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Keller MS, Carrascoza-Bolanos J. Pharmacists, nurses, and physicians' perspectives and use of formal and informal interpreters during medication management in the inpatient setting. PATIENT EDUCATION AND COUNSELING 2023; 108:107607. [PMID: 36566119 PMCID: PMC9877185 DOI: 10.1016/j.pec.2022.107607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 12/08/2022] [Accepted: 12/14/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE Language barriers during inpatient medication management can occur during medication reconciliation on admission and discharge, and during the hospitalization. Understanding inpatient clinicians' experiences with language barriers and use of interpreters can help inform interventions aimed at improving medication management with Limited English Proficient (LEP) patients. Our objective was to examine clinicians' experiences with language barriers around inpatient medication management. METHODS We used semi-structured interviews with pharmacist technicians, pharmacists, nurses, and physicians working in a tertiary care hospital. We used the constant comparison method to guide data collection and analysis. RESULTS We interviewed 14 providers. Nurses and physicians perceived lack of time to use formal interpreters, particularly during busy or night shifts. Clinicians strongly preferred virtual and in-person interpreter services over telephonic services, and highlighted communication challenges with patients with low health literacy, concerns about the quality of interpretation, and inconsistencies in the use of translated materials. CONCLUSIONS Ensuring access to formal interpreters during all shifts, translation of materials into the patient/caregiver's language, and access to in-person/virtual services would improve quality of care for LEP patients. PRACTICE IMPLICATIONS Current laws require use of interpreters, but do not provide for their reimbursement, resulting in suboptimal use. Reimbursement for interpreter services may increase their availability.
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Affiliation(s)
- Michelle S Keller
- Division of General Internal Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, USA; Division of Informatics, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, USA; Department of Health Policy and Management, University of California-Los Angeles, Los Angeles, USA.
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Kiptoo J, Yadesa TM, Muzoora C, Namugambe JS, Tamukong R. Predictors of Medication-Related Emergency Department Admissions Among Patients with Cardiovascular Diseases at Mbarara Regional Referral Hospital, South-Western Uganda. Open Access Emerg Med 2021; 13:279-290. [PMID: 34234583 PMCID: PMC8254663 DOI: 10.2147/oaem.s309508] [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] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 06/11/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Medication-related emergency department admissions impose a huge and unnecessary burden on the healthcare system. We sought to determine the prevalence and predictors of medication-related emergency department admissions, among patients with cardiovascular diseases at Mbarara Regional Referral Hospital, Uganda. METHODS Institutional research ethics approval was secured to conduct a cross-sectional study at the Mbarara Regional Referral Hospital emergency department, between February and September, 2020. All eligible and consenting patients were enrolled in a consecutive manner after a preliminary diagnosis was made by the attending physician. Structured questionnaire interview and comprehensive medication history reviews were used to identify medication therapy problems, in collaboration with a resident physician present on duty. We used sequential categorization for medication therapy problem(s). Descriptive and logistic regression analyses were used to determine prevalence and predictors of medication-related emergency department admissions. RESULTS Out of the 128 patients interviewed, 105 (82%) patient admissions were associated with a medication therapy problem: ineffectiveness of drug therapy (53.3%, 56), medication non-adherence (42.9%, 45), and adverse drug reactions (3.8%, 4). Out of a total of 90 incidences of medication non-adherence, 34.4% (31/90) were due to lack of understanding of patient medication regimen, and 27.8% (25/90) due to unaffordable cost of medicines. Female gender (AOR = 4.31 [1.43, 13.03 at 95% CI]; P-value = 0.010]) and a history of tobacco use (AOR = 9.58 [1.14, 80.28 at 95% CI]; P-value = 0.037) were statistically significant predictors of medication-related emergency department admissions in adjusted analysis. CONCLUSION Four in five emergency department admissions were associated with medication-related causes, majorly due to ineffectiveness of drug therapy. Knowledge gap on patient medication regimens was the most prevalent cause for medication non-adherence. Female gender and previous or current tobacco use was an independent risk factor for medication-related admissions.
