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Dohrn A, Hoskins R, Collier L, Kennelty K. Evaluation of a Telehealth-Based Pharmacist Led Chronic Care Management Program. J Pharm Pract 2024; 37:933-939. [PMID: 37595956 DOI: 10.1177/08971900231196624] [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: 08/20/2023]
Abstract
Background: Clinical pharmacy services improve several patient chronic disease outcomes. This review evaluates a pharmacist-led chronic care management (CCM) program partnered with a health system for patient outcomes and sustainability. Methods: A mixed methods evaluation based on the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework was completed. Patient A1c and blood pressure readings were retrospectively collected from the electronic health record from August 2018-April 2022. Patients that completed >4 CCM visits with a diagnosis of diabetes and/or hypertension were included. Results: 557 patients enrolled, 53 had uncontrolled systolic blood pressure (SBP), SBP >130 mmHg. Average SBP at baseline was 141.0 mmHg and average SBP at 6 months was 130.2 mmHg, (P < .001). 76 patients had uncontrolled diabetes, A1c > 7%. Average A1c at baseline = 9.1% and average A1c at 6 months = 8.3%, (P < .001). 4464 CCM visits with 247 disease-state targeted patients were completed over 44-month with a 100% adoption rate across clinic locations. Implementation facilitators included patient medication cost concerns, disease burden, provider revenue generation, CCM dedicated software, streamlined call process, and remote EMR access. Implementation barriers included provider discomfort "selling the program," potential patient costs, unclear need from patient, pharmacists not considered providers, pharmacist cost, multi-platform software, reprioritized stakeholder support, and lack of partner site diversification. Program maintenance showed revenue generation was $5925.31-$8879.89 from August 2021-May 2022 and profitability was $3385.61-$1614.23. Conclusion: This study provides lessons learned, strategies for implementation, and ideas for process efficiencies leading to maintenance of a telehealth pharmacist-led CCM service.
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Affiliation(s)
- Ashley Dohrn
- The University of Iowa College of Pharmacy, Iowa City, IA USA
| | - Rachel Hoskins
- The University of Iowa College of Pharmacy, Iowa City, IA USA
| | - Lauren Collier
- The University of Iowa College of Pharmacy, Iowa City, IA USA
| | - Korey Kennelty
- The University of Iowa College of Pharmacy, Iowa City, IA USA
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Sun Q, Wang Y, Wang P, Huang Y, Xi X. Residents Preferences for Pharmacist-Managed Clinic in China: A Discrete Choice Experiment. Patient Prefer Adherence 2024; 18:1409-1422. [PMID: 38978750 PMCID: PMC11228533 DOI: 10.2147/ppa.s457655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 06/14/2024] [Indexed: 07/10/2024] Open
Abstract
Purpose This study aimed to survey and analyze the preferences for pharmacist-managed clinic among urban residents in China. Materials and Methods A discrete choice experiment was conducted in Nanjing, China. A D-efficient fractional factorial design was used to generate the questionnaire. Three models were used to investigate each patient's strength of preference and preference heterogeneity. The relative importance for each treatment attribute was also determined. Results 156 usable questionnaires (of 228 questionnaires sent out) were received. Respondents preferred pharmacist-managed clinics with the following characteristics: good pharmacists' knowledge and clinical medication practice competency, lower consultation fees, a dedicated consultation room, physician-pharmacist joint clinic, with pharmacists' knowledge competency receiving the highest priority. Latent class analysis revealed three classes (Experiential Type, Content Type and Economic Type) were identified based on respondents' preferences for pharmacist-managed clinics. Conclusion The respondents were willing to choose a PMC relative to the current situation. When deciding on a pharmacist-managed clinic, residents are driven by pharmacists' competency, consultation fee, availability of consultation rooms and collaborative care or independent pharmacist service. Differences in patients' preferences identified in the study provide information on pharmacist-managed clinics that meet residents' expectations.
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Affiliation(s)
- Qingran Sun
- National Medical Products Administration Key Laboratory for Drug Regulatory Innovation and Evaluation, China Pharmaceutical University, Nanjing, Jiangsu Province, People’s Republic of China
| | - Yi Wang
- National Medical Products Administration Key Laboratory for Drug Regulatory Innovation and Evaluation, China Pharmaceutical University, Nanjing, Jiangsu Province, People’s Republic of China
| | - Pei Wang
- National Medical Products Administration Key Laboratory for Drug Regulatory Innovation and Evaluation, China Pharmaceutical University, Nanjing, Jiangsu Province, People’s Republic of China
| | - Yuankai Huang
- National Medical Products Administration Key Laboratory for Drug Regulatory Innovation and Evaluation, China Pharmaceutical University, Nanjing, Jiangsu Province, People’s Republic of China
| | - Xiaoyu Xi
- National Medical Products Administration Key Laboratory for Drug Regulatory Innovation and Evaluation, China Pharmaceutical University, Nanjing, Jiangsu Province, People’s Republic of China
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Hayashi D, Kubota Y, Nishino T, Watanabe Y, Iwade Y, Matsuda J, Kato K, Tara S, Ise Y, Iwasaki YK, Asai K. Impact of polypharmacy on 3-year mortality in patients with heart failure: a retrospective study. J Pharm Health Care Sci 2024; 10:34. [PMID: 38956739 PMCID: PMC11221177 DOI: 10.1186/s40780-024-00357-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Accepted: 06/25/2024] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND Guideline-directed medical therapy (GDMT) is important in heart failure management; however, polypharmacy itself may impact heart failure. Although measures against polypharmacy are needed, current discussion on unilateral drug tapering (including the drugs that should be tapered) is insufficient. In this study, we investigated the relationship between the number of prescribed GDMT drugs and prognosis in patients with heart failure. METHODS In this single-centre retrospective study, 3,146 eligible patients with heart failure were included and divided into four groups based on the median number of prescribed GDMT drugs and the median number of drugs not included in the GDMT (ni-GDMT) at the time of hospital discharge. The definition of GDMT was based on various Japanese guidelines. The primary outcome was all-cause mortality within 3 years of hospital discharge. RESULTS A total of 252 deaths were observed during the 3-year follow-up period. Kaplan-Meier analysis revealed that groups with GDMT drug count ≥ 5 and ni-GDMT drug count < 4 had the lowest mortality, and those with GDMT drug count < 5 and ni-GDMT drug count ≥ 4 had the highest mortality (log-rank, P < 0.001). Cox regression analysis revealed a significant association between ni-GDMT drug count and all-cause mortality, even after adjustment for number of GDMT medications, age, male, left ventricular ejection function < 40%, hemoglobin, albumin levels, and estimated glomerular filtration rate [HR = 1.06 (95% CI: 1.01-1.11), P = 0.020]. Conversely, the GDMT drug count was not associated with increased mortality rates. CONCLUSIONS The ni-GDMT drug count was significantly associated with 3-year mortality in patients with heart failure. Conversely, the GDMT drug count did not worsen the prognosis. Polypharmacy measures should consider ni-GDMT drug quantity to improve the prognosis and outcomes in patients with heart failure.
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Affiliation(s)
- Daisuke Hayashi
- Department of Pharmaceutical Service, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan
| | - Yoshiaki Kubota
- Department of Cardiovascular Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan.
| | - Takuya Nishino
- Department of Health Care Administration, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan
| | - Yukihiro Watanabe
- Department of Cardiovascular Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan
| | - Yoshiki Iwade
- Department of Pharmaceutical Service, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan
| | - Junya Matsuda
- Department of Cardiovascular Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan
| | - Katsuhito Kato
- Department of Hygiene and Public Health, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan
| | - Shuhei Tara
- Department of Cardiovascular Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan
| | - Yuya Ise
- Department of Pharmaceutical Service, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan
| | - Yu-Ki Iwasaki
- Department of Cardiovascular Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan
| | - Kuniya Asai
- Department of Cardiovascular Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan
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Lum ZK, Tan JY, Wong CSM, Kok ZY, Kwek SC, Tsou KYK, Gallagher PJ, Lee JYC. Reducing economic burden through split-shared care model for people living with uncontrolled type 2 diabetes and polypharmacy: a multi-center randomized controlled trial. BMC Health Serv Res 2024; 24:760. [PMID: 38907254 PMCID: PMC11193226 DOI: 10.1186/s12913-024-11199-2] [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: 01/24/2024] [Accepted: 06/12/2024] [Indexed: 06/23/2024] Open
Abstract
BACKGROUND Interprofessional collaborative care such as a split-shared care model involving family physicians and community pharmacists can reduce the economic burden of diabetes management. This study aimed to evaluate the economic outcome of a split-shared care model between family physicians and community pharmacists within a pharmacy chain in managing people with uncontrolled type 2 diabetes and polypharmacy. METHOD This was a multi-center, parallel arm, open label, randomized controlled trial comparing the direct and indirect economic outcomes of people who received collaborative care involving community pharmacists (intervention) versus those who received usual care without community pharmacist involvement (control). People with uncontrolled type 2 diabetes, defined as HbA1c > 7.0% and taking ≥ 5 chronic medications were included while people with missing baseline economic data (such as consultation costs, medication costs) were excluded. Direct medical costs were extracted from the institution's financial database while indirect costs were calculated from self-reported gross income and productivity loss, using Work Productivity Activity Impairment Global Health questionnaire. Separate generalized linear models with log link function and gamma distribution were used to analyze changes in direct and indirect medical costs. RESULTS A total of 175 patients (intervention = 70, control = 105) completed the trial and were included for analysis. The mean age of the participants was 66.9 (9.2) years, with majority being male and Chinese. The direct medical costs were significantly lower in the intervention than the control group over 6 months (intervention: -US$70.51, control: -US$47.66, p < 0.001). Medication cost was the main driver in both groups. There were no significant changes in productivity loss and indirect costs in both groups. CONCLUSION Implementation of split-shared visits with frontline community partners may reduce economic burden for patient with uncontrolled type 2 diabetes and polypharmacy. TRIAL REGISTRATION Clinicaltrials.gov Reference Number: NCT03531944 (Date of registration: June 6, 2018).
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Affiliation(s)
- Zheng Kang Lum
- Department of Pharmacy and Pharmaceutical Sciences, Faculty of Science, MD1, Tahir Foundation Building, National University of Singapore, 12 Science Drive #06-03, Singapore, 117549, Singapore
| | - Jia Yeong Tan
- Keat Hong Family Medicine Clinic, Trilink Healthcare Private Limited, 2 Choa Chu Kang Loop, Singapore, #03-02, Singapore
| | - Cynthia Sze Mun Wong
- Bukit Batok Polyclinic, National University Polyclinics, 50 Bukit Batok West Ave 3, Singapore, 659164, Singapore
| | - Zi Yin Kok
- Keat Hong Family Medicine Clinic, Trilink Healthcare Private Limited, 2 Choa Chu Kang Loop, Singapore, #03-02, Singapore
| | - Sing Cheer Kwek
- Bukit Batok Polyclinic, National University Polyclinics, 50 Bukit Batok West Ave 3, Singapore, 659164, Singapore
| | - Keith Yu Kei Tsou
- Bukit Batok Polyclinic, National University Polyclinics, 50 Bukit Batok West Ave 3, Singapore, 659164, Singapore
| | - Paul John Gallagher
- Department of Pharmacy and Pharmaceutical Sciences, Faculty of Science, MD1, Tahir Foundation Building, National University of Singapore, 12 Science Drive #06-03, Singapore, 117549, Singapore.
| | - Joyce Yu-Chia Lee
- Department of Clinical Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, University of California, 101 Theory, Suite 100, Irvine, CA, 92697, USA.
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Freitag M, Franzen J, Just KS, Eisert A, Bollheimer LC, Laurentius T. Pharmacist-Led Medication Management in Acute Geriatric Medicine and Its Associations with Rehospitalizations: A Cohort Study. Gerontology 2024; 70:914-929. [PMID: 38897188 DOI: 10.1159/000539710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 05/29/2024] [Indexed: 06/21/2024] Open
Abstract
INTRODUCTION Hospitalization and discharge in older patients are critical and clinical pharmacists have shown to ameliorate risks. Our objective was to assess their benefit as part of the geriatric team regarding rehospitalizations and related outcomes after discharge focusing on general practitioners' decision to continue or change discharge medication (GPD). METHODS Prospective implementation study with 6-month follow-up in an acute geriatric clinic. Patients ≥70 years with comorbidities, impairments, and a current drug therapy were consecutively assigned to three groups: control group (CG), implementation group (IG), and wash-out group (WG). CG only received medication reconciliation (MR) at admission; IG and their hospital physicians received a pharmaceutical counseling and medication management; during WG, pharmaceutical counseling except for MR was discontinued. We used a negative-binomial model to calculate rehospitalizations and days spent at home as well as a recurrent events survival model to investigate recurrent rehospitalizations. RESULTS One hundred thirty-two patients (mean age 82 years, 76 women [57.6%]) finished the project. In most of the models for rehospitalizations, a positive GPD led to fewer events. We also found an effect of pharmaceutical counseling on rehospitalizations and recurrent rehospitalizations in the CG versus WG but not in the CG versus IG models. 95.3% of medication recommendations by the pharmacist in the clinic setting were accepted. While the number of positive GPDs in CG was low (38%), pharmaceutical counseling directly to the GP in IG led to a higher number of positive GPDs (60%). DISCUSSION Although rehospitalizations were not directly reduced by our intervention in the CG versus IG, the pharmacist's acceptance rate in the hospital was very high and a positive GPD led to fewer rehospitalization in most models.
