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Chong MT, Chong DS. Web-Based Electronic Health Record Program: A Twelve-Month Evaluation on Pharmacist's Intervention in Medicare Part D Annual Comprehensive Medication Review. J Pharm Pract 2024; 37:132-139. [PMID: 36122167 DOI: 10.1177/08971900221129009] [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] [Indexed: 10/14/2022]
Abstract
Objective:The objective of this study was to evaluate the impact of pharmacist's intervention on annual comprehensive medication review (Annual CMR) for Medicare Part D beneficiaries. Background: To develop a new approach to assess Medicare Part D Annual CMR using a technological tool. Methods: One hundred sixty-three (163) eligible Medicare Part D beneficiaries were enrolled. By using an Electronic Health Record (EHR) Program, the pharmacist was able to assess laboratory, pharmacy, diagnosis, and patient information. A post-medication review summary was provided to the medical providers and patients which included a medication action plan. At the end of 3 months, 6 months and 12 months after the medication review, data were collected, assessed and compared. Results: The study showed that pharmacist's interventions were recommended to seventy-four (74) enrollees which comprised of 45% of the total enrollees. It showed that at 3-month, 6-month, and 12-month intervals after the medication review, the recommended interventions acknowledged and implemented by the medical providers were 20%, 51% and 64% respectively, which showed a significant difference over a 12-month period (P-value <.05). Different types of pharmacist's interventions that were recommended may include to initiate, to adjust and to discontinue medication. The most common disease states that required interventions were psychiatric disorder, cardiovascular disease, pulmonary disease, gastrointestinal disease, diabetes, dyslipidemia and pain. Conclusion: The finding of this study revealed that such a web-based EHR system was a very meaningful and effective tool in assisting pharmacists to assess the proper and safe use of medication in elderly patients.
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Affiliation(s)
- Mok Thoong Chong
- School of Pharmacy, American University of Health Sciences, Signal Hill, California, USA
- Liga Health, LLC, Henderson, NV, USA
| | - Desiree S Chong
- College of Pharmacy, Roseman University of Health Sciences, Henderson, NV, USA
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Schenkelberg CV, Al-Khatib A, Bakken BK, Arya V, Gaither CA, Kreling DH, Mott DA, Schommer JC, Witry MJ, Doucette WR. Identifying Services Provided in Community Pharmacy Practice Settings. Innov Pharm 2023; 14:10.24926/iip.v14i3.5543. [PMID: 38487385 PMCID: PMC10936450 DOI: 10.24926/iip.v14i3.5543] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2024] Open
Abstract
Background: To better address their patients' needs, community pharmacists are expanding from their traditional role of dispensing to managing medications and providing other care. Objective: This study characterized services reported by pharmacists practicing in community pharmacy settings in the 2019 National Pharmacist Workforce Study (NPWS). Methods: The 2019 NPWS was conducted via an online survey. E-mails containing survey links were sent to a systematic random sample of 96,110 U.S. pharmacists. The survey allowed tailoring of questions related to specific practice settings and for respondents in community pharmacies included reporting on delivery of twelve services. Other descriptive characteristic questions included community pharmacy type, staffing, monitoring activities, self-reported workload, and respondent demographics. An index was created by summing the number of yes responses for the service questions. This index served as the dependent variable in an ordinary least squares regression examining the association of work setting characteristics with the index. Results: Usable responses were received from 2,150 community pharmacists. The top four services were: administer vaccines (91.1%), patient medication assistance program (83.7%), naloxone dispensing (72.8%) and medication synchronization (67.2%). The regression model was significant, with supermarket pharmacies having a higher service index than large chains. Elevated service index scores were associated with more technicians on duty, CPESN participation, direct communication with primary care providers, practicing under a CPA and monitoring activities. Conclusions: Pharmacy operational characteristics were important influences on the delivery of services in community pharmacies. These findings can help inform the continuing transformation of community pharmacy practice.
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Salhia H, Mutlaq A, Alshaiban A, Alsaleh A, Alzahrani R, Alshennawi M. Patterns in counselling services provided at Saudi Ministry of Health medication counselling clinics - Reasons for referrals and subjects discussed: A cross-sectional study. Saudi Pharm J 2023; 31:1157-1166. [PMID: 37287507 PMCID: PMC10242628 DOI: 10.1016/j.jsps.2023.05.005] [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: 12/17/2022] [Accepted: 05/06/2023] [Indexed: 06/09/2023] Open
Abstract
Background Pharmacists provide medication counselling services to improve patient knowledge and their adherence to prescription instructions, and to achieve the best possible health-related outcomes. Our study aim was to describe the patterns of the reasons for referral to counselling and the subjects discussed between pharmacists and patients, and the possible associations related to the susceptible patient groups (chronic and elderly), in Saudi Ministry of Health (MOH) medication counselling clinics. Method This was a descriptive cross-sectional study. An electronic data collection form was developed to document details about the medication counselling services that were provided to patients. The form consisted of three main areas: (1) patient demographics and counselling services characteristics; (2) reasons for referrals to the medication counselling clinics; and (3) the subjects that were discussed between pharmacists and patients in the counselling session. A comparison was conducted between chronic and non-chronic, and elderly and non-elderly patients. Results From May 2020 to December 2021, a total of 36,672 counselling service sessions were provided to 28,998 patients. The greatest proportion of reasons for referrals to counselling was that patients had chronic diseases (50.84%), patients were added a new medication (33.69%) or patients received multiple medications (polypharmacy) (22.71%). The most frequent subject discussed during counselling was general knowledge about medication (85.62%), the duration of therapy (68.42%) and the action that patients should take if they missed a dose of their medication (44.51%). Patients with chronic diseases showed a significantly greater frequency of referral to counselling compared to patients without chronic disease, due to polypharmacy, medication use during Ramadhan, adverse drug reactions (ADRs), dosing/interactions, high-alert medication and suspected nonadherence (P < 0.001). This led to a significantly greater frequency of discussions with patients with chronic conditions about their general medication knowledge, the duration of their therapy, missed doses, ADRs, medication reconciliation and medication use during Ramadhan (P < 0.001). Elderly patients recorded significantly more referrals to counselling related to chronic diseases and polypharmacy than their younger counterparts (P < 0.001); however, there was no significant difference between the elderly and non-elderly in the patterns of subjects discussed that were related to polypharmacy and chronic disease consequences. A significant spike was also reported in the frequency of delivery of counselling services to caregivers for the elderly (P < 0.001). Conclusion The current state of medication counselling services in Saudi MOH facilities indicates that chronic disease and polypharmacy are the most significant reasons for referral to counselling, and that the subjects discussed the most during counselling are general knowledge about medication, duration of therapy and missed doses. Patients with chronic diseases have a higher frequency of referral to counselling and discussion about polypharmacy and its consequences than those without chronic conditions. Elderly patients also show a high frequency of referral to counselling about chronic diseases and polypharmacy. Caregivers of elderly patients require more education to maximise counselling effectiveness as they attend the majority of elderly patient counselling sessions.
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Affiliation(s)
- Huda Salhia
- General Administration of Pharmaceutical Care, Ministry of Health, Riyadh, Saudi Arabia
| | - Alaa Mutlaq
- General Administration of Pharmaceutical Care, Ministry of Health, Riyadh, Saudi Arabia
| | - Abdulrahman Alshaiban
- King Faisal Medical City for Southern Region, Ministry of Health, Abha, Saudi Arabia
| | - Ahmad Alsaleh
- General Administration of Pharmaceutical Care, Ministry of Health, Riyadh, Saudi Arabia
| | - Rasha Alzahrani
- Assistant Agency for Hospital Affairs, Ministry of Health, Riyadh, Saudi Arabia
| | - Mohammed Alshennawi
- General Administration of Pharmaceutical Care, Ministry of Health, Riyadh, Saudi Arabia
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Smith NI, Martinez AI, Huffmyer M, Eckmann L, George R, Abner EL, Jicha GA, Moga DC. Acceptability of patient-centered, multi-disciplinary medication therapy management recommendations: results from the INCREASE randomized study. BMC Geriatr 2023; 23:137. [PMID: 36894900 PMCID: PMC9999619 DOI: 10.1186/s12877-023-03876-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 03/06/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND Polypharmacy and inappropriate medications may be a modifiable risk factor for Alzheimer's Disease and Related Dementias (ADRD). Medication therapy management (MTM) interventions may mitigate medication-induced cognitive dysfunction and delay onset of symptomatic impairment. The objective of the current study is to describe an MTM protocol for a patient-centered team intervention (pharmacist and non-pharmacist clinician) in a randomized controlled trial (RCT) directed at delaying the symptomatic onset of ADRD. METHODS Community dwelling adults 65 + years, non-demented, using ≥ 1 potentially inappropriate medications (PIM) were enrolled in an RCT to evaluate the effect of an MTM intervention on improving medication appropriateness and cognition (NCT02849639). The MTM intervention involved a three-step process: (1) pharmacist identified potential medication-related problems (MRPs) and made initial recommendations for prescribed and over-the-counter medications, vitamins, and supplements; (2) study team reviewed all initial recommendations together with the participants, allowing for revisions prior to the finalized recommendations; (3) participant responses to final recommendations were recorded. Here, we describe initial recommendations, changes during team engagement, and participant responses to final recommendations. RESULTS Among the 90 participants, a mean 6.7 ± 3.6 MRPs per participant were reported. Of the 259 initial MTM recommendations made for the treatment group participants (N = 46), 40% percent underwent revisions in the second step. Participants reported willingness to adopt 46% of final recommendations and expressed need for additional primary care input in response to 38% of final recommendations. Willingness to adopt final recommendations was highest when therapeutic switches were offered and/or with anticholinergic medications. CONCLUSION The evaluation of modifications to MTM recommendations demonstrated that pharmacists' initial MTM recommendations often changed following the participation in the multidisciplinary decision-making process that incorporated patient preferences. The team was encouraged to see a correlation between engaging patients and a positive overall response towards participant acceptance of final MTM recommendations. TRIAL REGISTRATION Study registration number: clinicaltrial.gov NCT02849639 registered on 29/07/2016.
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Affiliation(s)
- Noah I. Smith
- University of Kentucky College of Pharmacy, Lexington, KY USA
| | - Ashley I. Martinez
- Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA USA
| | - Mark Huffmyer
- University of Kentucky College of Pharmacy, Lexington, KY USA
- University of Kentucky Healthcare, Lexington, KY USA
- LLC Consulting Services, Lexington, KY PRO2RX USA
| | | | - Rosmy George
- Sanders-Brown Center On Aging, University of Kentucky, Lexington, KY USA
| | - Erin L. Abner
- Sanders-Brown Center On Aging, University of Kentucky, Lexington, KY USA
- University of Kentucky College of Public Health, Lexington, KY USA
| | - Gregory A. Jicha
- Sanders-Brown Center On Aging, University of Kentucky, Lexington, KY USA
- University of Kentucky College of Medicine, 789 S Limestone, Lexington, KY 40536 USA
| | - Daniela C. Moga
- University of Kentucky College of Pharmacy, Lexington, KY USA
- Sanders-Brown Center On Aging, University of Kentucky, Lexington, KY USA
- University of Kentucky College of Public Health, Lexington, KY USA
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Carrier H, Zaytseva A, Bocquier A, Villani P, Fortin M, Verger P. General practitioners' attitude towards cooperation with other health professionals in managing patients with multimorbidity and polypharmacy: A cross-sectional study. Eur J Gen Pract 2022; 28:109-117. [PMID: 35593116 PMCID: PMC9132456 DOI: 10.1080/13814788.2022.2044781] [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] [Indexed: 11/25/2022] Open
Abstract
Background Cooperation between general practitioners (GPs) and other healthcare professionals appears to help reduce the risk of polypharmacy-related adverse events in patients with multimorbidity. Objectives To investigate GPs profiles according to their opinions and attitudes about interprofessional cooperation and to study the association between these profiles and GPs’ characteristics. Methods Between May and July 2016, we conducted a cross-sectional survey of a panel of French GPs about their management of patients with multimorbidity and polypharmacy, focussing on their opinions on the roles of healthcare professionals and interprofessional cooperation. We used agglomerative hierarchical cluster analysis to identify GPs profiles, then multivariable logistic regression models to study their associations with the characteristics of these doctors. Results 1183 GPs responded to the questionnaire. We identified four profiles of GPs according to their declared attitudes towards cooperation: GPs in the ‘very favourable’ profile (14%) were willing to cooperate with various health professionals, including the delegation of some prescribing tasks to pharmacists; GPs in the ‘moderately favourable’ profile (47%) had favourable views on the roles of health professionals, with the exception for this specific delegation of the task; GPs from the ‘selectively favourable’ profile (27%) tended to work only with doctors; GPs from the ‘non-cooperative’ profile (12%) did not seem to be interested in cooperation. Some profiles were associated with GPs’ ages or participation in continuing medical education. Conclusion Our study highlights disparities between GPs regarding cooperation with other professionals caring for their patients and suggests ways to improve cooperation.
