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Torrise VS. Utilizing policy and standardization to promote pharmacist practitioners in a large healthcare system. Am J Health Syst Pharm 2024; 81:e353-e357. [PMID: 38484182 DOI: 10.1093/ajhp/zxae019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2024] Open
Affiliation(s)
- Virginia S Torrise
- Pharmacy Benefits Management Services, Department of Veterans Affairs, Washington, DC, USA
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2
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Ciprandi G. Self-Management in Allergic Rhinitis: Strategies, Outcomes and Integration into Clinical Care. J Asthma Allergy 2023; 16:1087-1095. [PMID: 37818035 PMCID: PMC10561621 DOI: 10.2147/jaa.s273478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 10/03/2023] [Indexed: 10/12/2023] Open
Abstract
Allergic rhinitis (AR) is a common disease, characterized by typical symptoms and type 2 inflammation. Standard treatment is usually effective and safe, and most medications are available as over-the-counter (OTC). Therefore, AR patients, mostly at the AR onset or if symptoms are mild, prefer to manage symptoms themselves. However, self-management could be associated with problems, including inadequate control or medication abuse. Therefore, this paper aimed at presenting and discussing this issue. Ideally, self-management should be conducted under medical supervision. In this regard, telemedicine could represent a valuable tool for implementing self-management. Visual analog scale (VAS) is a perfect parameter to measure symptom severity, medications use, and AR control. In addition, VAS is easily monitored over time. Presently, a mobile application allows to AR patients of self-managing themselves. Therefore, mobile healthcare may supply fundamental support in communication and decision-making. In this regard, VAS represents the best tool to monitor symptoms' severity and control over time. Finally, pharmacological and non-pharmacological remedies are numerous and effective but should be used wisely.
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Al-Dujaili Z, Hallit S, Al Faraj A. Knowledge, attitude, and readiness of pharmacists toward medication therapy management for patients with attention deficit hyperactivity disorder: a cross-sectional quantitative study. Int J Clin Pharm 2023; 45:1277-1285. [PMID: 37695404 DOI: 10.1007/s11096-023-01628-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 07/18/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND Medication Therapy Management (MTM) is a patient-centered service that optimizes drug therapy, improves clinical outcomes, and enhances quality of life. Pharmacists play a critical role in MTM services and provide comprehensive medication management for patients with attention deficit hyperactivity disorder (ADHD). AIM The aim of this study was to assess the knowledge, attitude, and readiness of Iraqi community pharmacists regarding MTM services for ADHD patients. METHOD A cross-sectional study was conducted among 480 Iraqi pharmacists working in community pharmacies in Baghdad. Data were collected using a pre-validated, self-administered questionnaire with 34 items. RESULTS Results showed that only 127 (26.5%) pharmacists had good knowledge, 146 (30.4%) had good attitude, and 148 (30.8%) had high readiness regarding MTM services in ADHD patients. Multivariate analyses showed that a higher number of hours worked per week in the hospital was significantly associated with a lower likelihood of high attitude, whereas practicing MTM services, high knowledge, and high attitude were significantly associated with a higher likelihood of high readiness. CONCLUSION The findings of this study indicate that knowledge, attitudes, and readiness for MTM services for ADHD patients are inadequate. Therefore, there is an urgent need for effective educational strategies to better prepare pharmacists for their potential role in the community, particularly for providing MTM services to ADHD patients.
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Affiliation(s)
- Zahraa Al-Dujaili
- College of Pharmacy, American University of Iraq-Baghdad (AUIB), Baghdad, 10023, Iraq
| | - Souheil Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon
- Applied Science Research Center, Applied Science Private University, Amman, Jordan
- Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon
| | - Achraf Al Faraj
- College of Pharmacy, American University of Iraq-Baghdad (AUIB), Baghdad, 10023, Iraq.
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4
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Pestka DL, Paterson NL, Brummel AR, Norman JA, White KM. Barriers and facilitators to implementing pharmacist-provided comprehensive medication management in primary care transformation. Am J Health Syst Pharm 2022; 79:1255-1265. [PMID: 35390120 PMCID: PMC9305504 DOI: 10.1093/ajhp/zxac104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
DISCLAIMER In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE How to effectively integrate pharmacists into team-based models of care to maximize the benefit they bring to patients and care teams, especially during times of primary care transformation (PCT), remains unknown. The objective of this study was to identify barriers and facilitators when integrating pharmacist-provided comprehensive medication management (CMM) services into a health system's team-based PCT using the Consolidated Framework for Implementation Research (CFIR). METHODS Semistructured qualitative interviews were carried out with 22 care team members regarding their perceptions of the implementation of CMM in the PCT. Transcripts were coded to identify CMM implementation barriers and facilitators, and resulting codes were mapped to corresponding CFIR domains and constructs. RESULTS Fifteen codes emerged that were labeled as either a barrier or a facilitator to implementing CMM in the PCT. Facilitators were the perception of CMM as an invaluable resource, precharting, tailored appointment lengths, insurance coverage, increased pharmacy presence, enhanced team-based care, location of CMM, and identification of CMM advocates. Barriers included limited clinic leadership involvement, a need for additional resources, CMM pharmacists not always feeling part of the core team, understanding of and training around CMM's role in the PCT, changing mindsets to utilize resources such as CMM more frequently, underutilization of CMM, and CMM scheduling. CONCLUSION Clinical pharmacists providing CMM represent a valuable interdisciplinary care team member who can help improve healthcare quality and access to primary care. Identifying and addressing implementation barriers and facilitators early during PCT rollout is critical to the success of team-based services such as CMM and becoming a learning health system.
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Affiliation(s)
- Deborah L Pestka
- Department of Pharmaceutical Care & Health Systems, College of Pharmacy, University of Minnesota, Minneapolis, MN, USA
| | | | | | | | - Katie M White
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA
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Mulrooney M, Smith M, Sobieraj D, Shipley B, Miech E. Factors Influencing Primary Care Organization Commitment to Technical Assistance Services for Clinical Pharmacist Integration Using Configurational Comparative Methods. J Am Pharm Assoc (2003) 2022; 62:1564-1571. [DOI: 10.1016/j.japh.2022.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 03/03/2022] [Accepted: 03/24/2022] [Indexed: 11/28/2022]
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6
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Beal JL, Ades RS, Vernon V, Wilkinson TA, Meredith AH. Pharmacists' Perceptions, Barriers, and Potential Solutions to Implementing a Direct Pharmacy Access Policy in Indiana. Med Care Res Rev 2021; 78:789-797. [PMID: 33016218 PMCID: PMC8019683 DOI: 10.1177/1077558720963651] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study assessed pharmacists' perceptions, barriers, and potential solutions for implementing a policy allowing pharmacists to prescribe hormonal contraceptives in Indiana. A mixed-method survey (n = 131, 22.3% response rate), using Likert-type scales, dichotomous responses (yes/no), and open-ended questions, was distributed to pharmacy preceptors in Indiana. Pharmacists felt prescribing contraceptives would be beneficial (79.1%) and were interested in providing this service (76.0%), but only 35.6% reported having the necessary resources. Participants with a PharmD were significantly more likely to feel the service would be beneficial (odds ratio [OR] = 10.360, 95% confidence interval [CI: 1.679, 63.939]) and be interested in prescribing contraceptives (OR = 9.069, 95% CI [1.456, 56.485]). Reimbursement (86.4%), training courses (84.7%), private counseling rooms (69.5%), and increasing technician responsibilities (52.5%) were identified as ways to ease implementation. Women had significantly greater odds of being more comfortable than men prescribing injections (OR = 2.237, 95% CI [1.086, 4.605]), and intravaginal rings (OR = 2.215, 95% CI [1.066, 4.604]), when controlling for age, degree, and setting. Qualitative findings reinforced quantitative findings.
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Affiliation(s)
- Jenny L. Beal
- Department of Pharmacy Practice, Purdue University, 575 Stadium Mall Drive, West Lafayette, IN, 47907
| | - Ryan S. Ades
- Manchester University College of Pharmacy, 10627 Diebold Rd. Fort Wayne, IN 46845
| | - Veronica Vernon
- Butler University College of Pharmacy and Health Sciences, 4600 Sunset Ave, Indianapolis, IN 46208
| | - Tracey A. Wilkinson
- Indiana University School of Medicine, Department of Pediatrics, Division of Children’s Health Services Research, 410 W. 10th Street, Indianapolis, IN, 46202
| | - Ashley H. Meredith
- Department of Pharmacy Practice, Purdue University, 575 Stadium Mall Drive, West Lafayette, IN, 47907
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McCullough MB, Zogas A, Gillespie C, Kleinberg F, Reisman JI, Ndiwane N, Tran MH, Ourth HL, Morreale AP, Miller DR. Introducing clinical pharmacy specialists into interprofessional primary care teams: Assessing pharmacists' team integration and access to care for rural patients. Medicine (Baltimore) 2021; 100:e26689. [PMID: 34559093 PMCID: PMC8462613 DOI: 10.1097/md.0000000000026689] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 06/17/2021] [Indexed: 01/05/2023] Open
Abstract
Clinical pharmacy specialists (CPS) were deployed nationally to improve care access and relieve provider burden in primary care.The aim of this study was to assess CPS integration in primary care and the Clinical Pharmacy Specialist Rural Veteran Access (CRVA) initiative's effectiveness in improving access.Concurrent embedded mixed-methods evaluation of participating CRVA CPS and their clinical team members (primary care providers, others).Health care providers on primary care teams in Veterans Health Administration (VHA).Perceived CPS integration in comprehensive medication management assessed using the MUPM and semi-structured interviews, and access measured with patient encounter data.There were 496,323 medical encounters with CPS in primary care over a 3-year period. One hundred twenty-four CPS and 1177 other clinical team members responded to a self-administered web-based questionnaire, with semi-structured interviews completed by 22 CPS and clinicians. Survey results indicated that all clinical provider groups rank CPS as making major contributions to CMM. CPS ranked themselves as contributing more to CMM than did their physician team members. CPS reported higher job satisfaction, less burn out, and better role fit; but CPS gave lower scores for communication and decision making as clinic organizational attributes. Themes in provider interviews focused on value of CPS in teams, relieving provider burden, facilitators to integration, and team communication issues.This evaluation indicates good integration of CPS on primary care teams as perceived by other team members despite some communication and role clarification challenges. CPS may play an important role in improving access to primary care.