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Affiliation(s)
- Mathias Freitag
- Department of Geriatric Medicine (Medical Clinic VI), Uniklinik RWTH Aachen, Aachen, Germany
- Hospital Pharmacy, Uniklinik RWTH Aachen, Aachen, Germany
| | - Julia Franzen
- Bioinformatics Service, Pryzen UG, Stolberg, Germany
| | - Katja Susanne Just
- Institute of Clinical Pharmacology, Uniklinik RWTH Aachen, Aachen, Germany
| | - Albrecht Eisert
- Hospital Pharmacy, Uniklinik RWTH Aachen, Aachen, Germany
- Institute of Clinical Pharmacology, Uniklinik RWTH Aachen, Aachen, Germany
| | | | - Thea Laurentius
- Department of Geriatric Medicine (Medical Clinic VI), Uniklinik RWTH Aachen, Aachen, Germany
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Xiao J, Huang S, Wang Q, Tan S, Chen L, Yuan H, Xiang D, Zhang B, Li X, Guo Y, Huang H, Li Q, Liao Y, Tan Y, Cheng Y, Lu H, Xu P. Sustainable Implementation of Physician-Pharmacist Collaborative Clinics for Diabetes Management in Primary Healthcare Centers: A Qualitative Study. J Epidemiol Glob Health 2024:10.1007/s44197-024-00244-2. [PMID: 38780894 DOI: 10.1007/s44197-024-00244-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 05/12/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Although physician-pharmacist collaborative clinics for diabetes management have been shown to be effective and cost-effective worldwide, there is limited understanding of the factors that influence their sustainable implementation. This study aims to identify the associated factors and provide sustainability strategy to better implement physician-pharmacist collaborative clinics for diabetes management in primary healthcare centers in China. METHODS A sample of 43 participants were participated in face-to-face, in-depth, semi-structured interviews. Consolidated Framework for Implementation Research was used to identify facilitators and barriers to implementing physician-pharmacist collaborative clinics for diabetes management in primary healthcare centers, and to explore discriminating factors between low and high implementation units. A sustainable strategy repository based on dynamic sustainability framework was established to inform further implementation. RESULTS This study demonstrated that clear recognition of intervention benefits, urgent needs of patients, adaptive and tailored plan, highly collaborative teamwork and leadership support were the major facilitators, while the major barriers included process complexity, large number and poor health literacy of patients in primary areas, inappropriate staffing arrangements, weak financial incentives and inadequate staff competencies. Six constructs were identified to distinguish between high and low implementation units. Sixteen strategies were developed to foster the implementation of physician-pharmacist collaborative clinics, targeting Intervention, Practice setting, and Ecological system. CONCLUSION This qualitative study demonstrated facilitators and barriers to implementing physician-pharmacist collaborative clinics for diabetes management in primary healthcare centers and developed theory-based strategies for further promotion, which has the potential to improve the management of diabetes and other chronic diseases in under-resourced areas.
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Affiliation(s)
- Jie Xiao
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, CN, China
- Institute of Clinical Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, CN, China
| | - Shuting Huang
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, CN, China
- Institute of Clinical Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, CN, China
| | - Qing Wang
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, CN, China
- Institute of Clinical Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, CN, China
| | - Shenglan Tan
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, CN, China
- Institute of Clinical Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, CN, China
| | - Lei Chen
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, CN, China
- Institute of Clinical Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, CN, China
| | - Haiyan Yuan
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, CN, China
- Institute of Clinical Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, CN, China
| | - Daxiong Xiang
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, CN, China
- Institute of Clinical Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, CN, China
| | - Bikui Zhang
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, CN, China
- Institute of Clinical Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, CN, China
| | - Xia Li
- Department of Endocrine, The Second Xiangya Hospital, Central South University, Changsha, CN, China
| | - Yan Guo
- Department of Pharmacy, Taoyuan People's Hospital, Changde, CN, China
| | - Haiying Huang
- Department of Pharmacy, The People's Hospital of Liuyang, Changsha, CN, China
| | - Qun Li
- Department of Pharmacy, The Second People's Hospital of Huaihua, Huaihua, CN, China
| | - Yaqi Liao
- Department of Pharmacy, Taoyuan People's Hospital, Changde, CN, China
| | - Yuhan Tan
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, CN, China
- Institute of Clinical Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, CN, China
| | - Yining Cheng
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, CN, China
- Institute of Clinical Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, CN, China
| | - Hao Lu
- Intemed Hospital Management & Development (Beijing) Centre, Beijing, CN, China
| | - Ping Xu
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, CN, China.
- Institute of Clinical Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, CN, China.
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Angibaud M, Jourdain M, Girard S, Rouxel L, Mouhib A, Nogueira A, Rat C, Huon JF. Involving community pharmacists in interprofessional collaboration in primary care: a systematic review. BMC PRIMARY CARE 2024; 25:103. [PMID: 38561676 PMCID: PMC10983710 DOI: 10.1186/s12875-024-02326-3] [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: 05/04/2023] [Accepted: 02/28/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND The World Health Organization supports interprofessional collaboration in primary care. On over the past 20 years, community pharmacists had been taking a growing number of new responsibilities and they are recognized as a core member of collaborative care teams as patient-centered care providers. This systematic review aimed to describe interprofessional collaboration in primary care involving a pharmacist, and its effect on patient related outcomes. METHODS A systematic review of randomized controlled trials cited in the MEDLINE, EMBASE, PsycInfo and CINAHL in English and French was conducted from inception to November 2022. Studies were included if they described an intervention piloted by a primary care provider and included a pharmacist and if they evaluated the effects of intervention on a disease or on patient related outcomes. The search generated 3494 articles. After duplicates were removed and titles and abstracts screened for inclusion, 344 articles remained. RESULTS Overall, 19 studies were included in the review and assessed for quality. We found 14 studies describing an exclusive collaboration between physician and pharmacist with for all studies a three-step model of pharmacist intervention: a medication review, an interview with the patient, and recommendations made to physician. Major topics in the articles eligible for inclusion included cardiovascular diseases with blood pressure, diabetes, dyslipidemia, and risk of cardiovascular diseases. Positive effects concerned principally blood pressure. CONCLUSIONS Collaboration involving pharmacists is mainly described in relation to cardiovascular diseases, for which patient-centered indicators are most often positive. It underscores the need for further controlled studies on pharmacist-involved interprofessional collaboration across various medical conditions to improve consensus on core outcomes measures.
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Affiliation(s)
- Morgane Angibaud
- Primary Care Federative Department, Faculty of Medicine, Nantes Université, Nantes, France.
- National Institute for Health and Medical Research, INSERM U1302 Team 2, INCIT, Team 2, Nantes, France.
| | - Maud Jourdain
- Department of General Practice, Faculty of Medicine, Nantes Université, Nantes, France
| | - Solene Girard
- Department of General Practice, Faculty of Medicine, Nantes Université, Nantes, France
| | - Louise Rouxel
- Department of General Practice, Faculty of Medicine, Nantes Université, Nantes, France
| | - Adam Mouhib
- Clinical Pharmacy Unit, Faculty of Pharmacy, Nantes Université, Nantes, France
| | - Antoine Nogueira
- Department of General Practice, Faculty of Medicine, Nantes Université, Nantes, France
| | - Cédric Rat
- National Institute for Health and Medical Research, INSERM U1302 Team 2, INCIT, Team 2, Nantes, France
- Department of General Practice, Faculty of Medicine, Nantes Université, Nantes, France
| | - Jean-François Huon
- Nantes Université, CHU Nantes, Pharmacie, F-44000, France
- UMR INSERM 1246 SPHERE "methodS in Patient-centered Outcomes and HEalth ResEarch, Nantes Université, Université de Tours, Tours, France
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Hawes EM, Page C, Galloway E, McClurg MR, Lombardi B. Pharmacists Colocated With Primary Care Physicians: Understanding Delivery of Interprofessional Primary Care. Med Care 2024; 62:87-92. [PMID: 38051204 DOI: 10.1097/mlr.0000000000001960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
BACKGROUND While evidence supports interprofessional primary care models that include pharmacists, the extent to which pharmacists are working in primary care and the factors associated with colocation is unknown. OBJECTIVES This study aimed to analyze the physical colocation of pharmacists with primary care providers (PCPs) and examine predictors associated with colocation. RESEARCH DESIGN This is a retrospective cross-sectional study of pharmacists and PCPs with individual National Provider Identifiers in the National Plan and Provider Enumeration System's database. Pharmacist and PCP practice addresses of the health care professionals were geocoded, and distances less than 0.1 miles were considered physically colocated. SUBJECTS In all, 502,373 physicians and 221,534 pharmacists were included. RESULTS When excluding hospital-based pharmacists, 1 in 10 (11%) pharmacists were colocated with a PCP. Pharmacists in urban settings were more likely to be colocated than those in rural areas (OR=1.32, CI: 1.26-1.38). Counties with the highest proportion of licensed pharmacists per 100,000 people in the county had higher colocation (OR=1.38, CI: 1.32-1.45). Colocation was significantly higher in states with an expanded scope of practice (OR 1.37, CI: 1.32-1.42) and those that have expanded Medicaid (OR 1.07, CI: 1.03-1.11). Colocated pharmacists more commonly worked in larger physician practices. CONCLUSION Although including pharmacists on primary care teams improves clinical outcomes, reduces health care costs, and enhances patient and provider experience, colocation appears to be unevenly dispersed across the United States, with lower rates in rural areas. As the integration of pharmacists in primary care continues to expand, knowing the prevalence and facilitators of growth will be helpful to policymakers, researchers, and clinical administrators.
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Affiliation(s)
- Emily M Hawes
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
- University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC
| | - Cristen Page
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
- University of North Carolina School of Medicine, Chapel Hill, NC
| | - Evan Galloway
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Mary Roth McClurg
- University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC
| | - Brianna Lombardi
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Carolina Health Workforce Research Center, Chapel Hill, NC
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Bouton C, Journeaux M, Jourdain M, Angibaud M, Huon JF, Rat C. Interprofessional collaboration in primary care: what effect on patient health? A systematic literature review. BMC PRIMARY CARE 2023; 24:253. [PMID: 38031014 PMCID: PMC10685527 DOI: 10.1186/s12875-023-02189-0] [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: 12/09/2022] [Accepted: 10/20/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND In a period of change in the organization of primary care, Interprofessional Collaboration (IPC) is presented as one of the solutions to health issues. Although the number of inter-professional interventions grounded in primary care increases in all developed countries, evidence on the effects of these collaborations on patient-centred outcomes is patchy. The objective of our study was to assess the effects of IPC grounded in the primary care setting on patient-centred outcomes. METHODS We conducted a systematic literature review using the PubMed, Embase, PsycINFO and CINAHL databases from 01/01/1995 to 01/03/2021, according to the PRISMA guidelines. Studies reporting the effects of IPC in primary care on patient health outcomes were included. The quality of the studies was assessed using the revised Downs and Black checklist. RESULTS Sixty-five articles concerning 61 interventions were analysed. A total of 43 studies were prospective and randomized. Studies were classified into 3 main categories as follows: 1) studies with patients at cardiovascular risk (28 studies)-including diabetes (18 studies) and arterial hypertension (5 studies); 2) studies including elderly and/or polypathological patients (18 studies); and 3) patients with symptoms of mental or physical disorders (15 studies). The number of included patients varied greatly (from 50 to 312,377). The proportion of studies that reported a positive effect of IPC on patient-centred outcomes was as follows: 23 out of the 28 studies including patients at cardiovascular risk, 8 out of the 18 studies of elderly or polypathological patients, and 11 out of the 12 studies of patients with mental or physical disorders. CONCLUSIONS Evidence suggests that IPC is effective in the management of patients at cardiovascular risk. In elderly or polypathological patients and in patients with mental or physical disorders, the number of studies remains very limited, and the results are heterogeneous. Researchers should be encouraged to perform studies based on comparative designs: it would increase evidence on the positive effect and benefits of IPC on patient variables.
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Affiliation(s)
- Céline Bouton
- Department of General Practice, Faculty of Medicine, University of Nantes, 1, Rue Gaston Veil, 44035, Nantes, France.
- Primary Care Federative Department, Faculty of Medicine, University of Nantes, Nantes, France.
| | - Manon Journeaux
- Department of General Practice, Faculty of Medicine, University of Nantes, 1, Rue Gaston Veil, 44035, Nantes, France
| | - Maud Jourdain
- Department of General Practice, Faculty of Medicine, University of Nantes, 1, Rue Gaston Veil, 44035, Nantes, France
- Primary Care Federative Department, Faculty of Medicine, University of Nantes, Nantes, France
| | - Morgane Angibaud
- Primary Care Federative Department, Faculty of Medicine, University of Nantes, Nantes, France
| | - Jean-François Huon
- Primary Care Federative Department, Faculty of Medicine, University of Nantes, Nantes, France
- Faculty of Pharmacy, University of Nantes, Nantes, France
| | - Cédric Rat
- Department of General Practice, Faculty of Medicine, University of Nantes, 1, Rue Gaston Veil, 44035, Nantes, France
- Primary Care Federative Department, Faculty of Medicine, University of Nantes, Nantes, France
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10
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Mack K, Henneman A, Snyder T. Impact of pharmacist-provided Medicare annual wellness visits and chronic care management on reimbursement and quality measures in a privately owned family medicine clinic. Am J Health Syst Pharm 2023; 80:S143-S150. [PMID: 36860179 DOI: 10.1093/ajhp/zxad046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Indexed: 03/03/2023] Open
Abstract
PURPOSE Improvement in patient outcomes from collaboration between pharmacists and physicians in ambulatory clinics has been well documented. Barriers to payment have made widespread growth of these collaborations slow. Medicare annual wellness visits (AWVs) and chronic care management (CCM) provide an opportunity for pharmacist-physician collaborations that are directly revenue generating. The objective of this study was to evaluate the impact of pharmacist-led AWVs and CCM on reimbursement and quality measures in a private family medicine clinic. METHODS This was a retrospective observational study in which the rate of reimbursement for AWVs and CCM was compared before and after implementation of pharmacist-provided services. Claims data were reviewed for Current Procedural Terminology codes and reimbursement applicable to AWVs and CCM. Secondary outcomes included the total number of AWV and CCM appointments, Healthcare Effectiveness Data and Information Set (HEDIS) measure completion rates, and average change in quality ratings. Outcomes were analyzed utilizing descriptive statistics. RESULTS Reimbursement from AWVs increased by $25,807.21 in 2018 and $26,410.01 in 2019 compared to 2017. Reimbursement from CCM increased by $16,664.29 in 2018 and $5,698.85 in 2019. In 2017, 228 AWVs and 5 CCM encounters were completed. After implementation of pharmacist services, the number of CCM encounters increased to 362 in 2018 and 152 in 2019 and the number of AWVs totaled 236 and 267, respectively. Completed HEDIS measures and star ratings increased during the study. CONCLUSION Pharmacist provision of AWVs and CCM addressed a gap in care by increasing the number of patients who received these services while also increasing reimbursement in a privately owned family medicine clinic.
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Affiliation(s)
- Keri Mack
- Department of Pharmacy Practice, Palm Beach Atlantic University, West Palm Beach, FL, USA
| | - Amy Henneman
- Department of Pharmacy Practice, Belmont University, Nashville, TN, USA
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11
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Chung H, Patel U, Stein D, Collado K, Blackmore M. Medicaid Costs and Utilization of Collaborative Versus Colocation Care for Patients With Depression. Psychiatr Serv 2023; 74:1132-1136. [PMID: 37221885 DOI: 10.1176/appi.ps.20220604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVE The authors examined cost and utilization metrics for racially diverse Medicaid primary care patients with depression receiving care through either a collaborative care model (CoCM) of integration or the standard colocation model. METHODS Data from a retrospective cohort of Medicaid patients screening positive for clinically significant depression during January 2016-December 2017 were analyzed to assess health care costs and selected utilization measures. Seven primary care clinics providing CoCM were compared with 16 clinics providing colocated behavioral health care. Data for the first year and second year after a patient received an initial Patient Health Questionnaire-9 score ≥10 were analyzed. RESULTS In the first year, compared with patients receiving colocated care (N=3,061), CoCM patients (N=4,315) had significantly lower odds of emergency department (ED) visits (OR=0.95) and medical specialty office visits (OR=0.92), with slightly higher odds of primary care provider (PCP) visits (OR=1.03) and behavioral health office visits (OR=1.03). In year 2, CoCM patients (N=2,623) had significantly lower odds of inpatient medical admissions (OR=0.87), ED visits (OR=0.84), medical specialty office visits (OR=0.89), and PCP visits (OR=0.94) than the colocated care patients (N=1,838). The two groups did not significantly differ in total cost in both years. CONCLUSIONS Access to CoCM treatment in primary care for racially diverse Medicaid patients with depression was associated with more positive health care utilization outcomes than for those accessing colocated treatment. As organizations continue to seek opportunities to integrate behavioral health care into primary care, consideration of health care costs and utilization may be helpful in the selection and implementation of integration models.
