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McVannel T, Tangedal K, Haines A, Semchuk WM. Anticoagulation Interventions by Pharmacists in Acute Care. Can J Hosp Pharm 2023; 76:126-130. [PMID: 36998749 PMCID: PMC10049768 DOI: 10.4212/cjhp.3276] [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: 04/01/2023]
Abstract
Background Clinical pharmacy key performance indicators (cpKPIs) relate to activities performed by pharmacists that have been shown to improve patient outcomes. Within Saskatchewan Health Authority (SHA) Regina, most cpKPIs are incorporated into the organization's clinical practice standards, which provide guidance in prioritizing care, especially for high-risk medications, including anticoagulants. To track pharmacists' interventions associated with clinical practice standards, a locally developed electronic data-capture system (known as AIM High) was implemented. Objectives To quantify and describe pharmacists' anticoagulation interventions on 16 wards with dedicated ward-based clinical pharmacists and to compare intervention rates between the cardiology and internal medicine wards to further evolve the organization's practice model. Methods Data from the electronic data-capture system were retrospectively analyzed for a 5-year period (January 2016 to December 2020). Results A total of 94 201 interventions were recorded in the AIM High system (average 362 interventions per week or 26 interventions per pharmacist per week). Of these, 15 661 (16.6%) cited the anticoagulation standard (average 60 anticoagulation interventions per week or 4 anticoagulant interventions per pharmacist per week). For the cardiology and internal medicine wards, 4183 of 11 888 (35.2%) and 9034 of 54 843 (16.5%) interventions cited the anticoagulation standard, respectively. The top 4 types of anticoagulation interventions were dose changed (n = 4372 or 27.9%), drug started or restarted (n = 3867 or 24.7%), patient education (n = 3094 or 19.8%), and drug discontinued (n = 2944 or 18.8%). Conclusion Dedicated ward-based clinical pharmacists were following clinical practice standards incorporating the majority of cpKPIs to complete anticoagulation interventions. The types of anticoagulation interventions evolved over time and were influenced by the patient population.
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Affiliation(s)
- Taylor McVannel
- , BScPharm, ACPR, was, at the time of this study, a Pharmacy Resident with the Department of Pharmacy Services, Saskatchewan Health Authority, Regina, Saskatchewan. She is now with the Department of Pharmacy Services, Brandon Regional Health Centre - Prairie Mountain Health, Brandon, Manitoba
| | - Kirsten Tangedal
- , BSP, ACPR, is with the Department of Pharmacy Services, Saskatchewan Health Authority, Regina, Saskatchewan
| | - Aleina Haines
- , BSP, ACPR, is with the Department of Pharmacy Services, Saskatchewan Health Authority, Regina, Saskatchewan
| | - William M Semchuk
- , BSP, MSc, ACPR, PharmD, FCSHP, is with the Department of Pharmacy Services, Saskatchewan Health Authority, Regina, Saskatchewan
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2
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Bungard TJ, Ritchie B, Bolt J, Thomson P, Semchuk WM. Use of Direct Oral Anticoagulants Versus Traditional Therapies for Acute Venous Thromboembolism After Direct Discharge From the Emergency Department or After Hospitalization: An Audit of 16 Canadian Hospitals. Clin Ther 2020; 42:873-881. [PMID: 32284189 DOI: 10.1016/j.clinthera.2020.03.001] [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: 10/31/2019] [Revised: 02/12/2020] [Accepted: 03/04/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE This study compares and describes the use of direct oral anticoagulants (DOACs) versus traditional therapies (parenteral anticoagulant with or without warfarin) for acute venous thromboembolism (VTE) between individuals discharged directly from the emergency department (ED) versus those hospitalized. This study also reports patterns based on discharge from an academic, community, or rural-based site. METHODS This retrospective medical records study included patients discharged with acute VTE (2015-2016) from 16 institutions across 4 provinces. Patients with atypical clots, other indications for anticoagulants, or an anticipated lifespan <3 months or those who were pregnant or breastfeeding were excluded. FINDINGS Overall, 590 individuals (30.0%) discharged from the ED and 809 (53.8%) discharged after hospitalization were studied. Hospitalized patients were significantly older, had more comorbidities (cancer, pulmonary disease, and heart failure), and were more likely to have pulmonary embolism than deep vein thrombosis. DOAC use was significantly higher in the ED cohort versus the hospitalized cohort (51.4% vs 44.3%; P < 0.004) and more common for those having lower risk of pulmonary embolisms (simplified Pulmonary Embolism Severity Index score of 0 compared with ≥1) in the ED (58.0% and 26.5%; P < 0.0001) and hospitalized cohorts (57.1% and 35.7%; P < 0.0001). Use of DOACs was lowest in academic settings (46.2%) and highest in rural sites (56.7%). Follow-up patterns were different, with specialists and VTE clinics being most common in academic sites and family physicians being most common in rural practices. IMPLICATIONS DOACs were used in less than half of all patients, with more use in EDs and rural sites. Follow-up patterns (VTE clinic or specialist vs family physician) varied and likely contributed to therapy selection. Over time, use of DOACs is likely to increase, and patient factors (eg, those younger with fewer comorbidities) and health care contact (eg, place of discharge or availability of an ambulatory VTE clinic) will likely continue to influence practice patterns.
