Patient Satisfaction with Pharmacist-Provided Health-Related Services in a Primary Care Clinic

Integrating Clinical Pharmacy Services Into Comprehensive Multiple Sclerosis Care Teams: A Narrative Review of 4 Models

BACKGROUND: Over the past 30 years, the treatment landscape for multiple sclerosis (MS) has become increasingly complex. All MS disease-modifying therapies (DMTs) and several symptomatic medications are designated specialty medications, and their financial coverage is subject to complicated insurance processes and a wide array of patient support programs. Many patients receiving MS DMTs need ongoing monitoring or enrollment in a Risk Evaluation and Mitigation Strategy program. Integrated pharmacy services can facilitate financial, technical, and educational aspects of providing specialty medications. Although pharmacy services are often part of the care team for patients with complex chronic medical conditions, MS clinics may not have the benefit of full pharmacy services. We present 4 models of MS health care delivery and discuss how integrating pharmacy services into an MS multidisciplinary team can potentially increase the efficiency and quality of health care delivery. Clinical pharmacists, working with other providers, can optimize and accelerate access to medications requiring prior authorization, improve patient outcomes by promoting medication adherence and persistence, enhance safety by monitoring laboratory findings and potential drug-drug interactions, and minimize clinical workflow burden by improving process efficiency, which may be cost-effective for the MS health care delivery system.

How Do Pharmacists Distribute Their Work Time during a Clinical Intervention Trial?-A Time and Motion Study

Emergency departments (EDs) handle urgent medical needs for a diverse population. Medication errors and adverse drug events pose safety risks in the ED. Clinical pharmacists, experts in medication use, play a crucial role in identifying and optimizing medication therapy. The aim of this study was to investigate how clinical pharmacists introduced into the ED interdisciplinary teams distribute their work time. In a time and motion study, we used the Work Observation Method By Activity Timing (WOMBAT) to observe pharmacists in two Norwegian EDs. The pragmatic approach allowed pharmacists to adapt to ED personnel and patient needs. The pharmacists spent 41.8% of their work time on medication-related tasks, especially those linked to medication reconciliation, including documenting medication-related issues (16.2%), reading and retrieving written information (9.6%), and obtaining oral information about medication use from patients (9.5%). The remaining time was spent on non-medication-related tasks (41.8%), and on standby and movement (17.4%). In conclusion, ED pharmacists spent 42% of their work time on medication-related tasks, predominantly medication reconciliation. Their relatively new role in the interdisciplinary team may have limited their broader clinical impact. Relative to other ED healthcare professionals, ED pharmacists' goal remains to ensure accurate patient medication lists and appropriate medication use.

Direct Clinical Pharmacist-Patient Telephone Follow-Up: A Focus on GI Medical Oncology Symptom Management

PURPOSE

GI medical oncology care presents unique medication challenges. Here, we captured our clinical pharmacy specialists' (CPSs) involvement in patients with GI cancers starting cycle 1 of a new treatment.

METHODS

Our quality initiative was performed in three stages (preintervention, intervention, and postintervention). Preintervention: retrospective baseline data collection from May to December 2019. Intervention: one-time telephone encounters were conducted by a CPS between March 15 and June 11, 2021. The primary objective of the quality improvement initiative was to increase patient interaction with a CPS to 80%. Postintervention: data collection to review the impact of CPS telephone encounters.

RESULTS

Preintervention: we reviewed the electronic health records of 262 patients. Sixty nine percent of patients reported at least one adverse event (AE; range 1-6 AEs) at the first physician follow-up after treatment start. Most reported AEs (78%) were considered modifiable within the scope of CPS practice. Postintervention: during the intervention, 92% of patients (n = 389) received a telehealth encounter with the CPS. At the encounter, 315 patients (81%) reported at least one AE. CPS provided recommendations and/or additional education for 88% of reported AEs. Medication lists required correction 75% of the time. The median time for CPS encounters (including documentation) was 40 minutes.

CONCLUSION

During a 3-month period, this quality improvement initiative successfully provided an early CPS-based telehealth intervention to identify and make initial recommendations for management of AEs for patients on cycle 1 of systemic therapy for GI cancer.

Evaluation of the Impact of a Pharmacist-Conducted Hypertension Clinic

Background

Hypertension can lead to cardiovascular and other health complications. Many hypertensive patients in the community may receive poor care and monitoring due to financial and other concerns. Pharmacists could support patients in improving their health outcomes. This research aims to assess the impact of pharmacist-led hypertensive clinics in a community pharmacy setting.

Methods

The study was an interventional exploratory design in a community pharmacy in Dubai, UAE. All eligible patients who consented were enrolled in the study, making it a population-based study. Patients' blood pressure (BP) was measured before starting the intervention and measured monthly for a minimum of 6 months of care. Measuring BP, physician referral for management of hypertension, lifestyle, diet, and medication counseling were the interventions provided by the researcher on a case-to-case basis as needed in each patient encounter. Toward the end of the study, a patient satisfaction survey was conducted. The survey form showed internal consistency, Cronbach's alpha = 0.895.

Results

About 30 patients were provided pharmacy services by a pharmacist for 613 months. All patients'' BP were monitored monthly. Patients showed reductions in their systolic and diastolic BP levels with the continued care of the pharmacist. (The mean systolic BP significantly decreased from 155 mmHg (standard deviation (SD) = 14.4, median = 151) at baseline to 128 mmHg (SD = 3.1, median = 129) with a P = 0.001. The mean diastolic BP showed a decrease from 95 mmHg (SD = 8.4, Median = 93) at baseline to 82 mmHg (SD = 1.2, Median = 81) with a P = 0.17. The participants showed a high level of patient satisfaction. Some were willing to pay for the pharmacist's professional service.