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Affiliation(s)
- Henry Chung
- Department of Psychiatry and Behavioral Sciences (Chung, Blackmore) and Department of Social and Family Medicine (Patel), Albert Einstein College of Medicine, Bronx, New York City; Optum Tri-State, Chappaqua, New York (Stein); Montefiore Care Management Organization, Yonkers, New York (Chung, Collado)
| | - Urvashi Patel
- Department of Psychiatry and Behavioral Sciences (Chung, Blackmore) and Department of Social and Family Medicine (Patel), Albert Einstein College of Medicine, Bronx, New York City; Optum Tri-State, Chappaqua, New York (Stein); Montefiore Care Management Organization, Yonkers, New York (Chung, Collado)
| | - Dana Stein
- Department of Psychiatry and Behavioral Sciences (Chung, Blackmore) and Department of Social and Family Medicine (Patel), Albert Einstein College of Medicine, Bronx, New York City; Optum Tri-State, Chappaqua, New York (Stein); Montefiore Care Management Organization, Yonkers, New York (Chung, Collado)
| | - Kayla Collado
- Department of Psychiatry and Behavioral Sciences (Chung, Blackmore) and Department of Social and Family Medicine (Patel), Albert Einstein College of Medicine, Bronx, New York City; Optum Tri-State, Chappaqua, New York (Stein); Montefiore Care Management Organization, Yonkers, New York (Chung, Collado)
| | - Michelle Blackmore
- Department of Psychiatry and Behavioral Sciences (Chung, Blackmore) and Department of Social and Family Medicine (Patel), Albert Einstein College of Medicine, Bronx, New York City; Optum Tri-State, Chappaqua, New York (Stein); Montefiore Care Management Organization, Yonkers, New York (Chung, Collado)
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12
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Cai S, Huang X, Van C, Li W, Yan M, Lu Y, Li H, Deng Z, Lu P, Xu Z. General practitioners' attitudes towards and frequency of collaboration with pharmacists in China: a cross-sectional study. BMC Health Serv Res 2023; 23:1174. [PMID: 37891601 PMCID: PMC10612245 DOI: 10.1186/s12913-023-10151-0] [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: 07/08/2023] [Accepted: 10/16/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Building interprofessional working relationships between general practitioners (GPs) and pharmacists is essential to ensure high-quality patient care. However, there is limited Chinese literature on GP-pharmacist collaboration, and few studies have explored GPs' experiences with pharmacist integration into general practices. This study aimed to investigate GPs' attitudes towards and frequency of collaboration with pharmacists in China. METHODS This cross-sectional study used an online self-administered questionnaire integrating two scales, ATCI-GP and FICI-GP, which had been translated and validated to investigate 3,248 GPs from February 15 to March 15, 2023 across Zhejiang Province, China. Descriptive analyses were used, and the factors associated with GPs' frequency of collaboration with pharmacists were explored using logistic regression analysis. RESULTS A total of 2,487 GPs (76.6%) responded and consented to participate in the survey; 52.3% were male and the mean age was 35.4 years. Most GPs agreed that they shared common goals and objectives with pharmacists when caring for patients (90.0%), and pharmacists were open to working with them on patients' medication management (80.8%). However, half of the GPs did not change or seldom changed the patient's medication on the pharmacist's advice (51.4%). Logistic regression analysis showed that GPs who were older and had more years of practice were more likely to agree that pharmacists were willing to collaborate, had common goals for treatment and that they would change the patient's medication on the advice of the pharmacist. GPs who had regular communication protocols (adjusted odds ratio1 [aOR1] = 1.88, 95% CI 1.45-2.45; aOR2 = 3.33, 95% CI 2.76-4.02), participated in joint continuing education (aOR1 = 1.87, 95% CI 1.44-2.43; aOR2 = 2.27, 95% CI 1.91-2.70), provided recommendations for medication review (aOR1 = 3.01, 95% CI 2.07-4.38; aOR2 = 3.50, 95% CI 2.51-4.86), and communicated with pharmacists during resident training (aOR1 = 2.15, 95% CI 1.78-2.60; aOR2 = 1.38, 95% CI 1.18-1.62) were associated with a more positive attitude towards and higher frequency of cooperation. CONCLUSIONS GPs in China displayed a positive attitude towards cooperating with pharmacists, but they did not demonstrate a similar level of practice. As environmental determinants impact interdisciplinary collaboration, healthcare managers and policy-makers need to implement measures that foster a supportive environment conducive to interdisciplinary collaboration.
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Affiliation(s)
- Songtao Cai
- Department of General Practice, The Second Affiliated Hospital, School of Medicine, The Chinese University of Hong Kong, Shenzhen & Longgang District People's Hospital of Shenzhen, Shenzhen, 518172, China
| | - Xianghui Huang
- Xinsheng Community Health Service Center, Shenzhen Longgang Central Hospital, Shenzhen, 518116, China
| | - Connie Van
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Wanchao Li
- Lincheng Healthcare Center of Changxing County, Huzhou, 310016, China
| | - Ming Yan
- Department of General Practice, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310016, China
| | - Yiting Lu
- Department of General Practice, Tongji University School of Medicine, Shanghai, 200092, China
| | - Haixin Li
- Department of Pharmacy, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
| | - Zhiling Deng
- The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518033, China
| | - Panpan Lu
- Department of General Practice, Taizhou Municipal Hospital, Taizhou, 318000, China
| | - Zhijie Xu
- Department of General Practice, The Second Affiliated Hospital, Zhejiang University School of Medicine, No.88, Jiefang Rd, Hangzhou, Shangcheng District, 310009, China.
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13
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Nardolillo JA, Rosario N, Cheng V, Lobkovich AM. Initiating Primary Care Services when the World Is Paused: Lessons for Pharmacists in the Post-COVID-19 Era. J Pharm Pract 2023; 36:1052-1055. [PMID: 35440223 PMCID: PMC9024150 DOI: 10.1177/08971900221087934] [Citation(s) in RCA: 1] [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] [Indexed: 11/17/2022]
Abstract
The COVID-19 pandemic impacted primary care and required pharmacists to adapt when implementing primary care services. Many lessons learned through this process are applicable in the post-pandemic era. First, primary care pharmacists must prepare for an ever-changing role and communicate with stakeholders to align with shifting institutional priorities. Additionally, designing a workflow given limited staffing and in-person communication require flexibility for scheduling and referral processes. Proactive outreach and communication via virtual platforms may be used to build trust in place of in-office interactions with providers. Lastly, fostering relationships with patients is essential to the success of the service and often requires creation of patient-centered goals to account for personal barriers. Many pandemic obstacles are transient; however, telehealth, virtual communication, and the subsequent lessons learned in adaptability, creativity, and flexibility when building a clinic practice are everlasting.
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Affiliation(s)
- Joseph A. Nardolillo
- Wayne State University Eugene Applebaum College of Pharmacy and Health Sciences, Detroit, Detroit, MI, USA
| | | | - Vivian Cheng
- University of Washington Medicine Valley Family Medicine Clinic, Renton, WA
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Lum ZK, Kng KK, Goh CEM, Sule AA, Gallagher PJ, Lee JYC. Clinical activities that contributed to the effectiveness of a cardiologist-pharmacist collaborative care model in managing diabetes. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2023; 31:540-547. [PMID: 37410963 DOI: 10.1093/ijpp/riad046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 06/29/2023] [Indexed: 07/08/2023]
Abstract
OBJECTIVES The primary objectives of this study were to evaluate the change in glycated haemoglobin (HbA1c) and its association to clinical activities. The secondary objective was to elucidate moderators of the relationship between pharmacist-involved collaborative care (PCC) and change in HbA1c. METHODS This study was a retrospective cohort study conducted in a tertiary hospital over 12 months. Individuals with Type 2 diabetes, aged ≥21 years with established cardiovascular diseases were included while individuals with incomplete care documentation or missing data related to cardiovascular diseases were excluded. Individuals under the care of PCC were matched 1:1 based on baseline HbA1c with an eligible person who received care from the cardiologists (CC). Changes in mean HbA1c were analysed using linear mixed model. Linear regression was used to determine clinical activities that associated with improvement in HbA1c. Moderation analyses were conducted using the MacArthur framework. KEY FINDINGS A total of 420 participants (PCC:210, CC:210) were analysed. The mean age of the participants was 65.6 ± 11.1 years, with the majority being male and Chinese. The mean HbA1c among participants in the PCC group decreased significantly after 6 months (PCC: -0.4% versus CC: -0.1%, P = 0.016), with maintenance of improvement at 12 months (PCC: -0.4% versus CC: -0.2%, P < 0.001). Frequencies of lifestyle counselling, reinforcement of visits to healthcare providers, health education, resolution of drug-related problems, emphasis on medication adherence, dose adjustments and advice on self-care techniques were significantly higher in the intervention group (P < 0.001). CONCLUSION Improvements in HbA1c were associated with the provision of health education and medication adjustments.
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Affiliation(s)
- Zheng Kang Lum
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore
| | - Kwee Keng Kng
- Department of Pharmacy, Tan Tock Seng Hospital, Singapore
| | | | - Ashish Anil Sule
- Department of General Medicine, Tan Tock Seng Hospital, Singapore
| | - Paul John Gallagher
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore
| | - Joyce Yu-Chia Lee
- Department of Clinical Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, University of California, Irvine, CA, USA
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15
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Peled O, Vitzrabin Y, Beit Ner E, Lazaryan M, Berlin M, Barchel D, Berkovitch M, Beer Y, Tamir E. Acceptance rate of clinical pharmacists' recommendations-an ongoing journey for integration. Front Pharmacol 2023; 14:1253990. [PMID: 37781706 PMCID: PMC10535001 DOI: 10.3389/fphar.2023.1253990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 08/30/2023] [Indexed: 10/03/2023] Open
Abstract
Introduction: Multidisciplinary expert team collaboration in the clinical setting, which includes clinical pharmacist involvement can facilitate significant improvements in outcomes and optimize patient management by preventing drug-related problems (DRP). This type of collaboration is particularly valuable in patients with multi-morbidity and polypharmacy such as diabetic foot patients. Evidence regarding the successful integration of a new clinical pharmacist, without previous experience into a unit is still scarce. Therefore, this study aimed to describe and evaluate the actual successful integration process of the clinical pharmacist into a diabetic foot unit by measuring the change in recommendation acceptance rate over time. Methods: A prospective, exploratory treatment effectiveness study based on the recommendation acceptance rate of a new clinical pharmacist introduced into the diabetic foot unit was conducted over a 9- month period. The clinical pharmacist identified medical and drug-related problems (DRP) or any discrepancies in the prescribing and administration of medications. Each identified DRP was documented and formulated as a recommendation by the clinical pharmacist. The main outcome measure was the acceptance rate of recommendations over time. Results: A total of 86 patients, of which 67% were men, averagely aged 66.5 (SD 11.8) years were evaluated. Calculated BMI was 30.2 (SD 6.2). The average number of medical diagnoses was 8.9 (SD3.2), and 11.1 (SD 3.7) prescribed drugs for each patient. Cardiovascular disease was presented by 95% (n = 82) of the patients and 33% of them (n = 28) had uncontrolled hyperglycemia. Averagely, 3.3 (SD 1.9) DRPs were identified pre patient. The efficacy-related DRP recommendation acceptance rate increased over the study period from 37.8% in the first 4 months to 79.4% after a period of 4.75 months. Safety-related DRP recommendation acceptance rate increased from 56% to 67.6%. Conclusion: Improved clinical outcomes and optimized pharmacologic patient management may be achieved by the successful integration of a clinical pharmacist into the team. This study provides evidence of the increasing recommendation acceptance rate of integrated, pharmacist-driven comprehensive medication management in an unexperienced unit. To overcome challenges, team members should collaborate to fully integrate the clinical pharmacist into the team-based structure and utilize proper strategies to minimize and transcend barriers.
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Affiliation(s)
- Orit Peled
- Department of Pharmacy, Schneider Children’s Medical Center of Israel, Affiliated to School of Medicine, Tel Aviv University, Petach Tikva, Israel
| | - Yael Vitzrabin
- Pharmacy Department, Yitzhak Shamir Medical Center, Zerifin, Affiliated to School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Beit Ner
- Department of Orthopaedic Surgery, Yitzhak Shamir Medical Center, Zerifin, Affiliated to School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Moran Lazaryan
- Pharmacy Department, Yitzhak Shamir Medical Center, Zerifin, Affiliated to School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Maya Berlin
- Clinical Pharmacology and Toxicology Unit, Shamir Medical Center, Zerifin, The Andy Lebach Chair of Clinical Pharmacology and Toxicology, Tel-Aviv University, Tel-Aviv, Israel
| | - Dana Barchel
- Clinical Pharmacology and Toxicology Unit, Shamir Medical Center, Zerifin, The Andy Lebach Chair of Clinical Pharmacology and Toxicology, Tel-Aviv University, Tel-Aviv, Israel
| | - Matitiahu Berkovitch
- Clinical Pharmacology and Toxicology Unit, Shamir Medical Center, Zerifin, The Andy Lebach Chair of Clinical Pharmacology and Toxicology, Tel-Aviv University, Tel-Aviv, Israel
| | - Yiftah Beer
- Department of Orthopaedic Surgery, Yitzhak Shamir Medical Center, Zerifin, Affiliated to School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Tamir
- Diabetic Foot Unit, Yitzhak Shamir Medical Center, Zerifin, Affiliated to School of Medicine, Tel Aviv University, Tel Aviv, Israel
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16
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Schwenka N, Donovan A, Franck L, Coan C, McAdam-Marx C, Shin E. Patient-centered medical home pharmacists' impact on composite quality care measures for patients with uncontrolled type 2 diabetes. J Am Pharm Assoc (2003) 2023; 63:1545-1552.e4. [PMID: 37301508 DOI: 10.1016/j.japh.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 06/02/2023] [Accepted: 06/04/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Patients with uncontrolled diabetes are at risk for developing complications. Many health care systems have implemented multidisciplinary care models including pharmacists to help achieve quality care measures to reduce complications. OBJECTIVE This study aimed to evaluate whether patients with uncontrolled type 2 diabetes mellitus (T2D) seen at patient-centered medical home (PCMH) clinics affiliated with an academic medical center are more likely to meet a composite of diabetes quality care measures with a pharmacist on their care team than usual care patients without a pharmacist on their care team. METHODS This is a cross-sectional study. The setting included PCMH primary care clinics affiliated with an academic medical center from January 2017 to December 2020. Included were adults aged 18 to 75 years with a diagnosis of T2D, hemoglobin A1C (A1C) more than 9%, and established with a PCMH provider. The intervention is inclusion of PCMH pharmacist on the patient's care team for management of T2D per a collaborative practice agreement. The main outcome measures included A1C ≤9% per last recorded value during observation period, a composite A1C ≤9% and completion of yearly laboratory tests, and a composite A1C ≤9%, completion of yearly laboratory tests, and statin prescription for adults aged 40-75 years. RESULTS Identified were 1807 patients in the usual care cohort with mean baseline A1C of 10.7% and 207 patients in the pharmacist cohort with mean baseline A1C of 11.1%. The pharmacist cohort was more likely to have an A1C of ≤9% at the end of the observation period (70.1% vs. 45.4%; P < 0.001), a composite of measures met (28.5% vs. 16.8%; P < 0.001), and a composite of measures met for patients aged 40-75 years (27.2% vs. 13.7%; P < 0.001). CONCLUSION Pharmacist involvement in the multidisciplinary management of uncontrolled T2D is associated with a higher attainment of a composite of quality care measures at the population health level.