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Affiliation(s)
- Hélène Carrier
- Department of General Practice, Aix Marseille University, Marseille, France.,ORS Paca, Regional Health Observatory, Provence- Alpes-Côte d'Azur, Marseille, France
| | - Anna Zaytseva
- ORS Paca, Regional Health Observatory, Provence- Alpes-Côte d'Azur, Marseille, France.,Aix Marseille University, CNRS (French National Centre for Scientific Research), EHESS (School of Advanced Studies in the Social Sciences), Centrale Marseille, AMSE (Aix-Marseille School of Economics), France
| | - Aurélie Bocquier
- ORS Paca, Regional Health Observatory, Provence- Alpes-Côte d'Azur, Marseille, France
| | - Patrick Villani
- Internal Medicine, Geriatrics and Therapeutic Unit, Assistance Publique des Hôpitaux de Marseille (AP-HM), Marseille, France.,Anthropology Bio-Cultural, Law and Ethics (ADES), French Blood Agency (EFS), National Center for Scientific Research (CNRS), Aix Marseille University, Marseille, France
| | - Martin Fortin
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Québec, Canada.,Centre Universitaire de Santé et de Services Sociaux du Saguenay-Lac St-Jean, Chicoutimi, Quebec, Canada
| | - Pierre Verger
- ORS Paca, Regional Health Observatory, Provence- Alpes-Côte d'Azur, Marseille, France
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Marupuru S, Roether A, Guimond AJ, Stanley C, Pesqueira T, Axon DR. A Systematic Review of Clinical Outcomes from Pharmacist Provided Medication Therapy Management (MTM) among Patients with Diabetes, Hypertension, or Dyslipidemia. Healthcare (Basel) 2022; 10:healthcare10071207. [PMID: 35885734 PMCID: PMC9318817 DOI: 10.3390/healthcare10071207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 06/21/2022] [Accepted: 06/24/2022] [Indexed: 11/16/2022] Open
Abstract
This study aimed to compare the clinical outcomes of pharmacist-provided medication therapy management (MTM) services as compared to no MTM services (i.e., standard of care) on outpatient clinical outcomes for patients with diabetes, hypertension, or dyslipidemia. A systematic literature review of PubMed, EMBASE, Cochrane library, International Pharmaceutical Abstracts, PsycINFO, Scopus, CINAHL electronic databases, grey literature, websites, and journals, was conducted from 1 January 2005–20 July 2021. The search field contained a combination of keywords and MeSH terms such as: “medication therapy management”, “pharmacist”, “treatment outcomes”. Studies published in United States, included adults ≥18 years old who received at least one pharmacist-provided MTM consultation and at least one group who received no MTM, and reported pre-specified clinical outcomes for diabetes mellitus, hypertension, or dyslipidemia were included. Of 849 studies identified, eight were included (cohort studies = 6, randomized controlled trials = 2). Clinical outcomes improved with MTM interventions, as evidenced by statistically significant changes in at least one of the three chronic conditions in most studies. Improvements were observed for diabetes outcomes (n = 4 studies), hypertension outcomes (n = 4 studies), and dyslipidemia outcomes (n = 3 studies). Overall, this study indicated that pharmacist delivered MTM services (versus no MTM services) can improve clinical outcomes for patients with diabetes, hypertension, and dyslipidemia.
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Pharmacist Intention to Provide Medication Therapy Management Services in Saudi Arabia: A Study Using the Theory of Planned Behaviour. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095279. [PMID: 35564673 PMCID: PMC9101803 DOI: 10.3390/ijerph19095279] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/11/2022] [Accepted: 04/19/2022] [Indexed: 12/10/2022]
Abstract
Medication therapy management (MTM) is provided by pharmacists and other healthcare providers, improves patient health status, and increases the collaboration of MTM providers with others. However, little is known about pharmacists’ intention to provide MTM services in Saudi Arabia. This study aimed to predict the pharmacists’ willingness in this nation to commit to providing MTM services there. This study used a cross-sectional questionnaire based on the theory of planned behaviour (TPB). The survey was distributed to 149 pharmacists working in hospital and community pharmacies. It included items measuring pharmacist attitudes, intentions, subjective norms, perceived behavioural control, knowledge about the provision of MTM services, and other sociodemographic and pharmacy practice-related items. The pharmacists had a positive attitude towards MTM services (mean = 6.15 ± 1.12) and strong intention (mean = 6.09 ± 1.15), highly perceived social pressure to provide those services (mean = 5.42 ± 1.03), strongly perceived control over providing those services (mean = 4.98 ± 1.05), and had good MTM knowledge (mean = 5.03 ± 1.00). Pharmacists who completed a pharmacy residency programme and had good knowledge of MTM services and a positive attitude towards them usually strongly intended to provide MTM services. Thus, encouraging pharmacists to complete pharmacy residency programmes and educating them about the importance and provision of MTM services will enhance their motivation to provide them.
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8
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Anderson EJ, Dhatt H, Vaffis S, Nelson ML, Warholak T, Campbell PJ, Black H, Kolobova I, Axon DR. Key informant perspectives about telephonic comprehensive medication review services in the United States. J Am Pharm Assoc (2003) 2022; 62:817-825.e1. [DOI: 10.1016/j.japh.2022.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 12/07/2021] [Accepted: 01/04/2022] [Indexed: 11/26/2022]
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Campbell PJ, Axon DR, Anderson EJ, Ekstrand MJ, Brummel A, Warholak T. Psychometric evaluation of a comprehensive medication management service experience instrument. J Am Pharm Assoc (2003) 2021; 62:218-223. [PMID: 34493457 DOI: 10.1016/j.japh.2021.08.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 08/09/2021] [Accepted: 08/19/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The Health-Systems Alliance for Integrated Medication Management (HAIMM) instrument was developed to estimate patient experience following pharmacist-delivered comprehensive medication management (CMM). OBJECTIVES The objective of this paper was to assess the psychometric properties and factor structure of the HAIMM instrument. METHODS Data were collected from 5 members of the HAIMM collaborative. A one-factor confirmatory factor analysis (CFA) model was used to assess instrument dimensionality. A partial-credit item response theory model was used to assess the psychometric properties of the ten-item HAIMM patient experience instrument, consisting of tests for rating scale functioning, person and item fit, and content validity. RESULTS Among 516 respondents, there was a strong skew toward high satisfaction, including a strong ceiling effect. CFA results suggest a unidimensional construct. Item difficulty was spread across a low range and content redundancies were identified. The mean-square values for both infit and outfit all fell within the recommended range, whereas the z-standard fit was within the recommended range for most items. The 5-point Likert scale used in the HAIMM instrument did not distinguish between participants' level of experience following the pharmacist-delivered CMM service. CONCLUSION The psychometric analysis showed the HAIMM survey tool does not cover all of the content that should be assessed to fully evaluate CMM experiences. In its current form, the HAIMM instrument should not be used to make comparisons about the quality of CMM services provided, although it may be useful to monitor patient satisfaction for quality improvement purposes. Further research is required to develop an improved instrument that contains expanded content coverage, response options, and aspects of CMM to be useful by health care providers, health systems, and other decision makers.
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Luli AJ, Awdishu L, Hirsch JD, Watanabe JH, Bounthavong M, Morello CM. Transferring Key Success Factors from Ambulatory Care into the Community Pharmacy in the United States. PHARMACY 2021; 9:116. [PMID: 34201476 PMCID: PMC8293369 DOI: 10.3390/pharmacy9030116] [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: 05/27/2021] [Revised: 06/11/2021] [Accepted: 06/16/2021] [Indexed: 11/29/2022] Open
Abstract
In the United States, pharmacists' scope of practice continues to expand, with increasing opportunities for pharmacists in all practice settings to enhance health in society. In ambulatory care, pharmacists remain integral members on the healthcare team and have demonstrated positive impacts on patient care. Sharing similar characteristics as pharmacists in the community setting, a deeper look into common elements of a successful ambulatory care practice that can be applied in the community pharmacy setting is warranted. Key success factors identified from ambulatory care include (1) maximizing a pharmacist's unique knowledge base and skill set, (2) forming collaborations with physicians and other providers, (3) demonstrating outcomes and value, and (4) maintaining sustainability. Opportunities exist for pharmacists in the community setting to utilize these success factors when developing, implementing, and/or expanding direct patient care services that improve accessibility to quality care and population health.
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Affiliation(s)
- Alex J. Luli
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA; (L.A.); (M.B.); (C.M.M.)
| | - Linda Awdishu
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA; (L.A.); (M.B.); (C.M.M.)
| | - Jan D. Hirsch
- Department of Clinical Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, University of California Irvine, 101 Theory, Suite 100, Irvine, CA 92612, USA; (J.D.H.); (J.H.W.)
| | - Jonathan H. Watanabe
- Department of Clinical Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, University of California Irvine, 101 Theory, Suite 100, Irvine, CA 92612, USA; (J.D.H.); (J.H.W.)
| | - Mark Bounthavong
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA; (L.A.); (M.B.); (C.M.M.)
| | - Candis M. Morello
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA; (L.A.); (M.B.); (C.M.M.)
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11
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Negash Z, Berha AB, Shibeshi W, Ahmed A, Woldu MA, Engidawork E. Impact of medication therapy management service on selected clinical and humanistic outcomes in the ambulatory diabetes patients of Tikur Anbessa Specialist Hospital, Addis Ababa, Ethiopia. PLoS One 2021; 16:e0251709. [PMID: 34077431 PMCID: PMC8171943 DOI: 10.1371/journal.pone.0251709] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 05/02/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Diabetes mellitus (DM) patients are at increased risk of developing drug therapy problems (DTPs). The patients had a variety of comorbidities and complications, and they were given multiple medications. Medication therapy management (MTM) is a distinct service or group of services that optimize therapeutic outcomes for individual patients. The study assessed the impact of provision of MTM service on selected clinical and humanistic outcomes of diabetes patients at the diabetes mellitus clinic of Tikur Anbessa Specialized Hospital (TASH). METHODS A pre-post interventional study design was carried out at DM clinic from July 2018 to April 2019. The intervention package included identifying and resolving drug therapy problems, counseling patients in person at the clinic or through telephone calls, and providing educational materials for six months. This was followed by four months of post-intervention assessment of clinical outcomes, DTPs, and treatment satisfaction. The interventions were provided by pharmacist in collaboration with physician and nurse. The study included all adult patients who had been diagnosed for diabetes (both type I & II) and had been taking anti-diabetes medications for at least three months. Patients with gestational diabetes, those who decided to change their follow-up clinic, and those who refused to participate in the study were excluded. Data were analyzed using Statistical Package for the Social Sciences (SPSS). Descriptive statistics, t-test, and logistic regressions were performed for data analyses. RESULTS Of the 423 enrolled patients, 409 fulfilled the criteria and included in the final data analysis. The intervention showed a decrease in average hemoglobin A1c (HbA1c), fasting blood sugar (FBS), and systolic blood pressure (SBP) by 0.92%, 25.04 mg/dl, and 6.62 mmHg, respectively (p<0.05). The prevalence of DTPs in the pre- and post-intervention of MTM services was found to be 72.9% and 26.2%, respectively (p<0.001). The overall mean score of treatment satisfaction was 90.1(SD, 11.04). Diabetes patients of age below 40 years (92.84 (SD, 9.54)), type-I DM (93.04 (SD, 9.75)) & being on one medication regimen (93.13(SD, 9.17)) had higher satisfaction score (p<0.05). CONCLUSION Provision of MTM service had a potential to reduce DTPs, improve the clinical parameters, and treatment satisfaction in the post-intervention compared to the pre-intervention phase.
