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Jude D. Comprehensive specialty pharmacist support for HIV postexposure prophylaxis in a health system-based emergency department setting. Am J Health Syst Pharm 2024; 81:265-269. [PMID: 38141253 DOI: 10.1093/ajhp/zxad317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Indexed: 12/25/2023] Open
Affiliation(s)
- Daniel Jude
- Trellis Rx at North Memorial Health, Robbinsdale, MN
- University of Minnesota College of Pharmacy, Minneapolis, MN, USA
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Chen KL, Huang YM, Huang CF, Sheng WH, Chen YK, Shen LJ, Wang CC. Impact of an integrated medication management model on the collaborative working relationship among healthcare professionals in a hospital: an explanatory mixed methods study. J Interprof Care 2024; 38:220-233. [PMID: 37872101 DOI: 10.1080/13561820.2023.2263482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 09/20/2023] [Indexed: 10/25/2023]
Abstract
An integrated medication management (IMM) model was implemented in a medical center ward to improve the delivery of clinical pharmaceutical services (CPSs). This model incorporated a ward-based clinical pharmacist who performed medication reconciliation and medication reviews. It was perceived to promote interprofessional collaboration between pharmacists and non-pharmacist healthcare professionals (NPHPs, including attending physicians, nurse practitioners, and registered nurses). This study aimed to evaluate the effects of the IMM on NPHPs' intentions to collaborate with pharmacists and understand the mechanism of the impact of the IMM on interprofessional collaboration. A sequential explanatory mixed methods design was employed in the study. Initially, a questionnaire was administered to assess the effects of the IMM on NPHPs' intentions to collaborate with pharmacists. The NPHPs' experiences with the IMM were then documented using semi-structured interviews with inductive thematic analysis. Fifty-eight NPHPs completed the questionnaire, and NPHPs from the intervention ward reported a higher intention to discuss patient-related medication issues with pharmacists, indicating collaboration. Eleven NPHPs were interviewed, and they stated having better working relationships with pharmacists, experiencing more effective CPSs, and noting improved communication with pharmacists. The integration of quantitative and qualitative findings demonstrates that the critical mechanism of the IMM in promoting collaborative relationships is to integrate pharmacists into medical practice, which familiarizes NPHPs with pharmacists' roles, improves communication, and enables pharmacists to identify NPHPs' needs. To summarize, allowing ward-based pharmacists to engage in medical teams on a regular basis appears vital for improving interprofessional teamwork. Furthermore, stakeholders aiming to promote CPS in their institutions should consider the needs and communication channels among NPHPs.
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Affiliation(s)
- Kuan-Lin Chen
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan
| | - Yen-Ming Huang
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
- School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chih-Fen Huang
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
- School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Wang-Huei Sheng
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- School of Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yu-Kuei Chen
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
| | - Li-Jiuan Shen
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan
- School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chi-Chuan Wang
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan
- School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
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Hammonds WM, Bowman E, Chiplinski AN, Keeting TA, Pagenhardt SM, Valdez P, Street AF, Caccamo M, O'Neil D, Peters JE, Stoffa SL. Impact of a pharmacy technician on an interprofessional antithrombotic stewardship program at an academic medical center. Am J Health Syst Pharm 2024:zxae042. [PMID: 38373082 DOI: 10.1093/ajhp/zxae042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Indexed: 02/21/2024] Open
Abstract
DISCLAIMER In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE The need for monitoring and standardization of anticoagulation management has garnered the attention of national organizations, driving the implementation of antithrombotic stewardship programs (ASPs). Established ASPs have highlighted interdisciplinary collaboration between physicians, nurses, and pharmacists and demonstrated financial benefits and positive patient care outcomes. While pharmacy technicians are key members of the pharmacy profession, they are rarely utilized to expand clinical programs. The aim of this report is to describe the impact of adding a pharmacy technician to an ASP at an academic medical center. SUMMARY The departments of pharmacy and quality at West Virginia University Hospitals (WVUH) developed a business plan and financially justified an ASP. The ASP was implemented in January 2022 and consisted of 2 full-time clinical pharmacist specialists, 1 full-time clinical pharmacy technician, 2 full-time clinical nurse specialists, and 1 part-time physician medical director. The clinical pharmacy technician's primary role was to review patients' sequential compression device (SCD) compliance and newly started oral anticoagulants prior to discharge. The clinical nurse specialists educated patients newly started on oral anticoagulants within 24 hours of discharge and triaged any postdischarge medication access issues. The medical director provided high-level program oversight and acted as a clinical consultant on complex patient cases. In the first 6 months after the program's implementation, the clinical pharmacy technician made 174 recommendations to the clinical pharmacist specialists regarding discharge transitions of care and assessed SCD compliance in 246 patients. Of the 246 patients assessed, 217 patients (88%) were deemed to be noncompliant. CONCLUSION The pharmacy department at WVUH successfully justified and implemented an interprofessional ASP at an academic medical center, which is the first ASP to date to incorporate a clinical pharmacy technician.