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Jeemon P, Bahuleyan CG, Chandgalu Javaregowda D, Punnoose E, Rajendiran G, Unni G, Abdullakutty J, Balakrishnan J, Joseph J, Gnanaraj JP, Sreedharan M, Pillai MR, KR N, Thomas P, Sebastian P, Daniel R, Edakutty R, Ahmad S, Mattummal S, Thomas SC, Joseph S, Pisharody S, Chacko S, Syam N, Nair T, Nanjappa V, Ganesan V, George V, Ganapathi S, Harikrishnan S. Team based collaborative care model, facilitated by mHealth enabled and trained nurses, for management of heart failure with reduced ejection fraction in India (TIME-HF): design and rationale of a parallel group, open label, multi-centric cluster randomised controlled trial. Wellcome Open Res 2023; 8:197. [PMID: 37795133 PMCID: PMC10545985 DOI: 10.12688/wellcomeopenres.19196.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2023] [Indexed: 10/06/2023] Open
Abstract
Background: Heart failure (HF) is a debilitating condition associated with enormous public health burden. Management of HF is complex as it requires care-coordination with different cadres of health care providers. We propose to develop a team based collaborative care model (CCM), facilitated by trained nurses, for management of HF with the support of mHealth and evaluate its acceptability and effectiveness in Indian setting. Methods: The proposed study will use mixed-methods research. Formative qualitative research will identify barriers and facilitators for implementing CCM for the management of HF. Subsequently, a cluster randomised controlled trial (RCT) involving 22 centres (tertiary-care hospitals) and more than 1500 HF patients will be conducted to assess the efficacy of the CCM in improving the overall survival as well as days alive and out of hospital (DAOH) at two-years (CTRI/2021/11/037797). The DAOH will be calculated by subtracting days in hospital and days from death until end of study follow-up from the total follow-up time. Poisson regression with a robust variance estimate and an offset term to account for clustering will be employed in the analyses of DAOH. A rate ratio and its 95% confidence interval (CI) will be estimated. The scalability of the proposed intervention model will be assessed through economic analyses (cost-effectiveness) and the acceptability of the intervention at both the provider and patient level will be understood through both qualitative and quantitative process evaluation methods. Potential Impact: The TIME-HF trial will provide evidence on whether a CCM with mHealth support is effective in improving the clinical outcomes of HF with reduced ejection fraction in India. The findings may change the practice of management of HF in low and middle-income countries.
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Affiliation(s)
- Panniyammakal Jeemon
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, 695011, India
| | | | | | - Eapen Punnoose
- Malankara Orthodox Syrian Church Medical College, Kolenchery, Kerala, India
| | | | - Govindan Unni
- Jubilee Mission medical College and Research Institute, Thrissur, Kerala, India
| | | | | | | | - Justin Paul Gnanaraj
- Rajiv Gandhi Government General Hospital, Madras Medical College, Chennai, Tamilnadu, India
| | - Madhu Sreedharan
- NIMS Heart Foundation, NIMS Medicity, Thiruvananthapuram, Kerala, India
| | | | - Neenumol KR
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, 695011, India
| | | | | | - Rachel Daniel
- NS Memorial Institute of Medical Sciences, Kollam, Kerala, India
| | | | - Sajan Ahmad
- St Gregorios Memorial Mission Hospital, Parumala, Kerala, India
| | | | - Sunu C Thomas
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, 695011, India
| | - Stigi Joseph
- Little Flower Hospital and Research Centre, Angamaly, Ernakulam, Kerala, India
| | - Sunil Pisharody
- EMS Memorial Cooperative Hospital and Research Centre Ltd, Malappuram, Kerala, India
| | - Susanna Chacko
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, 695011, India
| | - N Syam
- Government District Hospital, Kollam, Kerala, India
| | - Tiny Nair
- PRS Hospital, Thiruvananthapuram, Kerala, India
| | - Veena Nanjappa
- Sri Jayadeva Institute of Cardiovascular Science and Research, Mysore, Karnataka, India
| | | | | | - Sanjay Ganapathi
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, 695011, India
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Buelow JR, Tillman P, Taggart H. Introspective Learning From Interprofessional Virtual Grand Rounds. Nurse Educ 2023; 48:E79-E84. [PMID: 36729872 DOI: 10.1097/nne.0000000000001340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Interprofessional collaboration in health care settings improves patient safety and outcomes, yet collaboration among health professionals requires specific competencies and skills. Providing nursing students with interprofessional learning experiences with multiple health professions is possible yet challenging. PROBLEM Opportunities for effective online interprofessional learning are lacking. APPROACH This article explores nursing students' reflections on how an interprofessional learning experience, Virtual Grand Rounds (VGRs), influenced their personal development and provided meaningful learning that they can use in their practices as professional nurses. Thematic analysis was done on the open-ended questions in students' final reflection assignment. OUTCOMES Analysis of student reflections identified 5 learning themes including the value of teamwork and collaboration, the importance of communication skills, professional identity, plans to engage diverse health professions, and the desire for future learning. CONCLUSIONS Student reflections indicate the VGR was an effective method for nursing students to experience collaboration with multiple health professions without disrupting curriculums.
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Affiliation(s)
- Janet R Buelow
- Professor (Dr Buelow), Health Sciences and Kinesiology-Health Administration, Associate Professor (Dr Tillman), Health Sciences and Kinesiology-Health Informatics, and Professor (Dr Taggart), School of Nursing, Water's College of Health Professions, Georgia Southern University, Savannah
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19
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Foo YY, Xin X, Rao J, Tan NCK, Cheng Q, Lum E, Ong HK, Lim SM, Freeman KJ, Tan K. Measuring Interprofessional Collaboration's Impact on Healthcare Services Using the Quadruple Aim Framework: A Protocol Paper. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20095704. [PMID: 37174222 PMCID: PMC10178681 DOI: 10.3390/ijerph20095704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/13/2023] [Accepted: 04/17/2023] [Indexed: 05/15/2023]
Abstract
Despite decades of research on the impact of interprofessional collaboration (IPC), we still lack definitive proof that team-based care can lead to a tangible effect on healthcare outcomes. Without return on investment (ROI) evidence, healthcare leaders cannot justifiably throw their weight behind IPC, and the institutional push for healthcare manpower reforms crucial for facilitating IPC will remain variable and fragmentary. The lack of proof for the ROI of IPC is likely due to a lack of a unifying conceptual framework and the over-reliance on the single-method study design. To address the gaps, this paper describes a protocol which uses as a framework the Quadruple Aim which examines the ROI of IPC using four dimensions: patient outcomes, patient experience, provider well-being, and cost of care. A multimethod approach is proposed whereby patient outcomes are measured using quantitative methods, and patient experience and provider well-being are assessed using qualitative methods. Healthcare costs will be calculated using the time-driven activity-based costing methodology. The study is set in a Singapore-based national and regional center that takes care of patients with neurological issues.
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Affiliation(s)
- Yang Yann Foo
- Department of Technology Enhanced Learning and Innovation, Duke-NUS Medical School, Singapore 169857, Singapore
| | - Xiaohui Xin
- Health Services Research Unit, Singapore General Hospital, Singapore 169608, Singapore
| | - Jai Rao
- Department of Neurosurgery, National Neuroscience Institute, Singapore 308433, Singapore
- Duke-NUS Medical School, Singapore 169857, Singapore
| | - Nigel C K Tan
- Duke-NUS Medical School, Singapore 169857, Singapore
- Department of Neurology, National Neuroscience Institute, Singapore 308433, Singapore
| | - Qianhui Cheng
- Department of Neuroradiology, National Neuroscience Institute, Singapore 308433, Singapore
| | - Elaine Lum
- Health Services & Systems Research, Duke-NUS Medical School, Singapore 169857, Singapore
| | - Hwee Kuan Ong
- Department of Physiotherapy, Singapore General Hospital, Singapore 169608, Singapore
- Singapore Institute of Technology, Singapore 138683, Singapore
| | - Sok Mui Lim
- Singapore Institute of Technology, Singapore 138683, Singapore
| | - Kirsty J Freeman
- Office of Education, Duke-NUS Medical School, Singapore 169857, Singapore
| | - Kevin Tan
- Duke-NUS Medical School, Singapore 169857, Singapore
- Department of Neurology, National Neuroscience Institute, Singapore 308433, Singapore
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20
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Crafford L, Kusurkar RA, Bronkhorst E, Gous A, Wouters A. Understanding of healthcare professionals towards the roles and competencies of clinical pharmacists in South Africa. BMC Health Serv Res 2023; 23:290. [PMID: 36978062 PMCID: PMC10044779 DOI: 10.1186/s12913-023-09222-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 02/27/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Incorporating clinical pharmacists in collaborative medical teams results in better patient treatment and health outcomes. In addition, the understanding of other healthcare professionals (HCPs) towards the role of clinical pharmacists can either facilitate or hinder the implementation and expansion of these services. The main distinction between pharmacists and clinical pharmacists lie in their different scope of duties. This study set out to explore other HCPs' understanding towards the role of the clinical pharmacists in South Africa, and to identify associated factors. METHODS An exploratory, survey-based, quantitative study was conducted. A survey assessing HCPs' understanding based on the competencies and role of a clinical pharmacist was distributed to 300 doctors, nurses, pharmacists and clinical pharmacists. An exploratory factor analysis was carried out to determine the construct validity of the measurement. Items were analysed for grouping into subscales through principal components analysis. Differences in the variable scores for gender, age, work experience and previous experience working with a clinical pharmacist were analyzed using independent t-tests. Analysis of variance was used to analyze differences in the variable scores for the different HCPs and the different departments of work in the hospital. RESULTS The factor analysis yielded two separate subscales, measuring HCPs' (n = 188) understanding towards the role of a clinical pharmacist, as well as the competencies of a clinical pharmacist. Doctors (85, n = 188) (p = 0.004) and nurses (76, n = 188) (p = 0.022), working in both surgical and non-surgical units, had significantly poorer understanding of the role of clinical pharmacists than clinical pharmacists (8, n = 188) and pharmacists (19, n = 188) (p = 0.028). Where specific clinical pharmacist activities were described, 5-16% of pharmacists were unsure whether an activity forms part of a clinical pharmacist's role. Over 50% of the clinical pharmacists disagreed that their role also includes pharmacist's activities, like stock procurement and control, pharmacy and administrative work, and hospital pharmacy-medication dispensing activities. CONCLUSION The findings highlighted the possible impact of role expectations and lack of understanding among HCPs. A standard job description with recognition from statutory bodies could promote other HCPs, as well as clinical pharmacists' understanding of their roles. Findings further suggested the need for interventions like interprofessional education opportunities, staff induction programmes and regular interprofessional meetings to foster acknowledgement of clinical pharmacy services, promoting the acceptance and growth of the profession.
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Affiliation(s)
- L Crafford
- Department of Clinical Pharmacy, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa.
- Research in Education, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1118, Amsterdam, The Netherlands.
| | - R A Kusurkar
- Research in Education, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1118, Amsterdam, The Netherlands
- LEARN! research institute for learning and education, Faculty of Psychology and Education, VU University Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, The Netherlands
| | - E Bronkhorst
- Department of Clinical Pharmacy, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa
| | - Ags Gous
- Department of Clinical Pharmacy, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa
| | - A Wouters
- Research in Education, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1118, Amsterdam, The Netherlands
- LEARN! research institute for learning and education, Faculty of Psychology and Education, VU University Amsterdam, Amsterdam, The Netherlands
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21
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Xiao J, Wang Q, Tan S, Chen L, Tang B, Huang S, Zhou Y, Xu P. Analysis of patient medication compliance and quality of life of physician-pharmacist collaborative clinics for T2DM management in primary healthcare in China: A mixed-methods study. Front Pharmacol 2023; 14:1098207. [PMID: 37033638 PMCID: PMC10080104 DOI: 10.3389/fphar.2023.1098207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 03/16/2023] [Indexed: 04/11/2023] Open
Abstract
Background: Physician-pharmacist collaboration is a well-established care mode for the management of type 2 diabetes mellitus (T2DM) in developed countries, but no study has been conducted in primary healthcare in China. This study aims to evaluate the effects of physician-pharmacist collaborative clinics to manage T2DM in primary healthcare in China, and to better understand the factors influencing the implementation of physician-pharmacist collaborative clinics. Methods: Two hundred and sixty-seven patients involved in a 12-month randomized controlled trial were assigned to physician-pharmacist collaborative clinics and usual clinics, completing surveys regarding medication compliance, quality of life (QoL) and care-seeking behavior at the baseline, 3rd, 6th, 9th and 12th month respectively, and diabetes knowledge at baseline and 12th month. A sample of twenty-two Patients, nine physicians and twelve pharmacists participated in semi-structured face-to-face interviews. The quantitative and qualitative data was integrated by triangulation. Results: Patients in physician-pharmacist collaborative clinics had significant improvements in medication compliance (p = 0.009), QoL (p = 0.036) and emergency visits (p = 0.003) over the 12-month. Pairwise comparison showed the medication compliance score in the intervention group had been significantly improved at 3rd month (p = 0.001), which is more rapidly than that in the control group at 9th month (p = 0.030). Factors influencing the implementation of physician-pharmacist collaborative clinics were driven by five themes: pharmaceutical service, team-base care, psychological support, acceptability of care and barriers to implementation. Conclusion: Integration of quantitative and qualitative findings showed the effectiveness of physician-pharmacist collaborative clinics in patient medication compliance and QoL in primary healthcare. The qualitative study uncovered barriers in insufficient clinical experience and understaffing of pharmacist. Therefore, the professional training of the primary pharmacist team should be improved in the future. Clinical Trial Registration: clinicaltrials.gov, identifier ChiCTR2000031839.
