2023] Open
Abstract
Objectives: To describe the drug therapy problems (DTPs) identified for patients enrolled in an Appointment Based Model (ABM) for medication synchronization, describe the pharmacist-delivered clinical interventions, and assess what patient characteristics are associated with the number of DTPs identified. Methods: A cross-sectional chart review of 1 month of pharmacist notes for telephone ABM encounters at one independent community pharmacy in the Midwest U.S. was performed for a systematic random sample of patients active in the program during September 2017. Included patients were 18 years and older and took one or more synchronized medications. Data included months in the program, gender, age, insurance type, refill interval, medications (synchronized and total), DTP category, and intervention category. Descriptive statistics were calculated, and a multiple linear regression tested the association between patient characteristics and the number of DTPs identified. Results: The study involved 209 subjects, 54% women, with a mean age of 69.5 years and. The average number of medications synchronized was 4.7, the mean total number of medications was 6.3, and mean length of time in the program was 20 months. The DTPs (n=334) identified included needs additional drug therapy (43.1%), inappropriate adherence (31.4%), unnecessary drug therapy (15.0%), and adverse drug reaction (9.6%). The regression showed age and number of medications was positively associated with number of DTPs identified, but months enrolled was not. Conclusions: This ABM approach identified several hundred DTPs with corresponding interventions within a one-month period, suggesting that ABMs have a significant potential to improve patient care. The data also suggest that pharmacist interventions within an ABM program are valuable beyond the first few fills as patients move into maintenance use of their medications, especially for patients of advancing age and polypharmacy.
Collapse
Affiliation(s)
- Rebecca M Fitzpatrick
- Hartig Drug, Dubuque, IA (United States). [At time of study, was PGY1 Community Pharmacy Resident at The College of Pharmacy, University of Iowa, Iowa City, IA (United States)].
| | - Matthew J Witry
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa. Iowa City, IA (United States).
| | - William R Doucette
- Division Head and Veale Professor in Healthcare Policy, Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa. Iowa City, IA (United States).
| | - Kelly Kent
- Director of Clinical Services. Towncrest Pharmacy. Iowa City, IA (United States).
| | | | | | - Stevie Veach
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa. Iowa City, IA (United States).
| |
Collapse
|
5
|
Ariyo O, Kinney O, Brookhart A, Nadpara P, Goode JVKR. Medication therapy problems and vaccine needs identified during initial appointment-based medication synchronization visits. J Am Pharm Assoc (2003) 2019; 59:S67-S71. [PMID: 31153823 DOI: 10.1016/j.japh.2019.04.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 04/08/2019] [Accepted: 04/13/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To characterize medication therapy problems (MTPs) and vaccines recommended and administered by pharmacists during initial appointment-based medication synchronization (ABMS) visits, in a community pharmacy setting. METHODS A retrospective observational study evaluated comprehensive medication reviews documented by pharmacists during initial ABMS visits in 16 supermarket chain pharmacies in Central Virginia from September to December 2017. The documentation was examined to obtain patient demographics, MTPs, and recommended and administered vaccines. Other data collected included disease states, number of medications synchronized per patient, and average time spent per initial ABMS visit. Classifications of MTPs were adherence (overuse and underuse), adverse drug reaction, cost-efficacy management, drug interactions (drug-drug/drug-disease), excessive dose/duration, needs additional therapy (for chronic conditions), suboptimal drug selection, and unnecessary therapy. Data were analyzed using descriptive statistics, and Wilcoxon-Mann-Whitney test was used to compare group differences. RESULTS One hundred eighty-four patients received an initial ABMS visit (118 female and 66 male patients). The mean age was 70 years for women and 65 years for men, range 18 to 19 years (P < 0.08). Disease states documented included asthma, benign prostatic hyperplasia, chronic pain, epilepsy, depression, diabetes mellitus, dementia, gastroesophageal reflux disease, history of myocardial infarction, human immunodeficiency virus, hyperlipidemia, and hypertension. Women had a significantly higher number of disease states than men did (P < 0.03). Thirty-seven MTPs were identified with no statistical difference between men and women (P < 0.98). Pharmacists reported spending an average of 17 minutes with patients during the initial visit for an average of 6 medications synchronized per patient. Six hundred thirty-three vaccines were recommended, and 51 were administered. CONCLUSION Initial ABMS visit with a comprehensive medication review facilitated pharmacists in detecting medication therapy problems. Although vaccines administered were lower than recommended, community pharmacists play an important role in preventive health through vaccine screenings and recommendations. Future plans include evaluating the outcomes of MTPs identified and resolved in the ABMS service.
