1
|
Luetsch K, Rowett D, Twigg MJ. A realist synthesis of pharmacist-conducted medication reviews in primary care after leaving hospital: what works for whom and why? BMJ Qual Saf 2020; 30:bmjqs-2020-011418. [PMID: 33127835 PMCID: PMC8070649 DOI: 10.1136/bmjqs-2020-011418] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 08/13/2020] [Accepted: 10/03/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Medication reviews for people transitioning from one healthcare setting to another potentially improve health outcomes, although evidence for outcome benefits varies. It is unclear when and why medication reviews performed by pharmacists in primary care for people who return from hospital to the community lead to beneficial outcomes. OBJECTIVE A realist synthesis was undertaken to develop a theory of what works, for whom, why and under which circumstances when pharmacists conduct medication reviews in primary care for people leaving hospital. METHODS The realist synthesis was performed in accordance with Realist And MEta-narrative Evidence Syntheses: Evolving Standards reporting standards. An initial programme theory informed a systematic literature search of databases (PubMed, Embase, Cumulative Index of Nursing and Allied Health Literature, International Pharmaceutical Abstracts, OpenGrey, Trove), augmented by agency and government sources of information. Documents were synthesised by exploring interactions between contexts, intervention, outcomes and causal mechanisms. RESULTS The synthesis identified 9 contexts in which 10 mechanisms can be activated to influence outcomes of pharmacist medication reviews conducted in primary care postdischarge. For a medication review to take place these include trust patients have in healthcare professionals, their healthcare priorities postdischarge, capacity to participate, perceptions of benefit and effort, and awareness required by all involved. For the medication review process, mechanisms which issue an invitation to collaborate between healthcare professionals, enable pharmacists employing clinical skills and taking responsibility for medication review outcomes were linked to more positive outcomes for patients. CONCLUSIONS Medication reviews after hospital discharge seem to work successfully when conducted according to patient preferences, programmes promote coordination and collaboration between healthcare professionals and establish trust, and pharmacists take responsibility for outcomes. Findings of this realist synthesis can inform postdischarge medication review service models.
Collapse
Affiliation(s)
- Karen Luetsch
- School of Pharmacy, The University of Queensland, Brisbane, Queensland, Australia
| | - Debra Rowett
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia
| | | |
Collapse
|
2
|
Costa S, Horta MR, Santos R, Mendes Z, Jacinto I, Guerreiro J, Cary M, Miranda A, Helling DK, Martins AP. Diabetes policies and pharmacy-based diabetes interventions in Portugal: a comprehensive review. J Pharm Policy Pract 2019; 12:5. [PMID: 30937173 PMCID: PMC6427867 DOI: 10.1186/s40545-019-0166-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 02/18/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pharmacy-based interventions are complex public health endeavors which include, but are not restricted to, the conventional medication supply role. In diabetes, such interventions may improve patients' outcomes. The aim of this study was to review relevant policies and research developed in Portugal directed at pharmacy-based diabetes interventions, and to inform future policies, practice and research in collaborative practice with primary care. RESEARCH METHOD An exploratory review of diabetes legislation and policy papers, as well as a comprehensive review in Embase, MEDLINE (via Ovid and PubMed), Google Scholar, and grey literature until November 2017 was performed. RESULTS Sixteen policy papers and 10 studies were included in the analysis. Positive evidence from pharmacy interventions was retrieved concerning screening individuals at risk, screening uncontrolled patients, managing diabetes, and supporting self-monitoring. CONCLUSIONS Some consistency in favorable findings, but also room for improvements in health policies, intervention design and research methods, were observed.
Collapse
Affiliation(s)
- Suzete Costa
- USFarmácia® Collaborative Care Project, Associação Nacional das Farmácias, R. Marechal Saldanha, 1, 1249-069 Lisboa, Portugal
| | - Maria Rute Horta
- Department of Pharmacy Services, Associação Nacional das Farmácias, R. Marechal Saldanha, 1, 1249-069 Lisboa, Portugal
| | - Rita Santos
- Post-Graduate School of Health & Management (EPGSG), Associação Nacional das Farmácias, R. Marechal Saldanha, 1, 1249-069 Lisboa, Portugal
| | - Zilda Mendes
- Centre for Health Evaluation & Research (CEFAR), Associação Nacional das Farmácias, R. Marechal Saldanha, 1, 1249-069 Lisboa, Portugal
| | - Isabel Jacinto
- Department of Pharmacy Services, Associação Nacional das Farmácias, R. Marechal Saldanha, 1, 1249-069 Lisboa, Portugal
| | - José Guerreiro
- Centre for Health Evaluation & Research (CEFAR), Associação Nacional das Farmácias, R. Marechal Saldanha, 1, 1249-069 Lisboa, Portugal
| | - Maria Cary
- Centre for Health Evaluation & Research (CEFAR), Associação Nacional das Farmácias, R. Marechal Saldanha, 1, 1249-069 Lisboa, Portugal
| | - Ana Miranda
- Registo Oncológico Nacional, IPO Lisboa, R. Prof. Lima Basto, 1099-023 Lisboa, Portugal
| | - Dennis K. Helling
- University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, 8189 East 5th Avenue, Denver, CO 80230 USA
| | - Ana Paula Martins
- Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, Lisboa, Portugal
| |
Collapse
|
3
|
Collaboration between hospital and community pharmacists to address drug-related problems: The HomeCoMe-program. Res Social Adm Pharm 2019; 15:267-278. [DOI: 10.1016/j.sapharm.2018.05.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 04/30/2018] [Accepted: 05/03/2018] [Indexed: 10/17/2022]