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Affiliation(s)
- Megan B. McCullough
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA
- University of Massachusetts, Lowell, Zuckerberg School of Health Sciences, Department of Public Health, Lowell, MA
| | - Anna Zogas
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA
| | - Chris Gillespie
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA
| | - Felicia Kleinberg
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA
| | - Joel I. Reisman
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA
| | - Ndindam Ndiwane
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA
| | - Michael H. Tran
- Pharmacy Benefits Management Services, Veterans Health Administration Central Office, Department of Veterans Affairs, Washington, DC
| | - Heather L. Ourth
- Pharmacy Benefits Management Services, Veterans Health Administration Central Office, Department of Veterans Affairs, Washington, DC
| | - Anthony P. Morreale
- Pharmacy Benefits Management Services, Veterans Health Administration Central Office, Department of Veterans Affairs, Washington, DC
| | - Donald R. Miller
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA
- University of Massachusetts, Lowell, Center for Population Health, Department of Biomedical and Nutritional Sciences, Lowell, MA
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8
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Moreno G, Fu JY, Chon JS, Bell DS, Grotts J, Tseng CH, Maranon R, Skootsky SS, Mangione CM. Reducing Emergency Department Visits Among Patients With Diabetes by Embedding Clinical Pharmacists in the Primary Care Teams. Med Care 2021; 59:348-353. [PMID: 33427796 PMCID: PMC7954858 DOI: 10.1097/mlr.0000000000001501] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pharmacists are effective at improving control of cardiovascular risk factors, but it less clear whether these improvements translate into less emergency department (ED) use and fewer hospitalizations. The UCMyRx program embed pharmacists in primary care. OBJECTIVE The objective of this study was to examine if the integration of pharmacists into primary care was associated with lower ED and hospital use for patients with diabetes. DESIGN This was a quasi-experimental study with a comparator group. SUBJECTS The analytic sample included patients with diabetes with uncontrolled cardiovascular risk factors (A1C >9%, blood pressure >140/90 mm Hg, low-density lipoprotein-cholesterol >130 mg/dL) who had 1 or more visits in either a UCMyRx (648 patients, 14 practices) or usual care practice (1944 patients, 14 practices). MEASURES Our outcomes were ED and hospitalization rates as measured before and after the consultations between UCMyRx and usual care. Our predictor variable was the pharmacist consultation. Poisson generalized estimating equations model was used to estimate the adjusted predicted change in utilization before and after the pharmacist consultation. The Average Treatment Effect on the Treated was estimated. RESULTS In models adjusted, the adjusted mean predicted number of emergency department visits/month during the year before the consultation was 0.09 among UCMyRx patients. During the year after initiating the care with the pharmacists, this rate decreased to an adjusted mean monthly rate of 0.07, with an Average Treatment Effect on the Treated=0.021 (P=0.035), a predicted reduction of 21% in emergency department visits associated with the clinical pharmacist consults. There was a nonsignificant predicted 3.2% reduction in hospitalizations over time for patients in the UCMyRx program. CONCLUSION Clinical pharmacists are an important addition to clinical care teams in primary care practices and significantly decreased utilization of the ED among patients with poorly controlled diabetes.
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Affiliation(s)
- Gerardo Moreno
- Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Jeffery Y Fu
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Janet S. Chon
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Douglas S. Bell
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Jonathan Grotts
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Chi-Hong Tseng
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Richard Maranon
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Samuel S. Skootsky
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Carol M. Mangione
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA
- Department of Health Policy and Management, UCLA Fielding School of Public Health, University of California, Los Angeles, CA
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Clements JN, Emmons RP, Anderson SL, Chow M, Coon S, Irwin AN, Mukherjee SM, Sease JM, Thrasher K, Witek SR. Current and future state of quality metrics and performance indicators in comprehensive medication management for ambulatory care pharmacy practice. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2021. [DOI: 10.1002/jac5.1406] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
| | | | | | - Marissa Chow
- American College of Clinical Pharmacy Lenexa Kansas USA
| | - Scott Coon
- American College of Clinical Pharmacy Lenexa Kansas USA
| | | | | | | | - Kim Thrasher
- American College of Clinical Pharmacy Lenexa Kansas USA
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10
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Measuring health care quality: Implications, threats, and opportunities for clinical pharmacists. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2021. [DOI: 10.1002/jac5.1344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Coe AB, Choe HM, Diez HL, Rockey NG, Ashjian EJ, Dorsch MP, Kim HM, Farris KB. Pharmacists providing care in statewide physician organizations: findings from the Michigan Pharmacists Transforming Care and Quality Collaborative. J Manag Care Spec Pharm 2020; 26:1558-1566. [PMID: 33251995 PMCID: PMC9837743 DOI: 10.18553/jmcp.2020.26.12.1558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND: Clinical services provided by pharmacists embedded in practices can improve patient outcomes within the primary care setting. Little is known about whether physician organizations (POs) will retain the services of clinical pharmacists after outside funding for a statewide implementation program is ended. OBJECTIVE: To evaluate a statewide program, Michigan Pharmacists Transforming Care and Quality (MPTCQ), that incorporated pharmacists within 17 POs. METHODS: A descriptive study was conducted using data collected from June 2016 to September 2018 from primary care clinical pharmacist encounters in POs participating in MPTCQ. Process outcomes included the number of participating POs, patient encounters, and average visits per patient. Analyses at the encounter level were stratified by 2 encounter types: disease state management (DSM) or comprehensive medication review (CMR). Separately by encounter type, pharmacist effect was described by the number, type, and reasons for medication changes, as well as medication adherence and cost barriers found and addressed. Clinical outcomes included hemoglobin A1c and blood pressure change. Sustainability and patient satisfaction of pharmacists providing clinical services are reported. RESULTS: Across 17 POs, 27 pharmacists participated in the MPTCQ program. Pharmacists completed 24,523 patient encounters for DSM with 5,942 patients, with an average of 5 visits per patient with diabetes and 2 visits for hypertension. Pharmacists made 15,153 therapeutic medication changes during visits for diabetes and hypertension, with approximately 70% related to efficacy. Pharmacists completed 4,203 CMR visits for 3,092 patients. During CMR visits, 1,296 therapeutic medication changes were recommended. Problems with medication cost were identified in 13% of CMR visits. Blood pressure and A1c levels decreased in patients managed by pharmacists. In 157 patients surveyed, 87% rated their pharmacists' care as excellent. Sixteen POs retained their pharmacists at the end of funding. CONCLUSIONS: A statewide provider-payer partnership successfully integrated and retained primary care pharmacists within POs. Pharmacists in the MPTCQ program contributed to improvements in disease control by changing medications to improve patient clinical outcomes. DISCLOSURES: Support for MPTCQ was provided by Blue Cross and Blue Shield of Michigan (BCBSM) as part of the BCBSM Value Partnerships program. Coe was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under award number KL2TR002241. Although BCBSM and MPTCQ work collaboratively, the opinions, beliefs, and viewpoints expressed by the authors do not necessarily reflect the opinions, beliefs, and viewpoints of BCBSM or any of its employees. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The authors have no conflicts of interest to report.
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Affiliation(s)
| | - Hae Mi Choe
- University of Michigan College of Pharmacy and Michigan Medicine, Ann Arbor
| | - Heidi L Diez
- University of Michigan College of Pharmacy and Michigan Medicine, Ann Arbor
| | | | - Emily J Ashjian
- University of Michigan College of Pharmacy and Michigan Medicine, Ann Arbor
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Pharmacists' Knowledge and Practice of Issues Related to Using Psychotropic Medication in Elderly People in Ethiopia: A Prospective Cross-Sectional Study. BIOMED RESEARCH INTERNATIONAL 2020; 2020:7695692. [PMID: 32851087 PMCID: PMC7441448 DOI: 10.1155/2020/7695692] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 07/30/2020] [Indexed: 11/20/2022]
Abstract
Purpose This study is aimed at assessing pharmacists' knowledge and practice of issue related to usage of psychotropic medications in elderly people, in Gondar town Northwest, Ethiopia. Methods A cross-sectional study was conducted among pharmacists working in community, health center, and hospital pharmacies in Gondar town from March 1 to May 30, 2020. A total of 73 medication retail outlets (40 pharmacies and 33 drug stores) were included in this study. Pharmacy personnel's knowledge and practice were assessed using self-administered validated questionnaires. Binary and multivariable logistic regression analyses were used to assess the association between different variables. P < 0.05 was used to declare the association. Result A total of 144 pharmacists were included in the study; the mean age was 30.13 (SD ±5.87), ranging from 20 to 55years. The mean knowledge score was 7.789 (SD ±2.98), and 75 (52.1%) of them had poor knowledge. The mean practice score was 2.32 ± 0.912 (mean ± SD), and 77 (53.5%) of the respondents had poor practice. All participants had not taken on-the-job training about psychotropic medication. Work experience (P < 0.029) and personal monthly income (P < 0.046) were significantly associated with pharmacists' knowledge. There was a significant association between work experience and practice level (P < 0.043). Conclusion The knowledge and practice of pharmacy personnel were low for issues related to the use of psychotropic medication in the elderly. This result indicates the need for training for pharmacists on pharmacotherapy of psychotropic medication.
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Spees LP, Wheeler SB, Zhou X, Amin KB, Baggett CD, Lund JL, Urick BY, Farley JF, Reeder-Hayes KE, Trogdon JG. Changes in chronic medication adherence, costs, and health care use after a cancer diagnosis among low-income patients and the role of patient-centered medical homes. Cancer 2020; 126:4770-4779. [PMID: 32780539 DOI: 10.1002/cncr.33147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 07/09/2020] [Accepted: 07/18/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Approximately 40% of patients with cancer also have another chronic medical condition. Patient-centered medical homes (PCMHs) have improved outcomes among patients with multiple chronic comorbidities. The authors first evaluated the impact of a cancer diagnosis on chronic medication adherence among patients with Medicaid coverage and, second, whether PCMHs influenced outcomes among patients with cancer. METHODS Using linked 2004 to 2010 North Carolina cancer registry and claims data, the authors included Medicaid enrollees who were diagnosed with breast, colorectal, or lung cancer who had hyperlipidemia, hypertension, and/or diabetes mellitus. Using difference-in-difference methods, the authors examined adherence to chronic disease medications as measured by the change in the percentage of days covered over time among patients with and without cancer. The authors then further evaluated whether PCMH enrollment modified the observed differences between those patients with and without cancer using a differences-in-differences-in-differences approach. The authors examined changes in health care expenditures and use as secondary outcomes. RESULTS Patients newly diagnosed with cancer who had hyperlipidemia experienced a 7-percentage point to 11-percentage point decrease in the percentage of days covered compared with patients without cancer. Patients with cancer also experienced significant increases in medical expenditures and hospitalizations compared with noncancer controls. Changes in medication adherence over time between patients with and without cancer were not determined to be statistically significantly different by PCMH status. Some PCMH patients with cancer experienced smaller increases in expenditures (diabetes) and emergency department use (hyperlipidemia) but larger increases in their inpatient hospitalization rates (hypertension) compared with non-PCMH patients with cancer relative to patients without cancer. CONCLUSIONS PCMHs were not found to be associated with improvements in chronic disease medication adherence, but were associated with lower costs and emergency department visits among some low-income patients with cancer.