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Affiliation(s)
- Jie Xiao
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, China
- Institute of Clinical Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Qing Wang
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, China
- Institute of Clinical Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Shenglan Tan
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, China
- Institute of Clinical Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Lei Chen
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, China
- Institute of Clinical Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Bingjie Tang
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, China
- Institute of Clinical Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Shuting Huang
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, China
- Institute of Clinical Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yangang Zhou
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, China
- Institute of Clinical Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Ping Xu
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, China
- Institute of Clinical Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, China
- *Correspondence: Ping Xu,
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Waszyk-Nowaczyk M, Guzenda W, Dragun P, Olsztyńska L, Liwarska J, Michalak M, Ferlak J, Drozd M, Sobiechowska R. Interdisciplinary Cooperation between Pharmacists and Nurses-Experiences and Expectations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11713. [PMID: 36141986 PMCID: PMC9517073 DOI: 10.3390/ijerph191811713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/14/2022] [Accepted: 09/14/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Getting to know the experience gained so far between professions such as pharmacists and nurses allows for introducing changes aimed at better cooperation, and that can improve the quality of patient care. The aim was to obtain the nurses' opinions on the ongoing cooperation with pharmacists and to analyze the possibilities of cooperation between these groups. METHODS The survey was conducted from January to March 2021 among 124 nurses in Poland. The link to the electronic questionnaire was sent by e-mails sourced from online social groups for nurses. Before completing the questionnaire, each participant was informed about the anonymous research and the purpose of the data obtained. RESULTS In total, 80.6% of the respondents confirmed that the pharmacist is a reliable advisor in the field of general information about a drug and 60.9% in the field of clinical information about the drug, and 54.8% of the nurses agreed that a pharmacist should carry out such practices as measuring blood pressure or glucose in a community pharmacy, with 70.1% agreeing that a pharmacist should provide pharmaceutical care in a community pharmacy in the future and the most convinced of this were people with a master's degree. Of the respondents, 74.1% indicated that pharmacist advice should be fully reimbursed by the National Health Fund or another insurance institution. CONCLUSIONS The study showed that the nursing community appreciates the role of pharmacists and has a positive attitude towards cooperation with this professional group. What is more is that it indicates willingness for interdisciplinary cooperation.
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Affiliation(s)
- Magdalena Waszyk-Nowaczyk
- Pharmacy Practice Division, Department of Pharmaceutical Technology, Poznan University of Medical Sciences, 6 Grunwaldzka Street, 60-780 Poznan, Poland
| | - Weronika Guzenda
- Pharmacy Practice Division, Department of Pharmaceutical Technology, Poznan University of Medical Sciences, 6 Grunwaldzka Street, 60-780 Poznan, Poland
| | - Paweł Dragun
- Student’s Pharmaceutical Care Group, Pharmacy Practice Division, Department of Pharmaceutical Technology, Poznan University of Medical Sciences, 6 Grunwaldzka Street, 60-780 Poznan, Poland
| | - Laura Olsztyńska
- Student’s Pharmaceutical Care Group, Pharmacy Practice Division, Department of Pharmaceutical Technology, Poznan University of Medical Sciences, 6 Grunwaldzka Street, 60-780 Poznan, Poland
| | - Julia Liwarska
- Student’s Pharmaceutical Care Group, Pharmacy Practice Division, Department of Pharmaceutical Technology, Poznan University of Medical Sciences, 6 Grunwaldzka Street, 60-780 Poznan, Poland
| | - Michał Michalak
- Department of Computer Science and Statistics, Poznan University of Medical Sciences, 7 Rokietnicka Street, 60-806 Poznan, Poland
| | - Jan Ferlak
- Department of Pharmaceutical Technology, Poznan University of Medical Sciences, 6 Grunwaldzka Street, 60-780 Poznan, Poland
| | - Mariola Drozd
- Department of Humanities and Social Medicine, Medical University of Lublin, 20-093 Lublin, Poland
| | - Renata Sobiechowska
- Ludwik Błażek Mulidisciplinary Hospital, 97 Poznanska Street, 88-100 Inowrocław, Poland
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Miller TA, Halza K, Hovis Z. Implementation of
pharmacist‐led HIV pre‐exposure
prophylaxis management to increase access to care at an academic internal medicine practice. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2022. [DOI: 10.1002/jac5.1667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Trisha A. Miller
- Department of Pharmacy University of Pittsburgh Medical Center Presbyterian Shadyside Pittsburgh Pennsylvania USA
| | - Katherine Halza
- Department of Pharmacy University of Pittsburgh Medical Center Presbyterian Shadyside Pittsburgh Pennsylvania USA
- Department of Pharmacy Kingman Regional Medical Center Kingman Arizona USA
| | - Zachary Hovis
- Department of Pharmacy University of Pittsburgh Medical Center Presbyterian Shadyside Pittsburgh Pennsylvania USA
- Clinical Sciences Department Medical College of Wisconsin Pharmacy School Milwaukee Wisconsin USA
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Kilroy S, Corte C, Park C, Vincent C, Borgers F, Hannan M, Corbridge S. Identifying contributing factors influencing pediatric nurses' and health professionals' self-reported collaborative practice behaviors. J Pediatr Nurs 2022; 64:164-173. [PMID: 34794847 DOI: 10.1016/j.pedn.2021.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 10/09/2021] [Accepted: 10/21/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE In this study, we examined the influence of interprofessional American Heart Association (AHA) resuscitation courses on pediatric health care professionals' (N = 218) self- reported collaborative practice behaviors (CPBs) and examined differences in CPBs between nursing, medicine, and respiratory therapy. DESIGN AND METHODS A mixed methods explanatory design was utilized with a sample of pediatric nurses, nurse practitioners, physicians, and respiratory therapists. Data were collected using the Interprofessional Collaborative Competency Attainment Survey (ICCAS) and two open-ended questions. Data analysis included: exploratory factor analysis, paired t-tests, mixed effects modeling and directed content analysis. Inferences were made across quantitative and qualitative data. RESULTS Statistically significant improvement in mean CPB scores was demonstrated by all professions (t (208) = -12.76; ρ < 0.001) immediately after the AHA courses. Qualitative responses indicated physicians identified roles and responsibilities (94%, n = 17) as the most important CPB. Communication was identified by nurses (78%, n = 76), nurse practitioners (100%, n = 11) and respiratory therapists (71%, n = 5) as most important. CONCLUSIONS Participation in an interprofessional AHA course significantly increased mean self-reported CPB scores. Changes in mean CPB scores were sustained over 6 weeks upon return to clinical practice. PRACTICE IMPLICATIONS Future research focused on CPBs of front-line health care professionals can provide an accurate portrayal of an interprofessional team and can inform how collaborative practice is established in everyday clinical practice.
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Affiliation(s)
- Susan Kilroy
- University of Illinois at Chicago, Department of Human Development Nursing Science, 845 S. Damen Ave, Chicago, IL 60612, United States of America.
| | - Colleen Corte
- University of Illinois Chicago, Department of Population Health Nursing Science, 845 S. Damen Ave, Chicago, IL 60612, United States of America.
| | - Chang Park
- University of Illinois Chicago, Department of Population Health Nursing Science, 845 S. Damen Ave, Chicago, IL 60612, United States of America.
| | - Catherine Vincent
- University of Illinois at Chicago, Department of Human Development Nursing Science, 845 S. Damen Ave, Chicago, IL 60612, United States of America.
| | - Frank Borgers
- University of Illinois Chicago, Health Policy and Administration, 1603 W. Taylor St., Chicago, IL 60608, United States of America.
| | - Mary Hannan
- University of Illinois Chicago, 1747 W Roosevelt Rd, Chicago, IL 60608, United States of America.
| | - Susan Corbridge
- University of Illinois Chicago, Department of Biobehavioral Nursing Science, 845 S. Damen Ave, Chicago, IL 60612, United States of America.
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Rosenfeld LC, Wang P, Holland J, Ruble M, Parsons T, Huang H. Care Management of Comorbid Medical and Psychiatric Illness: A Conceptual Framework for Improving Equity of Care. Popul Health Manag 2022; 25:148-156. [PMID: 35442788 PMCID: PMC9058884 DOI: 10.1089/pop.2021.0366] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Psychiatric and medical comorbidities are common among adults in the United States. Due to the complex interplay between medical and psychiatric illness, comorbidities result in substantial disparities in morbidity, mortality, and health care costs. There is, thus, both an ethical and fiscal imperative to develop care management programs to address the needs of individuals with comorbid conditions. Although there is substantial evidence supporting the use of care management for improving health outcomes for patients with chronic diseases, the majority of interventions described in the literature are condition-specific. Given the prevalence of comorbidities, the authors of this article reviewed the literature and drew on their clinical expertise to guide the development of future multimorbidity care management programs. Their review yielded one study of multimorbidity care management and two studies of multimorbidity collaborative care. The authors supplemented their findings by describing three key pillars of effective care management, as well as specific interventions to offer patients based on their psychiatric diagnoses and illness severity. The authors proposed short-, medium-, and long-term indicators to measure and track the impact of care management programs on disparities in care. Future studies are needed to identify which elements of existing multimorbidity collaborative care models are active ingredients, as well as which of the suggested supplemental interventions offer the greatest value.
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Affiliation(s)
- Lisa C Rosenfeld
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Philip Wang
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | | | - Hsiang Huang
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
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26
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Establishing and evaluating physician-pharmacist collaborative clinics to manage patients with type 2 diabetes in primary hospitals in Hunan province: study protocol of a multi-site randomized controlled trial in the era of COVID-19 pandemic. BMC Health Serv Res 2022; 22:299. [PMID: 35246117 PMCID: PMC8894569 DOI: 10.1186/s12913-022-07653-8] [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] [Received: 01/24/2022] [Accepted: 02/18/2022] [Indexed: 11/25/2022] Open
Abstract
Background The COVID-19 pandemic has exerted an unprecedented and universal impact on global health system, resulting in noticeable challenges in traditional chronic disease care, of which diabetes was reported to be most influenced by the reduction in healthcare resources in the pandemic. China has the world’s largest diabetes population, and current diabetes management in China is unsatisfactory, particularly in rural areas. Studies in developed countries have demonstrated that physician-pharmacist collaborative clinics are efficient and cost-effective for diabetes management, but little is known if this mode could be adapted in primary hospitals in China. The aim of this proposed study is to develop and evaluate physician-pharmacist collaborative clinics to manage type 2 diabetes mellitus (T2DM) in primary hospitals in Hunan province. Methods A multi-site randomized controlled trial will be conducted to evaluate the effectiveness and cost-effectiveness of the physician-pharmacist collaborative clinics compared with usual care for Chinese patients with T2DM. Six primary hospitals will participate in the study, which will recruit 600 eligible patients. Patients in the intervention group will receive services from both physicians and pharmacists in the collaborative clinics, while the control group will receive usual care from physicians. Patients will be followed up at the 3rd, 6th, 9th and 12th month. Comparison between the two groups will be conducted by assessing the clinical parameters, process indicators and costs on diabetes. A satisfaction survey will also be carried out at the end of the study. Discussion If effective, the physician-pharmacist collaborative clinics can be adapted and used in primary hospitals of China to improve glycemic control, enhance medication adherence, decrease incidence of complications and reduce patients’ dependence on physicians. Findings from the present study are meaningful for developing evidence-based diabetes care policy in rural China, especially in the COVID-19 pandemic era. Trial registration Chinese Clinical Trial Registry, ChiCTR2000031839, Registered 12 April 2020.
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27
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Mohammed RA, Marouf BH. Physicians’ attitude towards community pharmacists’ contribution in the treatment decision making. BRAZ J PHARM SCI 2022. [DOI: 10.1590/s2175-97902022e201095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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Wagner ML, McCarthy C, Bateman MT, Simmons D, Prioli KM. Pharmacists improve diabetes outcomes: a randomized controlled trial. J Am Pharm Assoc (2003) 2021; 62:775-782.e3. [PMID: 35027281 DOI: 10.1016/j.japh.2021.12.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 10/15/2021] [Accepted: 12/21/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND There is a growing shortage of primary care physicians. Pharmacists can fill the gap, and interdisciplinary teams are being evaluated as part of health care reform. OBJECTIVE This study aimed to determine whether adding a pharmacist to an interprofessional health team will improve diabetes outcomes. METHODS In this 2-phase pilot study, Medicaid-eligible patients with diabetes were randomized to receive standard of care (control arm) or standard of care plus the care of a pharmacist (intervention arm) for 12 months (phase 1). The primary outcome was change in glycated hemoglobin (A1C) from baseline. Secondary outcomes included identifying and correcting medication therapy problems (MTPs) for comorbid conditions, adherence to preventive care visits, health care utilization, self-rated health, and satisfaction surveys. After phase 1, patients in the control arm who did not achieve an A1C of < 8% were eligible to enroll into phase 2 where they received treatment with a pharmacist for 6 months. RESULTS Of the 239 patients enrolled, 122 completed phase 1. At 12 months, intervention patients' mean A1C was 1.85 percentage point (pp) below baseline versus 0.94 pp for control (between-group difference 0.91 pp; P = 0.0218). Most control patients (79%) who completed phase 1 and enrolled into phase 2 improved their A1C by more than 1 pp (P < 0.01). The pharmacists completed 806 patient visits and identified 2638 MTPs. Intervention patients were more adherent to preventive care visits with nutrition (P = 0.043), ophthalmology (P = 0.002), and dentistry (P = 0.007). For intervention patients, 78% rated their experience with the pharmacist as excellent whereas, for control patients, 37% rated their experience with their provider as excellent. CONCLUSION Pharmacist comanagement of patients with diabetes can significantly improve glucose control and patient satisfaction. Creative payment models were used to include pharmacists in the interprofessional patient care team.