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Affiliation(s)
- Zenebe Negash
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Alemseged Beyene Berha
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Workineh Shibeshi
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Abdurezak Ahmed
- Department of Internal Medicine, School of Medicine, College of Health, Sciences Addis Ababa University, Addis Ababa, Ethiopia
| | - Minyahil Alebachew Woldu
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ephrem Engidawork
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Geisler AN, Purvis CG, Dao DPD, Feldman SR. Medication therapy management in dermatology: a call to action. J DERMATOL TREAT 2021; 32:373-375. [PMID: 33909523 DOI: 10.1080/09546634.2021.1922571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Amaris N Geisler
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Caitlin G Purvis
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Diem-Phuong D Dao
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Steven R Feldman
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina.,Department of Pathology, Wake Forest School of Medicine, Winston-Salem, North Carolina.,Department of Social Sciences & Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina.,Department of Dermatology, University of Southern Denmark, Odense, Denmark
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13
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Berry M, Gustafson A, Wai M, Luli AJ. Evaluation of an Outpatient Pharmacist Consult Service at a Large Academic Medical Center. Innov Pharm 2021; 12. [PMID: 34345506 PMCID: PMC8326691 DOI: 10.24926/iip.v12i2.3238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective: To evaluate a novel outpatient pharmacist consult service in a large academic medical center. Setting: Four outpatient pharmacies that are part of a large academic medical center Methods: An outpatient pharmacist consult order was created and embedded in the electronic medical record (EMR). Medical center providers utilized this consult order when identifying patients in need of specific services provided by outpatient pharmacists. Descriptive data about each individual consult was collected including number completed, type of service, and duration. Rate of accepted pharmacy recommendations and patient cost savings were also evaluated. A survey was administered at the completion of the study period to assess provider and pharmacist satisfaction with the service. Patient demographic information was collected for those who had a documented completed consult. Results: A total of 193 consults were completed: 137 immunizations, 37 care affordability, 15 education, 3 polypharmacy and 1 OTC recommendation. 89% of completed consults took pharmacists 20 minutes or less to complete. Of completed care affordability consults (n=31), 55% of patients saved between $100 - $500 per medication fill. Of providers who completed a survey and utilized the service (n=12), 83.3% were extremely satisfied and 16.7% were satisfied with it. The provider acceptance rate of pharmacist’s recommendations was 74%. Conclusion: Implementation of an outpatient pharmacist consult service provided an alternative method for the utilization of pharmacist provided MTM services in outpatient pharmacies at a large academic medical center. The service was well received by both providers and pharmacists.
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Affiliation(s)
| | | | - Maya Wai
- University of Arkansas for Medical Sciences, College of Pharmacy
| | - Alex J Luli
- University of California San Diego, Skaggs School of Pharmacy and Pharmaceutical Sciences
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Abstract
Rationale & Objective Hemodialysis (HD) patients have complicated disease states, placing them at higher risk for medication-related problems, medication discrepancies, and nonadherence. The objective of this study is to evaluate the impact of a clinical pharmacist in a single HD facility by assessing the efficacy of medication reconciliation in HD patients and evaluating the potential impact on a single health care system. Study Design Retrospective study. Setting & Participants Greenfield Health Systems, a wholly owned subsidiary of Henry Ford Health System, operates 14 HD facilities throughout Southeast Michigan. The West Pavilion facility is located in Detroit, MI. Patients with end-stage kidney disease included in the study had a minimum of 4 encounters with the clinical pharmacist or pharmacy interns between August 2017 and October 2018. Exposure A clinical pharmacist performed medication reconciliation and medication reviews with HD patients to assess medication-related problems and identify gaps in care. Interventions made by the pharmacist were prespecified through a collaborative practice agreement. Outcomes To evaluate the impact of a clinical pharmacist in an HD facility by assessing the efficacy of medication reconciliation in HD patients and evaluating the potential impact on this health system through an estimated cost avoidance. Analytical Approach Descriptive statistics were used to collect medication-related problems and classified based on a modified Hepler-Strand approach. Results There were 1,403 medication-related problems, with an average of 8.96 medication-related problems per patient. Adherence was the most common medication-related problem (31%). Antihypertensive medication was the most common drug class in which the pharmacist intervened (37%), followed by vitamin D analogues and calcimimetics (29%). A projected total of US $447,355 was saved. Limitations Retrospective analysis of observational data and descriptive statistics with the potential for residual bias and confounding. Conclusions Pharmacists in HD facilities have a positive influence on HD patients through medication management that results in cost savings.
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Peasah SK, Hammonds T, Liu Y, Campbell V, Manolis C, Good CB. Economic assessment of changes to an existing medication therapy management program of a large regional health plan. J Manag Care Spec Pharm 2021; 27:147-156. [PMID: 33506728 PMCID: PMC10391146 DOI: 10.18553/jmcp.2021.27.2.147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND: Although medication therapy management (MTM) has specific eligibility criteria and is mandated for specific Medicare Part D enrollees, some health plans have expanded MTM eligibility beyond the minimum criteria to include other Medicare Part D enrollees, Medicaid, and commercial health plan patients. Differences exist in the mode of delivery, location of services, type of personnel involved in managing the service, and the subsequent outcomes. The type and intensity of MTM services delivered have evolved with time to more streamlined and robust interventions, necessitating ongoing evaluation of the effect on clinical and economic outcomes. OBJECTIVE: To assess the effect of changes to an existing MTM program on cost of care, utilization, and medication adherence. METHODS: UPMC Health Plan made changes to an existing MTM program by expanding eligibility (customized by the type of health plan), intervention types, pharmacist involvement, and patient followup contacts. After matching our intervention cohort (identified January 2017-June 2018) with the pre-2016 MTM historical controls (patients identified January 2014-June 2015 who would have been eligible if we used the intervention cohort eligibility criteria), we estimated that the effect of the program changes with a difference-in-difference model (preintervention [2014-2016] and postintervention [2017-2019]). Outcomes of interest included cost (total cost of care including medical, pharmacy, and unplanned care [i.e., unscheduled health care use such as emergency department visits] in 2017 U.S. dollars); utilization; medication adherence (proportion of days covered); and return on investment (ROI). Target population included continuously enrolled patients aged ≥ 21 years in the commercial, Medicare, and Medicaid health plans. RESULTS: Total propensity score-matched members was 10,747, 55% of which were in the historic control group. The average (SD) ages after matching the groups were similar (historical control group: 57.08 years [14.23], intervention group: 56.79 years [14.21]) and the majority was female (57%). Comorbidities identified most for patients included hypertension (77%), dyslipidemia (70%), and diabetes (52%). Forty-one percent were in the commercial, 37% in the Medicaid, and 23% in the Medicare health plans. Proportion of care activities undertaken in the intervention period compared with the control period were significantly different: "sent letter to physician" (67% vs. 87%), "sent letter to member" (15% vs. 0%), "pharmacist phone call to physician" (15% vs. 0.1%), and "pharmacist phone call to member" (13% vs. 7%). There were statistically significant reductions in unplanned care across all health plans especially in the Medicare population, in total cost of care, and increases in medication adherence in 4 therapeutic classes: anticoagulants (OR = 1.25, P = 0.005), cardiac medications (OR = 1.20, P < 0.001), statins (OR = 1.21, P < 0.001), and antidepressants (OR = 1.15, P < 0.001). There was a positive ROI of $18.50 per dollar spent, which equated to a cumulative net savings of $11 million over 24 months. CONCLUSIONS: In a large health plan, expanding MTM eligibility, intensifying patient follow-up contact and pharmacist involvement, and improving provider awareness had favorable clinical and economic benefits. DISCLOSURES: There was no funding for this project except employees' time. All authors are employees of UPMC and have no conflicts of interest to report.
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Affiliation(s)
- Samuel K Peasah
- Value-Based Pharmacy Initiatives, Center for High Value HealthCare, UPMC Health Plan, Pittsburgh, PA
| | | | - Yushu Liu
- Health Economics, UPMC Health Plan, Pittsburgh, PA
| | | | | | - Chester B Good
- Value-Based Pharmacy Initiatives, Center for High Value HealthCare, UPMC Health Plan, Pittsburgh, PA
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Daly CJ, Quinn B, Mak A, Jacobs DM. Community Pharmacists' Perceptions of Patient Care Services within an Enhanced Service Network. PHARMACY 2020; 8:pharmacy8030172. [PMID: 32947887 PMCID: PMC7559089 DOI: 10.3390/pharmacy8030172] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 09/09/2020] [Accepted: 09/11/2020] [Indexed: 11/20/2022] Open
Abstract
Background: Pharmacists are positioned as an accessible source of patient care services (PCS). Despite the adversity community pharmacies continue to face, the expanding opportunity of offering PCS continues to be a pathway forward. Objective: To identify community pharmacists’ perceptions to deliver PCS within an enhanced service network. Methods: One-on-one semi-structured phone interviews were conducted as part of a mixed-methods approach. Interview transcripts were analyzed using a consensus codebook to draft thematic findings. Participants were recruited from an electronic survey targeting community pharmacists from the New York chapters of the Community Pharmacy Enhanced Services Network (CPESN). Results: Twelve pharmacists were interviewed with four main themes identified. The majority of study participants were pharmacy owners (92%) devoting an average of 15 h/week to PCS and 8 h/week addressing social barriers. The main themes identified include: (1) perceptions of pharmacy profession, (2) reimbursement models and sustainability of PCS, (3) provision of patient care services, and (4) how PCS address social determinants of health. Conclusions: Offering PCS opportunities for patients is a direction many community pharmacists have embraced and are working to succeed. Ongoing research is needed focusing on community pharmacists’ self-perceptions of the clinical impact and role they hold in an evolving healthcare system.
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Axon DR, Aljadeed R, Potisarach P, Forbes S, DiLeo J, Warholak T. Pilot study of focus groups exploring student pharmacists' perceptions of a medication management center internship. CURRENTS IN PHARMACY TEACHING & LEARNING 2020; 12:1123-1128. [PMID: 32624142 DOI: 10.1016/j.cptl.2020.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 02/20/2020] [Accepted: 04/04/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Student pharmacists are expected to participate in real-life, patient-centered experiences to help develop clinical knowledge and professional skills. This study explored student pharmacist intern perceptions of work experience at a medication management center (MMC). We also examined how working at the MMC helped fulfill curricular requirements, helped develop leadership skills, and provided professional development opportunities. METHODS Two focus groups were conducted with first-, second-, and third-year student pharmacist interns at the MMC in April 2019. The focus groups were audio recorded for verification purposes, transcribed, and analyzed thematically by two independent reviewers. RESULTS A total of five student pharmacist interns participated. Four main themes were identified: (1) knowledge; (2) communication; (3) time management; and (4) leadership, mentorship, and networking. Participants had opportunities to acquire new knowledge and skills outside the classroom, providing them an academic advantage while recognizing areas of deficiency. Students practiced communication skills that helped improve language skills and manage difficult patients, although telephonic consultations were challenging. Students learned to prioritize time with patients but reported difficulty managing their work schedules. Leadership, mentorship, and networking opportunities facilitated learning and improved their self-confidence. CONCLUSIONS This qualitative analysis identified four key themes, highlighting the many benefits available for student pharmacist interns working at an academic-based MMC. Further research is needed to address challenges reported in this study and should include a larger sample of student pharmacists for more generalizable results.
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Affiliation(s)
- David R Axon
- University of Arizona College of Pharmacy, 1295 N Martin Ave, PO Box 210202, Tucson, AZ 85721, United States.
| | - Raniah Aljadeed
- University of Arizona College of Pharmacy, 1295 N Martin Ave, PO Box 210202, Tucson, AZ 85721, United States.
| | - Pemmarin Potisarach
- University of Arizona College of Pharmacy, 1295 N Martin Ave, PO Box 210202, Tucson, AZ 85721, United States.
| | - Stephanie Forbes
- SinfoniaRx, 100 N Stone Ave, Suite 109, Tucson, AZ 85701, United States.
| | - Jessica DiLeo
- University of Arizona College of Pharmacy, 1295 N Martin Ave, PO Box 210202, Tucson, AZ 85721, United States.
| | - Terri Warholak
- University of Arizona College of Pharmacy, 1295 N Martin Ave, PO Box 210202, Tucson, AZ 85721, United States.