|
4
|
Alhusein N, Killick K, Macaden L, Smith A, Stoddart K, Taylor A, Kroll T, Watson MC. "We're really not ready for this": A qualitative exploration of community pharmacy personnel's perspectives on the pharmaceutical care of older people with sensory impairment. Disabil Health J 2018; 12:242-248. [PMID: 30392961 PMCID: PMC6436755 DOI: 10.1016/j.dhjo.2018.10.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 10/15/2018] [Accepted: 10/22/2018] [Indexed: 12/27/2022]
Abstract
Background In most developed countries there is an increasing ageing population living in the community with long-term conditions and sensory impairment (sight; hearing; dual impairment). Community pharmacy personnel are key providers of pharmaceutical care to this patient population. Objective This study explored community pharmacy personnel's experiences with providing pharmaceutical care for older people with sensory impairment. Methods Semi-structured telephone interviews were conducted with community pharmacy personnel across Scotland between 2015 and 2016. Results Thirty interviews were completed with community pharmacists (n = 17) and other pharmacy personnel (n = 13). Two overarching themes emerged: safety and communication. Interviewees reported patients' reluctance to disclose their impairment “patients are very good at hiding it” and had considerable safety concerns “it's a fear that they're going to take too much … accidentally taking the same medicine twice”. Difficulties in communication were cited “no matter what you do or how you label things, leaflets and telling people, things can go wrong”. Additionally, interviewees identified training needs to increase their disability awareness and to identify strategies to provide safe and reliable pharmaceutical care to this vulnerable group “We don't specifically have anything in place to deal with anyone with impairments of that kind”. Conclusions This is the first in-depth exploration of providing pharmaceutical care to older people with sensory impairment from the perspective of community pharmacy personnel. Strategies are needed to encourage older people to disclose their sensory impairment. Education and training are also needed to optimise the provision of pharmaceutical care to this vulnerable population.
Collapse
Affiliation(s)
- N Alhusein
- Department of Pharmacy and Pharmacology, University of Bath, Bath, BA27AY, England, UK.
| | - K Killick
- NMAHP Research Unit, Unit 13 Scion House, University of Stirling Innovation Park, University of Stirling, Stirling, Scotland, FK9 4NF, UK.
| | - L Macaden
- Department of Nursing, University of the Highlands & Islands, Centre for Health Science, Old Perth Road, Inverness, IV2 3JH, Scotland, UK.
| | - A Smith
- Department of Nursing, University of the Highlands & Islands, Centre for Health Science, Old Perth Road, Inverness, IV2 3JH, Scotland, UK.
| | - K Stoddart
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, FK9 4LA, Scotland, UK.
| | - A Taylor
- Department of Pharmacy and Pharmacology, University of Bath, Bath, BA27AY, England, UK.
| | - T Kroll
- Midwifery and Health Systems, University College Dublin, Belfield, Dublin 4, Ireland.
| | - M C Watson
- Department of Pharmacy and Pharmacology, University of Bath, Bath, BA27AY, England, UK.
| |
Collapse
|
5
|
Quintana-Bárcena P, Lalonde L, Lauzier S. Beliefs influencing community pharmacists' interventions with chronic kidney disease patients: A theory-based qualitative study. Res Social Adm Pharm 2018; 15:145-153. [PMID: 29709530 DOI: 10.1016/j.sapharm.2018.04.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 03/14/2018] [Accepted: 04/05/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Drug-related problems (DRPs) are highly prevalent in chronic kidney disease (CKD) patients. Community pharmacists are ideally positioned to manage these DRPs. However, little is known about the factors influencing their interventions with CKD patients. OBJECTIVES Using the theory of planned behavior (TPB), this qualitative study sought to: (1) explore the behavioral beliefs (perceived advantages and disadvantages), normative beliefs (perceived expectations of significant others) and control beliefs (perceived barriers and facilitators) influencing community pharmacists' interventions related to identifying and managing DRPs in CKD; and (2) compare these beliefs among three DRPs prevalent in CKD patients. METHODS Community pharmacists in Quebec, Canada participated in face-to-face individual semi-structured interviews. The topic guide was based on the TPB. Three vignettes were presented to stimulate community pharmacists' thoughts about their interventions regarding: (1) the use of an inappropriate over-the-counter laxative; (2) prescriptions of anti-inflammatory medications; and (3) non-adherence to antihypertensive medication. Integral transcripts of audio recordings were analyzed using thematic analysis. The findings on each of the three DRPs were systematically compared. RESULTS Fifteen community pharmacists participated in the study. All expressed a positive attitude toward DRP management, mentioning advantages such as gaining the patient's loyalty as a client and avoiding CKD complications. Participants mentioned that patients and physicians generally approve their interventions, but the dynamics of these relationships may vary depending on the DRP. Common barriers in the management of the three DRPs were the pharmacists' limited time and heavy workloads. The pharmacists felt that the main disadvantage is that these interventions interrupt the workflow in the pharmacy. CONCLUSION Community pharmacists hold positive views of their interventions in CKD. However, enhancing community pharmacists' involvement in CKD care may require measures to facilitate pharmacists' proactivity, inter-professional collaboration and a work organization adapted to clinical activities.