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Jay JS, Ijioma SC, Holdford DA, Dixon DL, Sisson EM, Patterson JA. The cost-effectiveness of pharmacist-physician collaborative care models vs usual care on time in target systolic blood pressure range in patients with hypertension: a payer perspective. J Manag Care Spec Pharm 2021; 27:1680-1690. [PMID: 34818090 PMCID: PMC10390951 DOI: 10.18553/jmcp.2021.27.12.1680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND: Hypertension is highly prevalent in the United States, affecting nearly half of all adults (43%). Studies have shown that pharmacist-physician collaborative care models (PPCCMs) for hypertension management significantly improve blood pressure (BP) control rates and provide consistent control of BP. Time in target range (TTR) for systolic BP is a novel measure of BP control consistency that is independently associated with decreased cardiovascular risk. There is no evidence that observed improvement in TTR for systolic BP with a PPCCM is cost-effective. OBJECTIVE: To compare the cost-effectiveness of a PPCCM with usual care for the management of hypertension from the payer perspective. METHODS: We used a decision analytic model with a 3-year time horizon based on published literature and publicly available data. The population consisted of adult patients who had a previous diagnosis of high BP (defined as office-based BP ≥ 140/90 mmHg) or were receiving antihypertensive medications. Effectiveness data were drawn from 2 published studies evaluating the effect of PPCCMs (vs usual care) on TTR for systolic BP and the impact of TTR for systolic BP on 4 cardiovascular outcomes (nonfatal myocardial infarction [MI], stroke, heart failure [HF], and cardiovascular disease [CVD] death). The model incorporated direct medical costs, including both programmatic costs (ie, direct costs for provider time) and downstream health care utilization associated with acute cardiovascular events. One-way sensitivity and threshold analyses examined model robustness. RESULTS: In base-case analyses, PPCCM hypertension management was associated with lower downstream medical expenditures (difference: -$162.86) and lower total program costs (difference: -$108.00) when compared with usual care. PPCCM was associated with lower downstream medical expenditures across all parameter ranges tested in the deterministic sensitivity analysis. For every 10,000 hypertension patients managed with PPCCM vs usual care over a 3-year time horizon, approximately 27 CVD deaths, 29 strokes, 21 nonfatal MIs, and 12 incident HF diagnoses are expected to be averted. CONCLUSIONS: This is the first study to evaluate the cost-effectiveness of PPCCM compared to usual care on TTR for systolic BP in adults with hypertension. PPCCM was less costly to administer and resulted in downstream health care savings and fewer acute cardiovascular events relative to usual care. Although further research is needed to evaluate the long-term costs and outcomes of PPCCM, payer coverage of PPCCM services may prevent future health care costs and improve patient cardiovascular outcomes. DISCLOSURES: No funding was received for the completion of this research. The authors have nothing to disclose. Study results were presented as an abstract at the AMCP 2021 Virtual, April 12-16, 2021.
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Affiliation(s)
- Jessica S Jay
- Center for Pharmacy Practice Innovation, Virginia Commonwealth University School of Pharmacy, Richmond
| | - Stephen C Ijioma
- Center for Pharmacy Practice Innovation, Virginia Commonwealth University School of Pharmacy, Richmond
| | - David A Holdford
- Center for Pharmacy Practice Innovation, Virginia Commonwealth University School of Pharmacy, Richmond
| | - Dave L Dixon
- Center for Pharmacy Practice Innovation, Virginia Commonwealth University School of Pharmacy, Richmond
| | - Evan M Sisson
- Center for Pharmacy Practice Innovation, Virginia Commonwealth University School of Pharmacy, Richmond
| | - Julie A Patterson
- Center for Pharmacy Practice Innovation, Virginia Commonwealth University School of Pharmacy, Richmond
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Gemmechu WD, Eticha EM. Factors influencing the degree of physician-pharmacists collaboration within governmental hospitals of Jigjiga Town, Somali National Regional State, Ethiopia, 2020. BMC Health Serv Res 2021; 21:1269. [PMID: 34819071 PMCID: PMC8611947 DOI: 10.1186/s12913-021-07301-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 11/08/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Collaboration is the way to deliver the desired health outcome for the patients or service users in the healthcare. Inter-professional collaboration can improve medication safety, patient outcome and minimize healthcare costs. This study aimed to explore the degree of collaboration and factors influencing collaboration between physicians and pharmacists within the public hospitals of Jigjiga town, Somali National Regional State, Ethiopia, 2020. METHODS A cross-sectional study qualitative was conducted among 149 participants in the two governmental hospitals of the Jigjiga town with a response rate of 79.87%. The collaborative working relationship model and the physician-pharmacist collaborative instrument with three main exchange domains (trustworthiness, role specification, and relationship initiation) and collaborative care items were used. An independent sample t-test was used to compute the differences of the mean scores of physician-pharmacist collaborative instrument domains and collaborative care. Separate multiple regression was employed to assess factors influencing collaborative care for pharmacists and physicians. RESULTS This study showed that pharmacists reported higher mean of collaborative care (10.66 ± 4.75) than physicians (9.17 ± 3.92). The multiple regression indicated that area of practice influence both professionals' collaborative practice. A significant association between collaborative care and the two PPCI domains (trustworthiness and relationship initiation for the physicians; role specification and relationship initiation for pharmacists) was established. CONCLUSIONS The study showed that the collaboration between the physicians and pharmacists was sub-optimal and the exchange variables had a significant influence on their collaboration. RECOMMENDATION Physicians and pharmacists need to exert more efforts to enhance this collaboration. Further qualitative study might be needed to search for factors affecting, barriers and how to develop collaborative practice.
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Affiliation(s)
- Workineh Diriba Gemmechu
- College of Medicine and Health Science, School of Medicine, Jigjiga University, Jigjiga, Ethiopia
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Clinard V, Stebbins M, Lynch S. The Evolution of Drug Information Services to Asynchronous Delivery of Pharmacist eConsults. J Pharm Technol 2021; 37:316-319. [PMID: 34790970 DOI: 10.1177/87551225211049470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Drug information (DI) services provided an avenue to expand the role of pharmacists as the medication experts. The focus of DI has shifted from general questions submitted to DI centers to patient-specific questions that optimize care. One method to increase access to pharmacist expertise is through pharmacy eConsults. Pharmacy eConsults provide specialist care for medically complex patients using a patient-centered, asynchronous approach. The purpose of this article is to describe the evolution of consults from formal drug information services and describe one academic medical center's implementation of a pharmacy eConsult service to provide patient-specific DI.
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Ng CB, Chang CT, Ong SY, Mahmud M, Lee LC, Chew WY, Hamdan N, Kamaludin RS, Thong KS, Choo SJ. Awareness, expectation and satisfaction towards ward pharmacy services among patients in medical wards: a multi-centre study in Perak, Malaysia. BMC Health Serv Res 2021; 21:1175. [PMID: 34711230 PMCID: PMC8555295 DOI: 10.1186/s12913-021-07185-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 10/18/2021] [Indexed: 11/29/2022] Open
Abstract
Background Patient’s awareness and satisfaction towards ward pharmacy services may influence perception towards effectiveness and safety of drugs, affecting medication adherence and clinical outcome. Nevertheless, studies on local ward pharmacy services were lacking. This study evaluated awareness, expectation and satisfaction of ward pharmacy services among patients in medical wards and determined their association with demographic characteristics. Methods This was a cross-sectional study using self-administered questionnaire conducted in medical wards of fourteen Perak state public hospitals from September to October 2020. In-patients aged ≥18 years old were included. The validated questionnaire had four domains. The student’s t-test, one-way analysis of variance (ANOVA) and multiple linear regression were was employed to evaluate the association between patients’ demographic characteristics with their awareness, expectation and satisfaction towards ward pharmacy services. Results 467 patients agreed to participate (response rate = 83.8%) but only 441 were analysed. The mean age of the patients was 54.9 years. Majority was male (56.2%), Malay (77.3%), with secondary education (62.9%), rural resident (57.1%) and reported good medication adherence (61.6%). The mean awareness score was 49.6 out of 60. Patients were least aware about drug-drug interaction (3.85 ± 1.15) and proper storage of medications (3.98 ± 1.06). Elderly patients (β = − 2.82, P < 0.001) obtained lower awareness score. Patients with tertiary education (β = 3.87, P = 0.001), rural residents (β = 3.65, P < 0.001) and with good medication adherence (β = 2.55, P = 0.002) had higher awareness score. The mean expectation score was 44.0 out of 50. The patients had higher expectation to encounter a polite ward pharmacist (4.51 ± 0.56). Patients with tertiary education (β = 1.86, P = 0.024), rural residents (β = 1.79, P = 0.001) and with good medication adherence (β = 1.48, P = 0.006) demonstrated higher expectation. The mean satisfaction score was 43.6 out of 50. The patients had high satisfaction in language used (4.45 ± 0.57) and level of knowledge demonstrated (4.41 ± 0.62) by the ward pharmacists. Patients with tertiary education (β = 2.16, P = 0.009), rural residents (β = 1.82, P = 0.001) and with good medication adherence (β = 1.44, P = 0.009) demonstrated higher satisfaction, while elderly patients (β = − 1.17, P = 0.031) had lower satisfaction towards ward pharmacy services. Conclusion There was a high level of awareness, expectation and satisfaction towards ward pharmacy services in public hospitals of Perak, Malaysia.
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Affiliation(s)
- Chew Beng Ng
- Pharmacy Department, Hospital Taiping, Ministry of Health Malaysia, Taiping, Malaysia
| | - Chee Tao Chang
- Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ministry of Health Malaysia, Ipoh, Malaysia.
| | - Su Yin Ong
- Perak Pharmaceutical Services Division, Ministry of Health Malaysia, Ipoh, Malaysia
| | - Maslinatasha Mahmud
- Pharmacy Department, Hospital Parit Buntar, Ministry of Health Malaysia, Parit Buntar, Malaysia
| | - Lay Chin Lee
- Pharmacy Department, Hospital Teluk Intan, Ministry of Health Malaysia, Teluk Intan, Malaysia
| | - Wei Yee Chew
- Pharmacy Department, Hospital Selama, Ministry of Health Malaysia, Selama, Malaysia
| | - Normi Hamdan
- Pharmacy Department, Hospital Seri Manjung, Ministry of Health Malaysia, Seri Manjung, Malaysia
| | - Ros Sakinah Kamaludin
- Pharmacy Department, Hospital Slim River, Ministry of Health Malaysia, Slim River, Malaysia
| | - Kah Shuen Thong
- Pharmacy Department, Hospital Raja Permaisuri Bainun, Ministry of Health Malaysia, Ipoh, Malaysia
| | - Shea Jiun Choo
- Pharmacy Department, Hospital Taiping, Ministry of Health Malaysia, Taiping, Malaysia
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McDermott K. Utilizing diagnostic pharmacists to support Family Medicine Walk-In clinics during the COVID-19 pandemic. J Am Pharm Assoc (2003) 2021; 62:612-619. [PMID: 34802944 PMCID: PMC8539209 DOI: 10.1016/j.japh.2021.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 10/05/2021] [Accepted: 10/20/2021] [Indexed: 12/03/2022]
Abstract
Background During the coronavirus 2019 (COVID-19) pandemic, physician focus shifted from continuity of care to pandemic duties. However, patients still required in-person visits for acute or chronic complaints. Specially trained pharmacists were utilized to alleviate Family Medicine Walk-In (FMWI) provider shortages. Objective To describe the innovative practice utilizing diagnostic pharmacists in FMWI, evaluate their impact on provider time, compare workload with traditional advanced practice providers (APPs), and evaluate type of visits and medications prescribed. Practice description Pharmacists at an Indian Health Service medical center staffed FMWI 2.5 days per week to alleviate provider shortages during the COVID-19 pandemic. The privileged pharmacist had a diagnostic scope like APPs. Non-privileged pharmacists provided care to patients utilizing current protocols and were required to present all new complaints to providers. Practice innovation The facility utilized pharmacists that have completed or were progressing through the local diagnostic training program to alleviate provider shortages. Evaluation methods The absolute number of visits by pharmacists was determined and the number of provider hours shifted to pharmacy estimated. The number of visits by provider type was calculated and compared. ICD-10 codes were evaluated for purpose of visits. New prescriptions written by pharmacists were categorized and reimbursement rates determined. Results Pharmacists were responsible for 677 visits during 88 clinic days, with an estimated 338 provider hours shifted to pharmacists. Pharmacists saw 5.8 patients per day, APPs 5.2, and physicians 5.7. Pharmacists primarily evaluated hypertension, diabetes, musculoskeletal, and infectious disease complaints. New prescription categories included pain management, endocrine, cardiovascular, and infectious disease. The single billable pharmacist was reimbursed $77,945. Conclusion Diagnostic pharmacists in FMWI have allowed providers to shift to other pandemic duties and demonstrate similar workload as APPs. Most visits and prescriptions fall within known pharmacist practice. Pharmacists in this setting pay for the existence of this position and remain integrated in FMWI.
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Wei ET, Gregory P, Halpern DJ, Felton M, Goldstein BA, Yeatts J, Shah K, Smith BH. Impact of a clinical pharmacist on provider prescribing patterns in a primary care clinic. J Am Pharm Assoc (2003) 2021; 62:209-213.e1. [PMID: 34756524 DOI: 10.1016/j.japh.2021.10.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 09/17/2021] [Accepted: 10/07/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Sodium-glucose transporter 2 (SGLT2) inhibitors and glucagon-like peptide-1 (GLP-1) agonists have demonstrated beneficial outcomes in patients with type 2 diabetes at high cardiovascular risk. Unfortunately, these agents are still underutilized in primary care practice. A clinical pharmacist was embedded at a primary care clinic to provide diabetes and hypertension management under a collaborative practice agreement with a supervising physician. OBJECTIVES This study will evaluate whether the presence of an embedded pharmacist in a primary care clinic affects prescribing patterns of novel, evidence-based diabetes therapies. METHODS We abstracted information on SGLT2 inhibitor and GLP-1 agonist prescribing patterns from 3 primary care clinics across 2 time periods as a single-center, retrospective cohort study. We used a difference-in-difference analysis to compare prescription rates and assess the impact of embedding the pharmacist into clinical practice. Prescriptions written by the pharmacist were excluded. RESULTS Across all 3 clinics, 1309 and 1489 patients were included in the pre-intervention and postintervention periods, respectively. The percentage of patients prescribed either an SGLT2 inhibitor or GLP-1 agonist, similar between both groups at baseline, rose to 11.6% in the nonintervention clinics and 15.0% in the intervention clinic. There was a statistically significant increase in SGLT2 inhibitor and GLP-1 agonist prescribing in the intervention clinic compared with nonintervention clinics (P = 0.034). This change in prescribing patterns appeared even greater when excluding prescribers who were not present during both pre-intervention and postintervention periods (P = 0.009). CONCLUSION The presence of a pharmacist is associated with increased SGLT2 inhibitor and GLP-1 agonist prescribing within a clinic, even in patients not seen directly by the pharmacist. These results suggest that an on-site clinical pharmacist providing care for patients with diabetes may indirectly influence the prescribing behavior of co-located primary care providers, increasing the adoption of novel noninsulin diabetic medications.