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Affiliation(s)
- William M Hammonds
- Department of Pharmacy, West Virginia University Medicine - West Virginia University Hospitals, Morgantown, West Virginia, USA
| | - Emily Bowman
- Department of Pharmacy, West Virginia University Medicine - West Virginia University Hospitals, Morgantown, West Virginia, USA
| | - Amber N Chiplinski
- Department of Pharmacy, West Virginia University Medicine - West Virginia University Hospitals, Morgantown, West Virginia, USA
| | - Tessa A Keeting
- Department of Pharmacy, West Virginia University Medicine - West Virginia University Hospitals, Morgantown, West Virginia, USA
| | - Sarah M Pagenhardt
- Department of Pharmacy, West Virginia University Medicine - West Virginia University Hospitals, Morgantown, West Virginia, USA
| | - Patricia Valdez
- Department of Pharmacy, West Virginia University Medicine - West Virginia University Hospitals, Morgantown, West Virginia, USA
| | - Ashley F Street
- Department of Pharmacy, West Virginia University Medicine - West Virginia University Hospitals, Morgantown, West Virginia, USA
| | - Marco Caccamo
- Heart and Vascular Institute, West Virginia University Medicine - West Virginia University Hospitals, Morgantown, West Virginia, USA
| | - Daniel O'Neil
- Department of Pharmacy, West Virginia University Medicine - West Virginia University Hospitals, Morgantown, West Virginia, USA
| | - Julie E Peters
- Department of Nursing, West Virginia University Medicine - West Virginia University Hospitals, Morgantown, West Virginia, USA
| | - Stephanie L Stoffa
- Department of Nursing, West Virginia University Medicine - West Virginia University Hospitals, Morgantown, West Virginia, USA
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4
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Wilde AM, Song M, Allen WP, Junkins AD, Frazier JM, Moore SE, Schulz PS. Implementation of a pharmacy-driven rapid bacteremia response program. Am J Health Syst Pharm 2024; 81:74-82. [PMID: 37658845 DOI: 10.1093/ajhp/zxad211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Indexed: 09/05/2023] Open
Abstract
PURPOSE This report describes a comprehensive pharmacy-driven rapid bacteremia response program. SUMMARY This novel program positioned the pharmacy department at a large, community health system to receive and respond to critical microbiologic diagnostic testing results, 24/7/365. The program empowered pharmacists to provide centralized, comprehensive care including assessing blood culture Gram stain results, adjusting antibiotic therapy per protocol, ordering repeat blood cultures, analyzing and interpreting rapid molecular diagnostic test results, placing orders for contact isolation, and communicating antibiotic recommendations to the treatment team. In the first year after program implementation, 2,282 blood culture Gram stains and 2,046 rapid diagnostic test results were called in to the pharmacy department. The program reduced the median time to effective therapy in patients who did not already have active antimicrobial orders from over 10 hours to less than 1 hour. Based on the Gram stain results, antibiotics were started per protocol in 34.2% of patients. Based on the rapid molecular diagnostic test results, adjustments were made to antibiotic regimens in 55.7% of cases after discussion with a provider. Of these adjustments, 39.9% were for escalation of antibiotics and 37.7% were for de-escalation of antibiotics. CONCLUSION By expanding the scope of pharmacy practice, barriers to optimizing clinical care were overcome.
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Affiliation(s)
- Ashley M Wilde
- Norton Infectious Diseases Institute, Norton Healthcare, Louisville, KY, USA
| | - Matthew Song
- Norton Infectious Diseases Institute, Norton Healthcare, Louisville, KY, USA
| | - W Paul Allen
- Pharmacy Services, Norton Healthcare, Louisville, KY, USA
| | - Alan D Junkins
- Department of Microbiology, Norton Healthcare, Louisville, KY, USA
| | | | - Sarah E Moore
- Norton Infectious Diseases Institute, Norton Healthcare, Louisville, KY, USA
| | - Paul S Schulz
- Norton Infectious Diseases Institute, Norton Healthcare, Louisville, KY, USA
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Gill J, Duteau E, Bungard TJ, Kuzyk D, Danilak M. The Role of Home Care Pharmacists in the Edmonton Zone: A Retrospective Study. Can J Hosp Pharm 2023; 76:56-62. [PMID: 36683661 PMCID: PMC9817229 DOI: 10.4212/cjhp.3172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background Despite the rising demand for home-based health care services in Canada and the increasing medical complexity of elderly patients, there is limited literature exploring the role of home care pharmacists and the clinical activities they perform. Objectives The primary objective was to describe the types and frequencies of clinical activities (both interventions and recommendations) performed by home care pharmacists upon initial consultation. The secondary objective was to determine which patient characteristics resulted in the highest number of clinical activities. Methods This study was a retrospective review of adult patients who had an initial in-person or telemedicine consultation with home care pharmacists from June 2018 to May 2019 in the Edmonton Zone of Alberta Health Services. Results Of the 355 patients whose records were screened, 318 (89.6%) were included in the analysis. Of these, 191 (60.1%) were female, and the median age was 79 years (interquartile range [IQR] 68-86 years). The median numbers of medical conditions and medications were 6 and 10, respectively. Of the total of 1172 clinical activities, there was a median of 3 (IQR 2-5) per patient, irrespective of the patient's medical conditions, including those with the most common conditions. The most common activities were patient counselling (n = 160, 13.7%), collaboration with another health care professional (n = 157, 13.4%), and deprescribing (n = 140, 11.9%). Across all activities, pharmacists performed a total of 562 interventions and made 610 recommendations. Each additional year of age and each additional medication on a patient's medication list resulted in an increase in the number of clinical activities (by 0.01 for each additional year of age [p = 0.003] and by 0.03 for each additional medication [p < 0.001]). Conclusions Home care pharmacists in the Edmonton Zone performed a wide range of clinical activities, particularly for older patients and those with more medications. Further research is required to evaluate the outcomes of pharmacist consultations.