Collapse
Affiliation(s)
| | - Lyne Lalonde
- Faculty of Pharmacy, Université de Montréal, Montreal, Quebec, Canada; Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada; Sanofi Aventis Endowment Chair in Ambulatory Pharmaceutical Care, Université de Montréal, Centre Intégré de Santé et de Services Sociaux de Laval, Quebec, Canada
| | - Sophie Lauzier
- Faculty of Pharmacy, Université Laval, Quebec City, Quebec, Canada; CHU de Quebec - Université Laval Research Centre, Population Health and Optimal Health Practices Research Unit, Quebec City, Quebec, Canada.
| |
Collapse
|
6
|
Pharmacist-led medication review in community settings: An overview of systematic reviews. Res Social Adm Pharm 2017; 13:661-685. [DOI: 10.1016/j.sapharm.2016.08.005] [Citation(s) in RCA: 135] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 08/07/2016] [Accepted: 08/19/2016] [Indexed: 02/08/2023]
|
7
|
Nightingale G, Hajjar E, Pizzi LT, Wang M, Pigott E, Doherty S, Prioli KM, Swartz K, Chapman AE. Implementing a pharmacist-led, individualized medication assessment and planning (iMAP) intervention to reduce medication related problems among older adults with cancer. J Geriatr Oncol 2017; 8:296-302. [DOI: 10.1016/j.jgo.2017.04.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 02/23/2017] [Accepted: 04/20/2017] [Indexed: 10/19/2022]
|
8
|
Serag-Bolos ES, Miranda AC, Gelot SR, Dharia SP, Shaeer KM. Assessing students' knowledge regarding the roles and responsibilities of a pharmacist with focus on care transitions through simulation. CURRENTS IN PHARMACY TEACHING & LEARNING 2017; 9:616-625. [PMID: 29233434 DOI: 10.1016/j.cptl.2017.03.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Revised: 12/06/2016] [Accepted: 03/30/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND AND PURPOSE To evaluate the impact of a pharmacist-focused transitions of care (TOC) simulation on students' perceptions and knowledge of pharmacist roles in the healthcare continuum. Educational Activity and Setting: Two simulations, highlighting pharmacist roles in various practice settings, were conducted within the Pharmaceutical Skills courses in the third-year doctor of pharmacy curriculum. Patient cases were built utilizing electronic medical records (EMR). Students' knowledge was assessed before and after the simulations regarding pharmacist involvement in medication reconciliation, reduction in patient readmissions, reduction of inappropriate medication use, roles and communication on an interprofessional team, and involvement with health information technology (HIT) during care transitions. FINDINGS Fifty-one third-year pharmacy students were anonymously evaluated prior to and following the simulation to assess changes in knowledge and perceptions during the fall semester. Thirty-two (62.7%) students completed the pre-simulation and 21 (41.2%) students completed the post-simulation assessments, respectively. In the spring semester, 40 (80%) students completed the pre-simulation and 23 (46%) students finished the post-simulation assessments. Students predominately had community pharmacy work experience (n=28, 55%). Overall, students enjoyed the variety of pharmacist-led encounters throughout the simulation and assessments demonstrated an increase in knowledge after the simulations. SUMMARY TOC simulations enhance students' understanding of the significant impact that pharmacists have in ensuring continuity of care as members of an interdisciplinary team.
Collapse
Affiliation(s)
- Erini S Serag-Bolos
- University of South Florida, College of Pharmacy, Department of Pharmacotherapeutics and Clinical Research, 12901 Bruce B. Downs Blvd, MDC 30, Tampa, FL 3361233612, United States.
| | - Aimon C Miranda
- University of South Florida, College of Pharmacy, Department of Pharmacotherapeutics and Clinical Research, 12901 Bruce B. Downs Blvd, MDC 30, Tampa, FL 3361233612, United States.
| | - Shyam R Gelot
- Lee Memorial Health System, Department of Pharmacy, 636 Del Prado Blvd S, Cape Coral, FL 33991, United States.
| | - Sheetal P Dharia
- Abbvie/Clinical Pharmacokinetics and Pharmacodynamics, 1 North Waukegan Rd, R4PK AP31-3, North Chicago, IL 60064, United States.
| | - Kristy M Shaeer
- University of South Florida, College of Pharmacy, Department of Pharmacotherapeutics and Clinical Research, 12901 Bruce B. Downs Blvd, MDC 30, Tampa, FL 3361233612, United States.
| |
Collapse
|
9
|
Khanal S, Nissen L, Veerman L, Hollingworth S. Pharmacy workforce to prevent and manage non-communicable diseases in developing nations: The case of Nepal. Res Social Adm Pharm 2015; 12:655-9. [PMID: 26481826 DOI: 10.1016/j.sapharm.2015.09.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 09/18/2015] [Indexed: 11/30/2022]
Abstract
Non-communicable diseases (NCDs, e.g. cardiovascular diseases, cancer, chronic respiratory diseases and diabetes mellitus) are the main causes of mortality and morbidity in developing countries, including Nepal. Nearly half of the deaths in Nepal are caused by NCDs. Nepal lacks adequate human resources to prevent and manage NCDs, but the skills and expertise of pharmacists in Nepal are underused. There is evidence from many countries that pharmacists can contribute substantially to the prevention and management NCD. We aim to describe the opportunities and challenges for pharmacists to prevent and manage NCDs in Nepal. Pharmacists can contribute by screening and monitoring NCDs; counseling on lifestyle; providing medication therapy management services; promoting public health; and providing other pharmaceutical services. Challenges to the implementation of some of these activities in the current context include inadequate training of pharmacists in NCD prevention and management, the cost of pharmaceutical services to patients and government, and the existing health care service delivery model. There is a need for health services research to determine how pharmacists can be best used to prevent and manage NCDs in Nepal.