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Affiliation(s)
| | | | - Jennifer Bolt
- Regina Qu'Appelle Health Region, Regina, Saskatchewan, Canada
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3
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Barry AR, Semchuk WM, Thompson A, LeBras MH, Koshman SL. Use of low-dose acetylsalicylic acid for cardiovascular disease prevention: A practical, stepwise approach for pharmacists. Can Pharm J (Ott) 2020; 153:153-160. [PMID: 32528599 DOI: 10.1177/1715163520909137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Low-dose acetylsalicylic acid (ASA) is recommended in patients with established cardiovascular disease. However, the role of ASA in those without cardiovascular disease (i.e., primary prevention) is less clear, which has led to discordance among Canadian guidelines. In 2018, 3 double-blind, randomized controlled trials were published that evaluated ASA 100 mg daily versus placebo in patients without established cardiovascular disease. In the ASPREE trial, ASA did not reduce the risk of all-cause death, dementia, or persistent physical disability in patients ≥70 years of age but increased the risk of major bleeding. In the ARRIVE trial, ASA failed to lower the risk of a composite of cardiovascular events but increased any gastrointestinal bleeding in patients at intermediate risk of cardiovascular disease. In the ASCEND trial, ASA significantly reduced the primary composite cardiovascular outcome in patients with diabetes for a number needed to treat of 91 over approximately 7.4 years. Yet major bleeding was increased with ASA for a number needed to harm of 112. Therefore, in most situations, ASA should not be recommended for primary cardiovascular prevention. However, there are additional indications for ASA beyond cardiovascular disease. Thus, a sequential algorithm was developed based on contemporary evidence to help pharmacists determine the suitability of ASA in their patients and play an active role in educating their patients about the potential benefits (or lack thereof) and risks of ASA. Can Pharm J (Ott) 2020;153:xx-xx.
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Affiliation(s)
- Arden R Barry
- Chilliwack General Hospital (Barry), University of British Columbia, Vancouver, British Columbia.,Lower Mainland Pharmacy Services, Chilliwack and the Faculty of Pharmaceutical Sciences (Barry), University of British Columbia, Vancouver, British Columbia.,Provincial Pharmacy Services (Semchuk), University of Saskatchewan, Saskatoon, Saskatchewan.,Saskatchewan Health Authority, Regina General Hospital, Regina and the College of Medicine (Semchuk), University of Saskatchewan, Saskatoon, Saskatchewan.,College of Pharmacy and Nutrition (Semchuk, LeBras), University of Saskatchewan, Saskatoon, Saskatchewan.,Faculty of Pharmacy and Pharmaceutical Sciences (Thompson), Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta.,Division of Cardiology (Koshman), Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta
| | - William M Semchuk
- Chilliwack General Hospital (Barry), University of British Columbia, Vancouver, British Columbia.,Lower Mainland Pharmacy Services, Chilliwack and the Faculty of Pharmaceutical Sciences (Barry), University of British Columbia, Vancouver, British Columbia.,Provincial Pharmacy Services (Semchuk), University of Saskatchewan, Saskatoon, Saskatchewan.,Saskatchewan Health Authority, Regina General Hospital, Regina and the College of Medicine (Semchuk), University of Saskatchewan, Saskatoon, Saskatchewan.,College of Pharmacy and Nutrition (Semchuk, LeBras), University of Saskatchewan, Saskatoon, Saskatchewan.,Faculty of Pharmacy and Pharmaceutical Sciences (Thompson), Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta.,Division of Cardiology (Koshman), Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta
| | - Ann Thompson
- Chilliwack General Hospital (Barry), University of British Columbia, Vancouver, British Columbia.,Lower Mainland Pharmacy Services, Chilliwack and the Faculty of Pharmaceutical Sciences (Barry), University of British Columbia, Vancouver, British Columbia.,Provincial Pharmacy Services (Semchuk), University of Saskatchewan, Saskatoon, Saskatchewan.,Saskatchewan Health Authority, Regina General Hospital, Regina and the College of Medicine (Semchuk), University of Saskatchewan, Saskatoon, Saskatchewan.,College of Pharmacy and Nutrition (Semchuk, LeBras), University of Saskatchewan, Saskatoon, Saskatchewan.,Faculty of Pharmacy and Pharmaceutical Sciences (Thompson), Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta.,Division of Cardiology (Koshman), Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta