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Affiliation(s)
- Lisa P Spees
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Stephanie B Wheeler
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Xi Zhou
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Krutika B Amin
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Christopher D Baggett
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jennifer L Lund
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Benjamin Y Urick
- Division of Practice Advancement and Clinical Education, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Joel F Farley
- Department of Pharmaceutical Care and Health Systems, University of Minnesota, Minneapolis, Minnesota
| | - Katherine E Reeder-Hayes
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Division of Hematology/Oncology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Justin G Trogdon
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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14
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Hartkopf KJ, Heimerl KM, McGowan KM, Arndt BG. Expansion and Evaluation of Pharmacist Services in Primary Care. PHARMACY 2020; 8:pharmacy8030124. [PMID: 32707794 PMCID: PMC7559880 DOI: 10.3390/pharmacy8030124] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/15/2020] [Accepted: 07/16/2020] [Indexed: 02/06/2023] Open
Abstract
Challenges with primary care access and overextended providers present opportunities for pharmacists as patient care extenders for chronic disease management. The primary objective was to align primary care pharmacist services with organizational priorities and improve patient clinical outcomes. The secondary objective was to develop a technological strategy for service evaluation. An interdisciplinary workgroup developed primary care pharmacist services focused on improving performance measures and supporting the care team in alignment with ongoing population health initiatives. Pharmacist collaborative practice agreements (CPAs) were developed and implemented. An electronic dashboard was developed to capture service outcome measures. Blood pressure control to <140/90 mmHg was achieved in 74.15% of patients who engaged with primary care pharmacists versus 41.53% of eligible patients electing to follow usual care pathways. Appropriate statin use was higher in patients engaged with primary care pharmacists than in eligible patients electing to follow usual care pathways both for diabetes and ischemic vascular disease (12.4% and 2.2% higher, respectively). Seventeen of 54 possible process and outcome measures were identified and incorporated into an electronic dashboard. Primary care pharmacist services improve hypertension control and statin use. Service outcomes can be measured with discrete data from the electronic health record (EHR), and should align with organizational priorities.
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Affiliation(s)
- Katherine J. Hartkopf
- Department of Pharmacy, University of Wisconsin Health, Madison, WI 53792, USA; (K.M.H.); (K.M.M.)
- Correspondence:
| | - Kristina M. Heimerl
- Department of Pharmacy, University of Wisconsin Health, Madison, WI 53792, USA; (K.M.H.); (K.M.M.)
| | - Kayla M. McGowan
- Department of Pharmacy, University of Wisconsin Health, Madison, WI 53792, USA; (K.M.H.); (K.M.M.)
| | - Brian G. Arndt
- Department of Family Medicine and Community Health, School of Medicine and Public Health, University of Wisconsin, Madison, WI 53706, USA;
- University of Wisconsin Health PATH Collaborative (Primary Care Academics Transforming Healthcare), Madison, WI 53705, USA
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15
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Patient outcomes from implementing an enhanced services pharmacy network. J Am Pharm Assoc (2003) 2020; 60:843-852.e15. [PMID: 32680782 DOI: 10.1016/j.japh.2020.05.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 04/06/2020] [Accepted: 05/10/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate the effect of implementing a network of community pharmacies on medication adherence, health service utilization, and health care spending. DESIGN Quasi-experimental difference-in-difference analysis with a nonequivalent control group. SETTING AND PARTICIPANTS Eligible Medicaid-enrolled patients in North Carolina were attributed to intervention pharmacies between March 2015 and December 2016. A control group was propensity score-matched. Interventions consisted of enhanced services and a more intensive, comprehensive initial pharmacy assessment (CIPA). OUTCOME MEASURES Outcomes included hospitalizations; emergency department (ED) visits; health care spending for total medical, inpatient, outpatient, and ED services; and adherence to renin-angiotensin system antagonists (RASA), statins, noninsulin diabetes medications (NIDM), and multiple medications for chronic conditions (MMCC). RESULTS There were 31,509 patients who met eligibility criteria and were attributed to a participating pharmacy. Of these, 3897 received a CIPA. Before matching, patients attributed to participating pharmacies had greater Medicaid enrollment through aged, blind, or disabled status (49.2% vs. 31.5%, P < 0.001); greater case management (10.3% vs. 7%, P < 0.001); and worse rates of chronic disease (P < 0.001). Successful matching removed these differences. Adherence to RASA medications and MMCC increased by 9.5% and 10.3% (P < 0.05), respectively. Adherence did not change for statins and NIDM. The analysis also revealed a slower decline in average total medical spending of 5.7% (P < 0.01) relative to the control group over the same period, owed to a 9.6% (P < 0.001) slower decline in outpatient spending. ED utilization also decreased more slowly relative to controls by 4.8% (P < 0.05) following the intervention. CONCLUSION The pharmacy intervention resulted in a statistically significant improvement in medication adherence to RASA and multiple chronic medications, but did not change or may have worsened utilization and spending outcomes. More research is needed to explore patient selection and variation in implementation and heterogeneity of treatment effects when evaluating pharmacy interventions.
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Ferreri SP, Hughes TD, Snyder ME. Medication Therapy Management: Current Challenges. INTEGRATED PHARMACY RESEARCH AND PRACTICE 2020; 9:71-81. [PMID: 32309200 PMCID: PMC7136570 DOI: 10.2147/iprp.s179628] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 03/10/2020] [Indexed: 11/23/2022] Open
Abstract
Medication therapy management (MTM) services have evolved as a means for pharmacists and other providers to assist patients and caregivers in improving therapeutic outcomes and reducing health care expenditures. More than a decade has passed since the Medicare Modernization Act of 2003 provided pharmacists with the opportunity to deliver MTM services to Medicare beneficiaries. MTM continues to offer pharmacists the opportunity to use their knowledge; yet, pharmacists have reported challenges with service delivery. Identifying the challenges that affect MTM services in pharmacy practice is necessary in order to seek improvement to MTM delivery. This narrative review explores the current challenges pharmacists face with MTM delivery, summarizes potential solutions for addressing challenges, and seeks to incite further debate, service reconfiguration, and ultimately service improvement of pharmacist-provided MTM services.
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Affiliation(s)
- Stefanie P Ferreri
- UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7574, USA
| | - Tamera D Hughes
- UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7574, USA
| | - Margie E Snyder
- College of Pharmacy, Purdue University, Indianapolis, IN 46202, USA
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Martinez AI, Abner EL, Jicha GA, Rigsby DN, Eckmann LC, Huffmyer MJ, Moga DC. One-Year Evaluation of a Targeted Medication Therapy Management Intervention for Older Adults. J Manag Care Spec Pharm 2020; 26:520-528. [PMID: 32223601 PMCID: PMC7396972 DOI: 10.18553/jmcp.2020.26.4.520] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Older adults are especially susceptible to adverse effects of inappropriate medication therapy, and anticholinergic medications are common culprits for cognitive dysfunction due to their action on the central nervous system. Medication therapy management (MTM) interventions can aid in deprescribing and reducing inappropriate medication use in older adults. However, there is sparse literature on the long-term sustainability of these interventions. OBJECTIVES To (a) investigate whether the deprescribing of anticholinergic medications during an 8-week randomized controlled trial (RCT) of a targeted MTM intervention is sustained at 1-year postintervention follow-up and (b) compare anticholinergic utilization trends in the study population with a large sample of similar individuals not exposed to the intervention. METHODS Participants in the targeted MTM (tMTM) RCT had normal cognition or mild cognitive impairment and were recruited from enrollees in a longitudinal study at the University of Kentucky Alzheimer's Disease Center (ADC) and thus have pertinent medical information gathered approximately annually. In this posttrial observational follow-up, sustainability of the anticholinergic deprescribing intervention was assessed in participants in the RCT, and anticholinergic medication use trends were described from the RCT baseline (which occurred immediately following an ADC visit) to the next annual visit in all participants. Mean change in anticholinergic burden from RCT baseline to the next annual visit was estimated using analysis of covariance, and participants were compared with 2 external samples. Anticholinergic burden was measured using the Anticholinergic Drug Scale (ADS). The odds of decreasing baseline anticholinergic burden and number of total and strong anticholinergic medications at the follow-up study time point was assessed using logistic regression. RESULTS Of the deprescribing changes made during the initial RCT, 50% were sustained after 1 year. Participants in the tMTM trial reported decreases in the use of anticholinergic antihistamines and bladder agents (-6.5 and -4.4%, respectively), but there was no change in the use of anticholinergic agents targeted at the central nervous system. While the anticholinergic burden of RCT participants decreased over 1 year (adjusted mean ADS change [95% CI] = -0.33 [-0.72, 0.07]), it was not different than the change observed in 2 external samples at the trial center (-0.20 [-0.42, 0.02]) and nationally (-0.33 [-0.39, -0.26]). There were no statistically significant differences between trial participants and external samples in the odds of decreasing anticholinergic burden nor in decreasing the number of total, or strongly anticholinergic, medications at the 1-year follow-up. CONCLUSIONS This study demonstrates that the sustainability of deprescribing is limited to the period of intervention, rather than affording lasting effects even over periods as short as 1 year, which was demonstrated not only in the small group of RCT participants but also by comparison with external groups. Future work should extend the duration of intervention and follow-up periods for MTM interventions to allow further insights regarding the sustainability of deprescribing efforts in older adults. DISCLOSURES The original trial was supported by a pilot study award from the University of Kentucky Center for Clinical and Translational Sciences (UL1TR000117). Additional support for this study was provided by the National Institutes of Health/National Institute on Aging (R01 AG054130). Jicha reports contract research for Esai, Biohaven, Alltech, Suven, Novartis, and Lilly. The other authors have nothing to disclose.