Collapse
|
6
|
Alshehri AM, Barner JC, Rush S. The impact of a required course on third year pharmacy students' perceived abilities and intentions in providing medication therapy management. CURRENTS IN PHARMACY TEACHING & LEARNING 2019; 11:94-105. [PMID: 30527882 DOI: 10.1016/j.cptl.2018.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 07/10/2018] [Accepted: 09/21/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND AND PURPOSE To examine the impact of a Medication Therapy Management (MTM) course on third-year pharmacy students' (P3s) perceived abilities and intentions to provide MTM services before and after the course. EDUCATIONAL ACTIVITY AND SETTING An anonymous 48-item self-administered survey was administered to P3s before and after the MTM course. Forty-six items using a 5-point Likert scale (1 = strongly disagree to 5 = strongly agree) measured abilities in MTM provision using the following seven subdomains: general MTM ability (GA), medication therapy review (MTR), medication-related problems identification/recommendations (MRPIR), disease measurement/monitoring (DM), communication (CO), follow-up/referral (FR), and billing/documentation (BD). Two items assessed intent to provide MTM in practice. Descriptive statistics, Cronbach's alphas, and paired t-tests were used. FINDINGS All enrolled P3s (n = 110) completed both surveys. Subdomain Cronbach's alphas ranged from 0.70-0.97. Paired t-test showed no significant difference in intention to provide MTM before and after the course; however, the results revealed a significant increase in perceived abilities (before vs. after, respectively) regarding MTR (3.2 ± 0.6;4.2 ± 0.4; p < 0.0001), MRPIR (3.3 ± 0.6;4.2 ± 0.4; p < 0.0001), DM (4.2 ± 0.6;4.5 ± 0.5; p = 0.0004), CO (3.9 ± 0.5; 4.3 ± 0.4; p < 0.0001), FR (3.7±0.8;4.2±0.6; p = 0.0002), and BD (2.4±0.9;3.9±0.8; p < 0.0001). DISCUSSION AND SUMMARY A required MTM course with both didactic and experiential components were instrumental in improving P3s' perceived abilities to provide MTM services. Additional research is needed to understand why students' intention to provide MTM did not change pre- to post-course completion.
Collapse
Affiliation(s)
- Ahmed M Alshehri
- University of Texas at Austin, College of Pharmacy, Health Outcomes and Pharmacy Practice, 2409 University Avenue, Stop A1930, Austin, TX, United States; Prince Sattam bin Abdulaziz University, College of Pharmacy, Clinical Pharmacy Department, Al-Kharj, Riyadh, Saudi Arabia.
| | - Jamie C Barner
- University of Texas at Austin, College of Pharmacy, Health Outcomes and Pharmacy Practice, 2409 University Avenue, Stop A1930, Austin, TX 78712-1120, United States.
| | - Sharon Rush
- University of Texas at Austin, College of Pharmacy, Health Outcomes and Pharmacy Practice, 2409 University Avenue, Stop A1930, Austin, TX 78712-1120, United States.