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Affiliation(s)
- Joshua Kiptoo
- Department of Pharmacy, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Tadele Mekuriya Yadesa
- Department of Pharmacy, Mbarara University of Science and Technology, Mbarara, Uganda
- World Bank, ACE II, Pharmacy Biotechnology and Traditional Medicine Center, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Conrad Muzoora
- Department of Internal Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Juliet Sanyu Namugambe
- Department of Pharmacy, Mbarara University of Science and Technology, Mbarara, Uganda
- World Bank, ACE II, Pharmacy Biotechnology and Traditional Medicine Center, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Robert Tamukong
- Department of Pharmacy, Mbarara University of Science and Technology, Mbarara, Uganda
- World Bank, ACE II, Pharmacy Biotechnology and Traditional Medicine Center, Mbarara University of Science and Technology, Mbarara, Uganda
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Alizadeh S, Chavan M. Perceived Cultural Distance in Healthcare in Immigrant Intercultural Medical Encounters. INTERNATIONAL MIGRATION 2020. [DOI: 10.1111/imig.12680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Chauhan A, Walton M, Manias E, Walpola RL, Seale H, Latanik M, Leone D, Mears S, Harrison R. The safety of health care for ethnic minority patients: a systematic review. Int J Equity Health 2020; 19:118. [PMID: 32641040 PMCID: PMC7346414 DOI: 10.1186/s12939-020-01223-2] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 06/16/2020] [Indexed: 01/17/2023] Open
Abstract
INTRODUCTION Evidence to date indicates that patients from ethnic minority backgrounds may experience disparity in the quality and safety of health care they receive due to a range of socio-cultural factors. Although heightened risk of patient safety events is of key concern, there is a dearth of evidence regarding the nature and rate of patient safety events occurring amongst ethnic minority consumers, which is critical for the development of relevant intervention approaches to enhance the safety of their care. OBJECTIVES To establish how ethnic minority populations are conceptualised in the international literature, and the implications of this in shaping of our findings; the evidence of patient safety events arising among ethnic minority healthcare consumers internationally; and the individual, service and system factors that contribute to unsafe care. METHOD A systematic review of five databases (MEDLINE, PUBMED, PsycINFO, EMBASE and CINAHL) were undertaken using subject headings (MeSH) and keywords to identify studies relevant to our objectives. Inclusion criteria were applied independently by two researchers. A narrative synthesis was undertaken due to heterogeneity of the study designs of included studies followed by a study appraisal process. RESULTS Forty-five studies were included in this review. Findings indicate that: (1) those from ethnic minority backgrounds were conceptualised variably; (2) people from ethnic minority backgrounds had higher rates of hospital acquired infections, complications, adverse drug events and dosing errors when compared to the wider population; and (3) factors including language proficiency, beliefs about illness and treatment, formal and informal interpreter use, consumer engagement, and interactions with health professionals contributed to increased risk of safety events amongst these populations. CONCLUSION Ethnic minority consumers may experience inequity in the safety of care and be at higher risk of patient safety events. Health services and systems must consider the individual, inter- and intra-ethnic variations in the nature of safety events to understand the where and how to invest resource to enhance equity in the safety of care. REVIEW REGISTRATION This systematic review is registered with Research Registry: reviewregistry761.
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Affiliation(s)
- Ashfaq Chauhan
- School of Public Health and Community Medicine, University of New South Wales, Sydney, 2052, NSW, Australia.
| | - Merrilyn Walton
- School of Public Health, University of Sydney, Sydney, 2006, NSW, Australia
| | - Elizabeth Manias
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Melbourne, 3025, VIC, Australia
| | - Ramesh Lahiru Walpola
- School of Public Health and Community Medicine, University of New South Wales, Sydney, 2052, NSW, Australia
| | - Holly Seale
- School of Public Health and Community Medicine, University of New South Wales, Sydney, 2052, NSW, Australia
| | - Monika Latanik
- Multicultural Health, Western Sydney Local Health District, Westmead, 2145, NSW, Australia
| | - Desiree Leone
- Multicultural Health, Western Sydney Local Health District, Westmead, 2145, NSW, Australia
| | - Stephen Mears
- Hunter New England Health Libraries, Hunter New England Local Health District, Tamworth, 2310, NSW, Australia
| | - Reema Harrison
- School of Public Health and Community Medicine, University of New South Wales, Sydney, 2052, NSW, Australia
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Roman C, Edwards G, Dooley M, Mitra B. Roles of the emergency medicine pharmacist: A systematic review. Am J Health Syst Pharm 2019; 75:796-806. [PMID: 29802113 DOI: 10.2146/ajhp170321] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
PURPOSE Results of a systematic literature review to identify roles for emergency medicine (EM) pharmacists beyond traditionally reported activities and to quantify the benefits of these roles in terms of patient outcomes are reported. SUMMARY Emergency department (ED)-based clinical pharmacy is a rapidly growing practice area that has gained support in a number of countries globally, particularly over the last 5-10 years. A systematic literature search covering the period 1995-2016 was conducted to characterize emerging EM pharmacist roles and the impact on patient outcomes. Six databases were searched for research publications on pharmacist participation in patient care in a general ED or trauma center that documented interventions by ED-based pharmacists; 15 results satisfied the inclusion criteria. Six reported studies evaluated EM pharmacist involvement in the care of critically ill patients, 5 studies evaluated antimicrobial stewardship (AMS) activities via pharmacist review of positive cultures, 2 studies assessed pharmacist involvement in generating orders for nurse-administered home medications and 2 reviewed publications focused on EM pharmacist involvement in management of healthcare-associated pneumonia and dosing of phenytoin. A diverse range of positive patient outcomes was identified. The included studies were assessed to be of low quality. CONCLUSION A systematic review of the literature revealed 3 key emerging areas of practice for the EM pharmacist that are associated with positive patient outcomes. These included involvement in management of critically ill patients, AMS roles, and ordering of home medications in the ED.