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Šola KF, Mucalo I, Brajković A, Jukić I, Verbanac D, Vladimir Knežević S. Drug therapy problems identified among older adults placed in a nursing home: the Croatian experience. J Int Med Res 2020; 48:300060520928791. [PMID: 32493090 PMCID: PMC7273786 DOI: 10.1177/0300060520928791] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 04/30/2020] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE The aim of this study was to determine the frequency and type of drug therapy problems (DTPs) in older institutionalized adults. METHOD We conducted a cross-sectional observational study from February to June 2016 at a 150-bed public nursing home in Croatia, where comprehensive medication management (CMM) services were provided. A rational decision-making process, referred to as the Pharmacotherapy Workup method, was used to classify DTPs. RESULTS Data were prospectively collected from 73 residents, among which 71% were age 75 years or older. The median number of prescribed medications per patient was 7 (2-16) and polypharmacy (> 4) was recorded for 54 (74.0%) patients. A total 313 DTPs were identified, with an average of 4.3 ± 2 DTPs per patient. The most frequent DTP was needing additional drug therapy (n = 118; 37.7%), followed by adverse drug reaction (n = 55; 17.6%). Lactulose (14.4%), tramadol (6.7%), and potassium (6.4%) were the medications most frequently related to DTPs. CONCLUSION The high prevalence of DTPs identified among older institutionalized adults strongly suggests the need to incorporate new pharmacist-led CMM services within existing institutional care facilities, to improve the care provided to nursing home residents.
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Affiliation(s)
| | - Iva Mucalo
- University of Zagreb Faculty of Pharmacy and Biochemistry, Zagreb, Croatia
| | - Andrea Brajković
- University of Zagreb Faculty of Pharmacy and Biochemistry, Zagreb, Croatia
| | - Ivona Jukić
- Community Pharmacy Mandis Pharm, Zagreb, Croatia
| | - Donatella Verbanac
- University of Zagreb Faculty of Pharmacy and Biochemistry, Zagreb, Croatia
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Hui A, Latif A, Hinsliff-Smith K, Chen T. Exploring the impacts of organisational structure, policy and practice on the health inequalities of marginalised communities: Illustrative cases from the UK healthcare system. Health Policy 2020; 124:298-302. [DOI: 10.1016/j.healthpol.2020.01.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 12/12/2019] [Accepted: 01/06/2020] [Indexed: 10/25/2022]
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Rivera J, Shcherbakova N, Vala C, Capoccia K. Community pharmacists' interventions and documentation during medication therapy management encounters delivered face-to-face versus via telephone: The devil is in the details. Res Social Adm Pharm 2020; 16:1447-1451. [PMID: 31889640 DOI: 10.1016/j.sapharm.2019.12.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 12/21/2019] [Accepted: 12/22/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND To date, no studies are available comparing in-person versus telephone-administered medication therapy management (MTM) encounters in a community pharmacy setting with respect to medication-related problems, interventions and documentation. OBJECTIVE The objective of this study was to evaluate types of medication-related problems, interventions, and documentation among patients receiving MTM face-to-face versus over the telephone. METHODS A retrospective analysis was performed on all completed comprehensive medication reviews (CMR) between 2011 and 2017 in 14 community pharmacies in Western Massachusetts, USA that belong to one district of a national chain. Medication-related problems were classified as: Beers criteria medications, untreated condition, dose too high or low, medication omission, duplicate therapy, drug-drug interaction, non-adherence, complicated dosing. Pharmacist's interventions were classified as education, medication reconciliation, and vaccination. Documentation of assessment, plan, discussion notes, and recommendations were evaluated as being present or absent. RESULTS In total, 297 encounters (56.5% were over the telephone) were included in the analysis. There was no significant differences between clinical and demographic characteristics and types of medication-related problems and pharmacist interventions among patients who received face-to-face versus telephone MTM service. Assessment was documented among 28% of face-to-face and 42% of telephone CMR encounters (p < 0.05). Plan was documented among 27% of face-to-face and 40% of telephone CMR encounters (p < 0.05). Discussion notes were documented among 97% of face-to-face and 98% of telephone CMR encounters (p > 0.05). Pharmacist recommendations were documented among 92% of face-to-face and 95% of telephone CMR encounters (p > 0.05). CONCLUSIONS Pharmacists identify medication-related problems and provide education and medication reconciliation interventions independent of the mode of delivery. The overall low frequency of assessment and plan documentation raises concerns. It is imperative for pharmacists to document both instances of provider outreach and follow-up to ascertain resolutions of patients' medication-related problems.
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Affiliation(s)
| | - Natalia Shcherbakova
- College of Pharmacy and Health Sciences, Western New England University, Springfield, MA, USA.
| | | | - Kam Capoccia
- College of Pharmacy and Health Sciences, Western New England University, Springfield, MA, USA
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Nuffer W, Trujillo T, Griend JV. Estimated Potential Financial Impact of Pharmacist-Delivered Disease Management Services Across a Network of Pharmacies in Rural Colorado. J Manag Care Spec Pharm 2019; 25:984-988. [PMID: 31456492 PMCID: PMC6859940 DOI: 10.18553/jmcp.2019.25.9.984] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND This study summarizes the potential financial impact of a 3-year collaboration focused on delivering disease management services through pharmacies in 12 rural Colorado communities. OBJECTIVES To (a) identify components within the disease management program that would be billable and generate revenue to each pharmacy and (b) estimate the revenue amount that could be generated based on these services across the 3-year project. METHODS Reimbursable services included diabetes self-management education; medication therapy management services, including the comprehensive medication review; and improvements in Medicare star ratings through pharmacy interventions. RESULTS An estimated total of $117,800 could have been generated by services provided to patients across the 12 pharmacy sites. After subtracting the estimated cost of labor for a pharmacist to provide these services, an estimated net profit of $60,023 resulted over 3 years. Star rating impacts were discussed but were not able to be included as specific revenue based on the complex contracting between pharmacies and third-party insurers. CONCLUSIONS Based on these estimates, delivery of chronic disease management could represent a financially feasible option for community pharmacists. Some credentialing and changes to the mode of delivery would be required to meet billing requirements. Further research is needed to better estimate the cost savings resulting from these services to possibly expand pharmacists' reimbursement opportunities. DISCLOSURES This publication was supported by Cooperative Agreement Number DP004796-05, funded by the Centers for Disease Control and Prevention. The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention or the Department of Health and Human Services. None of the authors have any conflicts of interest to disclose regarding this work.
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Affiliation(s)
- Wesley Nuffer
- University of Colorado Skaggs School of Pharmacy & Pharmaceutical Sciences, Aurora
| | - Tara Trujillo
- Colorado Department of Public Health and Environment, Denver
| | - Joseph Vande Griend
- University of Colorado Skaggs School of Pharmacy & Pharmaceutical Sciences, Aurora
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22
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Carter BL, Levy B, Gryzlak B, Xu Y, Chrischilles E, Dawson J, Vander Weg M, Christensen A, James P, Polgreen L. Cluster-Randomized Trial to Evaluate a Centralized Clinical Pharmacy Service in Private Family Medicine Offices. Circ Cardiovasc Qual Outcomes 2019; 11:e004188. [PMID: 29884657 DOI: 10.1161/circoutcomes.117.004188] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 04/20/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND The use of clinical pharmacists in primary care has improved the control of several chronic cardiovascular conditions. However, many private physician practices lack the resources to implement team-based care with pharmacists. The purpose of this study was to evaluate whether a centralized, remote, clinical pharmacy service could improve guideline adherence and secondary measures of cardiovascular risk in primary care offices in rural and small communities. METHODS AND RESULTS This study was a prospective trial in 12 family medicine offices cluster randomized to either the intervention or usual care. The intervention was delivered for 12 months, and subjects had research visits at baseline and 12 months. The primary outcome was adherence to guidelines, and secondary outcomes included changes in key cardiovascular risk factors and preventative health measures. We enrolled 302 subjects. There was no improvement in the Guideline Advantage score from baseline to 12 months in the control group (64.7% versus 63.1%, respectively; P=0.21). There was a statistically significant improvement in the intervention group from 63.3% at baseline to 67.8% at 12 months (P=0.02). The estimated benefit of the intervention was 5.0%±2.4% (95% confidence interval=-0.5% to 10.4%; P=0.07). Several criteria were significantly better for intervention subjects, including appropriate statin therapy (P<0.001), body mass index, screening (P<0.001), and alcohol screening (P<0.001). Only 13.7% of subjects with diabetes mellitus had hemoglobin A1c at goal at baseline, and this increased to 30.8% and 21.0% in the intervention and control group, respectively, at 12 months (P=0.10). CONCLUSIONS The centralized, remote pharmacist intervention was successfully implemented. The improvements in outcomes were modest, in part because of higher than expected baseline guideline adherence. Future studies of this model should focus on patients with uncontrolled conditions at high risk for cardiovascular events. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT 01983813.
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Affiliation(s)
- Barry L Carter
- Department of Pharmacy Practice and Science, College of Pharmacy (B.L.C., B.G., L.P.) .,Department of Family Medicine, Roy J. and Lucille A. Carver College of Medicine (B.L.C., B.L., Y.X.)
| | - Barcey Levy
- Department of Family Medicine, Roy J. and Lucille A. Carver College of Medicine (B.L.C., B.L., Y.X.).,Department of Epidemiology, College of Public Health (B.L., B.G., E.C.)
| | - Brian Gryzlak
- Department of Pharmacy Practice and Science, College of Pharmacy (B.L.C., B.G., L.P.).,Department of Epidemiology, College of Public Health (B.L., B.G., E.C.)
| | - Yinghui Xu
- Department of Family Medicine, Roy J. and Lucille A. Carver College of Medicine (B.L.C., B.L., Y.X.)
| | | | - Jeffrey Dawson
- Department of Biostatistics, College of Public Health (J.D.)
| | - Mark Vander Weg
- Department of Internal Medicine, Carver College of Medicine (M.V.W., A.C.).,Department of Psychological and Brain Sciences, College of Liberal Arts and Sciences (M.V.W., A.C.).,University of Iowa. Iowa City Veterans Administration Health Care System (M.V.W.)
| | - Alan Christensen
- Department of Internal Medicine, Carver College of Medicine (M.V.W., A.C.).,Department of Psychological and Brain Sciences, College of Liberal Arts and Sciences (M.V.W., A.C.)
| | - Paul James
- Department of Family Medicine, University of Washington, Seattle (P.J.)
| | - Linnea Polgreen
- Department of Pharmacy Practice and Science, College of Pharmacy (B.L.C., B.G., L.P.)
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Abstract
PURPOSE OF REVIEW Hypertension remains a vital, modifiable risk factor in the prevention of cardiovascular disease. However, many patients do not achieve their therapeutic goals for numerous reasons which can include poor disease insight and nonadherence. Pharmacists can be key players in controlling hypertension, given their medication knowledge and patient counseling skills, yet they remain an underutilized resource in the management of chronic disease states. Various models exist that allow pharmacists to provide direct patient-centered care but practices differ from state to state since pharmacists are not recognized nationally as healthcare providers. This article aims to provide an update on the proven methods in which pharmacists contribute to the management of hypertensive patients. RECENT FINDINGS Several recently published studies demonstrate the positive impact of pharmacist intervention and care on patient outcomes in ambulatory and community settings. These practice models include medication therapy management, collaborative drug therapy management, telehealth and team-based care. SUMMARY The role of the pharmacist in hypertension encompasses medication management, disease state education and patient counseling and is most successful when integrated into the patient's care team. Further validation through larger, prospective trials and evaluation of long-term outcomes, such as mortality, remain viable research opportunities.
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Farhat NM, Farris KB, Patel MR, Cornish L, Choe HM. Comprehensive medication reviews: Optimal delivery setting and recommendations for quality assessment. J Am Pharm Assoc (2003) 2019; 59:642-645. [PMID: 31307965 DOI: 10.1016/j.japh.2019.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 04/05/2019] [Accepted: 06/01/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To propose a metric evaluating the quality of comprehensive medication reviews (CMRs), and to discuss the optimal setting for CMR delivery. SUMMARY First, we provide a current assessment of the quality of CMRs performed in community, payer, and health system/clinic settings, with recommended opportunities for improvement. Thereafter, a companion metric for CMR quality is discussed, because this is critical to ensuring that patients are not just receiving CMR services, but that CMRs reflect evidence-based recommendations supporting optimal patient outcomes. CONCLUSION Based on the data currently available, accessibility to electronic medical records would enhance patient-specific recommendations to optimize CMR delivery and patient outcomes. Future studies may help to identify additional factors, such as pharmacist-physician collaboration in clinic and use of evidence-based recommendations, that can further enhance CMR quality.