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Shahrami B, Sefidani Forough A, Najmeddin F, Hadidi E, Toomaj S, Javadi MR, Gholami K, Sadeghi K. Identification of drug-related problems followed by clinical pharmacist interventions in an outpatient pharmacotherapy clinic. J Clin Pharm Ther 2022; 47:964-972. [PMID: 35218217 DOI: 10.1111/jcpt.13628] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 01/10/2022] [Accepted: 01/11/2022] [Indexed: 12/01/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Pharmacotherapy is an essential strategy for the treatment of many medical conditions especially chronic disease and often involves multiple medications being used simultaneously. Increasing the use of medications may pose some challenges to safe and effective drug therapy and if not identified and prevented by the pharmacists eventually can lead to drug-related problems (DRPs). The present study aimed to examine the incidence of DRPs in Iranian patients and to evaluate patients' adherence to the clinical pharmacist interventions as well as the physicians' acceptance of these recommendations. METHODS This study was conducted in a university-affiliated outpatient pharmacotherapy clinic over a 22-month period. Patients aged 18 years and older with at least one chronic disease receiving at least four medications were included in the study. The patients were interviewed by a clinical pharmacist for comprehensive medication review. DRPs were identified using the DOCUMENT classification system. Recommendations were provided by the clinical pharmacist including interventions involving patient and/or physician to resolve DRPs. The patients were followed up after 2 weeks to evaluate their compliance and physician acceptance of clinical pharmacist recommendations. RESULTS AND DISCUSSION Two hundred patients were included in this study. Overall, 875 DRPs were identified with an average of 4.37 per patient. The most prevalent DRPs were related to patient education or information (22.8%), undertreated indications (17.4%) and patient compliance (17.2%). The most common drugs associated with DRPs were alimentary and metabolism (22.2% of DRPs) followed by the cardiovascular system (19.2%) and nervous system (9.6%) medications. The DRP incidence correlated with gender only and was higher in females (p = 0.019). The clinical pharmacist provided 912 interventions with an average of 4.56 and 1.04 interventions per patient and per DRPs respectively. Patient education (41.3%), medication initiation or discontinuation (24.5%), and non-pharmacological interventions (12.9%) were the most common clinical pharmacist interventions. Out of 912 interventions, 665 were followed up, out of which 427 were patient dependent and 228 involved physicians. The patient's compliance with clinical pharmacist recommendations was 81.2%. The physician acceptance rate of the recommendations was 44.1%. WHAT IS NEW AND CONCLUSION The study shows that especially designed services such as pharmacotherapy clinics running by clinical pharmacists are necessary to detect and resolve DRPs in an effective way. The high compliance rate of the patients indicates patients' confidence in the clinical pharmacist services provided in the pharmacotherapy clinic. The low acceptance rate of the physicians highlights the need to improve interprofessional collaboration between clinical pharmacists and physicians in an outpatient setting.
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Affiliation(s)
- Bita Shahrami
- Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Aida Sefidani Forough
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia
| | - Farhad Najmeddin
- Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Elham Hadidi
- 13-Aban Pharmacotherapy Clinic, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Somayeh Toomaj
- Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Javadi
- Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Kheirollah Gholami
- Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Kourosh Sadeghi
- Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
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7
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Hawkins WA, Butler SA, Poirier N, Wilson CS, Long MK, Smith SE. From theory to bedside: Implementation of fluid stewardship in a medical ICU pharmacy practice. Am J Health Syst Pharm 2021; 79:984-992. [PMID: 34849544 DOI: 10.1093/ajhp/zxab453] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
DISCLAIMER In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE Intravenous fluids are the most commonly prescribed medication in the intensive care unit (ICU) and can have a negative impact on patient outcomes if not utilized properly. Fluid stewardship aims to heighten awareness and improve practice in fluid therapy. This report describes a practical construct for implementation of fluid stewardship services and characterizes the pharmacist's role in fluid stewardship practice. SUMMARY Fluid stewardship services were integrated into an adult medical ICU at a large community hospital. Data characterizing these services over a 2-year span are reported and categorized based on the 4 rights (right patient, right drug, right route, right dose) and the ROSE (rescue, optimization, stabilization, evacuation) model of fluid administration. The review encompassed 305 patients totaling 905 patient days for whom 2,597 pharmacist recommendations were made, 19% of which were related to fluid stewardship. This corresponded to an average of 1.52 fluid stewardship recommendations per patient. Within the construct of the 4 rights, 39% of recommendations were related to the right patient, 33% were related to the right route, 17% were related to the right drug, and 11% were related to the right dose. By the ROSE model, 1% of recommendations were related to the rescue phase, 3% were related to optimization, 79% were related to stabilization, and 17% were related to evacuation. CONCLUSION Implementation of fluid stewardship pharmacy services in a community hospital medical ICU is feasible. Integration of this practice contributed to 19% of pharmacy recommendations. The most common recommendations involved evaluation of the patient for the appropriateness of fluid therapy during the stabilization phase. The impact of fluid stewardship on patient outcomes needs to be explored.
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Affiliation(s)
- W Anthony Hawkins
- Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, Albany, GA, and Department of Pharmacology and Toxicology, Medical College of Georgia at Augusta University, Albany, GA, USA
| | - Sydney A Butler
- Department of Pharmacy, Atrium Health Navicent The Medical Center, Macon, GA, USA
| | - Nicole Poirier
- Department of Pharmacy, Rush University Medical Center, Chicago, IL, USA
| | | | - Michael K Long
- Department of Pharmacy, Indiana University Health, Indianapolis, IN, USA
| | - Susan E Smith
- Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, Athens, GA, USA
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Ticcioni A, Piscitello K, Bjornstad M, Hensley K, Davis J, Drobac A, Canepa J. Stepwise Development and Yearlong Assessment of a Pharmacist-Driven Molecular Rapid Diagnostic Test Result Service for Bloodstream Infections. Innov Pharm 2021; 12. [PMID: 34345524 PMCID: PMC8326709 DOI: 10.24926/iip.v12i2.3720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Purpose: Provide a stepwise approach to the design and implementation of a service that integrates all staff pharmacists into the communication and interpretation of molecular rapid diagnostic tests (mRDT) for bloodstream infections and summarize outcomes from a 12-month post-implementation assessment. Physician and pharmacist impressions of the service are also described. Summary: mRDT have proven clinical benefit in the treatment of bacteremia. Pharmacy leadership can collaborate with other health system leaders to develop policies and a workflow that route result calls to pharmacists to maximize the impact of this technology. Pharmacist education, development of clinical resources and documentation templates allow all pharmacists to perform this antimicrobial stewardship service consistently and confidently. Physicians overwhelmingly recognize the value of this service and often accept the pharmacist’s recommendations. Antibiotic de-escalation was the most frequent outcome when changes to the antibiotic regimen were made. Conclusion: Pharmacists are well positioned to utilize results from mRDT to improve antibiotic selection. Through the use of competencies and internally-derived resources, all pharmacists, rather than just infectious diseases pharmacy specialists, can perform this important antibiotic stewardship activity and positively influence patient outcomes.