Collapse
Affiliation(s)
- Saval Khanal
- School of Pharmacy, The University of Queensland, Australia; Sankalpa Foundation, Pokhara, Kaski, Nepal.
| | - Lisa Nissen
- School of Clinical Sciences, Queensland University of Technology, Australia
| | - Lennert Veerman
- School of Public Health, The University of Queensland, Australia
| | | |
Collapse
|
10
|
Puspitasari HP, Aslani P, Krass I. Challenges in the management of chronic noncommunicable diseases by Indonesian community pharmacists. Pharm Pract (Granada) 2015; 13:578. [PMID: 26445618 PMCID: PMC4582742 DOI: 10.18549/pharmpract.2015.03.578] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 06/27/2015] [Indexed: 11/18/2022] Open
Abstract
Objectives: We explored factors influencing Indonesian primary care pharmacists’ practice in chronic noncommunicable disease management and proposed a model illustrating relationships among factors. Methods: We conducted in-depth, semistructured interviews with pharmacists working in community health centers (Puskesmas, n=5) and community pharmacies (apotek, n=15) in East Java Province. We interviewed participating pharmacists using Bahasa Indonesia to explore facilitators and barriers to their practice in chronic disease management. We audiorecorded all interviews, transcribed ad verbatim, translated into English and analyzed the data using an approach informed by “grounded-theory”. Results: We extracted five emergent themes/factors: pharmacists’ attitudes, Puskesmas/apotek environment, pharmacy education, pharmacy professional associations, and the government. Respondents believed that primary care pharmacists have limited roles in chronic disease management. An unfavourable working environment and perceptions of pharmacists’ inadequate knowledge and skills were reported by many as barriers to pharmacy practice. Limited professional standards, guidelines, leadership and government regulations coupled with low expectations of pharmacists among patients and doctors also contributed to their lack of involvement in chronic disease management. We present the interplay of these factors in our model. Conclusion: Pharmacists’ attitudes, knowledge, skills and their working environment appeared to influence pharmacists’ contribution in chronic disease management. To develop pharmacists’ involvement in chronic disease management, support from pharmacy educators, pharmacy owners, professional associations, the government and other stakeholders is required. Our findings highlight a need for systematic coordination between pharmacists and stakeholders to improve primary care pharmacists’ practice in Indonesia to achieve continuity of care.
Collapse
Affiliation(s)
- Hanni P Puspitasari
- Lecturer at Universitas Airlangga, Fakultas Farmasi in Surabaya, East Java Province ( Indonesia ).
| | - Parisa Aslani
- Faculty of Pharmacy, University of Sydney . Sydney, NSW ( Australia ).
| | - Ines Krass
- Faculty of Pharmacy, University of Sydney . Sydney, NSW ( Australia ).
| |
Collapse
|
11
|
Effectiveness of clinical pharmacy services: an overview of systematic reviews (2000–2010). Int J Clin Pharm 2015; 37:687-97. [DOI: 10.1007/s11096-015-0137-9] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 05/12/2015] [Indexed: 01/08/2023]
|
12
|
Nightingale G, Hajjar E, Swartz K, Andrel-Sendecki J, Chapman A. Evaluation of a Pharmacist-Led Medication Assessment Used to Identify Prevalence of and Associations With Polypharmacy and Potentially Inappropriate Medication Use Among Ambulatory Senior Adults With Cancer. J Clin Oncol 2015; 33:1453-9. [DOI: 10.1200/jco.2014.58.7550] [Citation(s) in RCA: 172] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose The use of multiple and/or inappropriate medications in seniors is a significant public health problem, and cancer treatment escalates its prevalence and complexity. Existing studies are limited by patient self-report and medical record extraction compared with a pharmacist-led comprehensive medication assessment. Patients and Methods We retrospectively examined medication use in ambulatory senior adults with cancer to determine the prevalence of polypharmacy (PP) and potentially inappropriate medication (PIM) use and associated factors. PP was defined as concurrent use of five or more and less than 10 medications, and excessive polypharmacy (EPP) was defined as 10 or more medications. PIMs were categorized by 2012 Beers Criteria, Screening Tool of Older Person's Prescriptions (STOPP), and the Healthcare Effectiveness Data and Information Set (HEDIS). Results A total of 248 patients received a geriatric oncology assessment between January 2011 and June 2013 (mean age was 79.9 years, 64% were women, 74% were white, and 87% had solid tumors). Only 234 patients (evaluated by pharmacists) were included in the final analysis. Mean number of medications used was 9.23. The prevalence of PP, EPP, and PIM use was 41% (n = 96), 43% (n = 101), and 51% (n = 119), respectively. 2012 Beers, STOPP, and HEDIS criteria classified 173 occurrences of PIMs, which were present in 40%, 38%, and 21% of patients, respectively. Associations with PIM use were PP (P < .001) and increased comorbidities (P = .005). Conclusion A pharmacist-led comprehensive medication assessment demonstrated a high prevalence of PP, EPP, and PIM use. Medication assessments that integrate both 2012 Beers and STOPP criteria and consider cancer diagnosis, prognosis, and cancer-related therapy are needed to optimize medication use in this population.