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Ferries E, Dye JT, Hall B, Ndehi L, Schwab P, Vaccaro J. Comparison of Medication Therapy Management Services and Their Effects on Health Care Utilization and Medication Adherence. J Manag Care Spec Pharm 2019; 25:688-695. [PMID: 31134865 PMCID: PMC10397886 DOI: 10.18553/jmcp.2019.25.6.688] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Medication therapy management (MTM) programs are designed to improve clinical outcomes and enhance appropriate medication use. Comprehensive medication reviews (CMRs) and targeted medication reviews (TMRs) are 2 broad interventions defined within MTM services. While MTM services have been extensively researched, there are few comparisons of CMR versus non-CMR interventions. Given the variability in MTM interventions and lack of a consistent TMR definition in the literature, this study sought to compare CMRs and TMRs that were clearly defined based on Centers for Medicare & Medicaid Services (CMS) criteria. OBJECTIVES To (a) compare acute inpatient admissions and emergency department (ED) visits between patients participating in MTM services (CMR, TMR, or both) and eligible nonparticipating patients and (b) examine the effect of receiving TMR services on medication adherence. METHODS This was a retrospective cohort study of patients with Medicare Part D coverage who received MTM services and a 1:1 propensity score-matched control group. Participants had to be eligible for MTM services in 2014 or 2015 based on CMS requirements. CMRs were offered to all MTM-eligible patients, while TMRs were completed based on clinical rules that helped identify medication-related problems (MRPs). The date of MTM intervention, or eligibility for the control group, was considered the index date. Participants had to be continuously enrolled in a Medicare Advantage plan that included prescription drug coverage during the study period and have at least 6 months of data before and after the index date. Medical and pharmacy claims were assessed to examine trend-adjusted inpatient admissions and ED visits from pre-index to post-index date for participants and matched controls. RESULTS In 2014 and 2015, receipt of TMR interventions was associated with statistically significant reductions in acute inpatient admissions. In 2014, there were 55.2 fewer admits per 1,000 individuals (95% CI = 29-81) and 30.8 fewer admits per 1,000 individuals in 2015 (95% CI = 20-42). Receipt of CMR-only interventions was associated with fewer acute inpatient admissions only when coupled with preidentification of MRPs (36.8 [95% CI = 25-49] fewer admits per 1,000 individuals). In 2015, there were significant reductions in ED visits for participants receiving TMR-only interventions or TMR/CMR interventions (26.1 [95% CI = 11-41] and 12.0 [95% CI = 1-23] fewer ED visits per 1,000 individuals, respectively). In both years, a larger percentage (0.4% for oral diabetes medications; 7.7% for antihypertensives; 3.0% for statins) of MTM participants had greater improvements in medication adherence in the post-index period compared with controls. CONCLUSIONS Receiving MTM services targeted at resolution of MRPs (TMR or CMR/TMR) resulted in positive reductions in health care utilization and increases in medication adherence. Given the importance of optimal medication utilization, this study highlights the need for additional focus on resolution of MRPs through TMRs and CMRs that can support improved clinical outcomes. DISCLOSURES No outside funding supported this study. Researchers completed the work as part of their employment with Humana. All authors are or were employees of Humana at the time of the study. There are no other conflicts of interest to disclose. This study was previously presented at AMCP Nexus 2017 on October 16, 2017, in Dallas, TX.
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Affiliation(s)
| | | | | | | | - Phil Schwab
- Humana Healthcare Research, Louisville, Kentucky
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A Study to Identify Medication-Related Problems and Associated Cost Avoidance by Community Pharmacists during a Comprehensive Medication Review in Patients One Week Post Hospitalization. PHARMACY 2019; 7:pharmacy7020051. [PMID: 31146447 PMCID: PMC6630417 DOI: 10.3390/pharmacy7020051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 05/21/2019] [Accepted: 05/22/2019] [Indexed: 11/29/2022] Open
Abstract
Objectives: To determine the numbers of medication discrepancies and medication-related problems (MRPs) identified and resolved when providing a transitions of care comprehensive medication review (CMR) after hospital discharge within a community pharmacy; and to estimate the cost-avoidance value of this service. Methods: Community pharmacists provided CMRs to covered employees and dependents of a self-insured regional grocery store chain who were discharged from the hospital. Data was collected prospectively over 4 months. Discrepancies were identified among patients’ medication regimens by comparing the hospital discharge record, the pharmacy profile, and what the patient reported taking. MRPs were categorized into ten categories, as defined by the OutcomesMTM® Encounter Worksheet. Interventions were categorized using the severity scale developed by OutcomesMTM®, a Cardinal Health company. Data were analyzed using descriptive statistics and bivariate correlations. Results: Nineteen patients were enrolled in the program. Pharmacists identified 34 MRPs and 81 medication discrepancies, 1.8 and 4.3 per patient, respectively. The most common type of MRP was underuse of medication (70.6%). Significant positive correlations were found between the number of scheduled prescription medications and the number of medications with discrepancies (p ≤ 0.01; r = 0.825) and number of scheduled prescription medications and the number of MRPs (p ≤ 0.01; r = 0.697). Most commonly, the severity levels associated with the MRPs involved the prevention of physician office visits or addition of new prescription medications (n = 10 each); however, four emergency room visits and three hospitalizations were also avoided. The total estimated cost avoidance was $92,143, or $4850 per patient. Extrapolated annual cost savings related to this service would be $276,428. Conclusions: This transitions of care service was successful in identifying and addressing MRPs and discrepancies for this patient population. By providing this service, community pharmacists were able to prevent outcomes of various severities and to avoid patient care costs.
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Feinstein JA, Hall M, Antoon JW, Thomson J, Flores JC, Goodman DM, Cohen E, Azuine R, Agrawal R, Houtrow AJ, DeCourcey DD, Kuo DZ, Coller R, Gaur DS, Berry JG. Chronic Medication Use in Children Insured by Medicaid: A Multistate Retrospective Cohort Study. Pediatrics 2019; 143:peds.2018-3397. [PMID: 30914443 PMCID: PMC6456893 DOI: 10.1542/peds.2018-3397] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/23/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Little is known about the use of chronic medications (CMs) in children. We assessed the prevalence of CM use in children and the association of clinical characteristics and health care resource use with the number of CMs used. METHODS This is a retrospective study of children ages 1 to 18 years using Medicaid from 10 states in 2014 grouped by the annual number of CMs (0, 1, 2-4, 5-9, and ≥10 medications), which are defined as a dispensed ≥30-day prescription with ≥2 dispensed refills. Trends in clinical characteristics and health care use by number of CMs were evaluated with the Cochran-Armitage trend test. RESULTS Of 4 594 061 subjects, 18.8% used CMs. CM use was 44.4% in children with a complex chronic condition. Across all children, the most common CM therapeutic class was neurologic (28.9%). Among CM users, 48.8% used multiple CMs (40.3% used 2-4, 7.0% used 5-9, and 0.5% used ≥10). The diversity of medications increased with increasing number of CMs: for 1 CM, amphetamine stimulants were most common (29.0%), and for ≥10 CMs, antiepileptics were most common (7.1%). Of $2.3 billion total pharmacy spending, 59.3% was attributable to children dispensed multiple CMs. Increased CM use (0 to ≥10 medications) was associated with increased emergency department use (32.1% to 56.2%) and hospitalization (2.3% to 36.7%). CONCLUSIONS Nearly 1 in 5 children with Medicaid used CMs. Use of multiple CMs was common and correlated with increased health care use. Understanding CM use in children should be fundamentally important to health care systems when strategizing how to provide safe, evidence-based, and cost-effective pharmaceutical care to children.
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Affiliation(s)
- James A. Feinstein
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado and Children’s Hospital Colorado, Aurora, Colorado
| | - Matt Hall
- Children’s Hospital Association, Lenexa, Kansas
| | - James W. Antoon
- College of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Joanna Thomson
- Division of Hospital Medicine, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center and College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Juan Carlos Flores
- Division of Pediatrics, Pontificia Universidad Catolica de Chile, Hospital Sotero del Rio, Santiago, Chile
| | - Denise M. Goodman
- Ann and Robert H. Lurie Children’s Hospital of Chicago and Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Eyal Cohen
- Division of Pediatric Medicine, Department of Pediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Romuladus Azuine
- Maternal and Child Health Bureau, US Department of Health and Human Services, Rockville, Maryland
| | - Rishi Agrawal
- Ann and Robert H. Lurie Children’s Hospital of Chicago and Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Amy J. Houtrow
- Departments of Physical Medicine and Rehabilitation and Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Dennis Z. Kuo
- Department of Pediatrics, University at Buffalo, Buffalo, New York
| | - Ryan Coller
- School of Medicine and Public Health, University of Wisconsin–Madison, Madison, Wisconsin; and
| | | | - Jay G. Berry
- Division of General Pediatrics, Department of Medicine, Boston Children’s Hospital and Harvard Medical School, Harvard University, Boston, Massachusetts
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SCIENTIFIC AND PRACTICAL APPROACHES TO FORM THE LIST OF SOCIAL-PSYCHOLOGICAL CHARACTERISTICS FOR PHARMACY SPECIALIST. EUREKA: HEALTH SCIENCES 2019. [DOI: 10.21303/2504-5679.2019.00871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Nowadays according to employers, pharmacy specialist should be not only competent professional, but versed in the consumer psychology and result oriented, at the same time, i.e. concentrated on the pharmacy competitiveness increase and on maximal income and customer satisfaction.
The aim of the presented work was to investigate the social-psychological characteristics for pharmacy specialist essential in his or her professional activity, and to substantiate the list of these characteristics.
Materials and methods. Analytical, graphical and comparative methods, methods of descriptive and abstract modeling, system analysis and synthesis, taxonomy and cluster analysis were applied in the study.
Results. Social-psychological characteristics for pharmacy specialist methodologically should be selected and substantiated by the main stakeholders: employers, pharmacists, doctors, customers and graduation course students. The research algorithm to define the professionally important social-psychological characteristics for pharmacy specialist was suggested. The professionally important social-psychological characteristics regarding the requirements of employers from different countries to pharmacy specialists include sociability, responsibility, attentiveness, orderliness, and command-orientation. The main social-psychological characteristics for pharmacy specialists based on content analysis are attentiveness, sociability, indulgence, goodwill, responsibility, neatness, sensitivity, patience. Comparison of four research results for pharmacists, doctors, customers and graduation course students form specialty "Pharmacy" allowed to select and to substantiate the social-psychological characteristics for pharmacy specialist essential in his or her professional activity. They are goodwill, stress-stability, honesty, command-orientation, neatness, affability, decency, purposefulness, desire for learn and develop, grammatically correct language, non-conflictedness.
Conclusion. The approaches to define the professionally important social-psychological characteristics for pharmacy specialist were analyzed. The research of the professionally important social-psychological characteristics for pharmacy specialist was conducted with the main stakeholders: employer, pharmacist, doctor, and customer. The list of the professionally important social-psychological characteristics for pharmacy specialist was formed on the base of conducted research.