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Moye RA, Mason K, Flatt A, Faircloth B, Livermore J, Brown B, Furr A, Starnes C, Yates JR, Hurt R. Emergency preparation and mitigation for COVID-19 response in an integrated pharmacy practice model. Am J Health Syst Pharm 2021; 78:705-711. [PMID: 33506860 PMCID: PMC7929428 DOI: 10.1093/ajhp/zxab015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Purpose The purpose of this descriptive report is to share experiences in crisis response planning and risk mitigation at a university health system department of pharmacy with an integrated clinical practice model in the early months of the coronarvirus disease 2019 (COVID-19) pandemic. Summary The department of pharmacy’s COVID-19 pandemic response included successful planning and implementation of measures to maintain pharmacy operations and minimize COVID-19 exposure of patients and staff. These measures included ensuring adequate personnel staffing using flexible staffing solutions, ongoing assessment of supply chain integrity, and continuation of integrated clinical pharmacy services 24/7 throughout the initial phase of the COVID-19 pandemic. Information technology (IT) and educational program modifications are also discussed. Conclusion This report describes successful crisis planning and risk mitigation in the setting of COVID-19, which was facilitated by the department of pharmacy’s integrated clinical practice model. This model enabled uninterrupted personnel scheduling, supply chain integrity, continued provision of 24/7 integrated clinical services, adaptive use of IT tools, and continuation of educational programs. The experiences described may be instructive to other pharmacy departments in evaluating their response to the COVID-19 pandemic and in planning for similar pandemic or other emergency scenarios.
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Affiliation(s)
- Robert A Moye
- Department of Pharmacy, University of Tennessee Medical Center, Knoxville, TN, USA
| | - Kim Mason
- Department of Pharmacy, University of Tennessee Medical Center, Knoxville, TN, USA
| | - Amy Flatt
- Department of Pharmacy, University of Tennessee Medical Center, Knoxville, TN, USA
| | - Barbara Faircloth
- Department of Pharmacy, University of Tennessee Medical Center, Knoxville, TN, USA
| | - Janisha Livermore
- Department of Pharmacy, University of Tennessee Medical Center, Knoxville, TN, USA
| | - Brittany Brown
- Department of Pharmacy, University of Tennessee Medical Center, Knoxville, TN, USA
| | - Adam Furr
- Department of Pharmacy, University of Tennessee Medical Center, Knoxville, TN, USA
| | - Cassey Starnes
- Department of Pharmacy, University of Tennessee Medical Center, Knoxville, TN, USA
| | - John R Yates
- Department of Pharmacy, University of Tennessee Medical Center, Knoxville, TN, USA
| | - Robert Hurt
- Department of Pharmacy, University of Tennessee Medical Center, Knoxville, TN, USA
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10
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Offei-Nkansah G, Amerine LB. Conversion from paper to electronic acute care chemotherapy orders. Am J Health Syst Pharm 2020; 77:1516-1521. [PMID: 32699883 DOI: 10.1093/ajhp/zxaa201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE UNC Medical Center converted to an electronic health record (EHR) in 2014. This conversion allowed for the transition of paper chemotherapy orders to be managed electronically. This article describes the process for converting inpatient paper chemotherapy orders into the new EHR in a safe and effective manner. SUMMARY A collaborative interdisciplinary approach to the EHR transition enabled our organization to move from using paper chemotherapy orders to fully electronic chemotherapy treatment plans in both ambulatory and acute care areas. Active chemotherapy orders for acute care inpatients were reviewed and transcribed by two oncology pharmacists in the cancer hospital prior to being signed by an attending physician. The newly input orders were independently verified by two pharmacists in the cancer hospital inpatient pharmacy. Nurse review of the signed and verified treatment plans, along with reconciliation of the medication administration record ensured a safe transition to the new EHR workflow. Providers benefit from the ability to review treatment plans remotely, track changes, and include supportive medications in one consolidated location. The coordinated team effort allowed for a smooth transition with minimal interruptions to patient care. CONCLUSION The pharmacist-led, multidisciplinary conversion to electronic chemotherapy orders was safe, accurate, and occurred ahead of schedule for the EHR go-live. Advance communication and planning around scheduled inpatient admissions helped to minimize the impact of the transition from paper to electronic treatment plans. Both pharmacist and physician engagement were necessary to ensure a smooth transition for active inpatient treatment plans.