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Affiliation(s)
- Ashley I. Martinez
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, Lexington
| | - Erin L. Abner
- Department of Epidemiology, College of Public Health, University of Kentucky, and Sanders-Brown Center on Aging, Lexington, Kentucky
| | - Gregory A. Jicha
- Sanders-Brown Center on Aging, Lexington, Kentucky, and Department of Neurology, College of Medicine, University of Kentucky, Lexington
| | | | | | - Mark J. Huffmyer
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, and PRO2RX LLC Pharmacy Consulting Services, Lexington, Kentucky
| | - Daniela C. Moga
- Department of Pharmacy Practice and Science, College of Pharmacy, and Department of Epidemiology, College of Public Health, University of Kentucky, and Sanders-Brown Center on Aging, Lexington, Kentucky
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18
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Modeling the Health and Budgetary Impacts of a Team-based Hypertension Care Intervention That Includes Pharmacists. Med Care 2020; 57:882-889. [PMID: 31567863 DOI: 10.1097/mlr.0000000000001213] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The objective of this study was to assess the potential health and budgetary impacts of implementing a pharmacist-involved team-based hypertension management model in the United States. RESEARCH DESIGN In 2017, we evaluated a pharmacist-involved team-based care intervention among 3 targeted groups using a microsimulation model designed to estimate cardiovascular event incidence and associated health care spending in a cross-section of individuals representative of the US population: implementing it among patients with: (1) newly diagnosed hypertension; (2) persistently (≥1 year) uncontrolled blood pressure (BP); or (3) treated, yet persistently uncontrolled BP-and report outcomes over 5 and 20 years. We describe the spending thresholds for each intervention strategy to achieve budget neutrality in 5 years from a payer's perspective. RESULTS Offering this intervention could prevent 22.9-36.8 million person-years of uncontrolled BP and 77,200-230,900 heart attacks and strokes in 5 years (83.8-174.8 million and 393,200-922,900 in 20 years, respectively). Health and economic benefits strongly favored groups 2 and 3. Assuming an intervention cost of $525 per enrollee, the intervention generates 5-year budgetary cost-savings only for Medicare among groups 2 and 3. To achieve budget neutrality in 5 years across all groups, intervention costs per person need to be around $35 for Medicaid, $180 for private insurance, and $335 for Medicare enrollees. CONCLUSIONS Adopting a pharmacist-involved team-based hypertension model could substantially improve BP control and cardiovascular outcomes in the United States. Net cost-savings among groups 2 and 3 make a compelling case for Medicare, but favorable economics may also be possible for private insurers, particularly if innovations could moderately lower the cost of delivering an effective intervention.
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19
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Renfro CP, Robinson JM, Turner K, Gaskins T, Ferreri SP. Care coordination and follow-up practices in the community pharmacy setting: A mixed methods study. J Am Pharm Assoc (2003) 2020; 60:631-638.e2. [PMID: 31919008 DOI: 10.1016/j.japh.2019.11.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 11/18/2019] [Accepted: 11/21/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVES This mixed methods study had 2 aims: (1) to describe the frequency of care coordination between pharmacists, prescribers, and care managers and (2) to identify pharmacists' strategies for care coordination and follow-up in a community pharmacy setting. DESIGN This study used a mixed methods design. SETTING AND PARTICIPANTS Pharmacists who were responsible for implementing North Carolina community pharmacy enhanced services network (NC CPESN®) activities in their pharmacy during the first or second year of the 3-year program (September 2014-August 2016). OUTCOME MEASURES A survey was administered to gather data on care coordination in community pharmacies and for follow-up. In-depth interviews were conducted to expand on the findings from the quantitative data. Descriptive statistics were calculated for survey data. Interviews were recorded, transcribed verbatim, and analyzed using thematic analysis. RESULTS Surveys were received from 101 pharmacies (82.1% response rate). Fourteen pharmacies with missing responses were removed, resulting in 87 pharmacies being included in the analysis. The majority of pharmacies were single, independent pharmacies (46.5%), and approximately one-third of pharmacies had a clinical pharmacist on the staff (31.1%). To communicate with prescribers, pharmacists most frequently used facsimile (fax) (82.1%) or phone (65.5%). A total of 12 pharmacists participated in the semistructured interviews. Pharmacists defined care coordination as interdisciplinary collaboration and communication among the members of the health care team to provide the best possible patient-centered care. All pharmacists agreed that good health care provider (i.e., care manager and prescriber) relationships are crucial to the success of patient care; however, participants mentioned that building these relationships has been or is currently difficult to establish. CONCLUSION Care coordination among pharmacists, prescribers, and care managers is important for improving patients' medication management and overall outcomes. To our knowledge, this is the first study to quantify care coordination between pharmacists, prescribers, and care managers and to identify strategies to facilitate care coordination. Results from this study have the potential to inform how care coordination and longitudinal follow-up are best implemented within the community pharmacy setting.
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20
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Krasniak A, Szymaniak G, Conn KM, Phillips E. Evaluation of clinical pharmacy priority scoring methods in an adult medicine residency clinic. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2019. [DOI: 10.1002/jac5.1110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Anne Krasniak
- Department of Pharmacy, Upstate University Hospital Syracuse New York
- Department of Pharmacy Practice and Administration St. John Fisher College Wegmans School of Pharmacy Rochester New York
| | - Gregory Szymaniak
- Department of Pharmacy, Upstate University Hospital Syracuse New York
| | - Kelly M. Conn
- Department of Pharmacy Practice and Administration St. John Fisher College Wegmans School of Pharmacy Rochester New York
| | - Elizabeth Phillips
- Department of Pharmacy, Upstate University Hospital Syracuse New York
- Department of Pharmacy Practice and Administration St. John Fisher College Wegmans School of Pharmacy Rochester New York
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21
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Shrestha S, Danekhu K, Thapa S, Khanal S, Shankar PR. The Unmet Need for Pharmacists as Important Members of the Emergency Department Team in Resource-Limited Settings: A Case of Nepal. J Pharm Technol 2019; 35:219-224. [PMID: 34752529 DOI: 10.1177/8755122519850118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: The role of pharmacists in many developed countries has evolved from the traditional practice of dispensing medicines to contributing directly or indirectly to improve patient health outcomes. They are providing hospital services and patient care including services in the emergency department (ED). However, there is limited evidence for pharmacist involvement in the ED from resource-limited countries such as Nepal. Objective: The aim of this study is to discuss the role of pharmacists and highlight the unmet need of pharmacists in ED in Nepal. Methods: A narrative review of existing literature was conducted. Results: The status of ED services in Nepalese hospitals is not yet at a desirable level, and there is limited information about the role of pharmacists in EDs. Evidence obtained from developed nations on the role of pharmacists in EDs suggests that they help in improving patient outcomes by minimizing medication errors, adverse drug reactions, and enhance patient care. Conclusion: The study highlights the need for pharmacists in EDs in resource-limited settings. There is limited evidence of pharmacists' role in EDs from Nepal. Therefore, this study suggests a need for further studies on the possible contribution of pharmacists to ED services in Nepal.
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Affiliation(s)
- Sunil Shrestha
- Nepal Cancer Hospital and Research Center Pvt Ltd, Harisiddhi, Lalitpur, Nepal.,Nepal Health Research and Innovation Foundation, Lalitpur Nepal
| | - Krisha Danekhu
- Nepal Health Research and Innovation Foundation, Lalitpur Nepal.,Universal College of Medical Sciences, Bhairahawa, Nepal
| | - Santosh Thapa
- Ashwins Medical College and Hospitals Pvt Ltd, Bhaisepati, Lalitpur, Nepal
| | - Saval Khanal
- Nepal Health Research and Innovation Foundation, Lalitpur Nepal
| | - P Ravi Shankar
- American International Medical University, Gros Islet, Saint Lucia
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22
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Abstract
BACKGROUND Medication adherence is associated with lower health care utilization and savings in specific patient populations; however, few empirical estimates exist at the population level. OBJECTIVE The main objective of this study was to apply a data-driven approach to obtain population-level estimates of the impact of medication nonadherence among Medicare beneficiaries with chronic conditions. RESEARCH DESIGN Medicare fee-for-service (FFS) claims data were used to calculate the prevalence of medication nonadherence among individuals with diabetes, heart failure, hypertension, and hyperlipidemia. Per person estimates of avoidable health care utilization and spending associated with medication adherence, adjusted for healthy adherer effects, from prior literature were applied to the number of nonadherent Medicare beneficiaries. SUBJECTS A 20% random sample of community-dwelling, continuously enrolled Medicare FFS beneficiaries aged 65 years or older with Part D (N=14,657,735) in 2013. MEASURES Avoidable health care costs and hospital use from medication nonadherence. RESULTS Medication nonadherence for diabetes, heart failure, hyperlipidemia, and hypertension resulted in billions of Medicare FFS expenditures, millions in hospital days, and thousands of emergency department visits that could have been avoided. If the 25% of beneficiaries with hypertension who were nonadherent became adherent, Medicare could save $13.7 billion annually, with over 100,000 emergency department visits and 7 million inpatient hospital days that could be averted. CONCLUSION Medication nonadherence places a large resource burden on the Medicare FFS program. Study results provide actionable information for policymakers considering programs to manage chronic conditions. Caution should be used in summing estimates across disease groups, assuming all nonadherent beneficiaries could become adherent, and applying estimates beyond the Medicare FFS population.
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23
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Moore GD, Kosirog ER, Vande Griend JP, Freund JE, Saseen JJ. Expansion of clinical pharmacist positions through sustainable funding. Am J Health Syst Pharm 2019; 75:978-981. [PMID: 29941536 DOI: 10.2146/ajhp170285] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Expansion of clinical pharmacist positions through sustainable funding is described. SUMMARY The University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences was awarded a 2-year program grant to establish an integrated clinical pharmacy program for underserved residents in family health centers in northeastern Colorado. The grant enabled the hiring of 2 bilingual, full-time, board-certified, postgraduate year 2-trained clinical pharmacists to initiate comprehensive clinical pharmacy services. Clinical pharmacy services for diabetes, hypertension, and dyslipidemia management were provided during direct patient care visits using collaborative drug therapy management protocols to facilitate comprehensive medication management. Initial visits lasted 1 hour, and follow-up visits lasted 30 minutes. In addition, clinical pharmacists provided point-of-care consultations for patients seeing other healthcare providers. All patient encounters and consultations were documented in the electronic health record. Success of the clinical pharmacy program was evaluated based on the achievement of goal blood pressure values, glycosylated hemoglobin values, and low-density-lipoprotein cholesterol levels. Pharmacists' involvement in patient care activities led to improvements in all of these clinical outcomes. This coincided with unique funding opportunities with regional accountable care organizations that sought to demonstrate improved patient care in an expansion population. As a result, 2 grant-funded clinical pharmacist positions in 2 community health clinics were converted into 4 faculty positions in 5 community health centers funded by regional accountable care organizations. CONCLUSION Collaboration with accountable care organizations resulted in the successful funding of ambulatory care clinical pharmacy services. These services resulted in improved chronic disease control and provider satisfaction.