| |
Collapse
|
7
|
MacDonald DA, Chang H, Wei Y, Hager KD. Drug Therapy Problem Identification and Resolution by Clinical Pharmacists in a Family Medicine Residency Clinic. Innov Pharm 2018; 9:1-7. [PMID: 34007698 DOI: 10.24926/iip.v9i2.971] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Purpose There are limited data to evaluate the impact of ambulatory clinical pharmacist recommendations on family medicine resident prescribing and monitoring of medications. The purpose of this study is to begin to gain insight in this area by answering the research question, "How many ambulatory clinical pharmacist recommendations for drug therapy problem (DTP) resolution are implemented on the day of a medication therapy management (MTM) visit in an outpatient family medicine residency clinic?" Methods This is a retrospective chart review of face-to-face MTM encounters conducted by ambulatory clinical pharmacists (including pharmacist residents) from August 1, 2012 to June 30, 2015 at a family medicine residency clinic. Descriptive statistics were conducted to both quantify the number of DTPs identified and resolved on the day of the MTM visit as well as categorize the DTPs. Results Based on the 728 MTM encounters analyzed, patients were an average of 53.6 years old and took 11.9 medications to treat 5.7 medical conditions. A total of 3057 DTPs were identified in the 728 encounters, of which 1303 were resolved the same day as the MTM visit. This resulted in an average of 4.2 DTPs identified and 2.0 resolved per visit per patient. The most common DTP category identified in this study was the need for additional drug therapy (41.6%). Conclusions Approximately half of the ambulatory clinical pharmacist's DTP resolution recommendations were implemented the same day they were identified, which highlights the strength of team-based patient care and interprofessional collaboration in a residency teaching clinic.
Collapse
Affiliation(s)
- Danielle A MacDonald
- Essentia Health Ambulatory Clinical Pharmacy Services, Duluth, MN and Duluth Family Medicine Clinic, Duluth, MN.,Pharmacy Practice and Pharmaceutical Sciences, College of Pharmacy, University of Minnesota, Duluth, MN.,Family Medicine and Community Health, School of Medicine, University of Minnesota, Minneapolis, MN
| | - Hannah Chang
- Pharmacy Practice and Pharmaceutical Sciences, College of Pharmacy, University of Minnesota, Duluth, MN
| | - Yi Wei
- Pharmacy Practice and Pharmaceutical Sciences, College of Pharmacy, University of Minnesota, Duluth, MN
| | - Keri D Hager
- Pharmacy Practice and Pharmaceutical Sciences, College of Pharmacy, University of Minnesota, Duluth, MN
| |
Collapse
|
8
|
Surbhi S, Munshi KD, Bell PC, Bailey JE. Drug therapy problems and medication discrepancies during care transitions in super-utilizers. J Am Pharm Assoc (2003) 2016; 56:633-642.e1. [DOI: 10.1016/j.japh.2016.07.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 07/01/2016] [Accepted: 07/01/2016] [Indexed: 11/29/2022]
|
9
|
Castaneda S, Melendez-Lopez S, Garcia E, De la Cruz H, Sanchez-Palacio J. The Role of the Pharmacist in the Treatment of Patients with Infantile Hemangioma Using Propranolol. Adv Ther 2016; 33:1831-1839. [PMID: 27461120 PMCID: PMC5055552 DOI: 10.1007/s12325-016-0391-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Infantile hemangiomas (IH) are the most common benign vascular tumors of childhood, with an incidence of 5-10% during the first year of age. Propranolol is considered the first-line treatment for this condition. Potentially there is a high probability of negative results to therapy, because in many countries there are no treatment protocols or propranolol formulations appropriate for the pediatric population. The objective of the present study was to evaluate the impact of pharmacist interventions such as detecting, analyzing, and solving problems presented during treatment with propranolol in patients with IH. METHODS An open observational prospective study was performed over 25 months in a group of pediatric patients diagnosed with infantile hemangioma treated with propranolol. Pharmacist participation consisted of development of an extemporaneous formulation and counseling the child's parents. At each visit to the pharmacy service, family members were interviewed, detecting and classifying problems related to treatment. RESULTS Sixty-three children with IH were treated during the period under review. Patient ages ranged from 3 to 11 months old; 64% were female and 36% were male. Forty-nine problems in 30 patients were detected, principally inadequate dose (18.4%), non-adherence to treatment (16.3%), side effects (14.3%), and wrong administration (14.3%). Of the problems detected, 81.6% were resolved. Interventions by the pharmacist in 27 patients were intensive counseling on adherence to therapy (20%), detection of adverse effects (11.4%), and adjustment of the dose (22.9%). In 95.2% of patients a good response to treatment was obtained compared with 77.2% reported in European studies without pharmacist intervention. CONCLUSION It seems that pharmacist participation increases adherence to treatment and reduces the likelihood of adverse effects, allowing for safe and effective therapy in patients with IH.