| | - Marlys H LeBras
- Chilliwack General Hospital (Barry), University of British Columbia, Vancouver, British Columbia.,Lower Mainland Pharmacy Services, Chilliwack and the Faculty of Pharmaceutical Sciences (Barry), University of British Columbia, Vancouver, British Columbia.,Provincial Pharmacy Services (Semchuk), University of Saskatchewan, Saskatoon, Saskatchewan.,Saskatchewan Health Authority, Regina General Hospital, Regina and the College of Medicine (Semchuk), University of Saskatchewan, Saskatoon, Saskatchewan.,College of Pharmacy and Nutrition (Semchuk, LeBras), University of Saskatchewan, Saskatoon, Saskatchewan.,Faculty of Pharmacy and Pharmaceutical Sciences (Thompson), Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta.,Division of Cardiology (Koshman), Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta
| | - Sheri L Koshman
- Chilliwack General Hospital (Barry), University of British Columbia, Vancouver, British Columbia.,Lower Mainland Pharmacy Services, Chilliwack and the Faculty of Pharmaceutical Sciences (Barry), University of British Columbia, Vancouver, British Columbia.,Provincial Pharmacy Services (Semchuk), University of Saskatchewan, Saskatoon, Saskatchewan.,Saskatchewan Health Authority, Regina General Hospital, Regina and the College of Medicine (Semchuk), University of Saskatchewan, Saskatoon, Saskatchewan.,College of Pharmacy and Nutrition (Semchuk, LeBras), University of Saskatchewan, Saskatoon, Saskatchewan.,Faculty of Pharmacy and Pharmaceutical Sciences (Thompson), Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta.,Division of Cardiology (Koshman), Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta
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Kary SJ, Dumont Z, Tangedal K, Bolt J, Semchuk WM. Measuring Competency of Pharmacy Residents: A Survey of Residency Programs’ Methods for Assessment and Evaluation. Can J Hosp Pharm 2019. [DOI: 10.4212/cjhp.v72i5.2927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
ABSTRACTBackground: The Canadian Pharmacy Residency Board (CPRB) specifies the competencies that pharmacy residents must attain and the need for assessment and evaluation. Methods of assessment and evaluation are left to the discretion of individual programs. There is a scarcity of published literature compiling and comparing the strategies used by Canadian residency programs. Objectives: To determine curricular components used for assessment and evaluation; to describe the tools used by programs; to characterize the scheduling, frequency, and repetition of curricular components; and to determine the individuals or groups involved.Methods: Coordinators of hospital pharmacy residency programs with CPRB accreditation or accreditation pending were surveyed to collect information about the assessment and evaluation of select CPRB standards. Results: From the 37 eligible residency programs, 20 unique responses (54%) were received. All respondents were general practice programs (100%) in predominantly multicentre organizations (70%). Programs were similar in terms of assessment components used, with all respondents citing care plan review, direct observation of patient care, journal clubs, creation of project timelines, and ethics submission. The predominant evaluation components were within-department presentations (100%), written manuscripts (95%), drug information rotations (85%), and longitudinal evaluations (75%). Standardized forms (70%–100%) defined by Bloom’s taxonomy (65%) and the CPRB “levels and ranges” document (60%) were the principle means used. Assessments for patient care and for provision of education were generally carried out immediately (80% and 95%, respectively), whereas project management skills were assessed predominantly at final evaluation (75%). Self-assessment and assessment by pharmacy team members occurred for every competency, whereas patients (0%–10%) and allied health professionals (5%) were less frequently involved. Conclusions: The assessment and evaluation strategies reported by programs were congruent. The results provide a summary of national practices and will allow existing and developing programs to examine their approach to assessment and evaluation for alignment with national standards.RÉSUMÉContexte: Le Conseil canadien de résidence en pharmacie (CCRP) précise les compétences que les résidents en pharmacie doivent acquérir ainsi que le besoin d’observation et d’évaluation. Les méthodes d’observation et d’évaluation sont laissées à la discrétion de chacun des programmes. La littérature publiée qui compile et compare les stratégies utilisées par les programmes en résidence canadiens est rare. Objectifs : Déterminer les composantes des