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Affiliation(s)
| | - Lindsey B Amerine
- UNC Health, Chapel Hill, NC, and UNC Eshelman School of Pharmacy, Chapel Hill, NC
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Shrestha S, Shakya D, Palaian S. Clinical Pharmacy Education and Practice in Nepal: A Glimpse into Present Challenges and Potential Solutions. Adv Med Educ Pract 2020; 11:541-548. [PMID: 32884392 PMCID: PMC7439280 DOI: 10.2147/amep.s257351] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 07/21/2020] [Indexed: 05/02/2023]
Abstract
This commentary article highlights the challenges in providing clinical pharmacy education in Nepal and suggests a few ways forward. Contrary to other health care professions, clinical pharmacy practice is a new healthcare discipline in the country which is currently undergoing transition. The existing pharmacy curriculum and training in the country can provide competencies needed for pharmacists in industrial settings. Considering the importance of clinical pharmacists in patient care, the Government of Nepal has implemented a policy recommending the recruitment of clinical pharmacists in hospitals. However, the education and training for pharmacists provided in the country are not sufficient enough for optimum patient care and for delivering clinical pharmacy services. International collaborations in terms of faculty and student exchanges, preceptor training, and accreditation by international organizations such as Accreditation Council for Pharmacy Education (ACPE), establishment of need-based curriculum, incorporating clinical pharmacy department under the organizational structure of hospitals, etc., may be the right approaches to improve the current status of clinical pharmacy education in the country.
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Affiliation(s)
- Sunil Shrestha
- Department of Pharmaceutical and Health Service Research, Nepal Health Research and Innovation Foundation, Lalitpur, Nepal
- Department of Pharmacy, Nepal Cancer Hospital and Research Center Pvt. Ltd, Harisiddhi, Lalitpur, Nepal
| | - Deepa Shakya
- Department of Pharmaceutical and Health Service Research, Nepal Health Research and Innovation Foundation, Lalitpur, Nepal
- Department of Pharmacy, Norvic International Hospital, Thapathali, Kathmandu, Nepal
| | - Subish Palaian
- Department of Clinical Sciences, College of Pharmacy and Health Sciences, Ajman University, Ajman, United Arab Emirates
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Abstract
Recently, the required training and credentials for as well as the various roles of the hematopoietic cell transplant (HCT) pharmacist have been endorsed by the leading organizations in cellular therapy, the American Society of Transplant and Cellular Therapy and the European Society of Blood and Bone Marrow Transplantation. While these documents establish the roles a HCT pharmacist can fulfill within the multi-disciplinary team, few reports have evaluated the impact of the HCT pharmacist on clinical, financial, or quality outcomes. Further, a paucity of information has been reported on types of practice models, such as the use of collaborative practice agreements, or described effective methods to overcome the barriers to the increased utilization of HCT pharmacists. Herein, a brief summary of available information is provided to aid readers in understanding the state of the science for pharmacists practicing in this specialty with the goal to stimulate further research to justify the roles of HCT pharmacists and the correlation of such research to various outcome measures. Practitioners are encouraged to build upon this existing knowledge to create the novel integration and elevation of pharmacy practice to improve outcomes for patients, providers, and payors.
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Affiliation(s)
- Amber Clemmons
- College of Pharmacy, Department of Clinical and Administrative Pharmacy, University of Georgia, Augusta, GA 30912, USA;
- Department of Pharmacy, Augusta University Medical Center, Augusta, GA 30912, USA
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13
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Zakinova A, Long-Boyle JR, French D, Croci R, Wilson L, Phillips KA, Kroetz DL, Shin J, Tamraz B. A Practical First Step Using Needs Assessment and a Survey Approach to Implementing a Clinical Pharmacogenomics Consult Service. J Am Coll Clin Pharm 2018; 2:214-221. [PMID: 32391517 DOI: 10.1002/jac5.1062] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Introduction Genetic-guided selection of non-oncologic medications is not commonly practiced in general, and at University of California, San Francisco (UCSF) Health, specifically. Understanding the unique position of clinicians with respect to clinical pharmacogenetics (PG) at a specific institution or practice is fundamental for implementing a successful PG consult service. Objectives To assess clinicians' current practices, needs, and interests with respect to clinical PG at UCSF Health, a large tertiary academic medical center. Methods A list of 42 target medications with clinical PG recommendations was complied. Clinical specialties that routinely used the target medications were identified. A 12-question survey focused on practice of PG for target medications was developed. Pharmacists and physicians were surveyed anonymously in several clinical specialties. Survey results were analyzed using descriptive statistics. Results Of the 396 clinicians surveyed, 76 physicians and 59 pharmacists participated, resulting in 27% and 50% average response rates, respectively. The current use of PG in clinical practice for physicians and pharmacists was 29% and 32%, respectively, however this number varied across clinical specialties from 0% to 80%. Of clinicians whom reported they do not currently apply PG, 63% of physicians and 54% of pharmacists expressed interest in integrating PG. However, the level of interest varied from 20% to 100% across specialties. Of the respondents, 64% of physicians and 56% of pharmacists elected to provide contact information to investigators to further discuss their interest related to clinical PG. Conclusions While PG is not uniformly practiced at UCSF Health, there is considerable interest in utilizing PG by the respondents. Our approach was successful at identifying clinicians and services interested in PG for specific drug-gene pairs. This work has set a foundation for next steps to advance PG integration at UCSF Health. Clinicians can adopt our approach as preliminary work to build a clinical PG program at their institutions.