Collapse
Affiliation(s)
- Ginah Nightingale
- Ginah Nightingale and Emily Hajjar, Jefferson School of Pharmacy; Kristine Swartz and Andrew Chapman, Thomas Jefferson University Hospital; and Jocelyn Andrel-Sendecki, Thomas Jefferson University, Philadelphia, PA
| | - Emily Hajjar
- Ginah Nightingale and Emily Hajjar, Jefferson School of Pharmacy; Kristine Swartz and Andrew Chapman, Thomas Jefferson University Hospital; and Jocelyn Andrel-Sendecki, Thomas Jefferson University, Philadelphia, PA
| | - Kristine Swartz
- Ginah Nightingale and Emily Hajjar, Jefferson School of Pharmacy; Kristine Swartz and Andrew Chapman, Thomas Jefferson University Hospital; and Jocelyn Andrel-Sendecki, Thomas Jefferson University, Philadelphia, PA
| | - Jocelyn Andrel-Sendecki
- Ginah Nightingale and Emily Hajjar, Jefferson School of Pharmacy; Kristine Swartz and Andrew Chapman, Thomas Jefferson University Hospital; and Jocelyn Andrel-Sendecki, Thomas Jefferson University, Philadelphia, PA
| | - Andrew Chapman
- Ginah Nightingale and Emily Hajjar, Jefferson School of Pharmacy; Kristine Swartz and Andrew Chapman, Thomas Jefferson University Hospital; and Jocelyn Andrel-Sendecki, Thomas Jefferson University, Philadelphia, PA
| |
Collapse
|
13
|
Caractéristiques des revues systématiques présentant les interventions de pharmaciens. ANNALES PHARMACEUTIQUES FRANÇAISES 2014; 72:429-39. [DOI: 10.1016/j.pharma.2014.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Revised: 05/13/2014] [Accepted: 05/16/2014] [Indexed: 11/24/2022]
|
14
|
Barriers and facilitators of medication reconciliation processes for recently discharged patients from community pharmacists' perspectives. Res Social Adm Pharm 2014; 11:517-30. [PMID: 25586885 DOI: 10.1016/j.sapharm.2014.10.008] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Revised: 10/20/2014] [Accepted: 10/20/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND Community pharmacists play a vital part in reconciling medications for patients transitioning from hospital to community care, yet their roles have not been fully examined in the extant literature. OBJECTIVES The objectives of this study were to: 1) examine the barriers and facilitators community pharmacists face when reconciling medications for recently discharged patients; and 2) identify pharmacists' preferred content and modes of information transfer regarding updated medication information for recently discharged patients. METHODS Community pharmacists were purposively and conveniently sampled from the Wisconsin (U.S. state) pharmacist-based research network, Pharmacy Practice Enhancement and Action Research Link (PEARL Rx). Community pharmacists were interviewed face-to-face, and transcriptions from audio recordings were analyzed using directed content analysis. The Theory of Planned Behavior (TPB) guided the development of questions for the semi-structured interviews. RESULTS Interviewed community pharmacists (N = 10) described the medication reconciliation process to be difficult and time-consuming for recently discharged patients. In the context of the TPB, more barriers than facilitators of reconciling medications were revealed. Themes were categorized as organizational and individual-level themes. Major organizational-level factors affecting the medication reconciliation process included: pharmacy resources, discharge communication, and hospital resources. Major individual-level factors affecting the medication reconciliation process included: pharmacists' perceived responsibility, relationships, patient perception of pharmacist, and patient characteristics. Interviewed pharmacists consistently responded that several pieces of information items would be helpful when reconciling medications for recently discharged patients, including the hospital medication discharge list and stop-orders for discontinued medications. CONCLUSIONS The TPB was useful for identifying barriers and facilitators of medication reconciliation for recently discharged patients from community pharmacists' perspectives. The elucidation of these specific facilitators and barriers suggest promising avenues for future research interventions to improve exchange of medication information between the community pharmacy, hospitals, and patients.
Collapse
|
15
|
Santana S, Szczygiel N, Redondo P. Integration of care systems in Portugal: anatomy of recent reforms. Int J Integr Care 2014; 14:e014. [PMID: 25114663 PMCID: PMC4113913 DOI: 10.5334/ijic.989] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Revised: 05/04/2014] [Accepted: 05/05/2014] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Integrated care is increasingly present in the agenda of policy-makers, health professionals and researchers as a way to improve care services in relation to access, quality, user satisfaction and efficiency. These are overarching objectives of most sectoral reforms. However, health care and social care services and systems are more and more dependent on the performance of each other, imposing the logic of network. Demographic, epidemiologic and cultural changes result in pressure to increase efficiency and efficacy of services and organisations in both sectors and that is why integrated care has become so relevant in the last years. METHODS We first used concept maps to organise and systematise information that we had gathered through deep literature review in order to set a framework where to base the subsequent work. Then, we interviewed informants at several levels of the health and social care systems and we built a list of major recent reforms addressing integrated care in Portugal. In a third step, we conducted two independent focus groups where those reforms were discussed and evaluated within the context of the concepts and frameworks identified from the literature. Results were confronted and reconciled, giving place to a list of requisites and guidelines that oriented further search for documentation on those reforms. RESULTS Several important health reforms are in course in primary and hospital care in Portugal, while a so-called third level of care has been introduced with the launch of the National Network of Long-Term Integrated Care (RNCCI - Rede Nacional de Cuidados Continuados Integrados). The social care sector has itself been a subject of alternative models springing from opposite political orientations. All these changes are having repercussions on the way the systems work with each other as they are leading to ongoing and ill-evaluated reformulations on the way they are governed, financed, structured and operated. CONCLUSIONS Care integration is not absent from policy-making and implementation endeavour in Portugal. However, recurrent issues seem to be consistently hampering the efforts regarding the integration of care in the country. It is urgent to assess current situation as experienced by those closely involved and directly affected.