Conclusion

In conclusion, the study has shown the impact of pharmacist-led antihypertensive clinics in systolic BP control and achieving high patient satisfaction. The study generated insights into participant cooperation with pharmacist services and needs. More research on different outcomes is planned for future studies, including systematic pharmacotherapy work-up, patient medication adherence, and other clinical outcomes in the study population.

Patient satisfaction and associated factor at red cross pharmacies in Addis Ababa, Ethiopia

BACKGROUND

Patient satisfaction is a crucial aspect of healthcare, reflecting the positive feelings patients experience when using a service. It serves as an indicator of the gap between expected and actual service quality from the patient's perspective. Measuring patient satisfaction is recommended for healthcare providers at all levels as it contributes to improvement efforts. In recent times, pharmacy services have evolved beyond merely supplying medications to becoming more patient-centered and caring. Given the high number of patients relying on the limited Red Cross community pharmacies in the city, this study aims to assess patient satisfaction and identify factors associated with patient satisfaction towards Red Cross Pharmacies in Addis Ababa, Ethiopia.

PATIENTS AND METHODS

Cross sectional study design was conducted from August 15 to August 30, 2022 in three Red Cross Pharmacies in Addis Ababa. Patients were selected by Convenience sampling technique. Structured questionnaire was used to assess patient satisfaction. Bivariate and Multivariate logistic regression were computed to assess statistical association between the outcome variable, and independent variables. SPSS version 21 was used for analysis.

RESULTS

Four hundred seven participants were willing and completed the study. The overall satisfaction towards Red Cross pharmacy service was 60.4%. Inadequate counselling was main reason for dissatisfaction (45%). Regarding associated factors, unavailability of some medications (Adjusted odds ratio = 0.393, 95% CI: 0.208-0.741), unfair medication cost (Adjusted odds ratio = 0.613, 95% CI: 0.607-0.910), and lack of organized pharmacy work flow (Adjusted odds ratio = 0.105, 95% CI: 0.049-0.221) were negatively associated with clients' satisfaction.

CONCLUSION

This study provides significant insights into patient satisfaction with Red Cross pharmacy services in Addis Ababa, Ethiopia, revealing an overall patient satisfaction rate of 60.4%. While a substantial number of patients had positive experiences, dissatisfaction due to inadequate counseling was a notable concern. Factors negatively associated with patient satisfaction, including medication unavailability, unfair cost, and a lack of organized workflow, further highlight the need for targeted interventions to improve patient experiences. Addressing these issues will be critical to enhance pharmaceutical care services and bridge the gap between patient needs and satisfaction.

A pharmacist-led medication review service with a deprescribing focus guided by implementation science

Background: Little research addressed deprescribing-focused medication optimization interventions while utilizing implementation science. This study aimed to develop a pharmacist-led medication review service with a deprescribing focus in a care facility serving patients of low income receiving medications for free in Lebanon followed by an assessment of the recommendations' acceptance by prescribing physicians. As a secondary aim, the study evaluates the impact of this intervention on satisfaction compared to satisfaction associated with receiving routine care. Methods: The Consolidated Framework for Implementation Research (CFIR) was used to address implementation barriers and facilitators by mapping its constructs to the intervention implementation determinants at the study site. After filling medications and receiving routine pharmacy service at the facility, patients 65 years or older and taking 5 or more medications, were assigned into two groups. Both groups of patients received the intervention. Patient satisfaction was assessed right after receiving the intervention (intervention group) or just before the intervention (control group). The intervention consisted of an assessment of patient medication profiles before addressing recommendations with attending physicians at the facility. Patient satisfaction with the service was assessed using a validated translated version of the Medication Management Patient Satisfaction Survey (MMPSS). Descriptive statistics provided data on drug-related problems, the nature and the number of recommendations as well as physicians' responses to recommendations. Independent sample t-tests were used to assess the intervention's impact on patient satisfaction. Results: Of 157 patients meeting the inclusion criteria, 143 patients were enrolled: 72 in the control group and 71 in the experimental group. Of 143 patients, 83% presented drug-related problems (DRPs). Further, 66% of the screened DRPs met the STOPP/START criteria (77%, and 23% respectively). The intervention pharmacist provided 221 recommendations to physicians, of which 52% were to discontinue one or more medications. Patients in the intervention group showed significantly higher satisfaction compared to the ones in the control group (p < 0.001, effect size = 1.75). Of those recommendations, 30% were accepted by the physicians. Conclusion: Patients showed significantly higher satisfaction with the intervention they received compared to routine care. Future work should assess how specific CFIR constructs contribute to the outcomes of deprescribing-focused interventions.

Pharmacy Practice Standards for Outpatient Nephrology Settings

Patients with kidney disease represent a medically complex group of patients with high medication burdens that could benefit from clinical pharmacy services as part of the interdisciplinary care team to optimize medication use. The "Advancing American Kidney Health" executive order includes new value-based reimbursement models to be tested by the Center for Medicare and Medicaid Innovation beginning January 2021 and January 2022. Advancing American Kidney Health executive order poses opportunities for the inclusion of comprehensive medication management. Following an iterative process integrating input from a diverse expert panel, published standards, clinical practice guidelines, peer review, and stakeholder feedback, our group developed practice standards for pharmacists caring for patients with kidney disease in health care settings. The standards focus on activities that are part of direct patient care and also include activities related to public health and advocacy, population health, leadership and management, and teaching, education and dissemination of knowledge. These standards are intended to be used by a variety of professionals, from pharmacists starting new practices to practice managers looking to add a pharmacist to the clinical team, to create standardization in services provided.