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Affiliation(s)
- Gina D Moore
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO
| | - Emily R Kosirog
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO
| | - Joseph P Vande Griend
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO.,Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | | | - Joseph J Saseen
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO.,Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
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24
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Bates KA, Stafford RA, Teeter BS, Diemer T, Thomas JL, Curran GM. Pharmacist-provided services and community pharmacist integration into a patient-centered medical home: A qualitative study of primary care clinic staff perceptions. J Am Pharm Assoc (2003) 2019; 59:S6-S11.e1. [PMID: 31101441 DOI: 10.1016/j.japh.2019.03.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 02/04/2019] [Accepted: 03/27/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To describe patient-centered medical home (PCMH) staff members' views toward community pharmacist involvement in patient care within the PCMH and to identify areas in which pharmacist-provided services can improve the quality of care in their clinics. DESIGN Qualitative semistructured interview study. SETTING One primary care clinic. PARTICIPANTS Multidisciplinary clinic staff members. OUTCOME MEASURES Views of staff toward implementing a community pharmacist into their clinic and top pharmacist services to help improve medication management within the clinic. RESULTS A total of 14 staff members of the clinic participated in the study. Participants included physicians, clinical staff members such as registered nurse assistants, licensed practical nurses, and medical assistants, and clinic management. Key themes included the following: the clinic was open to implementing pharmacy services; the providers would be very receptive to pharmacist recommendations; the clinic is willing to try different pharmacist integration models to see what works best within the workflow; the pharmacist must be readily available for consultation; the pharmacist should hold an introductory meeting with the clinic; opinions vary on the best timing of pharmacist appointments with patients; and ideas vary about the best location for pharmacist consultations. The top 5 pharmacist services mentioned by participants included chronic condition management, medication reconciliation training, Beers List education, diabetes education, and adherence counseling. CONCLUSION Primary care clinic staff support the integration of pharmacy services. Further research is needed to apply the results to other clinics and to identify barriers and opportunities in the implementation process.
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25
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Dombrowski SK, Bacci JL, Klatt PM, Osborne M, Castelli G, Burns A, Somma McGivney MA. Key factors for sustainable integration of pharmacists in team-based primary care physician practices. J Am Pharm Assoc (2003) 2019; 59:439-448.e1. [DOI: 10.1016/j.japh.2019.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 02/09/2019] [Accepted: 02/14/2019] [Indexed: 11/17/2022]
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26
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Improving care transitions through medication therapy management: A community partnership to reduce readmissions in multiple health-systems. J Am Pharm Assoc (2003) 2019; 59:319-328. [DOI: 10.1016/j.japh.2019.01.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 11/30/2018] [Accepted: 01/07/2019] [Indexed: 11/18/2022]
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Turner K, Weinberger M, Renfro C, Powell BJ, Ferreri S, Trodgon JG, Mark N, Trygstad T, Shea CM. Stages of Change: Moving Community Pharmacies From a Drug Dispensing to Population Health Management Model. Med Care Res Rev 2019; 78:57-67. [PMID: 30939978 DOI: 10.1177/1077558719841159] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Given their clinical training and accessibility, community pharmacists are well positioned to support primary care, especially in providing medication management services. There is limited evidence, however, on implementation of community pharmacist-led services in coordination with other health care providers. The aim of this study was to examine the implementation process of community pharmacies in North Carolina participating in a Medicaid population health management intervention. We conducted semistructured interviews with 40 representatives from high- and low-performing community pharmacies from June to August 2017. We analyzed for themes organized around Rogers's Stages in the Innovation Process in Organizations. Community pharmacies employed numerous implementation strategies such as developing relationships with providers and redefining job responsibilities to ensure pharmacists and pharmacy technicians are working at the top of their license. Findings also revealed differences in the implementation process among high- and low-performing pharmacies. Continued research is needed to determine which implementation strategies improve program performance.
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Affiliation(s)
- Kea Turner
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Chelsea Renfro
- University of Tennessee Health Science Center, Memphis, TN, USA
| | - Byron J Powell
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Stefanie Ferreri
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Justin G Trodgon
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Nicole Mark
- Community Care of North Carolina, Raleigh, NC, USA
| | - Troy Trygstad
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Community Care of North Carolina, Raleigh, NC, USA
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28
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Vande Griend JP, Saseen JJ, Sullivan KJ, Anderson HD. Identifying patients likely to be referred for a clinical pharmacist intervention in a family medicine residency‐training clinic. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2019. [DOI: 10.1002/jac5.1047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Joseph P. Vande Griend
- Department of Clinical Pharmacy University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences Aurora Colorado
| | - Joseph J. Saseen
- Department of Clinical Pharmacy University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences Aurora Colorado
| | - Katherine J. Sullivan
- Graduate Program in Pharmaceutical Sciences University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences Aurora Colorado
| | - Heather D. Anderson
- Department of Clinical Pharmacy University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences Aurora Colorado
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29
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Peterson J, Hinds A, Garza A, Barner J, Hill L, Nguyen M, Lai P, Gums T. Impact of Physician-Pharmacist Covisits at a Primary Care Clinic in Patients With Uncontrolled Diabetes. J Pharm Pract 2018; 33:321-325. [PMID: 30428760 DOI: 10.1177/0897190018807374] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE A popular method for enhancing medication management within a patient-centered medical home (PCMH) is the physician-pharmacist collaborative management (PPCM) model. To improve efficiency of health-care delivery within 4 federally qualified health centers (FQHCs), the PPCM model was implemented through coordinated physician-pharmacist covisits. OBJECTIVE To evaluate the impact of physician-pharmacist covisits on clinical outcomes among patients with uncontrolled diabetes. METHODOLOGY This was a retrospective multicenter cohort study including adults (≥18 years old) with uncontrolled type 1 or type 2 diabetes (hemoglobin A1c [HbA1c] ≥ 8 %) who had at least one covisit between January 1, 2013, and October 1, 2016. The primary clinical metric was mean change in HbA1c from baseline to follow-up. Secondary outcomes included adherence to select American Diabetes Association (ADA) Standards of Medical Care. RESULTS A total of 106 patients were included in this analysis. Patients who were managed in the PPCM model experienced a significant decrease in mean change in HbA1c from baseline to follow-up (-1.75 [2.63], P < .001). There was no significant difference in the proportion of patients receiving recommended vaccinations or cardiovascular (CV) risk reduction medications. CONCLUSION The results suggest that physician-pharmacist covisits may improve glucose control in patients with uncontrolled diabetes.
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Affiliation(s)
- Jasmine Peterson
- Department of Pharmacy, CommUnityCare Federally Qualified Health Centers-North Central, Austin, TX, USA
| | - April Hinds
- Department of Pharmacy, CommUnityCare Federally Qualified Health Centers-North Central, Austin, TX, USA.,Department of Pharmacy, The University of Texas at Austin, Austin, TX, USA
| | - Aida Garza
- Department of Pharmacy, CommUnityCare Federally Qualified Health Centers-North Central, Austin, TX, USA
| | - Jamie Barner
- Department of Pharmacy, The University of Texas at Austin, Austin, TX, USA
| | - Lucas Hill
- Department of Pharmacy, CommUnityCare Federally Qualified Health Centers-North Central, Austin, TX, USA.,Department of Pharmacy, The University of Texas at Austin, Austin, TX, USA
| | - Michelle Nguyen
- Department of Pharmacy, CommUnityCare Federally Qualified Health Centers-North Central, Austin, TX, USA
| | - Phillip Lai
- Department of Pharmacy, CommUnityCare Federally Qualified Health Centers-North Central, Austin, TX, USA
| | - Tyler Gums
- Department of Pharmacy, The University of Texas at Austin, Austin, TX, USA
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30
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Smith M. Primary Care Pharmacist Services Align With Payment Reform and Provider "Joy of Practice". Ann Pharmacother 2018; 53:311-315. [PMID: 30303028 DOI: 10.1177/1060028018807398] [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: 11/15/2022] Open
Abstract
The implementation and expansion of primary care (PC) pharmacist medication optimization and management services has been hindered mainly by the lack of a payment mechanism for PC providers to engage pharmacist services. If pharmacists expect to be included in new PC team-based payment models, we need to actively engage in ongoing PC practice transformation discussions with PC organizational leaders. In this commentary, examples of integrated PC pharmacist services and payment models are provided to (1) reinforce the feasibility of pharmacist integration into expanded PC teams and (2) share with PC leaders, payers, and policy makers.
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Affiliation(s)
- Marie Smith
- 1 University of Connecticut School of Pharmacy, Storrs, CT, USA
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Turner K, Weinberger M, Renfro C, Ferreri S, Trygstad T, Trogdon J, Shea CM. The role of network ties to support implementation of a community pharmacy enhanced services network. Res Social Adm Pharm 2018; 15:1118-1125. [PMID: 30291004 DOI: 10.1016/j.sapharm.2018.09.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 07/10/2018] [Accepted: 09/25/2018] [Indexed: 01/11/2023]
Abstract
BACKGROUND Limited evidence exists on how to integrate community pharmacists into team-based care models, as the inclusion of community pharmacy services into alternative payment models is relatively new. To be successful in team-based care models, community pharmacies need to successfully build relationship with diverse stakeholders including providers, care managers, and patients. OBJECTIVES The aims of this study are to: (1) identify the role of network ties to support implementation of a community pharmacy enhanced services network, (2) describe how these network ties are formed and maintained, and (3) compare the role of network ties among high- and low-performing community pharmacies participating in an enhanced services network. METHODS Using a semi-structured interview guide, we interviewed 40 community pharmacy representatives responsible for implementation of a community pharmacy enhanced services program. We analyzed for themes using social network theory to compare network ties among 24 high- and 16 low-performing community pharmacies. RESULTS The study found that high-performing pharmacies had a greater diversity of network ties (e.g., relationships with healthcare providers, care managers, and public health agencies). High-performing pharmacies were able to use those ties to support implementation of NC-CPESN. High- and low-performing pharmacies used similar strategies for establishing ties with patients, such as motivational interviewing and assigning staff members to be responsible for engaging high-risk patients. High-performing pharmacies used additional strategies such as assessing patient preferences to support patient engagement, increasing patient receptivity towards enhanced services. CONCLUSIONS Community pharmacies may vary in their ability to develop relationships with other healthcare providers, care management and public agencies, and patients. As enhanced services interventions that require care coordination are scaled up and spread, additional research is needed to test implementation strategies that support community pharmacies with developing and maintaining relationships across a diverse group of stakeholders (e.g., healthcare providers, care managers, public health agencies, patients).