Collapse
Affiliation(s)
- Silvina Santana
- Institute of Electronics Engineering and Telematics of Aveiro (IEETA), University of Aveiro, Aveiro, Portugal
| | - Nina Szczygiel
- Department of Economics, Management and Industrial Engineering, University of Aveiro, Aveiro, Portugal
| | - Patrícia Redondo
- Department of Economics, Management and Industrial Engineering, University of Aveiro, Aveiro, Portugal
| |
Collapse
|
16
|
Rodriguez HP, Ivey SL, Raffetto BJ, Vaughn J, Knox M, Hanley HR, Mangione CM, Shortell SM. As good as it gets? Managing risks of cardiovascular disease in California's top-performing physician organizations. Jt Comm J Qual Patient Saf 2014; 40:148-58. [PMID: 24864522 DOI: 10.1016/s1553-7250(14)40019-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND The California Right Care Initiative (RCI) accelerates the adoption of evidence-based guidelines and improved care management practices for conditions for which the gap between science and practice is significant, resulting in preventable disability and death. METHODS Medical directors and quality improvement leaders from 11 of the 12 physician organizations that met the 2010 national 90th percentile performance benchmarks for control of hyperlipidemia and glycated hemoglobin in 2011 were interviewed in 2012. Interviews, as well as surveys, assessed performance reporting and feedback to individual physicians; medication management protocols; team-based care management; primary care team huddles; coordination of care between primary care clinicians and specialists; implementation of shared medical appointments; and telephone visits for high-risk patients. RESULTS All but 1 of 11 organizations implemented electronic health records. Electronic information exchange between primary care physicians and specialists, however, was uncommon. Few organizations routinely used interdisciplinary team approaches, shared medical appointments, or telephonic strategies for managing cardiovascular risks among patients. Implementation barriers included physicians' resistance to change, limited resources and reimbursement for team approaches, and limited organizational capacity for change. Implementation facilitators included routine use of reliable data to guide improvement, leadership facilitation of change, physician buy-in, health information technology use, and financial incentives. CONCLUSION To accelerate improvements in managing cardiovascular risks, physician organizations may need to implement strategies involving extensive practice reorganization and work flow redesign.
Collapse
|
17
|
Vogler S, Habimana K, Arts D. Does deregulation in community pharmacy impact accessibility of medicines, quality of pharmacy services and costs? Evidence from nine European countries. Health Policy 2014; 117:311-27. [PMID: 24962537 DOI: 10.1016/j.healthpol.2014.06.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Revised: 04/28/2014] [Accepted: 06/02/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To analyse the impact of deregulation in community pharmacy on accessibility of medicines, quality of pharmacy services and costs. METHODS We analysed and compared community pharmacy systems in five rather deregulated countries (England, Ireland, the Netherlands, Norway, Sweden) and four rather regulated countries (Austria, Denmark, Finland, Spain). Data were collected by literature review, a questionnaire survey and interviews. RESULTS Following a deregulation, several new pharmacies and dispensaries of Over-the-Counter (OTC) medicines tended to be established, predominantly in urban areas. Unless prevented by regulation, specific stakeholders, e.g. wholesalers, were seen to gain market dominance which limited envisaged competition. There were indications for an increased workload for pharmacists in some deregulated countries. Economic pressure to increase the pharmacy turnover through the sale of OTC medicines and non-pharmaceuticals was observed in deregulated and regulated countries. Prices of OTC medicines were not found to decrease after a deregulation in pharmacy. CONCLUSIONS Access to pharmacies usually increases after a deregulation but this is likely to favour urban populations with already good accessibility. Policy-makers are recommended to take action to ensure equitable accessibility and sustainable competition in a more deregulated environment. No association between pharmaceutical expenditure and the extent of regulation/deregulation appears to exist.
Collapse
Affiliation(s)
- Sabine Vogler
- WHO Collaborating Centre for Pharmaceutical Pricing and Reimbursement Policies, Health Economics Department, Gesundheit Österreich GmbH/Österreichisches Bundesinstitut für Gesundheitswesen (GÖG/ÖBIG, Austrian Health Institute), Stubenring 6, 1010 Vienna, Austria(2).
| | - Katharina Habimana
- WHO Collaborating Centre for Pharmaceutical Pricing and Reimbursement Policies, Health Economics Department, Gesundheit Österreich GmbH/Österreichisches Bundesinstitut für Gesundheitswesen (GÖG/ÖBIG, Austrian Health Institute), Stubenring 6, 1010 Vienna, Austria(2).
| | - Danielle Arts
- WHO Collaborating Centre for Pharmaceutical Pricing and Reimbursement Policies, Health Economics Department, Gesundheit Österreich GmbH/Österreichisches Bundesinstitut für Gesundheitswesen (GÖG/ÖBIG, Austrian Health Institute), Stubenring 6, 1010 Vienna, Austria(2); Leibniz Institute for Prevention Research and Epidemiology - BIPS GmbH, Achterstraße 30, 28359 Bremen, Germany.
| |
Collapse
|
18
|
Health care providers' perspectives of medication adherence in the treatment of depression: a qualitative study. Soc Psychiatry Psychiatr Epidemiol 2013. [PMID: 23179094 DOI: 10.1007/s00127-012-0625-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE Non-adherence to antidepressant medications is a significant barrier to the successful treatment of depression. The purpose of this study was to explore the perspectives of health care providers on antidepressant medication non-adherence in clinical practice. METHODS Individual semi-structured interviews were conducted with a purposive sample of 31 health care providers from a range of disciplines and settings in the state of New South Wales, Australia. Interviews focused on medication adherence issues in depression and participants' strategies in addressing them. Interviews were audio recorded, transcribed verbatim and thematically content analyzed using a constant comparison approach. RESULTS Participants acknowledged medication non-adherence to be a complex problem in depression, and attributed this problem to patient, medication and environmental-specific issues. Five approaches in addressing non-adherence were reported: patient education, building partnerships with patients, pharmacological management, developing behavioural skills and building supportive networks. Challenges to the management of non-adherence were lack of time and skills, assessment of medication adherence, transition period immediately post-discharge and conflicts in views between providers. CONCLUSION Participants were able to identify issues and strategies in addressing antidepressant non-adherence; however, barriers were also identified that could impact on providers' ability to address this issue effectively. More research is needed to develop effective multidisciplinary strategies that take into account providers' perspectives in improving adherence to antidepressant medications.