programmes utilisés pour l’observation et l’évaluation des normes; décrire les outils utilisés par ces programmes; établir l’horaire, la fréquence et la répétition des éléments qui constituent ces programmes et déterminer les personnes ou les groupes concernés.Méthodes : Les coordinateurs des programmes de résidence en pharmacie hospitalière ayant un agrément ou dont l’agrément est en cours de procédure ont été interrogés afin qu’ils fournissent des informations concernant l’observation et l’évaluation des normes CCRP sélectionnées. Résultats : Des 37 programmes de résidence admissibles, 20 réponses individuelles (54 %) sont parvenues aux investigateurs. Tous les répondants représentaient des programmes de pratique générale (100 %) dans des organismes majoritairement multicentriques (70 %). Les programmes étaient similaires en termes de points à observer : tous les répondants citaient l’examen des plans de soins, l’observation directe des soins aux patients, les clubs de journaux, la création d’échéanciers pour la réalisation de projets et la proposition de documents sur l’éthique. Les critères d’évaluation prédominants consistaient en des présentations au sein du département (100 %), la rédaction de manuscrits (95 %), des rotations reliées au service d’information pharmacothérapeutique (85 %) et les évaluations longitudinales (75 %). Les formulaires standardisés (70 %–100 %) définis par la taxonomie de Bloom (65 %) et le document Levels and ranges (niveaux de performance des compétences) du CCRP (60 %) étaient les ressources de base utilisées. L’observation des soins aux patients et de la formation avait généralement lieu immédiatement (respectivement 80 % et 95 %,), tandis que les compétences en matière de gestion de projet étaient majoritairement évaluées en dernier (75 %). L’auto-observation et l’observation effectué par des membres de l’équipe de pharmacie portaient sur chaque compétence, tandis que les patients (0 % – 10 %) et les autres professionnels de la santé (5 %) participaient plus rarement à cette observation.Conclusions : Les stratégies d’observation et d’évaluation rapportées par les programmes concordaient. Les résultats fournissent un résumé des pratiques nationales et permettront aux responsables des programmes existants et en cours d’élaboration d’étudier l’approche de l’observation et de l’évaluation pour l’aligner sur les normes nationales.
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Lamb DA, Bungard TJ, Lowerison J, Semchuk WM, Thomson P, Brocklebank C, Bolt J. Jurisdictional Guidance on DOAC Use-Will It Affect Practice? A Comparison of European, American, and Canadian Product Monographs. Ann Pharmacother 2019; 54:277-282. [PMID: 31529984 DOI: 10.1177/1060028019877215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 11/17/2022] Open
Abstract
Objective: To identify clinically relevant areas of concordance and discordance between product monographs for 4 direct oral anticoagulants (DOACs) approved by regulatory authorities in Europe, the United States, and Canada. Data Sources: For each DOAC (apixaban, dabigatran, edoxaban, rivaroxaban), manufacturer product monographs were retrieved from the European Medicines Database, US Food and Drug Administration, and Health Canada Drug Product Database. Data Extraction: Monographs for each DOAC were independently reviewed by 2 investigators to identify areas of concordance and discordance. Discordance existed if it was deemed that a potentially clinically relevant difference existed. A heat map summarizing the data was created to identify areas of complete concordance, partial concordance (concordance between 2 of 3 monographs), and complete discordance. Data Synthesis: The areas of concordance were indications for use, use in extremes of weight, and switching to/from the DOAC. Areas of discordance included the following: differing recommendations for use/dosing with renal dysfunction; contraindication or use with caution with drug interactions, pregnancy, and hepatic/renal dysfunction; and timing of DOAC with spinal/epidural anesthesia after a procedure or traumatic puncture. Relevance to Patient Care and Clinical Practice: Concordance was most evident for uncomplicated patients with atrial fibrillation or venous thromboembolism, whereas discordance emerged for those having characteristics/factors wherein clinicians may seek clarification within product monographs (eg, impaired renal/hepatic function, drug interactions). As such, clinicians must be familiar with product information within their country of practice. Conclusion: Variability between jurisdictions was evident, and variability of DOAC use is likely to increase with expanding worldwide uptake.