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Casper EA, El Wakeel LM, Saleh MA, El-Hamamsy MH. Management of pharmacotherapy-related problems in acute coronary syndrome: Role of clinical pharmacist in cardiac rehabilitation unit. Basic Clin Pharmacol Toxicol 2019; 125:44-53. [PMID: 30739389 DOI: 10.1111/bcpt.13210] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 01/29/2019] [Indexed: 11/30/2022]
Abstract
Acute coronary syndrome (ACS) is one of the leading causes of mortality worldwide and negatively impacts healthcare costs, productivity and quality of life. Polymorbidity and polypharmacy predispose ACS patients to medication discrepancies between cardiologist-prescribed medication and drug use by the patient, drug-related problems (DRPs) and inadequate drug adherence. This study aimed to evaluate the impact of clinical pharmacist-provided services on the outcome of ACS patients. This was a prospective, randomized, controlled study on ACS patients participating in a cardiac rehabilitation programme. Forty ACS patients were randomly assigned to either control group, who received standard medical care, or intervention group, who received standard medical care plus clinical pharmacist-provided services. Services included DRP management, clinical assessment and enforcing the patient education and adherence. For both groups, the following were assessed at baseline and after 3 months: DRPs, adherence (assessed by 8-item Morisky Adherence Questionnaire), patient's knowledge (assessed by Coronary Artery Disease Questionnaire), 36-Short Form Health Survey (SF-36), heart rate, systolic and diastolic blood pressure, low-density lipoprotein (LDL), total cholesterol (TC) and fasting blood glucose (FBG). After 3 months, there was a significant difference between the intervention and control groups in the per cent change of DRPs (median: -100 vs 5.882, P = 0.0001), patient's adherence score (median: 39.13 vs -14.58, P = 0.0001), knowledge score (median: 30.28 vs -5.196, P = 0.0001), SF-36 scores, heart rate (mean: -10.04 vs 6.791, P = 0.0001), diastolic blood pressure (mean: -17.87 vs 10.45, P = 0.0001), systolic blood pressure (mean: -16.22 vs 4.751, P = 0.0001), LDL (median: -25.73 vs -0.2538, P = 0.0071), TC (median: -14.62 vs 4.123, P = 0.0005) and FBG (median: -11.42 vs 5.422, P = 0.0098). Clinical pharmacists can play an important role as part of a cardiac rehabilitation team through patient education and interventions to minimize DRPs.
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Affiliation(s)
- Eman Ahmed Casper
- Department of Clinical Pharmacy, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt
| | | | - Mohamed Ayman Saleh
- Department of Cardiology, Faculty of Medicine, Cardiac Rehabilitation Unit, Ain Shams University Hospitals, Ain Shams University, Cairo, Egypt
| | - Manal Hamed El-Hamamsy
- Department of Clinical Pharmacy, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia Kingdom
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Consumer decision making for using comprehensive medication review services. J Am Pharm Assoc (2003) 2019; 59:168-177.e5. [PMID: 30612919 DOI: 10.1016/j.japh.2018.11.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 11/06/2018] [Accepted: 11/07/2018] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To identify main factors associated with older adults' decision making for using a Medicare Part D comprehensive medication review (CMR) service. DESIGN Cross-sectional self-administered mailed survey. SETTING AND PARTICIPANTS The survey was conducted from December 2016 to February 2017. Sampled subjects were 1) at least 65 years of age, 2) taking at least 1 prescription medication, and 3) a Medicare Part D beneficiary living in Florida (n = 310), Washington (n = 310), Wisconsin (n = 310), or Pennsylvania (n = 310) or active members of an Iowa senior registry (n = 460). MAIN OUTCOME MEASURES Responses to survey items assessing factors in the domains of internal need, external influences, perceived risks of using CMRs, and alternatives comparison that may affect older adults' decision to use CMRs. RESULTS The overall completed response rate was 24% (n = 381). About 28% of respondents (n = 105) reported being a CMR recipient. Recommendations from a pharmacist (P < 0.0001) or a physician (P = 0.0350), pharmacist's communication in previous encounters (P = 0.0007), perceived susceptibility to medication-related problems (P < 0.0001), and positive outcome expectancy (P = 0.0147) were positively associated with consumers' decision to participate in CMRs, whereas perceived functional risk (P < 0.0001), access to general counseling in previous experiences (P = 0.0145), and family or friends' influence (P = 0.0065) were negatively associated factors. CONCLUSION CMR uptake remains low after being available for years. Recommendations from health professionals and understanding of service benefits were identified as main factors affecting consumers' decision making for participating in CMRs. Policy makers could consider 1) seeking collaboration with community pharmacists and physicians and 2) addressing key components and benefits of CMRs in older adults as new promotion strategies.
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Alshehri AM, Barner JC, Rush S. The impact of a required course on third year pharmacy students' perceived abilities and intentions in providing medication therapy management. CURRENTS IN PHARMACY TEACHING & LEARNING 2019; 11:94-105. [PMID: 30527882 DOI: 10.1016/j.cptl.2018.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 07/10/2018] [Accepted: 09/21/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND AND PURPOSE To examine the impact of a Medication Therapy Management (MTM) course on third-year pharmacy students' (P3s) perceived abilities and intentions to provide MTM services before and after the course. EDUCATIONAL ACTIVITY AND SETTING An anonymous 48-item self-administered survey was administered to P3s before and after the MTM course. Forty-six items using a 5-point Likert scale (1 = strongly disagree to 5 = strongly agree) measured abilities in MTM provision using the following seven subdomains: general MTM ability (GA), medication therapy review (MTR), medication-related problems identification/recommendations (MRPIR), disease measurement/monitoring (DM), communication (CO), follow-up/referral (FR), and billing/documentation (BD). Two items assessed intent to provide MTM in practice. Descriptive statistics, Cronbach's alphas, and paired t-tests were used. FINDINGS All enrolled P3s (n = 110) completed both surveys. Subdomain Cronbach's alphas ranged from 0.70-0.97. Paired t-test showed no significant difference in intention to provide MTM before and after the course; however, the results revealed a significant increase in perceived abilities (before vs. after, respectively) regarding MTR (3.2 ± 0.6;4.2 ± 0.4; p < 0.0001), MRPIR (3.3 ± 0.6;4.2 ± 0.4; p < 0.0001), DM (4.2 ± 0.6;4.5 ± 0.5; p = 0.0004), CO (3.9 ± 0.5; 4.3 ± 0.4; p < 0.0001), FR (3.7±0.8;4.2±0.6; p = 0.0002), and BD (2.4±0.9;3.9±0.8; p < 0.0001). DISCUSSION AND SUMMARY A required MTM course with both didactic and experiential components were instrumental in improving P3s' perceived abilities to provide MTM services. Additional research is needed to understand why students' intention to provide MTM did not change pre- to post-course completion.
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Affiliation(s)
- Ahmed M Alshehri
- University of Texas at Austin, College of Pharmacy, Health Outcomes and Pharmacy Practice, 2409 University Avenue, Stop A1930, Austin, TX, United States; Prince Sattam bin Abdulaziz University, College of Pharmacy, Clinical Pharmacy Department, Al-Kharj, Riyadh, Saudi Arabia.
| | - Jamie C Barner
- University of Texas at Austin, College of Pharmacy, Health Outcomes and Pharmacy Practice, 2409 University Avenue, Stop A1930, Austin, TX 78712-1120, United States.
| | - Sharon Rush
- University of Texas at Austin, College of Pharmacy, Health Outcomes and Pharmacy Practice, 2409 University Avenue, Stop A1930, Austin, TX 78712-1120, United States.
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Impact of an ambulatory care pharmacist in an occupational health clinic. J Am Pharm Assoc (2003) 2018; 59:64-69.e1. [PMID: 30396761 DOI: 10.1016/j.japh.2018.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 09/08/2018] [Accepted: 09/09/2018] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To describe and evaluate a novel practice setting for a pharmacist within an occupational health clinic. SETTING Ambulatory care facility. PRACTICE DESCRIPTION Implementation and evaluation of a new practice site embedding a clinical pharmacist into the workplace to provide ambulatory care services, such as comprehensive medication management, disease state management, and immunizations to a broad diversity of patients. PRACTICE INNOVATION A clinical pharmacist provides pharmacy services as part of a collaborative occupational health clinic at a large, self-insured company. The pharmacy services are open to employees and family members with any chronic disease states, elevated biometric results, or medication questions, with the goal of improving patient care on a consistent basis. During visits, the pharmacist works to identify and resolve drug-related problems by educating the patient or reaching out to the patient's health care provider and to develop strategies with the patient to achieve desired health care outcomes. The pharmacist assists with patient outreach events and immunizations during the flu clinic. EVALUATION Identification of drug-related problems, resolution status, patient satisfaction via survey results, immunizations provided. RESULTS In 4.3 years of operation, the pharmacist conducted 604 visits with 172 patients. During these visits, the pharmacist identified 611 drug-related problems, of which 49.4% have been confirmed as resolved. All patients who completed the patient satisfaction survey said that they would recommend the pharmacy services to others. For the past 3 years, the pharmacist and pharmacy students immunized approximately 1000 patients each year during the company flu clinic. CONCLUSION An occupational health clinic is a unique and convenient location for a pharmacist to provide ambulatory care services to employees and family members, as long as methods to identify patients and appropriate sources of referral exist. The pharmacist was able to help patients resolve approximately 50% of identified drug-related problems, and patients were highly satisfied with services provided.
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Roshanzamiri S, Eslami K, Najmeddin F, Izadpanah M, Hadidi E, Ganji R. Validating a Drug-Related Problems Classification System in Outpatient Setting in Iran. J Res Pharm Pract 2018; 7:117-122. [PMID: 30211235 PMCID: PMC6121761 DOI: 10.4103/jrpp.jrpp_18_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Objective Medication Therapy Management service (MTMs) has been introduced to improve cooperation among pharmacists and other healthcare professionals in the management of chronic diseases, drug therapy, and patients on polypharmacy. One part of MTMs is detection and resolution of possible drug-related problems (DRPs). Nowadays, numerous DRPs classification systems are available, but due to some defects none of them are currently accepted and implemented universally. The purpose of this study is to design and validate a comprehensive system for classification and documentation of possible DRPs for the Iranian patients. Methods In this methodological study, four classification systems were studied, and their differences were reviewed, compared. Ultimately, a comprehensive documentation system was developed and tested for validity using experts' opinions. Findings A comprehensive list of 53 DRPs under eight categories was developed and examined for validity. After collecting the data and validity assessment, questions with content validity ratio of <0.4 and content validity index of <70% were excluded and modified. Finally, with the exclusion and modification of eight DRPs, a modified DRPs list was created. Conclusion According to the universality and validity assessment and based on consensus of 20 experts, this DRPs list can be used to regulate the standard operation procedure of outpatient clinics in Iran, and could act toward standardization of this service.
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Affiliation(s)
- Soheil Roshanzamiri
- Tutorial Pharmacy, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Kaveh Eslami
- Department of Clinical Pharmacy, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Farhad Najmeddin
- Department of Clinical Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Mandana Izadpanah
- Department of Clinical Pharmacy, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Elham Hadidi
- 13-Aban Pharmacotherapy Clinic, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Ganji
- Department of Clinical Pharmacy, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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MacKeigan LD, Dolovich L, Petrovic B, MacCallum L, Bojarski EA, Pojskic N. Audit of community pharmacists' prescribing interventions: Quality assessment of a newly reimbursed service. J Am Pharm Assoc (2003) 2018; 58:622-629. [PMID: 30190200 DOI: 10.1016/j.japh.2018.07.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 06/07/2018] [Accepted: 07/17/2018] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To evaluate community pharmacists' reimbursed prescribing interventions (called pharmaceutical opinions/POs in Canada) by determining the types of drug-related problems (DRPs) identified; the type, quality, and clinical impact of recommendations made; and variation in recommendation quality across regions, pharmacy ownership type, and pharmacy size. DESIGN Retrospective audit of randomly sampled service documentation records. SETTING Community pharmacies in Ontario, Canada, 3 years after implementation of a government program that reimburses pharmacies for providing DRP-based POs to physicians. PARTICIPANTS Thirty-six community pharmacies in 4 regions of Ontario. MAIN OUTCOME MEASURES For each PO, 2 experienced clinical pharmacists independently, and then by consensus, determined the primary drug implicated and its therapeutic category, the type of DRP, and the type of prescriber recommendation. Each PO recommendation was assessed for clinical impact, evidence base, and overall quality. Chi-square analyses assessed the relationship between PO quality and pharmacy characteristics. RESULTS Of 563 POs, 261 (46%) met reimbursement criteria for stating a DRP and prescriber recommendation. Among these eligible POs, systemic antiinfective (22%), alimentary tract and metabolism (19%), nervous system (15%), and cardiovascular (15%) drugs were most commonly identified in the DRP. Adverse drug reactions (which included drug interactions) were the most common type of DRP (42.5%), followed by "dose too high" (16%) and "needs additional therapy" (14%). Top recommendations were to change the drug (41%) and to decrease the dose (20%). The quality of the pharmacist's recommendation was judged to be good to excellent in 70% of the 261 eligible POs; quality was associated with region and ownership type. CONCLUSION PO quality was suboptimal: the primary issue was failure to state a prescriber recommendation. Collaborative efforts are needed from community pharmacy stakeholders (schools of pharmacy, regulatory colleges, and continuing education providers) to help pharmacists enhance the quality of their POs, beginning with their clinical documentation skills.