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Affiliation(s)
- Kea Turner
- Department of Health Policy and Management, University of North Carolina Gillings School of Global Public Health, Chapel Hill, USA.
| | - Morris Weinberger
- Department of Health Policy and Management, University of North Carolina Gillings School of Global Public Health, Chapel Hill, USA
| | - Chelsea Renfro
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center, Memphis, USA
| | - Stefanie Ferreri
- Division of Practice Advancement and Clinical Education, University of North Carolina Eshelman School of Pharmacy, USA
| | - Troy Trygstad
- Division of Practice Advancement and Clinical Education, University of North Carolina Eshelman School of Pharmacy, USA; Community Pharmacy Enhanced Services Network, Community Care of North Carolina, USA
| | - Justin Trogdon
- Department of Health Policy and Management, University of North Carolina Gillings School of Global Public Health, Chapel Hill, USA
| | - Christopher M Shea
- Department of Health Policy and Management, University of North Carolina Gillings School of Global Public Health, Chapel Hill, USA
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Nuffer W, Trujillo T, Harmon C, Thompson M. Engaging with In-need Rural Patient Populations through Public Health Partnerships. Innov Pharm 2018; 9. [PMID: 31750008 DOI: 10.24926/iip.v9i2.1055] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
A public health partnership was established between a state Medicare Regional Care Collaborative Organization (RCCO), the state health department, a pharmacy school and three community pharmacies located in rural Colorado to optimize the utilization of a free public health service provided through each pharmacy. Fourth-year pharmacy students were allocated year-round by the University of Colorado to support disease management and medication therapy management (MTM) services offered to patients in three rural towns served by the RCCO. Faculty from the school of pharmacy reviewed data provided by the RCCO to identify patients who could benefit from MTM or disease state management (DSM) services. These patients were contacted and encouraged to take advantage of these free pharmacy-based services. Additionally, a number of targeted interventions were performed within these populations to optimize their health. Concerted efforts were made to improve information flow and communication between these pharmacy sites and partnering medical offices. Additionally, pharmacy students were successfully integrated in to medical offices to work alongside medical providers in these communities. This manuscript describes the implementation and coordination of this project as well as the impact these pharmacies had on the communities they served.
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Affiliation(s)
- Wes Nuffer
- University of Colorado Skaggs School of Pharmacy & Pharmaceutical Sciences
| | - Tara Trujillo
- Colorado Department of Public Health and Environment
| | - Christy Harmon
- University of Colorado Skaggs School of Pharmacy & Pharmaceutical Sciences
| | - Megan Thompson
- University of Colorado Skaggs School of Pharmacy & Pharmaceutical Sciences
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Bingham J, Scovis N, Taylor AM, Leal S. Past, present, and continued need for provider status legislation: Navigating clinical practice with significant sustainability barriers. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2018. [DOI: 10.1002/jac5.1026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
| | - Nicole Scovis
- University of Arizona College of Pharmacy; Tucson Arizona
| | - Ann M. Taylor
- University of Arizona College of Pharmacy; Tucson Arizona
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Giannitrapani KF, Glassman PA, Vang D, McKelvey JC, Thomas Day R, Dobscha SK, Lorenz KA. Expanding the role of clinical pharmacists on interdisciplinary primary care teams for chronic pain and opioid management. BMC FAMILY PRACTICE 2018; 19:107. [PMID: 29970008 PMCID: PMC6031118 DOI: 10.1186/s12875-018-0783-9] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 05/31/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND Facilitating appropriate and safe prescribing of opioid medications for chronic pain management in primary care is a pressing public health concern. Interdisciplinary team-based models of primary care are exploring the expansion of clinical pharmacist roles to support disease management for chronic conditions, e.g. pain. Our study aims to 1) identify roles clinical pharmacists can assume in primary care team based chronic pain care processes and 2) understand the barriers to assuming these expanded roles. METHODS Setting: Veterans Health Administration (VA) has implemented an interdisciplinary team-based model for primary care which includes clinical pharmacists. DESIGN We employed an inductive two part qualitative approach including focus groups and semi-structured interviews with key informants. PARTICIPANTS 60 members of VA primary care teams in two states participated in nine preliminary interdisciplinary focus groups where a semi-structured interview guide elucidated provider experiences with screening for and managing chronic pain. To follow up on emergent themes relating to clinical pharmacist roles, an additional 14 primary care providers and clinical pharmacists were interviewed individually. We evaluated focus group and interview transcripts using the method of constant comparison and produced mutually agreed upon themes. RESULTS Clinical pharmacists were identified by primary care providers as playing a central role with the ongoing management of opioid therapy including review of the state prescription drug monitoring program, managing laboratory screening, providing medication education, promoting naloxone use, and opioid tapering. Specific barriers to clinical pharmacists role expansion around pain care include: limitations of scopes of practice, insufficient institutional support (low staffing, dedicated time, insufficient training, lack of interdisciplinary leadership support), and challenges and opportunities for disseminating clinical pharmacists' expanded roles. CONCLUSIONS Expanding the role of the clinical pharmacist to collaborate with providers around primary care based chronic pain management is a promising strategy for improving pain management on an interdisciplinary primary care team. However, expanded roles have to be balanced with competing responsibilities relating to other conditions. Interdisciplinary leadership is needed to facilitate training, resources, adequate staffing, as well as to prepare both clinical pharmacists and the providers they support, about expanded clinical pharmacists' scopes of practice and capabilities.
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Affiliation(s)
- Karleen F Giannitrapani
- VA Palo Alto Health Care System, Center for Innovation to Implementation (Ci2i), Menlo Park, CA, 94025, USA.
| | - Peter A Glassman
- VA Greater Los Angeles Health Care System, Center for the Study of Healthcare Innovation, Implementation, and Policy (CSHIIP), Los Angeles, CA, 90073, USA.,David Geffen School of Medicine, University of California, Los Angeles, 10945 Le Conte Ave, Los Angeles, CA, 90024, USA
| | - Derek Vang
- VA Minneapolis Center for Chronic Disease Outcomes Research (CCDOR), 5445 Minnehaha Avenue South, Minneapolis, MN, 55417, USA
| | - Jeremiah C McKelvey
- VA Northern California Health Care System, 10535 Hospital Way, Mather, CA, 95655, USA
| | - R Thomas Day
- VA Palo Alto Health Care System, Center for Innovation to Implementation (Ci2i), Menlo Park, CA, 94025, USA
| | - Steven K Dobscha
- VA Portland Health Care System, Center to Improve Veteran Involvement in Care (CIVIC), 3710 SW US Veterans Hospital Rd, Portland, OR, 97239, USA.,Department of Psychiatry, Oregon Health and Science University, 3181 SW Sam Jackson Park RD, Portland, OR, 97239, USA
| | - Karl A Lorenz
- VA Palo Alto Health Care System, Center for Innovation to Implementation (Ci2i), Menlo Park, CA, 94025, USA.,Stanford Medical School, Palo Alto, CA, 94305, USA.,RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
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Pednekar P, Peterson A. Mapping pharmacy deserts and determining accessibility to community pharmacy services for elderly enrolled in a State Pharmaceutical Assistance Program. PLoS One 2018; 13:e0198173. [PMID: 29864159 PMCID: PMC5986116 DOI: 10.1371/journal.pone.0198173] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 05/15/2018] [Indexed: 11/20/2022] Open
Abstract
Objectives Limited studies have investigated geographic accessibility to a nearby community pharmacy for elderly which is an essential determinant of the access to medications and pharmacy services. This research identified pharmacy deserts and investigated availability of different types of community pharmacies and their services for elderly enrolled in a State Pharmaceutical Assistance Program (SPAP). Methods The state of Pennsylvania in the US was used as a case to demonstrate the geographic accessibility to community pharmacy and services for elderly enrolled in SPAP. The locations of community pharmacies and households of elderly enrolled in SPAP were derived from Pharmaceutical Assistance Contract for the Elderly programs’ database. The street addresses were geocoded and the distance to a nearby community pharmacy was calculated for study sample using the haversine formula. The demographic and geographic data were aggregated to Census Tracts and pharmacy deserts were identified using the predefined criteria. Descriptive statistical analysis was used to determine whether there are statistical differences in the socio-demographic profiles and distribution of different types of community pharmacies and their services in pharmacy deserts and non-deserts. This research used hot spot analyses at county level to identify clusters of pharmacy deserts, areas with high concentration of different racial/ethnic groups and clusters of high densities of chain and independent pharmacies. Results The Spatial analysis revealed that 39% and 61% Census Tracts in Pennsylvania were pharmacy deserts and non-deserts respectively (p < 0.001). Pharmacy deserts were found to have significantly more females, married and white elderly and fewer blacks and Hispanics compared to pharmacy non-deserts. Pharmacy deserts had significantly fewer chain and independent pharmacies and less delivery and 24-hour services in pharmacies than pharmacy non-deserts. Hot spot analyses showed that clusters of pharmacy deserts were more concentrated in southcentral, northwest and northeast regions of the state which represent rural areas and overlapped with clusters of high concentration of white individuals. Conclusions The findings suggest that urban-rural inequality, racial/ethnic disparity and differences in availability of pharmacies and their services exist between pharmacy deserts and non-deserts. The methodological approach and analyses used in this study can also be applied to other public health programs to evaluate the coverage and breadth of public health services.