Collapse
Affiliation(s)
- Saul Castaneda
- Department of Pharmacy, Children's Hospital of the Californias, Tijuana, Baja California, Mexico.
| | - Samuel Melendez-Lopez
- Faculty of Chemical Sciences and Engineering, Autonomous University of Baja California, Tijuana, Mexico
| | - Esbeydy Garcia
- Department of Pediatric Dermatology, Children's Hospital of the Californias, Tijuana, Mexico
| | - Hermelinda De la Cruz
- Faculty of Chemical Sciences and Engineering, Autonomous University of Baja California, Tijuana, Mexico
| | - Jose Sanchez-Palacio
- Faculty of Chemical Sciences and Engineering, Autonomous University of Baja California, Tijuana, Mexico
| |
Collapse
|
10
|
Van C, Krass I, Mitchell B. General Practitioner Perceptions of Extended Pharmacy Services and Modes of Collaboration with Pharmacists. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2015. [DOI: 10.1002/j.2055-2335.2007.tb00739.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
|
11
|
Basger BJ, Moles RJ, Chen TF. Application of drug-related problem (DRP) classification systems: a review of the literature. Eur J Clin Pharmacol 2014; 70:799-815. [DOI: 10.1007/s00228-014-1686-x] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 04/16/2014] [Indexed: 11/28/2022]
|
12
|
Chrischilles EA, Doucette W, Farris K, Lindgren S, Gryzlak B, Rubenstein L, Youland K, Wallace RB. Medication therapy management and complex patients with disability: a randomized controlled trial. Ann Pharmacother 2013; 48:158-67. [PMID: 24259652 DOI: 10.1177/1060028013512472] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Drug therapy problems, adverse drug events (ADEs), and symptom burden are high among adults with disabilities. OBJECTIVE To compare the effects of a modified medication therapy management (MTM) program within a self-efficacy workshop versus the workshop alone or usual care on symptom burden among adults with activity limitations. METHODS Three-group randomized controlled trial among adults (age 40 and older) with self-reported activity limitations in community practice. INTERVENTIONS 8 weekly Living Well With a Disability (LWD) 2-hour workshop sessions with and without a collaborative medication management (CMM) module. PRIMARY OUTCOME mean number of moderate to very severe symptoms from a list of 11 physical and mental symptoms. Process measures: changes in medication regimens and self-reported ADEs. ANALYSIS general linear mixed models (continuous outcomes) and generalized estimating equations (categorical outcomes). RESULTS Participants had high symptom burden, low physical health, and took many medications. There was a significant increase in ADE reporting in the LWD + CMM group relative to the other 2 groups (Study group × Time P = .014), and there were significantly more changes in medication regimens in the LWD + CMM group (P = .013 LWD only vs LWD + CMM). The oldest third of participants had significantly fewer mean symptoms but received more intense CMM. There was no difference between the LWD-only, LWD + CMM, and usual care groups in symptom burden over time. CONCLUSION Pharmacist MTM practices and MTM guidelines may need to be modified to affect symptom burden in a population with physical activity limitations.
Collapse
|
13
|
Cheong LHM, Armour CL, Bosnic-Anticevich SZ. Primary health care teams and the patient perspective: a social network analysis. Res Social Adm Pharm 2013; 9:741-57. [PMID: 23395532 DOI: 10.1016/j.sapharm.2012.12.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Revised: 12/17/2012] [Accepted: 12/17/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Multidisciplinary care (MDC) has been proposed as a potential strategy to address the rising challenges of modern health issues. However, it remains unclear as to how patients' health connections may impact on multidisciplinary processes and outcomes. OBJECTIVES This research aims to gain a deeper understanding of patients' potential role in MDC: i) describe patients' health networks, ii) compare different care groups, iii) gain an understanding of the nature and extent of their interactions, and iv) identify the role of pharmacists within patient networks. METHODS In-depth, semi-structured interviews were conducted with asthma patients from Sydney, Australia. Participants were recruited from a range of standard asthma health care access points (community group) and a specialized multidisciplinary asthma clinic (clinic group). Quantitative social network analysis provided structural insight into asthma networks while qualitative social network analysis assisted in interpretation of network data. RESULTS A total of 47 interviews were conducted (26 community group participants and 21 clinic group participants). Although participants' asthma networks consisted of a range of health care professionals (HCPs), these did not reflect or encourage MDC. Not only did participants favor minimal interaction with any HCP, they preferred sole-charge care and were found to strongly rely on lay individuals such as family and friends. While general practitioners and respiratory specialists were participants' principal choice of HCP, community pharmacists were less regarded. CONCLUSION Limited opportunities were presented for HCPs to collaborate, particularly pharmacists. As patients' choices of HCPs may strongly influence collaborative processes and outcomes, this research highlights the need to consider patient perspectives in the development of MDC models in primary care.