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Nuffer W, Harmon C, Dye L, Nishiyama M. A novel advanced pharmacy practice experience training model focused on medication therapy management delivery within provider offices. CURRENTS IN PHARMACY TEACHING & LEARNING 2018; 10:1288-1294. [PMID: 30497633 DOI: 10.1016/j.cptl.2018.06.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 04/02/2018] [Accepted: 06/08/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND AND PURPOSE Pharmacist-delivered medication therapy management (MTM) services are an important part of practice, and students should be trained in MTM provision. Current MTM utilization falls short of the potential benefits that pharmacists could provide, and there are barriers to successful MTM completion. New MTM models need to be explored to demonstrate the pharmacist's role on the medical team and to provide models for cost saving to insurers. EDUCATIONAL ACTIVITY AND SETTING This manuscript describes a novel grant-funded MTM model supported by fourth year pharmacy students in partnership with several medical clinics. Qualifying patients receive MTM services in the provider office. Students are responsible for maintaining day-to-day operations of the MTM program. FINDINGS Twe pharmacy students completed their MTM training through this model between April 2016 and September 2017. 123 patients received MTM services, with the average time spent with patients estimated at 41 min. A total of 238 patient encounters were provided. Poor adherence, inappropriate drug dose/dosage form or frequency, and patient side effects were the most common problems addressed. Students reported high satisfaction with this model. DISCUSSION Providing MTM services, directly in the medical clinic, represents an innovative model of care where students have multiple interprofessional interactions. The extended period of time spent with patients is not supported by reimbursement rates, suggesting an expansion may be appropriate. Further cost analyses and health outcomes need to be collected to justify this increased expense. SUMMARY This MTM model represents an important alternative to current practice and promotes interprofessional collaboration.
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Affiliation(s)
- Wesley Nuffer
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy & Pharmaceutical Sciences, 12850 E Montview Blvd., C238-V20-1116J, Aurora, CO 80045, United States.
| | - Christy Harmon
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy & Pharmaceutical Sciences, 12850 E Montview Blvd., C238-V20-1116J, Aurora, CO 80045, United States.
| | - Leigh Dye
- Contract Public Health Pharmacist with Tri-County Health Department, 4857 S Broadway, Englewood, CO 80113, United States.
| | - Masayo Nishiyama
- Tri-County Health Department, 15400 E. 14th Place, Suite 115, Aurora, CO 80011, United States.
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Taylor AM, Axon DR, Campbell P, Fair MK, Nelson M, Boesen K, Martin R, Warholak TL. What Patients Know About Services to Help Manage Chronic Diseases and Medications: Findings from Focus Groups on Medication Therapy Management. J Manag Care Spec Pharm 2018; 24:904-910. [PMID: 30156456 PMCID: PMC10398267 DOI: 10.18553/jmcp.2018.24.9.904] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Managing and treating patients with multiple chronic conditions presents challenges on many levels. Pharmacist-delivered medication therapy management (MTM) services, mandated as part of the Medicare Part D drug benefit, are designed to help patients manage their chronic conditions and medications. OBJECTIVE To identify factors that influence patient understanding and use of MTM services and potential strategies to educate individuals about MTM. METHODS Participants who had at least 2 chronic conditions, were taking 2 or more prescription medications, and were aged 18 years or older were recruited from community-based settings to participate in focus groups. The focus groups aimed to identify participants' perceptions and use of MTM services, barriers and facilitators to utilization, and medication problems. Participants were asked to complete a 14-item health care questionnaire and view a brief, 3-minute video introducing the topic of MTM before the group discussion. The health care questionnaire data were analyzed in Microsoft Excel. The focus group responses were transcribed and entered into the computer program ATLAS.ti for thematic analysis. Two independent reviewers qualitatively coded the discussion question responses; a third reviewer investigated discrepancies and facilitated consensus among the reviewers. RESULTS Participants (N = 27) were mostly female (70.4%), college educated (62.9%), and had Medicare insurance (81.5%). Seven themes were identified: (1) new proposed names for MTM, (2) mechanisms to gain interest in and to promote the value of MTM, (3) familiarity with MTM, (4) pharmacists' training and expertise in MTM, (5) experience with MTM, (6) reasons for nonparticipation in MTM, and (7) preferred method to learn about MTM. Participants did not understand the term "medication therapy management" and felt the interpretation of "therapy"' differed between health care professionals and the public. Some participants used MTM services to learn about appropriate use of their medications, while others were unsure about their eligibility, associated costs, and how to access the services. Participants had limited pharmaceutical knowledge but felt pharmacist-provided MTM services were helpful. Participants were unfamiliar with pharmacists' skills and training. Participants' experiences with MTM services ranged from disregarding the invitation to participate to having pharmacists identify drug-drug interactions. Reasons for nonparticipation in MTM services included being unaware of their eligibility, failing to read excessive information from insurance companies, and being uncertain of the identity of the telephone caller. Preferred methods for learning more about MTM services included the Internet, e-mail, information availability at physician's office, and television advertisements. CONCLUSIONS These results suggest that the lay public remains largely unaware of MTM services and that the term "MTM" is not well understood. Clearly, tailored public health campaigns and patient engagement strategies are needed to promote MTM in chronic disease management, pharmacists as respected providers, and the importance of the prescriber-MTM pharmacist collaborative relationship in managing medications for patients with multiple chronic conditions. DISCLOSURES Grant funding from SinfoniaRx to Taylor, Axon, Campbell, Fair, and Warholak was used to help conduct this project. Boesen is employed by SinfoniaRx. The other authors have nothing to disclose. This original research was presented as a poster at the Academy of Managed Care Pharmacy 27th Annual Meeting and Expo; April 7-10, 2015; San Diego, CA.
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Affiliation(s)
- Ann M Taylor
- 1 University of Arizona College of Pharmacy, Tucson
| | | | | | | | | | | | - Rose Martin
- 2 Medication Management Center, University of Arizona College of Pharmacy, Tucson
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Rose O, Richling I, Voigt K, Gottschall M, Köberlein-Neu J. Patient selection and general practitioners' perception of collaboration in medication review. Res Social Adm Pharm 2018; 15:521-527. [PMID: 30139537 DOI: 10.1016/j.sapharm.2018.06.019] [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] [Received: 09/26/2017] [Revised: 06/19/2018] [Accepted: 06/28/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Implementation of collaborative Medication Review (MR) into routine care faces several barriers. OBJECTIVE The study aim was to gain information on patient selection for a MR by general practitioners (GPs). GP selection was compared to objective selection criteria on identifying patients, who would benefit from a MR the most. A secondary objective of this study was to get insight into GPs perception on interprofessional collaboration with pharmacists. METHODS GPs were interviewed for a qualitative study on expected outcomes of MR in former study patients. They were asked to select patients, for whom they expected a major benefit from the MR. Results were compared to objective selection criteria, obtained from the WestGem study. Further interviews were done on aspects of patient selection and perception of interprofessional collaboration, results were presented descriptively. RESULTS The study covered 6 GPs with 78 former study patients. GPs would have chosen 45 out of the 78 patients (57.7%) for a MR. According to changes in the Medication Appropriateness Index, 24 of these patients had a greater benefit from the MR. Patient selection by the number of prescribed drugs had reached a higher specificity at a cut-off of 9 drugs, compared to selection by the GP (67% vs. 61.5%). GPs mentioned medication safety, certain diseases, polymedication, multimorbidity as selection criteria. Increasing quality of therapy and better insight into the patient's drug regimen was appreciated by the GPs as perceived personal advantage of the MR. GPs preferred to have a MR initiated by themselves, but appraised concise interprofessional collaboration with pharmacists. CONCLUSIONS Patient selection for MR should take objective parameters into account and combine them with subjective impressions. GPs preferred the initiation of a MR by themselves but expressed a positive attitude towards collaboration with a pharmacist afterwards. Recommendations should be relevant and concise.
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Affiliation(s)
- Olaf Rose
- College of Pharmacy, Department of Pharmacotherapy & Translational Research, College of Pharmacy, University of Florida, USA.
| | - Ina Richling
- College of Pharmacy, Department of Pharmacotherapy & Translational Research, College of Pharmacy, University of Florida, USA
| | - Karen Voigt
- Department of General Practice/Medical Clinic III, Medical School, Technische Universität Dresden, Dresden, Germany
| | - Mandy Gottschall
- Department of General Practice/Medical Clinic III, Medical School, Technische Universität Dresden, Dresden, Germany
| | - Juliane Köberlein-Neu
- Center for Health Economics and Health Services Research, Schumpeter School of Business and Economics, University of Wuppertal, Germany
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Abstract
With a growing aging population, the appropriate, effective, and safe use of medicines is a global health policy priority. One concern is patients' non-adherence to medicines, which is estimated to be up to 50%. Policymakers seek to reconfigure medicine management services and consider community pharmacy as especially well-placed to improve medicine use. In England and Wales, a commissioned medication review service called "Medicines Use Reviews (MURs)" was made available in through the National Health Service (NHS) in 2005. This involves a patient-pharmacist consultation to improve patients' knowledge and the use of medicines and to help reduce avoidable waste. However, over a decade since their introduction, questions remain over the extent to which the MUR policy has successfully been embedded in practice and translated into more effective use of medicines. The MUR intervention continues to hold many challenges ranging from poor public awareness and acceptance of MURs, organizational constraints, and issues over interprofessional collaboration. Many of these challenges are not exclusive to the MUR service, or even to the community pharmacy setting. Nevertheless, by identifying and exposing such challenges, an opportunity exists for policymakers and commissioners to seek to improve this service to patients. This narrative review explores the current challenges that face MURs. Damschroder et al's consolidated framework for implementation research is employed to help organize these challenges from patient and professional perspectives across multiple contexts. Over the past decade, MUR policy and practice has continued to evolve, being shaped by research, organizational and professional influences, and policy. Reforms to the service suggest that the MURs are becoming more responsive to patients' need and preferences. It is intended that this review will create impetus and scope for further debate, service reconfiguration, and ultimately service improvement.
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Affiliation(s)
- Asam Latif
- School of Health Sciences, Queen's Medical Centre, The University of Nottingham, Nottingham, UK,
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Latif A, Mandane B, Anderson E, Barraclough C, Travis S. Optimizing medicine use for people who are homebound: an evaluation of a pilot domiciliary Medicine Use Review (dMUR) service in England. INTEGRATED PHARMACY RESEARCH AND PRACTICE 2018; 7:33-40. [PMID: 29765871 PMCID: PMC5942398 DOI: 10.2147/iprp.s160149] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background As global life expectancy increases, older people with chronic diseases are being required to manage multiple and complex medicine regimes. However, polypharmacy raises the risk of medicine-related problems and preventable hospital admissions. To improve medicine use, English community pharmacies are commissioned to deliver Medicines Use Reviews (MURs), which are typically delivered from the pharmacy. People who are homebound rarely receive the service. This paper describes the uptake and impact of a pilot project that seeks to provide domiciliary Medicines Use Reviews (dMURs). Methods Participating pharmacists collected data on their dMUR activity over a 12-month period. Outcome measures (eg, adherence, side-effects, pharmacist assessment of preventable hospital admissions) were recorded. Pharmacists were also invited to submit written testimonies of their experiences of undertaking dMURs. Results Out of 433 possible pharmacies eligible to take part in the pilot, 186 pharmacies expressed an interest, and 91 actively engaged in providing the dMUR service. The total number of dMURs performed were 1092 (mean number performed by each pharmacy was 12). Two thirds of patients reported problems and concerns about side-effects and missed doses regarding their medicines. Pharmacists’ assessment to prevent hospital admissions found that over one-third of the dMURs had contributed towards preventing either a possible or likely emergency hospital admission. Twelve pharmacists’ testimonies were submitted providing context of the problems patients faced with medicines. Discussion dMURs are feasible and improve patient medicines use. The results indicate that dMUR potentially prevents hospital admissions and readmissions. dMURs offer an opportunity to support the self-care agenda and ensure homebound patients can successfully manage their medicines.