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Affiliation(s)
- Priti Pednekar
- Department of Health Policy, University of the Sciences, Philadelphia, Pennsylvania, United States of America
- * E-mail:
| | - Andrew Peterson
- Department of Health Policy, University of the Sciences, Philadelphia, Pennsylvania, United States of America
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Shrestha S, Poudel RS, Thapa P, Baniya S, KC B. Perception of patients towards the role of pharmacist: a cross-sectional study from selected three hospitals in Central Nepal. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2018. [DOI: 10.1111/jphs.12217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Shakti Shrestha
- Department of Pharmacy; Shree Medical and Technical College; Chitwan Nepal
| | | | - Priyanka Thapa
- Department of Pharmacy; Shree Medical and Technical College; Chitwan Nepal
| | - Susmita Baniya
- Department of Pharmacy; Shree Medical and Technical College; Chitwan Nepal
| | - Bhuvan KC
- School of Pharmacy; Monash University Malaysia; Subang Jaya Malaysia
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Turner K, Renfro C, Ferreri S, Roberts K, Pfeiffenberger T, Shea CM. Supporting Community Pharmacies with Implementation of a Web-Based Medication Management Application. Appl Clin Inform 2018; 9:391-402. [PMID: 29847843 DOI: 10.1055/s-0038-1651488] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2022] Open
Abstract
OBJECTIVE Community pharmacists' role in clinical care is expanding in the United States and information systems are needed that extend beyond a dispensing workflow. As pharmacies adopt new systems, implementation support will be needed. This study identifies the barriers and facilitators experienced by community pharmacies in implementing a Web-based medication management application and describes the implementation strategies used to support these pharmacies. METHODS Semistructured interviews were conducted with 28 program and research staff that provides support to community pharmacies participating in a statewide pharmacy network. Interviews were recorded, transcribed verbatim, and analyzed for themes using the Expert Recommendations for Implementing Change (ERIC). RESULTS Findings suggest that leadership support, clinical training, and computer literacy facilitated implementation, while lack of system integration, staff resistance to change, and provider reluctance to share data served as barriers. To overcome the barriers, implementation support was provided, such as assessing readiness for implementation, developing a standardized and interoperable care plan, and audit and feedback of documentation quality. CONCLUSION Participants used a wide array of strategies to support community pharmacies with implementation and tailored approaches to accommodate pharmacy-specific preferences. Most of the support was delivered preimplementation or in the early phase of implementation and by program or research staff rather than peer-to-peer. Implementing new pharmacy information system requires a significant amount of implementation support to help end-users learn about program features, how to integrate the software into workflow, and how to optimize the software to improve patient care. Future research should identify which implementation strategies are associated with program performance.
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Affiliation(s)
- Kea Turner
- Department of Health Policy and Management, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, United States
| | - Chelsea Renfro
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center, Memphis, Tennessee, United States
| | - Stefanie Ferreri
- Division of Practice Advancement and Clinical Education, University of North Carolina Eshelman School of Pharmacy, Chapel Hill, North Carolina, United States
| | - Kim Roberts
- Community Pharmacy Enhanced Services Network, Community Care of North Carolina, Raleigh, North Carolina, United States
| | - Trista Pfeiffenberger
- Community Pharmacy Enhanced Services Network, Community Care of North Carolina, Raleigh, North Carolina, United States
| | - Christopher M Shea
- Department of Health Policy and Management, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, United States
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Armistead LT, Ferreri SP. Improving Value Through Community Pharmacy Partnerships. Popul Health Manag 2018; 22:5-8. [PMID: 29757078 DOI: 10.1089/pop.2018.0040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Lori T Armistead
- 1 Center for Medication Optimization through Practice and Policy , UNC Eshelman School of Pharmacy, Chapel Hill, North Carolina
| | - Stefanie P Ferreri
- 2 Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy , Chapel Hill, North Carolina
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Alhaddad MS. Youth Experience With Community Pharmacy Services and Their Perceptions Toward Implementation of Medication Therapy Management Services by Community Pharmacists in the Western Region of Saudi Arabia. Ther Innov Regul Sci 2018; 53:95-99. [PMID: 29714597 DOI: 10.1177/2168479018769299] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Pharmacists are the part of the health care team who can counsel patients on the most appropriate use of medications. This study aims to measure patients' experience with services provided by community pharmacists and their perceptions toward providing medication therapy management (MTM) services by community pharmacists in the Western Region of Saudi Arabia. In addition, this study aims to measure patients' willingness to pay (WTP) for participating in the MTM program led by community pharmacists. METHODS Using a cross-sectional research design, a prevalidated questionnaire was developed and posted to respondents through either face-to-face interviews or online social media. All data were analyzed using SPSS, version 22.0, and all alpha values less than 0.05 were considered significant. RESULTS A total of 953 responses were obtained in this study. Overall, 47.6% of the respondents always buy their medications from different community pharmacies, and 46.1% of respondents said that community pharmacists always respond to all of their questions. In addition, 96% of respondents perceived the MTM program to be beneficial for patient care. Moreover, 70.3% of respondents were willing to register in the MTM program if implemented at community pharmacies. CONCLUSION Residents in the Western Region of Saudi Arabia highly appreciate the additional values of the MTM program if implemented by community pharmacists. Decisions makers should encourage community pharmacists to plan for MTM services.
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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.
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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
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Watanabe JH, McInnis T, Hirsch JD. Cost of Prescription Drug-Related Morbidity and Mortality. Ann Pharmacother 2018; 52:829-837. [PMID: 29577766 DOI: 10.1177/1060028018765159] [Citation(s) in RCA: 191] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Public attention and recent US Congressional activity has intensified focus on escalating medication prices. However, the actual cost of medication use extends beyond the up-front cost of purchasing medicines. It also encompasses the additional medical costs of morbidity and mortality resulting from nonoptimized medication regimens, including medication nonadherence. OBJECTIVES Applying the most current nationally representative data sources, our goal was to estimate the cost of prescription drug-related morbidity and mortality in the United States. METHODS Total costs of nonoptimized prescription drug use and average pathway costs for a patient who experienced a treatment failure (TF), a new medical problem (NMP), or a TF and NMP were modeled in Microsoft Excel (Microsoft Corporation, Redmond, WA) and TreeAge Pro Healthcare, v2014 (TreeAge Software, Inc, Williamstown, MA), respectively. RESULTS The estimated annual cost of prescription drug-related morbidity and mortality resulting from nonoptimized medication therapy was $528.4 billion in 2016 US dollars, with a plausible range of $495.3 billion to $672.7 billion. The average cost of an individual experiencing TF, NMP, or TF and NMP after initial prescription use were $2481 (range: $2233, $2742), $2610 (range: $2374, $2848) and $2572 (range: $2408, $2751), respectively. CONCLUSIONS The estimated annual cost of drug-related morbidity and mortality resulting from nonoptimized medication therapy was $528.4 billion, equivalent to 16% of total US health care expenditures in 2016. We propose expansion of comprehensive medication management programs by clinical pharmacists in collaborative practices with physicians and other prescribers as an effective and scalable approach to mitigate these avoidable costs and improve patient outcomes.
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Affiliation(s)
| | - Terry McInnis
- 2 Value Based Care, Laboratory Corporation of America, Burlington, NC, USA
| | - Jan D Hirsch
- 1 University of California San Diego, La Jolla, CA, USA
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Lozano P, Houtrow A. Supporting Self-Management in Children and Adolescents With Complex Chronic Conditions. Pediatrics 2018; 141:S233-S241. [PMID: 29496974 DOI: 10.1542/peds.2017-1284h] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/01/2017] [Indexed: 11/24/2022] Open
Abstract
Self-management improves health outcomes in chronic illness not only by improving adherence to the treatment plan but also by building the individual's capacity to navigate challenges and solve problems. Support for self-management is a critical need among children and adolescents with (medically and/or socially) complex chronic conditions. Self-management support refers to services that health systems and community agencies provide to persons with chronic illness and their families to facilitate self-management; it is a collaboration between the patient, family, and care providers. Evidence has guided the development of self-management support approaches and tools for adults and has led to an increased adoption of best practices in adult chronic illness care. However, adult models fail to account for some key differences between children and adults, namely, the integral role of parents and/or caregivers and youth development over time. There is a need for self-management support models that take into account the developmental trajectory across the pediatric age range. Effective approaches must also recognize that in pediatrics, self-management is really shared management between the youth and the parent(s) and/or caregiver(s). Health systems should design care to address self-management for pediatric patients. Although clinicians recognize the importance of self-management in youth with complex chronic conditions, they need standardized approaches and tools to do the following: assess the self-management skills of youth and families, assess modifiable environmental influences on chronic conditions, collaboratively set self-management goals, promote competence and eventual autonomy in youth, share the responsibility for self-management support among nonphysician members of the health care team, and leverage community resources for self-management support.
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Affiliation(s)
- Paula Lozano
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington; and
| | - Amy Houtrow
- Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Kennelty KA, Polgreen LA, Carter BL. Team-Based Care with Pharmacists to Improve Blood Pressure: a Review of Recent Literature. Curr Hypertens Rep 2018; 20:1. [PMID: 29349522 DOI: 10.1007/s11906-018-0803-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE OF REVIEW We review studies published since 2014 that examined team-based care strategies and involved pharmacists to improve blood pressure (BP). We then discuss opportunities and challenges to sustainment of team-based care models in primary care clinics. RECENT FINDINGS Multiple studies presented in this review have demonstrated that team-based care including pharmacists can improve BP management. Studies highlighted the cost-effectiveness of a team-based pharmacy intervention for BP control in primary care clinics. Little information was found on factors influencing sustainability of team-based care interventions to improve BP control. Future work is needed to determine the best populations to target with team-based BP programs and how to implement team-based approaches utilizing pharmacists in diverse clinical settings. Future studies need to not only identify unmet clinical needs but also address reimbursement issues and stakeholder engagement that may impact sustainment of team-based care interventions.
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Affiliation(s)
- Korey A Kennelty
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, 115 S. Grand Ave, Iowa City, IA, 52242, USA.
- Department of Family Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USA.
| | - Linnea A Polgreen
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, 115 S. Grand Ave, Iowa City, IA, 52242, USA
| | - Barry L Carter
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, 115 S. Grand Ave, Iowa City, IA, 52242, USA
- Department of Family Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
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Bucheit JD, Helsing H, Nadpara P, Virani SS, Dixon DL. Clinical pharmacist understanding of the 2013 American College of Cardiology/American Heart Association cholesterol guideline. J Clin Lipidol 2017; 12:367-374.e3. [PMID: 29277495 DOI: 10.1016/j.jacl.2017.11.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 11/28/2017] [Accepted: 11/29/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Clinical pharmacists are frequently involved in the management of dyslipidemia, yet clinical pharmacists' knowledge, awareness, and the level of agreement with the 2013 American College of Cardiology (ACC)/American Heart Association (AHA) cholesterol guideline are unknown. OBJECTIVE The objective of the study was to examine clinical pharmacists' knowledge, awareness, and the level of agreement with the 2013 ACC/AHA cholesterol guideline. METHODS We administered a validated questionnaire via an online survey that was electronically mailed to clinical pharmacists. We compared responses between those in practice for ≤ 10 and those in practice for > 10 years, and according to practice specialty. RESULTS The response rate was 11% (314 of 2845). Most respondents were from the Midwestern and Southeastern US, in practice for ≤ 10 years, and practiced in family practice/primary care. Nearly all (92%) respondents had read the guideline and 72% were able to identify the 4 statin benefit groups. Notable knowledge gaps included recalling the 4 outcomes of the 10-year atherosclerotic cardiovascular disease (ASCVD) risk estimator (41.4%), understanding differences between the Framingham Risk Score and the ASCVD risk estimator (33.7%), and monitoring lipids after initiating a statin (41.1%). More knowledge gaps were identified in those practicing for > 10 years and who specialized in internal medicine. The use of the ASCVD risk estimator was high; yet nearly half (44.2%) were concerned whether the ASCVD risk estimator would overestimate 10-year ASCVD risk. CONCLUSION Although most clinical pharmacists had read the 2013 ACC/AHA cholesterol guideline, several knowledge gaps were identified, especially among those with more experience and those practicing in internal medicine. Targeted education efforts are needed to address these gaps.