Collapse
Affiliation(s)
- Lynn H M Cheong
- Faculty of Pharmacy, Pharmacy Building A15, University of Sydney, Camperdown, NSW 2006, Australia.
| | | | | |
Collapse
|
14
|
Moczygemba LR, Barner JC, Gabrillo ER. Outcomes of a Medicare Part D telephone medication therapy management program. J Am Pharm Assoc (2003) 2012; 52:e144-52. [DOI: 10.1331/japha.2012.11258] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
15
|
Witry MJ, Doucette WR, Gainer KL. Evaluation of the pharmaceutical case management program implemented in a private sector health plan. J Am Pharm Assoc (2003) 2011; 51:631-5. [DOI: 10.1331/japha.2011.09137] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
16
|
Van C, Mitchell B, Krass I. General practitioner–pharmacist interactions in professional pharmacy services. J Interprof Care 2011; 25:366-72. [DOI: 10.3109/13561820.2011.585725] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
17
|
Higgins L, Brown M, Murphy JE, Malone DC, Armstrong EP, Woosley RL. Community pharmacy and pharmacist staff call center: Assessment of medication safety and effectiveness. J Am Pharm Assoc (2003) 2011; 51:82-9. [DOI: 10.1331/japha.2011.09108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
|
18
|
Examining the development of pharmacist-physician collaboration over 3 months. Res Social Adm Pharm 2010; 6:324-33. [DOI: 10.1016/j.sapharm.2009.11.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2009] [Revised: 11/16/2009] [Accepted: 11/16/2009] [Indexed: 11/23/2022]
|
19
|
Scott DM, Dewey MW, Johnson TA, Kessler ML, Friesner DL. Preliminary Evaluation of Medication Therapy Management Services in Assisted Living Facilities in Rural Minnesota. ACTA ACUST UNITED AC 2010; 25:305-19. [DOI: 10.4140/tcp.n.2010.305] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
20
|
Doucette WR, Witry MJ, Farris KB, McDonough RP. Community pharmacist-provided extended diabetes care. Ann Pharmacother 2009; 43:882-9. [PMID: 19401477 DOI: 10.1345/aph.1l605] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Pharmacists in various settings have been effective in initiating diabetes treatment. Patients with diabetes require ongoing disease management, and community pharmacists are in a strategic position to provide such extended care. Little is known, however, about the effects of community pharmacist-provided interventions beyond the initial treatment period. OBJECTIVE To evaluate the effect of community pharmacist-provided extended diabetes care service on primary clinical outcomes, including hemoglobin A(1c) (A1C), low-density lipoprotein cholesterol (LDL-C), and blood pressure, and on patients' reported self-care activities. METHODS A randomized controlled trial was conducted in patients with diabetes. Participants had already completed at least 2 diabetes education sessions at a local diabetes education center. Nine specially trained pharmacists administered interventions during up to 4 quarterly visits per patient. Interventions included discussing medications, clinical goals, and self-care activities with patients and recommending medication changes to physicians when appropriate. The main outcome measures were 12-month changes in A1C, LDL-C, blood pressure, and self-report of self-care activities. RESULTS Seventy-eight patients participated in the study (36 intervention, 42 control); 66 were included in the final analysis (31 intervention, 35 control). Compared with changes in the control group, patients who received interventions significantly increased the number of days per week that they engaged in a set of diet and diabetes self-care activities (1.25 and 0.73 more days/wk, respectively). The mean 12-month changes for A1C, LDL-C, and blood pressure were not significantly different between the 2 study groups. CONCLUSIONS Although pharmacist-provided interventions did not demonstrate statistically significant improvements in clinical outcomes over the study period, study results did show that pharmacists were effective at increasing the number of days that patients spent engaging in healthy diet and diabetes self-care activities. Addressing lifestyle and self-care behaviors can be a beneficial component of a pharmacist-provided extended diabetes care service.