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Affiliation(s)
- Angela Zakinova
- School of Pharmacy, University of California San Francisco, San Francisco, CA
| | - Janel R Long-Boyle
- Department of Clinical Pharmacy, University of California San Francisco, San Francisco, CA
| | - Deborah French
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA
| | - Rhiannon Croci
- Department of Health Informatics, University of California San Francisco, San Francisco, CA
| | - Leslie Wilson
- Department of Clinical Pharmacy, University of California San Francisco, San Francisco, CA
| | - Kathryn A Phillips
- UCSF Center for Translational and Policy Research on Personalized Medicine (TRANSPERS), Department of Clinical Pharmacy, University of California San Francisco, San Francisco, CA
| | - Deanna L Kroetz
- Department of Bioengineering and Therapeutic Sciences, University of California San Francisco, San Francisco, CA
| | - Jaekyu Shin
- Department of Clinical Pharmacy, University of California San Francisco, San Francisco, CA
| | - Bani Tamraz
- Department of Clinical Pharmacy, University of California San Francisco, San Francisco, CA
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14
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Nguyen V, Sarik DA, Dejos MC, Hilmas E. Development of an Interprofessional Pharmacist-Nurse Navigation Pediatric Discharge Program. J Pediatr Pharmacol Ther 2018; 23:320-328. [PMID: 30181724 DOI: 10.5863/1551-6776-23.4.320] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Numerous challenges face clinically complex patients as they transition from hospital to home. The purpose of this project was to add pharmacy discharge services to an existing nurse-led discharge service (patient navigation program) to facilitate the transition of care process for clinically complex pediatric patients. METHODS For select patients referred to the service, a pharmacist resolved medication discrepancies, provided discharge counseling, and conducted follow-up telephone encounters on days 1, 7, and 14 post discharge. Patient demographics, admitting diagnosis, and number of discharge medications were recorded. The impact on patient outcomes was measured by the number and type of pharmacist interventions identified. Program utilization was measured by the number of referrals received, percentage of patients seen by a pharmacist, follow-up phone call completion rate, and pharmacist time required. Financial benefit gained from the program was estimated by translating each pharmaceutical intervention into potential cost savings. RESULTS There were 321 patient navigation referrals during the 5 months of pharmacist service. A pharmacist was able to provide discharge counseling for 56 discharges (17%). Patients who were provided pharmacy services had a median of 8 comorbidities, 10-day length of stay, and 4 discharge medications. Pharmacists identified 168 interventions, of which 93.5% were accepted or informational in nature. The most frequently identified interventions included clarification of drug order, assistance obtaining medication, and dose rounding. This program resulted in an estimated cost savings of $22,308 in the first 5 months. CONCLUSIONS A unique partnership between nurses and pharmacists facilitated the discharge process for clinically complex children.
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15
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Lee Y, Gettman L. Descriptive Analysis of Acceptance by Prescribers and Economic Benefit of Pharmacist Recommended Interventions in a Critical Care Unit. Innov Pharm 2018; 9:1-20. [PMID: 34007688 PMCID: PMC6438544 DOI: 10.24926/iip.v9i2.958] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Pharmacist clinical intervention is defined as the action that identifies and prevents medication-related problems and optimizes patient's medication therapy in cooperation with other healthcare professionals. Types of clinical interventions may vary, but each is patient specific. Few studies have focused on clinical pharmacists interventions in a critical care setting at a rural hospital. OBJECTIVES The purpose of this study was to assess physician acceptance rate of pharmacist-recommended interventions in the critical care unit (CCU) at a rural hospital over five years and to evaluate the economic benefit of accepted pharmacist-recommended interventions over a one-year time period. METHODS This study was a retrospective chart review over a five-year time period. Each intervention was categorized and analyzed for acceptance or non-acceptance by the treating physician. Evaluation of economic benefit, cost saving and cost avoidance, for a one-year time period was performed. RESULTS A total of 1275 interventions were documented during study period. The average acceptance rate for documented interventions was 56%. The acceptance rate by physicians increased over the study period; with the acceptance rate in 2013 being statistically significantly higher than any other years. The overall cost saving for selected interventions was $432 for the one year. The overall cost avoidance of all accepted interventions for the one year was $453,339.36-$468,327.62. CONCLUSION Clinical pharmacists provide various types of interventions to improve patient care. The analysis of potential cost saving and cost avoidance of selected interventions illustrated a positive economic outcome.
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Affiliation(s)
- YoonJung Lee
- Texas Tech University Health Sciences Center
- Harding University College of Pharmacy
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16
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Nies YH, Ali AM, Abdullah N, Islahudin F, Shah NM. A qualitative study among breast cancer patients on chemotherapy: experiences and side-effects. Patient Prefer Adherence 2018; 12:1955-1964. [PMID: 30319245 PMCID: PMC6167974 DOI: 10.2147/ppa.s168638] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The objective of this study was to explore the experiences and side-effects of breast cancer patients on chemotherapy in Malaysia. PARTICIPANTS AND METHODS Purposive sampling of 36 breast cancer patients who have completed chemotherapy and agreed to participate in semi-structured in-depth interviews. A constant comparative method and thematic analysis were used to analyze the interviews. RESULTS Data were categorized into six main themes: know nothing of chemotherapy; fear of chemotherapy; patients' beliefs in alternative treatments; symptom management; staying healthy after chemotherapy; and concerns of patients after chemotherapy. CONCLUSION Despite complaints about the bad experiences of their chemotherapy-induced side-effects, these patients still managed to complete the entire course of chemotherapy. Moreover, there is a need for a clinical pharmacy service in the oncology clinic setting in Malaysia in order to provide relevant information to help patients understand the chemotherapy received.
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Affiliation(s)
- Yong Hui Nies
- Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia,
| | - Adliah Mhd Ali
- Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia,
| | - Norlia Abdullah
- Department of Surgery, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Farida Islahudin
- Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia,
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17
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Biltaji E, Yoo M, Jennings BT, Leiser JP, McAdam-Marx C. Outcomes Associated with Pharmacist-Led Diabetes Collaborative Drug Therapy Management in a Medicaid Population. J Pharm Health Serv Res 2017. [PMID: 28630653 DOI: 10.1111/jphs.12162] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Pharmacist-led diabetes collaborative drug therapy management (CDTM) has been shown to improve outcomes. Whether such programs are effective specifically in Medicaid patients, who face barriers to access and self-management, has not been well characterized. This pilot study explores glycemic control, utilization and costs associated with pharmacist-led CDTM in a small population of Medicaid patients with type 2 diabetes mellitus (T2DM). METHODS A pre-post, historical cohort study was conducted of patients with T2DM and Medicaid coverage who received pharmacist-led CDTM in community-based primary clinics between 2008-2012. Outcomes included change in HbA1c, healthcare costs and utilization. RESULTS This study included 79 Medicaid patients with T2DM who received pharmacist-led CDTM. A subset of 46 patients with Medicaid coverage through an affiliated Medicaid Plan, Healthy U, was identified for additional analysis. At 6-months follow-up, HbA1c was a mean (SD) of 2.0% (2.0) lower than the baseline of 10.3% (1.7). Primary care clinic encounters increased by a mean (median) of 3.4 (2) visits. Per patient health system charges increased by a mean (median) of $4,392 ($620) and the amount paid by Medicaid in the Healthy U subset was $822 ($68) higher in the follow-up period. CONCLUSION A pharmacist-led diabetes CDTM intervention was associated with improved glycemic control in Medicaid patients, which corresponded with a higher number of primary care visits and observed costs. These findings are consistent with studies not limited to Medicaid, suggesting that CDTM can be effective in type 2 diabetes patients with Medicaid coverage.