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Physician-pharmacist collaborative management in patients after percutaneous coronary intervention: a retrospective propensity score matching cohort study. Int J Clin Pharm 2021; 44:90-99. [PMID: 34643858 DOI: 10.1007/s11096-021-01316-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 07/31/2021] [Indexed: 10/20/2022]
Abstract
AIM Evaluate the effect of the Physician-Pharmacist Collaborative Management (PPCM) practice model in patients after percutaneous coronary intervention (PCI). METHOD A retrospective cohort study was conducted in post-PCI patients. The study enrolled patients who underwent PCI at our hospital from May 1, 2018, to January 31, 2020. Patients were divided into two groups: the PPCM group if they utilized the Complex Coronary Interventions Medication Therapy Management (CCI-MTM) clinic and the usual care (UC) group if they used the physician-only cardiology clinic. Patients had clinic visits monthly, and data were analyzed after 6-months of follow-up. A propensity score matching (PSM) method was used to control confounding bias between groups. RESULTS A total of 727 patients met the inclusion criteria, including 67 patients in the PPCM group and 660 patients in the UC group. Using the 1:2 nearest neighbor matching method, 61 pairs were successfully matched; this included 61 patients in the PPCM group and 122 patients in the UC group. The proportion of patients reaching both LDL-C (73.8% versus 41.0%, P < 0.001) and heart rate (14.8% versus 4.1%, P = 0.007) goals in the PPCM was higher compared to the UC group. The median time to achieving the goal LDL-C was shorter in the PPCM group (31 days versus 126 days, P = 0.001). The utilization rates of [Formula: see text]-receptor blockers (73.8% versus 56.6%, P = 0.005) and ACEIs or ARBs (72.1% versus 56.6%, P = 0.018) were higher in the PPCM group compared to the UC group. There was no significant difference in adverse drug events between the two groups (P > 0.05). All recommendations to resolve drug-related problems were accepted by the physicians and patients. CONCLUSION The pharmaceutical care provided by the pharmacist in the PPCM clinic improved risk factor control and increased the utilization of preventive drugs in post-PCI patients.
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Mulrooney M, Smith M. Primary Care Pharmacist Practice Models Shape the Comprehensive Medication Management Process. Ann Pharmacother 2021; 56:620-625. [PMID: 34431714 DOI: 10.1177/10600280211042031] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Pharmacists are well positioned to collaborate with primary care providers (PCPs) to conduct comprehensive medication management (CMM). However, depending on organizational needs and pharmacist staffing resources, different pharmacist practice models have been implemented. In this commentary, we (1) describe 2 common pharmacist practice models in primary care settings, (2) explain variations in the CMM process based on 2 practice models, and (3) outline outcomes and implications of this expanded CMM process. By tailoring the CMM process to their practice model, pharmacists can follow consistent delivery of CMM services to create a common understanding among patients, PCPs, and other care team members.
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Affiliation(s)
- Mary Mulrooney
- University of Connecticut, School of Pharmacy, Storrs, CT, USA
| | - Marie Smith
- University of Connecticut, School of Pharmacy, Storrs, CT, USA
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Caldwell BA, Alessi EJ, DiGiulio M, Findley P, Oursler J, Wagner M. Integrating Behavioral Health into Primary Care: The Role of Psychiatric Nursing in the Development of the Interprofessional Team. Issues Ment Health Nurs 2021; 42:758-767. [PMID: 33539194 DOI: 10.1080/01612840.2020.1867676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Integrated behavioral health in a primary care setting is a paradigm shift that requires academic reconfiguration on how health care professionals are educated and trained in the clinical arena. METHOD An academic university was able to create interprofessional didactic and clinical learning experiences for students within the Schools of Nursing, Social Work, Health Professions-Rehabilitation Counseling Department and Pharmacy resulting in improved models for patient care delivery. RESULTS Interdisciplinary faculty developed the didactic, clinical and evaluative areas based on the HRSA grant work plan. Deliverables included 18 modules, case studies focused on population health, and team-focused standardized patient experiences to test their behavioral health and psychiatric skills in a primary care setting. CONCLUSIONS Faculty from the different disciplines were able to collaborate on the deliverables, take the opportunities to engage students and collaborate on scholarly presentations at a national, state and local professional organizations. Academic course for interprofessional practice has been developed and implemented as an outcome of this grant.
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Affiliation(s)
| | - Edward J Alessi
- School of Social Work, Graduate Department, Rutgers University, New Brunswick, New Jersey, USA
| | - Mary DiGiulio
- School of Nursing, Rutgers University, Newark, New Jersey, USA
| | - Patricia Findley
- School of Social Work, Graduate Department, Rutgers University, New Brunswick, New Jersey, USA
| | - Janice Oursler
- School of Health Professions, Department of Psychiatric Rehabilitation and Counseling Professions, Rutgers University, Piscataway, New Jersey, USA
| | - Mary Wagner
- Department of Pharmacy Practice and Administration Ernest Mario School of Pharmacy, Rutgers University, Piscataway, New Jersey, USA
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Assadi RA, Gulam SM. Medication Therapy Management Clinics: A Model to Improve Healthcare Access. GLOBAL JOURNAL ON QUALITY AND SAFETY IN HEALTHCARE 2021; 4:85-87. [PMID: 37261061 PMCID: PMC10228995 DOI: 10.36401/jqsh-21-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 05/25/2021] [Accepted: 06/17/2021] [Indexed: 06/02/2023]
Affiliation(s)
- Rizah Anwar Assadi
- Department of Pharmacy Practice, College of Pharmacy, Gulf Medical University Ajman, United Arab Emirates
- Clinical Pharmacy Department, Thumbay University Hospital Ajman, United Arab Emirates
| | - Shabaz Mohiuddin Gulam
- Department of Pharmacy Practice, College of Pharmacy, Gulf Medical University Ajman, United Arab Emirates
- Clinical Pharmacy Department, Thumbay University Hospital Ajman, United Arab Emirates
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Mulrooney M, Smith M, Lewis K, Vuernick E, Anderson D, Channamsetty V, Giannotti T. Practical implementation insights from 2 population health pharmacist project approaches to improve blood pressure control. J Am Pharm Assoc (2003) 2021; 62:270-280. [PMID: 34400071 DOI: 10.1016/j.japh.2021.07.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 07/07/2021] [Accepted: 07/17/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Population health pharmacists (PHPs) can optimize medication regimens for blood pressure (BP) control using various approaches based on the timing of medication recommendations sent to providers. OBJECTIVE To identify the contextual factors and implementation insights from 2 PHP approaches to consider when implementing PHP initiatives. PRACTICE DESCRIPTION A federally qualified health center with 14 sites throughout Connecticut. PRACTICE INNOVATION A centralized PHP performed medication reviews and sent recommendations to providers. The providers reviewed the recommendations for implementation into patients' care plans. The 2 PHP approaches used were: JUST-IN-TIME (JIT) APPROACH: A part-time, contracted PHP used weekly reports to identify 204 patients with uncontrolled hypertension (BP ≥ 140/90 mm Hg) and same-week provider appointments. ANYTIME (ANY) APPROACH A full-time staff PHP used a registry report to identify 41 patients with uncontrolled hypertension (systolic BP: 140-150 mm Hg) and diabetes (glycosylated hemoglobin: 9%-10%) regardless of the next appointment date. EVALUATION METHODS Four of the 5 Reach, Effectiveness, Adoption, Implementation, and Maintenance framework dimensions were used to assess the JIT and ANY approaches. Quantitative data were analyzed using descriptive statistics and chi-square or Fisher exact tests. RESULTS The contextual factors that affected the reach, effectiveness, adoption, and implementation of the 2 projects included the timing of PHP recommendations, PHP employment status, and PHP's prior work experience. The PHP insights to consider when implementing these projects include the need to (1) build trusted relationships with providers/other team members; (2) demonstrate sensitivity and respect for providers' workload/workflow; (3) send concise, actionable, and timely recommendations; and (4) measure value/impact of PHP interventions with defined metrics. The organizational implementation insights to consider include clearly defining the role of the PHP, providing clinical/administrative buy-in and support, fostering a strong organizational culture for team-based care, and collaboration with the data analytics team to identify patients classified as high impact. CONCLUSION The contextual factors and implementation insights identified can be used pragmatically by primary care clinical leaders to integrate a limited PHP resource on an existing population health team.
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King PK, Burkhardt C, Rafferty A, Wooster J, Walkerly A, Thurber K, Took R, Masterson J, St. Peter WL, Furuno JP, Williams E, Ferren J, Rascon K. Quality measures of clinical pharmacy services during transitions of care. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2021. [DOI: 10.1002/jac5.1479] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
| | | | | | | | | | | | - Roxane Took
- American College of Clinical Pharmacy Lenexa Kansas USA
| | | | | | - Jon P. Furuno
- American College of Clinical Pharmacy Lenexa Kansas USA
| | - Evan Williams
- American College of Clinical Pharmacy Lenexa Kansas USA
| | - Janie Ferren
- American College of Clinical Pharmacy Lenexa Kansas USA
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Informing collaborative relationships between community pharmacists and health care professionals in primary care practices. J Am Pharm Assoc (2003) 2021; 61:778-784.e1. [PMID: 34303615 DOI: 10.1016/j.japh.2021.06.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 06/02/2021] [Accepted: 06/11/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Collaborative relationships between community pharmacists and health care professionals in primary care practices can assist with the provision of medication and disease management services in community pharmacy settings. OBJECTIVES The objective was to describe the attitudes of providers working in primary care practices with on-site pharmacist collaborators to understand how to facilitate similar collaborations with pharmacists in community pharmacy settings. METHODS This qualitative study was conducted among physicians, nurse practitioners, and nurses of 3 primary care practice sites in the Commonwealth of Pennsylvania. A demographic survey and a semistructured interview were conducted to elicit feedback on participant perceptions about building relationships with community pharmacists. Interviews were audio-recorded and transcribed. A qualitative analysis was performed to identify emerging themes using an inductive approach. Demographic data were summarized using descriptive statistics. This study was approved by the University's Institutional Review Board. RESULTS Nineteen interviews were conducted. Fifty-eight percent of participants were physicians and 68% were female with a mean age of approximately 46 years. Five themes were identified: (1) Pharmacists were highly valued and were effective team members to promote coordination of medication-related care; (2) Direct access to pharmacists facilitates efficient communication and effective patient care; (3) Trust is the foundation of an effective collaboration between pharmacists and providers; (4) Pharmacists demonstrating responsibility for patients enables collaboration with providers who view themselves as stewards of patient care; and (5) Providers believe that community pharmacists' dispensing requirements may limit their ability to participate in patient care. CONCLUSIONS The following strategies to establish relationships with primary care practices are suggested: pharmacists should initiate face-to-face relationships with providers in practices; communication and patient interventions should be conveyed directly to providers and be conducted by the same person; and pharmacists need to demonstrate their commitment to patient care by following up promptly on patient interventions.
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Homan MJ, Reid JH, Nachar VR, Benitez LL, Brown AM, Kraft S, Hough S, Christen C, Frame D, McDevitt RL. Implementation and outcomes of a pharmacist-led collaborative drug therapy management program for oncology symptom management. Support Care Cancer 2021; 29:6505-6510. [PMID: 33905012 DOI: 10.1007/s00520-021-06239-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 04/19/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Nausea, vomiting, constipation, and diarrhea are common cancer and cancer therapy adverse effects. Pharmacists are uniquely positioned to optimize patient symptom control and minimize excess use of hospital resources, such as emergency department visits. METHODS Michigan Medicine oncology clinical pharmacists have been independently providing patient symptom management through a collaborative drug therapy management (CDTM) program which established guidelines for management of gastrointestinal toxicities (nausea, vomiting, diarrhea, and/or constipation) secondary to a patient's cancer diagnosis or treatment of the cancer. Patients were referred to the pharmacist by the treating oncologist or hematologist. RESULTS From June 2019 to May 2020, there were a total of 62 patient referrals. Ten of the 62 referrals did not meet the CDTM inclusion criteria, resulting in 52 patients who were managed by the pharmacists. The total number of individual pharmacist visits was 136, with a median of 2.2 (range, 0-11) visits per patient referred. A total of 169 categorized pharmacist interventions were captured. Most interventions (100/169, 59.2%) were related to nausea/vomiting. Diarrhea-related and constipation-related interventions accounted for 10 (5.9%) and 13 (7.7%) of the total interventions, respectively. Most patients (36/52, 69.2%) had a reduction in the severity of their referral diagnosis symptom(s) based on Common Terminology Criteria for Adverse Events grading. CONCLUSION The Michigan Medicine Pharmacist CDTM program allowed pharmacists to independently manage gastrointestinal toxicities of patients with cancer and improved patient symptom severity. The CDTM program has the opportunity to improve quality of care.
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Affiliation(s)
- Morgan J Homan
- Department of Pharmacy Services and Clinical Pharmacy, Michigan Medicine, C427 Med Inn, SPC 5843, 1500 E Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Justin H Reid
- Department of Pharmacy Services and Clinical Pharmacy, Michigan Medicine, C427 Med Inn, SPC 5843, 1500 E Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Victoria R Nachar
- Department of Pharmacy Services and Clinical Pharmacy, Michigan Medicine, C427 Med Inn, SPC 5843, 1500 E Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Lydia L Benitez
- Department of Pharmacy Services and Clinical Pharmacy, Michigan Medicine, C427 Med Inn, SPC 5843, 1500 E Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Anna M Brown
- Department of Pharmacy Services and Clinical Pharmacy, Michigan Medicine, C427 Med Inn, SPC 5843, 1500 E Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Shawna Kraft
- Department of Pharmacy Services and Clinical Pharmacy, Michigan Medicine, C427 Med Inn, SPC 5843, 1500 E Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Shannon Hough
- Department of Pharmacy Services and Clinical Pharmacy, Michigan Medicine, C427 Med Inn, SPC 5843, 1500 E Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Catherine Christen
- Department of Pharmacy Services and Clinical Pharmacy, Michigan Medicine, C427 Med Inn, SPC 5843, 1500 E Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - David Frame
- Department of Pharmacy Services and Clinical Pharmacy, Michigan Medicine, C427 Med Inn, SPC 5843, 1500 E Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Rachel L McDevitt
- Department of Pharmacy Services and Clinical Pharmacy, Michigan Medicine, C427 Med Inn, SPC 5843, 1500 E Medical Center Drive, Ann Arbor, MI, 48109, USA.