Collapse
Affiliation(s)
- William R Doucette
- Division of Clinical and Administrative Pharmacy, College of Pharmacy, University of Iowa, Iowa City, IA 52242, USA.
| | | | | | | |
Collapse
|
21
|
Roth MT, Moore CG, Ivey JL, Esserman DA, Campbell WH, Weinberger M. The quality of medication use in older adults: methods of a longitudinal study. ACTA ACUST UNITED AC 2009; 6:220-33. [PMID: 19028378 DOI: 10.1016/j.amjopharm.2008.10.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2008] [Indexed: 11/18/2022]
Abstract
BACKGROUND The quality of medication use in older adults is a recurring problem of substantial concern. Efforts to both measure and improve the quality of medication use often define quality too narrowly and fall short of addressing the complexity of an older adult's medication regimen. OBJECTIVES In an effort to more comprehensively define the quality of medication use in older adults, we conducted a prospective cohort study to: (1) describe the quality of medication use in community-dwelling older adults at baseline, examining differences between whites and blacks; (2) examine the effect of race on medication-related problems; and (3) assess the change in quality medication use between whites and blacks over time. This paper presents the research design and methods of this longitudinal study. METHODS We interviewed white and black community-dwelling older adults (aged > or =60 years) 3 times over 1 year (baseline, 6, and 12 months). We oversampled blacks so that we could estimate racial differences in the quality of medication use. We collected information on the quality of medication use, relying on a clinical pharmacist's assessment of quality and the Assessing Care of Vulnerable Elders quality indicators. We also collected data on demographic characteristics, health literacy, functional status, and participant-reported drug therapy concerns. RESULTS Four hundred thirty-five older adults were assessed for inclusion; 200 older adults (100 white, 100 black) were enrolled in the study and completed a baseline visit. Of the 200, 92% completed the 6-month visit (n = 183) and 88% completed the 12-month visit (n = 176). We present baseline demographic characteristics for the 200 older adults enrolled in the study. CONCLUSION This longitudinal study is an initial step toward developing more comprehensive, patient-centered measures and interventions to address the quality of medication use in older adults.
Collapse
Affiliation(s)
- Mary T Roth
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-7360, USA.
| | | | | | | | | | | |
Collapse
|
22
|
Jean-Venable "Kelly" R. Goode,, Mott DA, Chater R. Collaborations to facilitate success of community pharmacy practice-based research networks. J Am Pharm Assoc (2003) 2008; 48:153-162. [DOI: 10.1331/japha.2008.07139] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
23
|
Armour CL, Smith L, Krass I. Community Pharmacy, Disease State Management, and Adherence to Medication. ACTA ACUST UNITED AC 2008. [DOI: 10.2165/00115677-200816040-00005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
|
24
|
Christensen DB, Roth M, Trygstad T, Byrd J. Evaluation of a pilot medication therapy management project within the North Carolina State Health Plan. J Am Pharm Assoc (2003) 2007; 47:471-83. [PMID: 17616493 DOI: 10.1331/japha.2007.06111] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To assess the feasibility of a pharmacist-based medication therapy management (MTM) service for North Carolina State Health Plan enrollees. DESIGN Before/after design with two control groups. SETTING Community pharmacies and an ambulatory care clinic in North Carolina serving patients from October 2004 to March 2005. PARTICIPANTS 67 patients who used a large number of prescription drugs, 10 community/ambulatory care pharmacists, and more than 600 participants from two control groups. INTERVENTIONS Pharmacist-conducted MTM reviews for volunteering patients. MAIN OUTCOME MEASURES Process measures (type and frequency of drug therapy problems detected and services performed), economic measures (number and cost of medications dispensed), and humanistic measures (patient satisfaction with services). RESULTS Pharmacists identified an average of 3.6 potential drug therapy problems (PDTPs) per patient at the first visit. The most common PDTP categories were "potential underuse" and "more cost-effective drug available." Pharmacist actions were divided nearly equally between activities that would result in increased and decreased drug use. Pharmacists recommended a drug therapy change in about 50% of patients and contacted the prescriber more than 85% of the time. About 50% of patients with PDTPs had a change in drug therapy. Prescription use during the postintervention period decreased in both the study and control groups but was statistically significant only among the control groups. No significant differences were observed in patient co-payment or insurer prescription costs. Pharmacists provided the following educational services: medication use (90%), disease management (88%), adherence, and self-care (60%). Survey results indicated that patients highly valued the service. CONCLUSION A voluntary MTM program targeted at ambulatory patients using a large number of medications reduced the number of PDTPs but did not necessarily result in reductions in prescription drug use or cost. Nearly all patients received some form of medication adherence or disease education associated with problem detection and resolution. Patient satisfaction levels with the service were very high.