Collapse
|
19
|
The impact of pharmacist’s counseling on pediatric patients’ caregiver’s knowledge on epilepsy and its treatment in a tertiary hospital. Int J Clin Pharm 2013; 35:829-34. [DOI: 10.1007/s11096-013-9817-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Accepted: 06/24/2013] [Indexed: 10/26/2022]
|
20
|
Expanding the role of community pharmacists: Policymaking in the absence of policy-relevant evidence? Health Policy 2013; 111:135-48. [DOI: 10.1016/j.healthpol.2013.04.003] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Revised: 03/23/2013] [Accepted: 04/02/2013] [Indexed: 01/08/2023]
|
21
|
Spinewine A, Claeys C, Foulon V, Chevalier P. Approaches for improving continuity of care in medication management: a systematic review. Int J Qual Health Care 2013; 25:403-17. [DOI: 10.1093/intqhc/mzt032] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
22
|
Abstract
Objectives: The primary objective was to examine the consistency of prioritization decisions made by pharmacy residents in a simulated environment where the available resources are constrained. Secondary objectives were to rank the factors that influenced their prioritization and to compare the residents’ results with those of Canadian pharmacy leaders. Methods: We have developed a prioritization exercise that aims at evaluating how pharmaceutical activities are prioritized. The simulation was conducted with hospital pharmacy residents in 2 Quebec universities in 2011. Results: Residents covered a similar number of activities in the prioritization simulation (mean 27 of 32). Teams tended to favor a broad range of services delivered less comprehensively. Participants ranked “perception of the favorable impact of the activity on health outcomes” higher than “conclusive evidence available to support the decisions.” The relative weight attributed per domain was similar between pharmacy residents and pharmacy leaders, but their ranking of factors that influenced their decisions was different. Conclusions: Pharmacy residents opted to provide a wide range of services, but at a low level of comprehensiveness. The high variation between each team’s coverage per activity in this simulation supports the observation that pharmacy residents do not agree on a core set of pharmaceutical activities that should be prioritized.
Collapse
Affiliation(s)
- Sophie Renet
- Département de Pharmacie, Unité de recherche en pratique pharmaceutique, Centre Hospitalier Universitaire Sainte-Justine, Montréal, QC, Canada
- Département de Pharmacie, Université Paris Descartes, Paris, France
| | - Cynthia Tanguay
- Département de Pharmacie, Unité de recherche en pratique pharmaceutique, Centre Hospitalier Universitaire Sainte-Justine, Montréal, QC, Canada
| | - Kevin Hall
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, AB, Canada
| | - Jean-François Bussières
- Département de Pharmacie, Unité de recherche en pratique pharmaceutique, Centre Hospitalier Universitaire Sainte-Justine, Montréal, QC, Canada
- Faculté de pharmacie, Université de Montréal, Montréal, QC, Canada
| |
Collapse
|
23
|
Hume AL, Kirwin J, Bieber HL, Couchenour RL, Hall DL, Kennedy AK, LaPointe NMA, D.O. Burkhardt C, Schilli K, Seaton T, Trujillo J, Wiggins B. Improving Care Transitions: Current Practice and Future Opportunities for Pharmacists. Pharmacotherapy 2012; 32:e326-37. [DOI: 10.1002/phar.1215] [Citation(s) in RCA: 112] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
| | - Anne L. Hume
- American College of Clinical Pharmacy; Lenexa; Kansas
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Berdine H, Dougherty T, Ference J, Karpa K, Klootwyk J, Kozminski M, Leon N, Osborne M, Welch AC, Willey VJ, Peterson A, Stanchak LA, Whisler AG. The pharmacists' role in the Patient-Centered Medical Home (PCMH): a white paper created by the Health Policy Committee of the Pennsylvania Pharmacists Association (PPA). Ann Pharmacother 2012; 46:723-50. [PMID: 22535839 DOI: 10.1345/aph.1r189] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
25
|
Renet S, Rochais É, Bussières JF, Lebel D, Tanguay C, Bourdon O. [Prioritization of healthcare programs by pharmacy students from France and from Quebec, according to the perceived impact of a decentralized pharmacist]. ANNALES PHARMACEUTIQUES FRANÇAISES 2012; 70:94-103. [PMID: 22500961 DOI: 10.1016/j.pharma.2012.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Revised: 12/29/2011] [Accepted: 01/05/2012] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Healthcare decision makers need to establish priorities and their decisions must be justified. However, few data is available on the prioritization process of the healthcare programs that should benefit from decentralized pharmacists. PATIENTS AND METHODS The main objective was to prioritize healthcare programs according to the perceived impact of a decentralized pharmacist for outpatient and inpatient clienteles. The secondary objective was to compare the prioritization made by pharmacy students from two Quebec universities and from one French university. Two different approaches were developed (perceived impact according to three indicators and according to the global impact). RESULTS The majority of healthcare programs with a high evidence based literature quality score (5/6 outpatient programs and 5/8 inpatient programs) were highly prioritized by at least two out of three cohorts. The median rank that was attributed for each healthcare program was significantly different between the three cohorts for 8/17 (47%) of outpatient programs and for 10/18 (56%) of inpatient programs. DISCUSSION A higher rank was attributed to healthcare programs when the evidence based literature quality score was high. The prioritization was also influenced by the difference in pharmaceutical practice between France and Quebec (e.g. sterilization and medical devices in France). CONCLUSIONS This study presented two approaches for the prioritization of healthcare programs that should benefit from a decentralized pharmacist, according to students from France and from Quebec.