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Affiliation(s)
- Asam Latif
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | | | - Emma Anderson
- Centre for Pharmacy Postgraduate Education, The University of Manchester, Manchester, UK
| | - Caroline Barraclough
- Centre for Pharmacy Postgraduate Education, The University of Manchester, Manchester, UK
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Erzkamp S, Rose O. Development and evaluation of an algorithm-based tool for Medication Management in nursing homes: the AMBER study protocol. BMJ Open 2018; 8:e019398. [PMID: 29678967 PMCID: PMC5914904 DOI: 10.1136/bmjopen-2017-019398] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Residents of nursing homes are susceptible to risks from medication. Medication Reviews (MR) can increase clinical outcomes and the quality of medication therapy. Limited resources and barriers between healthcare practitioners are potential obstructions to performing MR in nursing homes. Focusing on frequent and relevant problems can support pharmacists in the provision of pharmaceutical care services. This study aims to develop and evaluate an algorithm-based tool that facilitates the provision of Medication Management in clinical practice. METHODS AND ANALYSIS This study is subdivided into three phases. In phase I, semistructured interviews with healthcare practitioners and patients will be performed, and a mixed methods approach will be chosen. Qualitative content analysis and the rating of the aspects concerning the frequency and relevance of problems in the medication process in nursing homes will be performed. In phase II, a systematic review of the current literature on problems and interventions will be conducted. The findings will be narratively presented. The results of both phases will be combined to develop an algorithm for MRs. For further refinement of the aspects detected, a Delphi survey will be conducted. In conclusion, a tool for clinical practice will be created. In phase III, the tool will be tested on MRs in nursing homes. In addition, effectiveness, acceptance, feasibility and reproducibility will be assessed. The primary outcome of phase III will be the reduction of drug-related problems (DRPs), which will be detected using the tool. The secondary outcomes will be the proportion of DRPs, the acceptance of pharmaceutical recommendations and the expenditure of time using the tool and inter-rater reliability. ETHICS AND DISSEMINATION This study intervention is approved by the local Ethics Committee. The findings of the study will be presented at national and international scientific conferences and will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER DRKS00010995.
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Affiliation(s)
| | - Olaf Rose
- Elefanten-Apotheke, gegr. 1575, Steinfurt, Germany
- Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, Gainesville, Florida, USA
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Lengel M, Kuhn CH, Worley M, Wehr AM, McAuley JW. Pharmacy technician involvement in community pharmacy medication therapy management. J Am Pharm Assoc (2003) 2018; 58:179-185.e2. [DOI: 10.1016/j.japh.2017.12.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 12/12/2017] [Accepted: 12/22/2017] [Indexed: 11/30/2022]
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Köberlein-Neu J, Mennemann H, Hamacher S, Waltering I, Jaehde U, Schaffert C, Rose O. Interprofessional Medication Management in Patients With Multiple Morbidities. DEUTSCHES ARZTEBLATT INTERNATIONAL 2018; 113:741-748. [PMID: 27890050 DOI: 10.3238/arztebl.2016.0741] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 03/24/2016] [Accepted: 08/22/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND Medication reviews and medication management are being used more and more around the world to improve medication safety. Both of these tools were originally conceived as pharmaceutical care activities and have recently been developed into interdisciplinary approaches. We studied the efficacy of interprofessional medication management for multimorbid patients that takes their medical conditions, but also their general living situation into account. METHODS A comprehensive medication management was performed, which involved the collection of information on the drugs each patient took, the way they were stored, the patient's drug intake and handling, and any problems that arose with pharmacotherapy. The interventional approach was evaluated over a period of 15 months in a cluster-randomized controlled trial with a stepped wedge design. The primary endpoint was the quality of pharmacotherapy, as assessed with the Medication Appropriateness Index (MAI). A mixed model was used to analyze efficacy. RESULTS 162 patients were enrolled in the study; 142 were included in the intention-to-treat analysis (53.3% women, mean age 76.8 ± 6.3 years). The mean total MAI score decreased significantly (p ≤ 0.001) from the control phase (29.21, 95% CI [26.09; 32.33]) to the intervention phase (22.27 [19.00; 25.54]), with an effect strength (Cohen's d) of -0.24 [-0.36; -0.13]. The number of drug-related problems declined as well. CONCLUSION In this study, interprofessional collaboration increased medication safety. Working across disciplinary boundaries allowed for a decrease in drugrelated problems and brought up aspects outside the purview of the primary care physician.
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Affiliation(s)
- Juliane Köberlein-Neu
- Center for Health Economics and Health Services Research, Schumpeter School of Business and Economics, University of Wuppertal; Department of Social Work, M¨nster University of Applied Sciences; Institute of Medical Statistics, Informatics and Epidemiology, University of Cologne; Department of Pharmaceutical and Medicinal Chemistry, University of M¨nster; Clinical Pharmacy, Institute of Pharmacy, University of Bonn, Bonn, Germany
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Vande Griend JP, Rodgers M, Nuffer W. Effect of an Advanced Pharmacy Practice Experience on Medication Therapy Management Services in a Centralized Retail Pharmacy Program. J Manag Care Spec Pharm 2018; 23:561-565. [PMID: 28448777 PMCID: PMC10398193 DOI: 10.18553/jmcp.2017.23.5.561] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Medication therapy management (MTM) delivery is increasingly important in managed care. Successful delivery positively affects patient health and improves Centers for Medicare & Medicaid Services star ratings, a measure of health plan quality. As MTM services continue to grow, there is an increased need for efficient and effective care models. The primary objectives of this project were to describe the delivery of MTM services by fourth-year Advanced Pharmacy Practice Experience (APPE) students in a centralized retail pharmacy system and to evaluate and quantify the clinical and financial contributions of the students. The secondary objective was to describe the engagement needed to complete comprehensive medication reviews (CMRs) and targeted interventions. PROGRAM DESCRIPTION From May 2015 to December 2015, thirty-five APPE students from the University of Colorado Skaggs School of Pharmacy provided MTM services at Albertsons Companies using the OutcomesMTM and Mirixa platforms. Students delivered patient care services by phone at the central office and provided face-to-face visits at pharmacies in the region. With implementation of the MTM APPE in 2015, the team consisted of 2 MTM pharmacists and pharmacy students, as compared with 1 MTM pharmacist in 2014. The number of CMRs and targeted interventions completed and the estimated additional revenue generated during the 2015 time period were compared with those completed from May through December 2014. The patient and provider engagement needed to complete the CMRs and targeted interventions was summarized. OBSERVATIONS 125 CMRs and 1,918 targeted interventions were billed in 2015, compared with 13 CMRs and 767 targeted interventions in 2014. An estimated $16,575-$49,272 of additional revenue was generated in 2015. To complete the interventions in 2015, the team engaged in 1,714 CMR opportunities and 4,686 targeted intervention opportunities. IMPLICATIONS/RECOMMENDATIONS In this MTM rotation, students provided real-life care to patients, resulting in financial and clinical contributions. This model of education and care delivery can be replicated in the community pharmacy or managed care setting. APPE students are an important component of this model of care delivery, particularly when considering the level of patient engagement needed to complete MTM interventions. DISCLOSURES No outside funding supported this research. The authors have no conflicts of interest to disclose related to this work. All authors contributed to study concept and design. Rodgers collected the data, and data interpretation was performed by Vande Griend, along with Rodgers and Nuffer. The manuscript was written and revised primarily by Vande Griend, along with Nuffer and Rodgers. This project was presented at the Pharmacy Quality Alliance Annual Meeting in Arlington, Virginia, in May 2016.
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Affiliation(s)
- Joseph P Vande Griend
- 1 Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, and Department of Family Medicine, University of Colorado School of Medicine, Aurora
| | - Melissa Rodgers
- 2 Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora
| | - Wesley Nuffer
- 2 Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora
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Doellner JF, Dettloff RW, DeVuyst-Miller S, Wenstrom KL. Prescriber acceptance rate of pharmacists' recommendations. J Am Pharm Assoc (2003) 2017; 57:S197-S202. [DOI: 10.1016/j.japh.2017.03.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Revised: 02/26/2017] [Accepted: 03/06/2017] [Indexed: 10/19/2022]
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Rose O, Köberlein-Neu J. In Reply. DEUTSCHES ARZTEBLATT INTERNATIONAL 2017; 114:224-225. [PMID: 28434441 PMCID: PMC5624450 DOI: 10.3238/arztebl.2017.0224b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Olaf Rose
- *Pharmazeutisches Institut Klinische Pharmazie Rheinische Friedrich-Wilhelms-Universität Bonn
| | - Juliane Köberlein-Neu
- **Bergisches Kompetenzzentrum für Gesundheitsökonomik und Versorgungsforschung Fakultät für Wirtschaftswissenschaft Bergische Universität Wuppertal
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Nuffer W, Gilliam E, Thompson M, Vande Griend J. Establishment and Implementation of a Required Medication Therapy Management Advanced Pharmacy Practice Experience. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2017; 81:36. [PMID: 28381896 PMCID: PMC5374925 DOI: 10.5688/ajpe81236] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 11/03/2016] [Indexed: 05/30/2023]
Abstract
Objective. To develop a community pharmacy-based medication therapy management (MTM) advanced pharmacy practice experience (APPE) that provides students with skills and knowledge to deliver entry-level pharmacy MTM services. Design. The University of Colorado Skaggs School of Pharmacy & Pharmaceutical Sciences (SSPPS) partnered with three community pharmacy chains to establish this three-week, required MTM APPE. Students completed the American Pharmacists Association MTM Certificate Course prior to entering the APPE. Students were expected to spend 90% or more of their time at this experience working on MTM interventions, using store MTM platforms. Assessment. All 151 students successfully completed this MTM APPE, and each received a passing evaluation from their preceptor. Preceptor evaluations of students averaged above four (entry-level practice) on a five-point Likert scale. The majority of students reported engagement in MTM services for more than 80% of the time on site. Students' self-reporting of their ability to perform MTM interventions improved after participation in the APPE. Conclusion. The SSPPS successfully implemented a required MTM APPE, preparing students for entry-level delivery of MTM services.
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Smith MG, Shea CM, Brown P, Wines K, Farley JF, Ferreri SP. Pharmacy characteristics associated with the provision of medication management services within an integrated care management program. J Am Pharm Assoc (2003) 2017; 57:217-221.e1. [DOI: 10.1016/j.japh.2016.12.073] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 12/20/2016] [Accepted: 12/20/2016] [Indexed: 11/30/2022]
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How pharmacists check the appropriateness of drug therapy? Observations in community pharmacy. Res Social Adm Pharm 2017; 13:349-357. [DOI: 10.1016/j.sapharm.2016.03.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Revised: 03/11/2016] [Accepted: 03/12/2016] [Indexed: 11/23/2022]
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Haga SB, Moaddeb J, Mills R, Voora D. Assessing feasibility of delivering pharmacogenetic testing in a community pharmacy setting. Pharmacogenomics 2017; 18:327-335. [PMID: 28244804 DOI: 10.2217/pgs-2016-0175] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
AIM To describe the rationale and design of a study evaluating the delivery of pharmacogenetic (PGx) testing in community pharmacies. Study rationale: Pharmacists have expressed interest in offering PGx testing; however, their lack of knowledge and experience, patients' acceptance and feasibility are unknown in this setting. STUDY DESIGN Through a cluster randomized trial, we will assess pharmacist and patient experiences with delivery of PGx testing as a standalone service or integrated into medication therapy management services. Anticipated results: We anticipate that PGx testing can be delivered in a community pharmacy setting and accepted and valued by patients. CONCLUSION This study is expected to provide valuable evidence about the real-world feasibility and acceptance of a community pharmacist-delivered approach of PGx testing.
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Affiliation(s)
- Susanne B Haga
- Center for Applied Genomics & Precision Medicine, Duke University School of Medicine, 304 Research Drive, Box 90141, Durham, NC 27708, USA
| | - Jivan Moaddeb
- Center for Applied Genomics & Precision Medicine, Duke University School of Medicine, 304 Research Drive, Box 90141, Durham, NC 27708, USA
| | - Rachel Mills
- Center for Applied Genomics & Precision Medicine, Duke University School of Medicine, 304 Research Drive, Box 90141, Durham, NC 27708, USA
| | - Deepak Voora
- Center for Applied Genomics & Precision Medicine, Duke University School of Medicine, 304 Research Drive, Box 90141, Durham, NC 27708, USA
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Impact of a medication therapy management service on the clinical status of patients with chronic obstructive pulmonary disease. Int J Clin Pharm 2016; 39:95-103. [DOI: 10.1007/s11096-016-0402-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 11/21/2016] [Indexed: 11/27/2022]
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