Collapse
Affiliation(s)
- Dale B Christensen
- Division of Pharmaceutical Outcomes and Policy, School of Pharmacy, University of North Carolina, Chapel Hill, NC 27599-7360, USA.
| | | | | | | |
Collapse
|
25
|
Peterson AM. Improving adherence in patients with alcohol dependence: A new role for pharmacists. Am J Health Syst Pharm 2007; 64:S23-9. [PMID: 17322179 DOI: 10.2146/ajhp060648] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To review medication adherence rates with various pharmacotherapies and the role of pharmacists in improving medication adherence in patients with alcohol dependence. SUMMARY Nonadherence diminishes the effectiveness of treatment for all chronic diseases, including alcohol dependence. Rates of adherence to pharmacotherapies for alcohol dependence range widely, both within and among agents. Factors undermining adherence include high pill burden and adverse effects, both of which occur with common treatments for alcohol dependence. There is a clear need for interventions that improve patient adherence to treatment. CONCLUSION Adherence-enhancing psychosocial interventions have demonstrated some efficacy, but there is a dearth of controlled trials on this subject. Pharmacist-based interventions have successfully identified and treated nonadherence in other chronic disease states, utilizing tools such as medication reminders, extended-release formulations, and patient education. Similar interventions may improve treatment adherence, and thus drinking outcomes, in patients with alcohol dependence.
Collapse
Affiliation(s)
- Andrew M Peterson
- Department of Pharmacy Practice/Pharmacy Administration, Philadelphia College of Pharmacy, University of the Sciences in Philadelphia, 600 South 43rd Street, Philadelphia, PA 19102, USA.
| |
Collapse
|
26
|
Doucette WR, McDonough RP, Klepser D, McCarthy R. Comprehensive Medication Therapy Management: Identifying and Resolving Drug-Related Issues in a Community Pharmacy. Clin Ther 2005; 27:1104-11. [PMID: 16154490 DOI: 10.1016/s0149-2918(05)00146-3] [Citation(s) in RCA: 107] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The aim of this study was to characterize comprehensive medication therapy management (MTM) involving a community pharmacy and local physicians by describing the drug-related issues encountered, identifying which medication types were associated with these issues, and listing the actions taken by physicians and pharmacists to address them. METHODS In the MTM program studied, community pharmacists and physicians worked together to manage the drug therapy of ambulatory Iowa Medicaid recipients dispensed > or =4 medications for chronic conditions by a community pharmacy. After initial assessment, pharmacists made written recommendations to the patient's physician, and the physicians subsequently responded. Data were extracted from pharmacy records for patients who made > or =1 visit during the first 2 years of the program. Collected data included patient demographics, number of chronic conditions and medications at enrollment, type and number of drug-related issues, medication category, pharmacist recommendations, and physician acceptance of recommendations. RESULTS Data were gathered for 150 patients. The mean (SD) age was 54.4 (19.4) years and 74.0% were female. They were taking a mean (SD) of 9.3 (4.6) medications and had a mean (SD) of 6.1 (3.1) medical conditions at enrollment. A total of 886 drug-related issues were classified into 7 categories: inappropriate adherence (25.9%), needs additional therapy (22.0%), wrong drug (13.2%), unnecessary drug therapy (12.9%), adverse drug reaction (11.1%), dose too low (9.7%), and dose too high (5.3%). Overall, physicians accepted 313 (47.4%) of the 659 recommendations to alter drug therapy made by pharmacists, with the highest rates of agreement to stop or change a medication (50.3% and 50.0%, respectively) and the lowest rate of agreement to start a new medication (41.7%). CONCLUSION The MTM program showed that drug therapy for ambulatory patients taking multiple medications to treat chronic conditions can be improved through collaboration between physicians and community pharmacists.