Collapse
Affiliation(s)
- S Renet
- Unité de recherche en pratique pharmaceutique, département de pharmacie, CHU Sainte-Justine, 3175, chemin de la Côte Sainte-Catherine, Montréal, Québec, H3T 1C5 Canada
| | | | | | | | | | | |
Collapse
|
26
|
Melchiors AC, Correr CJ, Venson R, Pontarolo R. An analysis of quality of systematic reviews on pharmacist health interventions. Int J Clin Pharm 2011; 34:32-42. [PMID: 22183578 DOI: 10.1007/s11096-011-9592-0] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2011] [Accepted: 11/29/2011] [Indexed: 01/08/2023]
|
27
|
Gorgas Torner MQ, Pàez Vives F, Camós Ramió J, de Puig Cabrera E, Jolonch Santasusagna P, Homs Peipoch E, Schoenenberger Arnaiz JA, Codina Jané C, Gómez-Arbonés J. [Integrated pharmaceutical care programme in patients with chronic diseases]. FARMACIA HOSPITALARIA 2011; 36:229-39. [PMID: 22137609 DOI: 10.1016/j.farma.2011.06.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2010] [Revised: 05/31/2011] [Accepted: 06/03/2011] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To assess whether an integrated pharmaceutical care programme (IPCP) improves clinical evolution, patient quality of life, and reduces health costs in chronic patients. MATERIAL AND METHODS A parallel, open, and multi-centre clinical trial of an IPCP in patients with heart failure (HF) and/or chronic obstructive pulmonary disease (COPD) in 8 different health areas in Cataluña. The intervened patient was monitored for pharmacotherapeutic evolution by hospital pharmacists, primary care physicians, and community pharmacists. Controls received normal follow-up. All patients were monitored for 12 months, with quality of life tests administered at the beginning and end of follow-up. RESULTS We had the participation of 8 different hospitals, 8 primary care centres, and 109 community pharmacies. 238 patients completed the study, with 2.9% of participants lost during the study period. There were no significant differences in terms of readmissions, visits to the doctors, or to emergency services. We detected 50 different medication-related problems (MRP) in 37 patients, with a statistically significant difference in terms of MRP between the control and treatment groups of patients with HF, and almost significant differences in COPD patients. MRP were moderate-severe in 36% of cases. MRP were avoidable in 94% of cases, and the pharmacist resolved the issue in 90% of cases. There were no differences in terms of patient quality of life or health costs between the start and end of the study. CONCLUSIONS Integrated pharmaceutical care programs facilitate an improvement in the quality of patient care, but electronic registries are necessary to promote communication between sections of the health care network.
Collapse
Affiliation(s)
- M Q Gorgas Torner
- Servicio de Farmacia, Corporación Sanitaria Parc Taulí, Sabadell, Barcelona, España.
| | | | | | | | | | | | | | | | | |
Collapse
|
28
|
An expert panel assessment of comprehensive medication reviews for clients of community mental health teams. Soc Psychiatry Psychiatr Epidemiol 2010; 45:1071-9. [PMID: 19826745 DOI: 10.1007/s00127-009-0148-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2009] [Accepted: 09/25/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Few studies have investigated strategies to identify and resolve drug-related problems among clients of community mental health teams (CMHTs). OBJECTIVE The objective of this study was to evaluate the clinical impact and appropriateness of comprehensive medication reviews for clients of CMHTs. METHODS Trained pharmacists conducted interviews (30-45 min each) with clients of CMHTs to identify actual and potential drug-related problems. The pharmacists prepared medication review reports that detailed their findings and recommendations to optimize drug therapy. An expert panel comprising a psychiatrist, general medical practitioner, mental health pharmacist and medication review pharmacist evaluated reviews for 48 clients of 5 CMHTs. Panelists independently assessed review findings, review recommendations, likelihood of recommendation implementation and the overall expected clinical impact. RESULTS Two hundred and nine medication review findings and 208 medication review recommendations were evaluated. Panelists agreed with 76% of findings and considered that 81% of recommendations were appropriate. Collectively, 69% of recommendations were considered likely to be implemented. Thirty-seven (77%) reviews were deemed potentially to have a positive clinical impact. The agreement between panelists was statistically significant (P < 0.01) for the assessment of the findings, recommendations and likelihood of recommendation implementation. CONCLUSIONS Pharmacists' findings and recommendations to optimize drug therapy were considered appropriate and likely to result in improved clinical outcomes. Comprehensive medication reviews may be a valuable strategy to identify and resolve drug-related problems among clients of CMHTs.
Collapse
|
29
|
Drug related problems after discharge from an Australian teaching hospital. ACTA ACUST UNITED AC 2010; 32:622-30. [DOI: 10.1007/s11096-010-9406-9] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2009] [Accepted: 06/11/2010] [Indexed: 11/27/2022]
|
30
|
(Mick) Murray MD. Continuity of Health Care and the Pharmacist: Let's Keep It Simple. Ann Pharmacother 2009; 43:745-7. [DOI: 10.1345/aph.1l666] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Pharmacists are a cornerstone of quality medication management. High-quality continuity of care involves patient-centered medication therapy management, which could be bolstered for 26 million Part D Medicare beneficiaries. Yet, many patients do not receive sufficient instruction about their prescription medications. Patient-centered aspects are important because of the heterogeneity in patient types and severity of disease, varying treatment requirements, lifestyle factors, and differences in health literacy. Although time constraints for all health professionals are apparent, a simple but crucial contribution by pharmacists to the continuity of care is to increase the emphasis on patient-centered medication instruction.
Collapse
Affiliation(s)
- Michael D (Mick) Murray
- Pharmaceutical Outcomes & Policy, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC
| |
Collapse
|