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Affiliation(s)
- John D Bucheit
- Center for Pharmacy Practice Innovation, Virginia Commonwealth University School of Pharmacy, Richmond, VA, USA; Department of Pharmacotherapy & Outcomes Science, Virginia Commonwealth University School of Pharmacy, Richmond, VA, USA
| | - Haleigh Helsing
- Department of Pharmacotherapy & Outcomes Science, Virginia Commonwealth University School of Pharmacy, Richmond, VA, USA
| | - Pramit Nadpara
- Department of Pharmacotherapy & Outcomes Science, Virginia Commonwealth University School of Pharmacy, Richmond, VA, USA
| | - Salim S Virani
- Health Policy, Quality & Informatics Program, Michael E. DeBakey Veterans Affairs Medical Center Health Services Research and Development Center for Innovations, Houston, TX, USA; Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Dave L Dixon
- Center for Pharmacy Practice Innovation, Virginia Commonwealth University School of Pharmacy, Richmond, VA, USA; Department of Pharmacotherapy & Outcomes Science, Virginia Commonwealth University School of Pharmacy, Richmond, VA, USA.
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45
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Sharp LK, Tilton JJ, Touchette DR, Xia Y, Mihailescu D, Berbaum ML, Gerber BS. Community Health Workers Supporting Clinical Pharmacists in Diabetes Management: A Randomized Controlled Trial. Pharmacotherapy 2017; 38:58-68. [PMID: 29121408 DOI: 10.1002/phar.2058] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To evaluate the effectiveness of clinical pharmacists and community health workers (CHWs) in improving glycemic control within a low-income ethnic minority population. METHODS In a two-arm 2-year crossover trial, 179 African-American and 65 Hispanic adult patients with uncontrolled diabetes mellitus (hemoglobin A1c [HbA1C] of 8% or higher) were randomized to CHW support either during the first or second year of the study. All participants received clinical pharmacist support for both years of the study. The primary outcome was change in HbA1C over 1 and 2 years. RESULTS Similar HbA1C declines were noted after receiving the 1 year of CHW support: -0.45% (95% confidence interval [CI] -0.96 to 0.05) with CHW versus -0.42% (95% CI -0.93 to 0.08) without CHW support. In addition, no differences were noted in change on secondary outcome measures including body mass index, systolic blood pressure, high-density lipoprotein and low-density lipoprotein cholesterol, quality of life, and perceived social support. A difference in diastolic blood pressure change was noted: 0.80 mm Hg (95% CI -1.92 to 3.53) with CHW versus -1.85 mm Hg (95% CI -4.74 to 1.03) without CHW support (p=0.0078). Patients receiving CHW support had more lipid-lowering medication intensifications (0.39 [95% CI 0.27-0.52]) compared with those without CHW support (0.26 [95% CI 0.14-0.38], p<0.0001). However, no significant differences in intensification of antihyperglycemic and antihypertensive medications were observed between patients receiving CHW support and those without CHW support. Patients with low health literacy completed significantly more encounters with the pharmacist and CHW than those with high health literacy, although outcomes were comparable. CONCLUSIONS No significant differences were noted between a clinical pharmacist-CHW team and clinical pharmacist alone in improving glycemic control within a low-income ethnic minority population.
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Affiliation(s)
- Lisa K Sharp
- Pharmacy Systems, Outcomes, and Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois.,Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois
| | - Jessica J Tilton
- Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois
| | - Daniel R Touchette
- Pharmacy Systems, Outcomes, and Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois
| | - Yinglin Xia
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois.,Division of Academic Internal Medicine and Geriatrics, College of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Daniel Mihailescu
- Division of Endocrinology and Metabolism, College of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Michael L Berbaum
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois
| | - Ben S Gerber
- Pharmacy Systems, Outcomes, and Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois.,Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois.,Division of Academic Internal Medicine and Geriatrics, College of Medicine, University of Illinois at Chicago, Chicago, Illinois
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46
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Moreno G, Lonowski S, Fu J, Chon JS, Whitmire N, Vasquez C, Skootsky SA, Bell DS, Maranon R, Mangione CM. Physician experiences with clinical pharmacists in primary care teams. J Am Pharm Assoc (2003) 2017; 57:686-691. [DOI: 10.1016/j.japh.2017.06.018] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 06/21/2017] [Accepted: 06/22/2017] [Indexed: 11/27/2022]
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47
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Coe AB, Choe HM. Pharmacists supporting population health in patient-centered medical homes. Am J Health Syst Pharm 2017; 74:1461-1466. [DOI: 10.2146/ajhp161052] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Antoinette B. Coe
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, MI
| | - Hae Mi Choe
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, MI, and University of Michigan Medical Group, Ann Arbor, MI
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48
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Brunisholz KD, Olson J, Anderson JW, Hays E, Tilbury PM, Winter B, Rickard J, Hamilton S, Parkin G. "Pharming out" support: a promising approach to integrating clinical pharmacists into established primary care medical home practices. J Int Med Res 2017; 46:234-248. [PMID: 28789606 PMCID: PMC6011325 DOI: 10.1177/0300060517710885] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective Embedding clinical pharmacists into ambulatory care settings needs to be assessed in the context of established medical home models. Methods A retrospective, observational study examined the effectiveness of the Intermountain Healthcare Collaborative Pharmacist Support Services (CPSS) program from 2012–2015 among adult patients diagnosed with diabetes mellitus (DM) and/or high blood pressure (HBP). Patients who attended this program were considered the intervention (CPSS) cohort. These patients were matched using propensity scores with a reference group (no-CPSS cohort) to determine the effect of achieving disease management goals and time to achievement. Results A total of 17,684 patients had an in-person office visit with their provider and 359 received CPSS (the matched no-CPSS cohort included 999 patients). CPSS patients were 93% more likely to achieve a blood pressure goal < 140/90 mmHg, 57% more likely to achieve HbA1c values < 8%, and 87% more likely to achieve both disease management goals compared with the reference group. Time to goal achievement demonstrated increasing separation between the study cohorts across the entire study period (P < .001), and specifically, at 180 days post-intervention (HBP: 48% vs 27% P < .001 and DM: 39% vs 30%, P < .05). Conclusions CPSS participation is associated with significant improvement in achievement of disease management goals, time to achievement, and increased ambulatory encounters compared with the matched no-CPSS cohort.
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Affiliation(s)
| | - Jeff Olson
- 1 Intermountain Healthcare, Salt Lake City, UT, USA
| | | | - Emily Hays
- 1 Intermountain Healthcare, Salt Lake City, UT, USA
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49
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Application of the Consolidated Framework for Implementation Research to community pharmacy: A framework for implementation research on pharmacy services. Res Social Adm Pharm 2017; 13:905-913. [PMID: 28666816 DOI: 10.1016/j.sapharm.2017.06.001] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 06/01/2017] [Accepted: 06/01/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND Community pharmacies are an increasingly important health care setting with opportunities for improving quality and safety, yet little is understood about determinants of implementation in this setting. OBJECTIVE This paper presents an implementation framework for pharmacy based on the Consolidated Framework for Implementation Research (CFIR). METHODS This study employed a critical review of 45 articles on professional services provided in community pharmacies, including medication therapy management (MTM), immunizations, and rapid HIV testing. RESULTS The relevant domains and associated constructs for pharmacy services were as follows. Intervention Characteristics ultimately depend on the specific service; of particular note for pharmacy are relative advantage and complexity. The former because implementation of services can pose a cost-benefit challenge where dispensing is the primary role and the latter because of the greater challenge implementing multi-faceted services like MTM compared to a discrete service like immunizations. "In terms of Outer Setting, pharmacies are affected by patient needs and acceptance, and external policies and incentives such as reimbursement and regulations. For Inner Setting, structural characteristics like pharmacy type, size and staff were important as was pharmacists' perception of their role and available resources to provide the service. Key Characteristics of Individuals include training, preparedness, and self-efficacy of the pharmacist for providing a new service. Few studies revealed relevant Process constructs, but if they did it was primarily related to engaging (e.g., champions). CONCLUSIONS As pharmacists' roles in health care are continuing to expand, a framework to inform implementation research in community pharmacy (and other) settings is crucially needed.
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50
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Harder VS, Long WE, Varni SE, Samuelson J, Shaw JS. Pediatric-Informed Facilitation of Patient-Centered Medical Home Transformation. Clin Pediatr (Phila) 2017; 56:564-570. [PMID: 27681310 DOI: 10.1177/0009922816669788] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Patient-centered medical home (PCMH) transformation has been challenging for pediatric practices, in part because of the National Committee for Quality Assurance (NCQA) PCMH focus on conditions and processes specific to adult patients. Realizing the potential challenges faced by pediatric practices, Vermont supported pediatric-informed facilitators to help practices during PCMH transformation. This study characterizes the impact of pediatric-informed facilitators; provides benchmark data on NCQA scores, number of facilitation meetings, and the time between facilitation start and end; and compares pediatric- and adult-serving practices. We found no difference between pediatric and matched adult-serving practices in NCQA score, number of facilitation meetings, or weeks to NCQA scoring. These results suggest that pediatric-informed facilitators can help pediatric practices achieve NCQA PCMH recognition on par with practices serving adult patients. Supporting primary care practices with specialty-informed facilitators can assist integration into health care reform efforts.
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Affiliation(s)
- Valerie S Harder
- 1 University of Vermont College of Medicine, Burlington, VT, USA
| | - Webb E Long
- 2 Pediatrician at Child Health Associates PC, Auburn, MA, USA
| | - Susan E Varni
- 1 University of Vermont College of Medicine, Burlington, VT, USA
| | | | - Judith S Shaw
- 1 University of Vermont College of Medicine, Burlington, VT, USA
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