Collapse
|
27
|
Willink DP, Isetts BJ. Becoming ‘Indispensable’: Developing Innovative Community Pharmacy Practices. J Am Pharm Assoc (2003) 2005; 45:376-86; quiz 387-9. [PMID: 15991760 DOI: 10.1331/1544345054003859] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To describe common characteristics of successful innovative community pharmacy practices. DATA SOURCES Four pharmacists who are successfully incorporating pharmaceutical care services into their pharmacy practices were identified for inclusion by key informants. Sites considered for inclusion were within 300 miles of the University of Minnesota College of Pharmacy. The four innovative community pharmacy practices were located in Maquoketa, Iowa, and in Bemidji, Anoka, and Minneapolis, Minn. Published articles identified through a Medline search-using the terms pharmaceutical care, Medicaid, Medicare, pharmacist, pharmacy, and collaborative practice-provided information to prepare for pharmacist interviews. STUDY SELECTION By the authors. DATA EXTRACTION Previsit telephone interviews with each pharmacist, combined with literature selected by the authors, were used to identify common characteristics of successful practices. Structured, on-site empirical observation was then performed to devise a tool for pharmacists to use for the development of innovative community pharmacy practices. The tool was then validated by two additional practitioners. DATA SYNTHESIS Components of successful innovative community pharmacy practices include philosophy of practice, patient care process, management system, and clinical knowledge. A checklist tool is presented to be used in conjunction with the narrative description of the four components. CONCLUSION Advanced pharmacy services delivered within pharmaceutical care practices can be a successful business opportunity for community pharmacists. Community pharmacists motivated to develop an innovative practice and provide pharmaceutical care services can use the checklist tool during practice implementation.
Collapse
Affiliation(s)
- David P Willink
- College of Pharmacy, University of Minnesota, Minneapolis 55455, USA
| | | |
Collapse
|
28
|
Van Wijk BL, Klungel OH, Heerdink ER, de Boer A. Effectiveness of Interventions by Community Pharmacists to Improve Patient Adherence to Chronic Medication: A Systematic Review. Ann Pharmacother 2005; 39:319-28. [PMID: 15632223 DOI: 10.1345/aph.1e027] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE: To systematically review the impact of interventions by community pharmacists on patients' adherence with chronic medication. DATA SOURCES: A MEDLINE search (1966–November 30, 2003) and a review of reference sections were done to identify all pertinent English- and German-language journal articles. Search terms included compliance, adherence, persistence, discontinuation, pharmacist, and intervention. STUDY SELECTION AND DATA EXTRACTION: From each relevant study, the following data were extracted: study design, country, disease, number of patients, patients' age and gender, type of intervention, duration of follow-up, method of measurement of adherence and adherence rate, and data concerning the quality of the included studies. DATA SYNTHESIS: A total of 162 studies were identified, of which 18 matched our inclusion criteria. Twelve were randomized controlled trials and 6 were non-crossover single-group trials. Eight studies showed significant improvement of adherence at one or more time points. Eight studies did not show any effect, 7 of which were randomized controlled trials. In most studies, adherence rates at baseline were high compared with rates reported in the general population. Counseling, monitoring, and education during weekly or monthly appointments showed some effect. However, these same types of interventions showed no effect in other studies. The overall quality of the included studies was low. CONCLUSIONS: Currently, it is impossible to identify an overall successful adherence-improving strategy performed by pharmacists. More well-designed and well-conducted studies on the effectiveness of interventions by a community pharmacist to improve patient adherence to chronic medication need to be performed.
Collapse
Affiliation(s)
- Boris Lg Van Wijk
- Department of Pharmacoepidemiology & Pharmacotherapy, Faculty of Pharmaceutical Sciences, Utrecht, Netherlands
| | | | | | | |
Collapse
|