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Affiliation(s)
- Eman Biltaji
- Department of Pharmacotherapy, Pharmacotherapy Outcomes Research Center, University of Utah, 30 S. 2000 E., Salt Lake City, UT 84112, 801 585 1065,
| | - Minkyoung Yoo
- Department of Economics, University of Utah, 332 S 1400 E, Salt Lake City, UT 84112, 801 581 7481,
| | - Brandon T Jennings
- Department of Pharmacy Practice, Shenandoah University Bernard J. Dunn School of Pharmacy, 1460 University Drive, Winchester, VA 22601, 540 665 1282,
| | - Jennifer P Leiser
- Department of Family & Preventive Medicine, 375 Chipeta Way Rm 201, Salt Lake City, UT 84108, 801 581 7961,
| | - Carrie McAdam-Marx
- Department of Pharmacotherapy, University of Utah, 30 S. 2000 E., Salt Lake City, UT 84112, 801 587 7728,
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18
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Morath B, Mayer T, Send AFJ, Hoppe-Tichy T, Haefeli WE, Seidling HM. Risk factors of adverse health outcomes after hospital discharge modifiable by clinical pharmacist interventions: a review with a systematic approach. Br J Clin Pharmacol 2017; 83:2163-2178. [PMID: 28452063 DOI: 10.1111/bcp.13318] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 04/12/2017] [Accepted: 04/13/2017] [Indexed: 12/19/2022] Open
Abstract
The present review assessed the evidence on risk factors for the occurrence of adverse health outcomes after discharge (i.e. unplanned readmission or adverse drug event after discharge) that are potentially modifiable by clinical pharmacist interventions. The findings were compared with patient characteristics reported in guidelines that supposedly indicate a high risk of drug-related problems. First, guidelines and risk assessment tools were searched for patient characteristics indicating a high risk of drug-related problems. Second, a systematic PubMed search was conducted to identify risk factors significantly associated with adverse health outcomes after discharge that are potentially modifiable by a clinical pharmacist intervention. After the PubMed search, 37 studies were included, reporting 16 risk factors. Only seven of 34 patient characteristics mentioned in pertinent guidelines corresponded to one of these risk factors. Diabetes mellitus (n = 11), chronic obstructive lung disease (n = 9), obesity (n = 7), smoking (n = 5) and polypharmacy (n = 5) were the risk factors reported most frequently in the studies. Additionally, single studies also found associations of adverse health outcomes with different drug classes {e.g. warfarin [hazard ratio 1.50; odds ratio (OR) 3.52], furosemide [OR 2.25] or high beta-blocker starting doses [OR 3.10]}. Although several modifiable risk factors were found, many patient characteristics supposedly indicating a high risk of drug-related problems were not part of the assessed risk factors in the context of an increased risk of adverse health outcomes after discharge. Therefore, an obligatory set of modifiable patient characteristics should be created and implemented in future studies investigating the risk for adverse health outcomes after discharge.
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Affiliation(s)
- Benedict Morath
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.,Cooperation Unit Clinical Pharmacy, Heidelberg University, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.,Hospital Pharmacy, Heidelberg University, Im Neuenheimer Feld 670, 69120, Heidelberg, Germany
| | - Tanja Mayer
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.,Cooperation Unit Clinical Pharmacy, Heidelberg University, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Alexander Francesco Josef Send
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.,Cooperation Unit Clinical Pharmacy, Heidelberg University, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Torsten Hoppe-Tichy
- Cooperation Unit Clinical Pharmacy, Heidelberg University, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.,Hospital Pharmacy, Heidelberg University, Im Neuenheimer Feld 670, 69120, Heidelberg, Germany
| | - Walter Emil Haefeli
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.,Cooperation Unit Clinical Pharmacy, Heidelberg University, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Hanna Marita Seidling
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.,Cooperation Unit Clinical Pharmacy, Heidelberg University, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
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19
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Dosea AS, Brito GC, Santos LMC, Marques TC, Balisa-Rocha B, Pimentel D, Bueno D, Lyra DP. Establishment, Implementation, and Consolidation of Clinical Pharmacy Services in Community Pharmacies: Perceptions of a Group of Pharmacists. Qual Health Res 2017; 27:363-373. [PMID: 26658232 DOI: 10.1177/1049732315614294] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
When pharmacists incorporate clinical practice into their routine, barriers and facilitators influence the implementation of patient care services. Three focus groups were conducted with 11 pharmacists who were working for the Farmácia Popular do Brasil program on the establishment, implementation, and consolidation of clinical pharmacy services. The perception of the pharmacists in Brazil about the program was that it facilitated access to health care and medication. The distance between neighboring cities made it difficult for patients to return for services. Lack of staff training created a lack of communication skills and knowledge. The pharmacists wanted to have increased technical support, skill development opportunities, and monitoring of researchers who assessed progress of the service. Pharmacists overcame many of their insecurities and felt more proactive and committed to quality service. Positive experiences in service implementations have shown that it is possible to develop a model of clinical services in community pharmacies.