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Affiliation(s)
- Cristina Roman
- Pharmacy Department and Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Australia
| | - Gail Edwards
- Pharmacy Department, The Alfred Hospital, Melbourne, Australia
| | - Michael Dooley
- Pharmacy Department, The Alfred Hospital, Melbourne, Australia.,Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia
| | - Biswadev Mitra
- Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
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Green JL, Anderson V, Dart RC, Heard K. Medication history assessment in research: A randomized controlled trial comparing tablet-based (eMedHAT) versus structured interview (MedHAT). Pharmacoepidemiol Drug Saf 2018; 27:1356-1360. [DOI: 10.1002/pds.4665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 08/22/2018] [Accepted: 08/30/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Jody L. Green
- Rocky Mountain Poison and Drug Center; Denver Health and Hospitals; Denver CO USA
- Inflexxion, Inc.; Waltham MA USA
| | - Victoria Anderson
- Rocky Mountain Poison and Drug Center; Denver Health and Hospitals; Denver CO USA
- Colorado Prevention Center; Aurora CO USA
| | - Richard C. Dart
- Rocky Mountain Poison and Drug Center; Denver Health and Hospitals; Denver CO USA
- Section of Medical Pharmacology and Toxicology, Department of Emergency Medicine; University of Colorado School of Medicine; Aurora CO USA
| | - Kennon Heard
- Rocky Mountain Poison and Drug Center; Denver Health and Hospitals; Denver CO USA
- Section of Medical Pharmacology and Toxicology, Department of Emergency Medicine; University of Colorado School of Medicine; Aurora CO USA
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Farmer BM, Hayes BD, Rao R, Farrell N, Nelson L. The Role of Clinical Pharmacists in the Emergency Department. J Med Toxicol 2018; 14:114-116. [PMID: 29075954 PMCID: PMC6013729 DOI: 10.1007/s13181-017-0634-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Accepted: 10/05/2017] [Indexed: 10/18/2022] Open
Affiliation(s)
- Brenna M Farmer
- Division of Emergency Medicine, Weill Cornell Medical College of Cornell University, New York, NY, USA.
| | - Bryan D Hayes
- Department of Pharmacy, Massachusetts General Hospital and Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA
| | - Rama Rao
- Division of Emergency Medicine, Weill Cornell Medical College of Cornell University, New York, NY, USA
| | | | - Lewis Nelson
- Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
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Trinh-Duc A, Painbeni T, Byzcko A, Fort PA. Le dossier pharmaceutique dans un service d’accueil des urgences : évaluation de son accessibilité et de son impact sur le niveau de connaissance du traitement du patient. ANNALES PHARMACEUTIQUES FRANÇAISES 2016; 74:288-95. [DOI: 10.1016/j.pharma.2015.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 11/03/2015] [Accepted: 11/04/2015] [Indexed: 10/22/2022]
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Blennerhassett J, Hilbers J. Medicine Management in Older People from Non‐English Speaking Backgrounds. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2015. [DOI: 10.1002/j.2055-2335.2011.tb00063.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Julieanne Hilbers
- Diversity Health Coordinator, Prince of Wales Hospital Randwick New South Wales
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Wilbur K, Hazi H, El-Bedawi A. Drug-Related Hospital Visits and Admissions Associated with Laboratory or Physiologic Abnormalities-A Systematic-Review. PLoS One 2013; 8:e66803. [PMID: 23826139 PMCID: PMC3694970 DOI: 10.1371/journal.pone.0066803] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2012] [Accepted: 05/15/2013] [Indexed: 11/18/2022] Open
Abstract
Countless studies have demonstrated that many emergency-room visits and hospital admissions are drug-related and that a significant proportion of these drug-related visits (DRVs) are preventable. It has not been previously studied which DRVs could be prevented through enhanced monitoring of therapy. The objective of the study was to determine the incidence of DRVs attributed to laboratory or physiologic abnormalities. Three authors independently performed comprehensive searches in relevant health care databases using pre-determined search terms. Articles discussing DRV associated with poisoning, substance abuse, or studied among existing in-patient populations were excluded. Study country, year, sample, design, duration, DRV identification method, proportion of DRVs associated with laboratory or physiologic abnormalities and associated medications were extracted. The three authors independently assessed selected relevant articles according to the Strengthening the reporting of observational studies in epidemiology (STROBE) as applicable according to the studies' methodology. The initial literature search yielded a total of 1,524 articles of which 30 articles meeting inclusion criteria and reporting sufficient laboratory or physiologic data were included in the overall analysis. Half employed prospective methodologies, which included both chart review and patient interview; however, the overwhelming majority of identified studies assessed only adverse drug reactions (ADRs) as a drug-related cause for DRV. The mean (range) prevalence of DRVs found in all studies was 15.4% (0.44%–66.7%) of which an association with laboratory or physiologic abnormalities could be attributed to a mean (range) of 29.4% (4.3%–78.1%) of cases. Most laboratory-associated DRVs could be linked to immunosuppressant, antineoplastic, anticoagulant and diabetes therapy, while physiologic-associated DRVs were attributed to cardiovascular therapies and NSAIDs. Significant proportions of laboratory and physiologic abnormalities contribute to DRVs and are consistently linked to specific drugs. These therapies are potential targets for enhanced medication monitoring initiatives to proactively avert potential DRVs.
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Affiliation(s)
- Kerry Wilbur
- College of Pharmacy, Qatar University, Doha, Qatar
- * E-mail:
| | - Huda Hazi
- College of Pharmacy, Qatar University, Doha, Qatar
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Hussainy SY, Box M, Scholes S. Piloting the role of a pharmacist in a community palliative care multidisciplinary team: an Australian experience. BMC Palliat Care 2011; 10:16. [PMID: 22035160 PMCID: PMC3215169 DOI: 10.1186/1472-684x-10-16] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Accepted: 10/31/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND While the home is the most common setting for the provision of palliative care in Australia, a common problem encountered here is the inability of patient/carers to manage medications, which can lead to misadventure and hospitalisation. This can be averted through detection and resolution of drug related problems (DRPs) by a pharmacist; however, they are rarely included as members of the palliative care team. The aim of this study was to pilot a model of care that supports the role of a pharmacist in a community palliative care team. A component of the study was to develop a cost-effective model for continuing the inclusion of a pharmacist within a community palliative care service. METHODS The study was undertaken (February March 2009-June 2010) in three phases. Development (Phase 1) involved a literature review; scoping the pharmacist's role; creating tools for recording DRPs and interventions, a communication and education strategy, a care pathway and evidence based patient information. These were then implemented in Phase 2. Evaluation (Phase 3) of the impact of the pharmacist's role from the perspectives of team members was undertaken using an online survey and focus group. Impact on clinical outcomes was determined by the number of patients screened to assess their risk of medication misadventure, as well as the number of medication reviews and interventions performed to resolve DRPs. RESULTS The pharmacist screened most patients (88.4%, 373/422) referred to the palliative care service to assess their risk of medication misadventure, and undertook 52 home visits. Medication reviews were commonly conducted at the majority of home visits (88%, 46/52), and a variety of DRPs (113) were detected at this point, the most common being "patient requests drug information" (25%, 28/113) and "condition not adequately treated" (22%, 25/113). The pharmacist made 120 recommendations in relation to her interventions.Fifty percent of online survey respondents (10/20) had interacted 10 or more times with the pharmacist for advice. All felt that the pharmacist's role was helpful, improving their knowledge of the different medications used in palliative care. The six team members who participated in the focus group indicated that there were several benefits of the pharmacist's contributions towards medication screening and review. CONCLUSIONS The inclusion of a pharmacist in a community palliative care team lead to an increase in the medication-related knowledge and skills of its members, improved patients' medication management, and minimised related errors. The model of care created can potentially be duplicated by other palliative care services, although its cost-effectiveness was unable to be accurately tested within the study.
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Affiliation(s)
- Safeera Y Hussainy
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, 381 Royal Parade, Parkville 3052, Melbourne, Australia.
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