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Pharmacist-Led Collaborative Medication Management for the Elderly with Chronic Kidney Disease and Polypharmacy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18084370. [PMID: 33924094 PMCID: PMC8074256 DOI: 10.3390/ijerph18084370] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 04/15/2021] [Accepted: 04/16/2021] [Indexed: 11/17/2022]
Abstract
Inappropriate polypharmacy is likely in older adults with chronic kidney disease (CKD) owing to the considerable burden of comorbidities. We aimed to describe the impact of pharmacist-led geriatric medication management service (MMS) on the quality of medication use. This retrospective descriptive study included 95 patients who received geriatric MMS in an ambulatory care clinic in a single tertiary-care teaching hospital from May 2019 to December 2019. The average age of the patients was 74.9 ± 7.3 years; 40% of them had CKD Stage 4 or 5. Medication use quality was assessed in 87 patients. After providing MMS, the total number of medications and potentially inappropriate medications (PIMs) decreased from 13.5 ± 4.3 to 10.9 ± 3.8 and 1.6 ± 1.4 to 1.0 ± 1.2 (both p < 0.001), respectively. Furthermore, the number of patients who received three or more central nervous system-active drugs and strong anticholinergic drugs decreased. Among the 354 drug-related problems identified, “missing patient documentation” was the most common, followed by “adverse effect” and “drug not indicated.” The most frequent intervention was “therapy stopped”. In conclusion, polypharmacy and PIMs were prevalent in older adults with CKD; pharmacist-led geriatric MMS improved the quality of medication use in this population.
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Malcolm O, Nelson A, Modeste NN, Gavaza P. Factors influencing implementation of personalized prevention plans among annual wellness visit patients using the theory of planned behavior: A quantitative study. Res Social Adm Pharm 2021; 17:1636-1644. [PMID: 33678585 DOI: 10.1016/j.sapharm.2021.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 01/03/2021] [Accepted: 01/04/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The Affordable Care Act provides Medicare Part B beneficiaries access to cost-free Annual Wellness Visits (AWVs). Patients receive health behavior recommendations from a Personalized Prevention Plan (PPP) during AWV encounters. AIMS To identify factors clinical pharmacists can use to influence adoption of PPPs in primary care practices. METHOD Utilizing a cross-sectional design, 77 Medicare patients (mean age 74.05 ± 8.04 years) presenting for subsequent AWV completed a theory of planned behavior (TPB) based questionnaire at two primary care practices. RESULTS 66.2% reported they were in the process of implementing PPPs and 51.9% reported implementing recommendations in the previous 12 months. TPB constructs accounted for 35.8% (p < .001) of the variation in intention, with subjective norm (SN) (β = 0.359, p = 0.004) as the strongest determinant, followed by attitude (β = 0.195, p = 0.093), and perceived behavioral control (PBC) (β = 0.103, p = 0.384). Intention accounted for 27.1% of the variance for implementing PPPs and was not a significant determinant (β = 0.047, p = 0.917). Addition of past behavior with TPB constructs significantly improved the predictability of the TPB model, accounted for 55% of the variation in intention (p < .001), and demonstrated a significant positive influence (β = 0.636, p < 0.001) on future PPP implementations. DISCUSSION This study demonstrates utility of the TPB in predicting implementation of PPPs. CONCLUSIONS Clinical pharmacists positioned as providers of AWVs can strengthen intention to adopt PPPs by integrating referents into AWV processes, and evaluating past behavior trends to improve future PPP implementation.
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Affiliation(s)
- O'Neal Malcolm
- Loma Linda University, School of Public Health, Loma Linda, CA, USA.
| | - Anna Nelson
- Health Promotion and Education, Loma Linda University, School of Public Health, Loma Linda, CA, USA
| | - Naomi N Modeste
- Health Promotion and Education, Loma Linda University, School of Public Health, Loma Linda, CA, USA
| | - Paul Gavaza
- Pharmaceutical and Administrative Sciences, Loma Linda University, School of Pharmacy, Loma Linda, CA, USA
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Frazier C, Marshall-Aiyelawo K, Gliner M, Holden C, Fowler T, Black C. Identifying Best Practices in Pharmacy Experience: An Analysis of Military Treatment Facilities With the Highest Pharmacy Patient Experience Scores. Mil Med 2021; 187:e1047-e1050. [PMID: 33604665 DOI: 10.1093/milmed/usab064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 01/13/2021] [Accepted: 02/08/2021] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Pharmacy patient experience within military treatment facilities (MTFs) is a significant indicator of healthcare quality, as hospital admissions correlate with medication use (Budnitz et al., 2006) and pharmacists have a unique opportunity to influence patients' health (Dalton & Byrne, 2017). To improve patient care across the military health system (MHS), we investigated best practices within MTF pharmacies with the highest patient experience scores. MATERIALS AND METHODS Researchers performed semi-structured telephone interviews with pharmacists, pharmacy technicians, and patient experience officers from three of the highest ranked MTF pharmacies according to outpatient satisfaction survey results to glean "best practice" approaches to patient care. Researchers utilized the Gioia approach as a guiding theory for qualitative analysis of the interview data, and the study was excluded from a requirement to obtain institutional review board approval due to the number of respondents in accordance with the Paperwork Reduction Act of 1980 guidelines. RESULTS Interview participants from highly rated pharmacies emphasized the importance of communication among and between staff and patients, staff engagement and morale, and supportive leadership at their facilities for creating a positive patient experience and clinical environment. CONCLUSION These findings provide valuable insights to improve public health in military-connected populations through improved patient care practices in pharmacies across the MHS. Initiatives aimed at improving health care for pharmacy patients should prioritize improved communication and structural support for team members to create patient-friendly environments, which enables pharmacists and technicians to connect with patients and positively impact health outcomes. Limitations include lack of comparison data for lower performing pharmacies; future research will explore practices at lower ranking pharmacies to provide insights into communication practices, environments, and staff relationships impacting patient experience scores as well as the role patient demographics (e.g., retirees vs. active duty) and characteristics including facility size play in potential improvements.
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Affiliation(s)
- Chantell Frazier
- Center for Military and Veterans Health, Altarum, Washington, DC 20036, USA
| | | | - Melissa Gliner
- Analytics and Evaluation Division, Defense Health Agency, Falls Church, VA 22042, USA
| | - Craig Holden
- Public Health Department, NORC, Bethesda, MD 20814, USA
| | - Tara Fowler
- Center Healthy Women and Children, Altarum, Washington, DC 20036, USA
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Walling J, Zelnicek T, Johnson EJ, O'Neal KS. Shot of a lifetime: How pharmacists stay ahead of the season. J Am Pharm Assoc (2003) 2021; 61:e214-e217. [PMID: 33582029 DOI: 10.1016/j.japh.2021.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 01/06/2021] [Accepted: 01/10/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The profession of pharmacy has long advocated for the advancement of practice through increased clinical responsibility. Provision of immunization related services has been one service pharmacists have been able to provide to add to their existing responsibilities. A universal influenza vaccination has been under investigation and is nearing success. While other clinical services should be considered, now more than ever, development of the universal vaccine should provide a pause for the profession and consideration of not only the impact on student learning opportunities but also pharmacy revenue. SUMMARY The development of the universal influenza vaccination poses a potential challenge to existing service-related revenue models for community pharmacies. There are many other opportunities pharmacists can capitalize on including, but not limited to, travel and other vaccinations, point-of-care testing, and transitions-of-care. In addition, through initiatives such as "Flip the Pharmacy" and Community Pharmacy Enhanced Service Network, pharmacists are in a great position to be innovative with clinical services while continuing to provide learners with training opportunities. CONCLUSION Many opportunities exist for pharmacists to expand services that lean into their clinical training and add other vaccination opportunities. These opportunities can augment revenue streams and still provide learners with training.
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Snyder MS, Fogel J, Pyatigorskaya S, Rubinstein S. Dose adjustment of antidiabetic medications in chronic kidney disease. Avicenna J Med 2021; 11:33-39. [PMID: 33520787 PMCID: PMC7839266 DOI: 10.4103/ajm.ajm_110_20] [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: 11/04/2022] Open
Abstract
Purpose: The purpose of this study is to identify whether Internal Medicine house-staff (IMHS) have awareness and knowledge about the correct dosage of antidiabetic medications for patients with chronic kidney disease (CKD), as dosing errors result in adverse patient outcomes for those with diabetes mellitus (DM) and CKD. Methods: There were 353 IMHS surveyed to evaluate incorrect level of awareness of medication dose adjustment in patients with CKD (ILA) and incorrect level of knowledge of glomerular filtration rate level for medication adjustment (ILK-GFR) for Glipizide, Pioglitazone, and Sitagliptin. Results: Lack of awareness and knowledge was high, with the highest for Pioglitazone at 72.8%. For ILA, the percentages were: Pioglitazone: 72.8%, Glipizide: 43.9%, and Sitagliptin: 42.8%. For ILK-GFR, the percentages were: Pioglitazone: 72.8%, Glipizide: 68.3%, and Sitagliptin: 65.4%. Conclusions: IMHS have poor awareness and knowledge for antidiabetic medication dose adjustment in patients with DM and CKD. Both Electronic Medical Rerecord best practice advisory and physician–pharmacist collaborative drug therapy management can enhance safe drug prescribing in patients with CKD. In addition, IMHS’s practice for antidiabetic medication dose adjustment was better with Nephrology exposure. A formal didactic educational training during medical school and residency for antidiabetic medication dose adjustment in patients with DM and CKD is highly encouraged to prevent medication dosing errors and to more effectively and safely allow IMHS to manage complex treatment regimens.
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Affiliation(s)
- Matthew Salvatore Snyder
- New York Institute of Technology College of Osteopathic Medicine, 101 Northern Boulevard, Old Westbury, NY, USA
| | - Joshua Fogel
- Department of Business Management, Brooklyn College, 218 Whitehead Hall, Brooklyn, NY, USA
| | - Svetlana Pyatigorskaya
- Division of Nephrology and Hypertension, Nassau University Medical Center, 2201 Hempstead Turnpike, East Meadow, NY, USA
| | - Sofia Rubinstein
- Division of Nephrology and Hypertension, Nassau University Medical Center, 2201 Hempstead Turnpike, East Meadow, NY, USA
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Bužančić I, Dragović P, Pejaković TI, Markulin L, Ortner-Hadžiabdić M. Exploring Patients' Attitudes Toward Deprescribing and Their Perception of Pharmacist Involvement in a European Country: A Cross-Sectional Study. Patient Prefer Adherence 2021; 15:2197-2208. [PMID: 34588769 PMCID: PMC8476111 DOI: 10.2147/ppa.s323846] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 09/14/2021] [Indexed: 02/05/2023] Open
Abstract
PURPOSE To explore how adult patients perceive deprescribing in a country with developing pharmaceutical care. PATIENTS AND METHODS This was a multicenter cross-sectional study conducted in ten community pharmacies across Croatia. Community-dwelling adults 40 years and older, taking at least one prescription medication long term, were invited to participate. The revised and validated Patients' Attitude Towards Deprescribing Questionnaire was used to investigate community-dwelling adults' opinions on potential medication discontinuation. Questions regarding the patients' perception of pharmacist competences and involvement as well as patients' preferences in deprescribing were added. Collected data were analyzed using IBM SPSS Statistics using descriptive and inferential statistical analysis. Binary logistic regression was used to explore potential predictive factors of willingness to have medication deprescribed. All tests were performed as two-tailed and a p < 0.05 was considered statistically significant. RESULTS A total of 315 adults aged 40 years and older completed the questionnaire. Majority of participants, 83.81% (95% CI, 79.72% to 87.90%) stated that they were satisfied with their medications, and 83.81% (95% CI, 79.72% to 87.90%) would be willing to deprescribe one or more medications. Participants expressed a positive attitude toward pharmacists' competences (68.89%, 95% CI, 63.75% to 74.03%) and involvement in deprescribing (71.11%, 95% CI, 66.08% to 76.14%). Participants who stated specific medication as deprescribing preference were more likely show dissatisfaction with current medication and show greater willingness to have medication deprescribed. Three factors were found to be associated with a positive attitude towards deprescribing: low concerns about stopping factor score (aOR 0.54, 95% CU=0.35-0.84; p=0.006), low appropriateness factor score (aOR 0.62, 95% CI=0.39-0.98; p=0.039), and a positive opinion on pharmacist involvement (aOR 2.35, 95% CI=1.18-4.70; p= 0.016). CONCLUSION This study showed the patient's willingness for deprescription as well as their positive attitude towards pharmacists being involved in the process. Results favour transition to a patient-centred care and shared-decision making model.
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Affiliation(s)
- Iva Bužančić
- City Pharmacies Zagreb, Zagreb, 10 000, Croatia
- Centre for Applied Pharmacy, Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, 10 000, Croatia
| | | | | | - Luka Markulin
- Pharmacy Unit, Psychiatric Hospital Ugljan, Ugljan, 23275, Ugljan Island, Croatia
| | - Maja Ortner-Hadžiabdić
- Centre for Applied Pharmacy, Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, 10 000, Croatia
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Integration of Clinical Pharmacists Into Family Medicine. Am J Ther 2020; 28:e727-e728. [PMID: 33021533 DOI: 10.1097/mjt.0000000000001242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Moore GD, Burns AL, Fish H, Gandhi N, Kebodeaux C, Meny LM, Policastri A, Sneed KB, Traynor A, Vosooney A, Bradley-Baker LR. The Report of the 2019-2020 Professional Affairs Standing Committee: Pharmacist Integration with Primary Care Practices. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2020; 84:ajpe8199. [PMID: 33149338 PMCID: PMC7596612 DOI: 10.5688/ajpe8199] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
The 2019-2020 Professional Affairs Committee was charged to (1) Describe the leadership role of schools of pharmacy in advancing interprofessional practice, with an emphasis on physician-pharmacist collaborative relationships; (2) Establish an inventory of resources that can support school efforts to grow collaborative partnerships between pharmacists and physicians; (3) Determine gaps that exist in the resources required to support schools in efforts to facilitate expansion of interprofessional partnerships; and (4) Define strategies and draft an action plan for AACP's role in facilitating member school efforts to accelerate the development of interprofessional practices within their geography of influence. This report provides information on the committee's process to address the committee charges as well as background and resources pertaining to the charges, describes the rationale for and the results from the focus groups conducted at the 2020 AACP Interim Meeting, communicates the results of an initial inventory of models that integrate pharmacists with primary care practices, and provides an overview on issues to continue the work to integrate pharmacists with primary care practices. The committee offered several revisions to current association policy statements and provided a proposed policy statement and several recommendations to AACP pertaining to the committee charges.
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Affiliation(s)
- Gina D Moore
- University of Colorado, Skaggs School of Pharmacy & Pharmaceutical Sciences, Aurora, Colorado
| | - Anne L Burns
- American Pharmacists Association, Washington, District of Columbia
| | - Hannah Fish
- National Community Pharmacists Association, Alexandria, Virginia
| | - Nidhi Gandhi
- American Association of Colleges of Pharmacy, Arlington, Virginia
| | - Clark Kebodeaux
- University of Kentucky, College of Pharmacy, Lexington, Kentucky
| | - Lisa M Meny
- Ferris State University, College of Pharmacy, Grand Rapids, Michigan
| | - Anne Policastri
- American Society of Health-System Pharmacists, Bethesda, Maryland
| | - Kevin B Sneed
- University of South Florida, College of Pharmacy, Tampa, Florida
| | - Andy Traynor
- Concordia University of Wisconsin, School of Pharmacy, Mequon, Wisconsin
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