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Affiliation(s)
- Aline S Dosea
- 1 Federal University of Sergipe, São Cristóvão, Brazil
| | - Giselle C Brito
- 1 Federal University of Sergipe, São Cristóvão, Brazil
- 2 Federal University of Sergipe, Lagarto, Brazil
| | | | | | | | | | - Denise Bueno
- 4 Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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20
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Maldonado AQ, Bowman LJ, Szempruch KR. Expanding transplant pharmacist presence in pretransplantation ambulatory care. Am J Health Syst Pharm 2017; 74:22-25. [PMID: 28069678 DOI: 10.2146/ajhp160142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
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21
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Han J, Bhat S, Gowhari M, Gordeuk VR, Saraf SL. Impact of a Clinical Pharmacy Service on the Management of Patients in a Sickle Cell Disease Outpatient Center. Pharmacotherapy 2016; 36:1166-1172. [PMID: 27639254 DOI: 10.1002/phar.1834] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Ambulatory care clinical pharmacy services have expanded beyond primary care settings, but literature supporting the benefits of clinical pharmacy involvement with patients who have rare diseases such as sickle cell disease (SCD) is lacking. Hydroxyurea is the only agent approved by the U.S. Food and Drug Administration for the treatment of SCD; full benefit in controlling pain episodes and other complications is achieved through monitored escalation to a maximum tolerated dose. The primary objective of this analysis was to evaluate the impact of a newly implemented clinical pharmacy service on the management of patients with SCD. We performed a retrospective cross-sectional analysis of 385 adults with SCD who received care between January 1, 2014, and December 31, 2014, at a single Sickle Cell Outpatient Center that implemented a clinical pharmacy service in August 2013. Data were collected on hydroxyurea dose escalation, immunization completion rates, and health maintenance metrics (screening for nephropathy with microalbuminuria testing, retinopathy with annual retinal examinations, and pulmonary hypertension with echocardiography). The impact of the clinical pharmacy service on quality measurements was evaluated by using univariate and multivariate analyses. The number of pharmacist encounters, defined as a clinic visit when a clinical pharmacist interacted with a patient as documented in the medical records, was associated with an improved hydroxyurea dose escalation rate (odds ratio [OR] 1.48, 95% confidence interval [CI] 1.07-2.05, p=0.02). Immunization rates for the 23-valent pneumococcal polysaccharide vaccine, the 13-valent pneumococcal conjugate vaccine, and influenza vaccine were 66%, 47%, and 62%, respectively. The number of pharmacist encounters was associated with improved immunization completion rates (OR 1.38, 95% CI 1.17-1.62, p<0.001). Improved screening for microalbuminuria (OR 2.14, 95% CI 1.60-2.86, p<0.001) and sickle cell retinopathy (OR 1.16, 95% CI 1.00-1.35, p=0.05) were also associated with the number of pharmacist encounters. A new clinical pharmacy service implemented in managing a rare disease, SCD, was associated with an improved hydroxyurea dose escalation rate, immunization completion rates, and health maintenance metrics.
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Affiliation(s)
- Jin Han
- Department of Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois.,Comprehensive Sickle Cell Center, Section of Hematology/Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Shubha Bhat
- Department of Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois
| | - Michel Gowhari
- Comprehensive Sickle Cell Center, Section of Hematology/Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Victor R Gordeuk
- Comprehensive Sickle Cell Center, Section of Hematology/Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Santosh L Saraf
- Comprehensive Sickle Cell Center, Section of Hematology/Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
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22
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Zhao SJ, Zhao HW, Du S, Qin YH. The Impact of Clinical Pharmacist Support on Patients Receiving Multi-drug Therapy for Coronary Heart Disease in China. Indian J Pharm Sci 2015; 77:306-11. [PMID: 26180276 PMCID: PMC4502145 DOI: 10.4103/0250-474x.159632] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 01/08/2015] [Accepted: 05/27/2015] [Indexed: 12/12/2022] Open
Abstract
The study determined pharmacist support on patients receiving multi-drug therapy for coronary heart disease by evaluating patient self-care ability, quality of life, and drug therapy compliance. In this study, ninety patients were randomly assigned to an experimental group (n=45) and a control group (n=45). The control group received conventional clinical care. The experimental group received clinical care plus pharmacist support that included medication review, patient education, lifestyle management, discharge guidance, and telephone follow-up. Eighty-five patients completed the study. Self-care ability and quality of life were evaluated before hospital discharge. The experimental group understood their condition better than the control group (P<0.05), the differences between the groups in understanding treatment goals, drug regimens, lifestyle modifications, psychogenic disorders, and satisfaction evaluations were more pronounced (P<0.01). At six-month follow-up, the difference between the groups in drug therapy compliance was P<0.01, as was success rate by intention-to-treat (77.8% vs. 48.9%) and per-protocol (81.4% vs. 52.4%). Two adverse drug reactions occurred in the experimental group and three in the control group. Pharmacist support improved self-care ability, quality of life, drug therapy compliance, and treatment success rate in coronary heart disease patients.
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Affiliation(s)
- S J Zhao
- Department of Pharmacy, People's Hospital of Henan Province, Zhengzhou-450 003, China
| | - H W Zhao
- Department of Pharmacy, People's Hospital of Henan Province, Zhengzhou-450 003, China
| | - S Du
- Department of Cardiovascular Medicine, People's Hospital of Henan Province, Zhengzhou-450 003, China
| | - Y H Qin
- Department of Pharmacy, People's Hospital of Henan Province, Zhengzhou-450 003, China
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