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Affiliation(s)
- Darcy A Lamb
- Saskatchewan Health Authority, Saskatoon, SK, Canada
| | | | | | | | - Peter Thomson
- University of Manitoba and Winnipeg Regional Health Authority, Winnipeg, MB, Canada
| | | | - Jennifer Bolt
- Interior Health Authority and University of British Columbia Faculty of Pharmaceutical Sciences, Kelowna, BC, Canada
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6
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Kary SJ, Dumont Z, Tangedal K, Bolt J, Semchuk WM. Measuring Competency of Pharmacy Residents: A Survey of Residency Programs' Methods for Assessment and Evaluation. Can J Hosp Pharm 2019; 72:343-352. [PMID: 31692605 PMCID: PMC6799962] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND The Canadian Pharmacy Residency Board (CPRB) specifies the competencies that pharmacy residents must attain and the need for assessment and evaluation. Methods of assessment and evaluation are left to the discretion of individual programs. There is a scarcity of published literature compiling and comparing the strategies used by Canadian residency programs. OBJECTIVES To determine curricular components used for assessment and evaluation; to describe the tools used by programs; to characterize the scheduling, frequency, and repetition of curricular components; and to determine the individuals or groups involved. METHODS Coordinators of hospital pharmacy residency programs with CPRB accreditation or accreditation pending were surveyed to collect information about the assessment and evaluation of select CPRB standards. RESULTS From the 37 eligible residency programs, 20 unique responses (54%) were received. All respondents were general practice programs (100%) in predominantly multicentre organizations (70%). Programs were similar in terms of assessment components used, with all respondents citing care plan review, direct observation of patient care, journal clubs, creation of project timelines, and ethics submission. The predominant evaluation components were within-department presentations (100%), written manuscripts (95%), drug information rotations (85%), and longitudinal evaluations (75%). Standardized forms (70%-100%) defined by Bloom's taxonomy (65%) and the CPRB "levels and ranges" document (60%) were the principle means used. Assessments for patient care and for provision of education were generally carried out immediately (80% and 95%, respectively), whereas project management skills were assessed predominantly at final evaluation (75%). Self-assessment and assessment by pharmacy team members occurred for every competency, whereas patients (0%-10%) and allied health professionals (5%) were less frequently involved. CONCLUSIONS The assessment and evaluation strategies reported by programs were congruent. The results provide a summary of national practices and will allow existing and developing programs to examine their approach to assessment and evaluation for alignment with national standards.
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Affiliation(s)
- Steven J Kary
- , BSP, ACPR, is with Oncology Pharmacy Services, Saskatoon Cancer Centre, Saskatoon, Saskatchewan
| | - Zack Dumont
- , BSP, ACPR, MS(Pharm), is with Pharmacy Services, Saskatchewan Health Authority Regina Area, Regina, Saskatchewan
| | - Kirsten Tangedal
- , BSP, ACPR, is with Pharmacy Services, Saskatchewan Health Authority Regina Area, Regina, Saskatchewan
| | - Jennifer Bolt
- , BScPharm, ACPR, PharmD, is with Clinical Support Services, Central Okanagan Seniors' Health and Wellness Centre, Kelowna, British Columbia
| | - William M Semchuk
- , BSP, MSc, PharmD, FCSHP, is with Pharmacy Services, Saskatchewan Health Authority Regina Area, Regina, Saskatchewan
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Turgeon RD, Semchuk WM, Thomson P, Bungard TJ. Exploring discrepancies between pharmacists’ perceived and actual roles towards optimising care in patients prescribed direct oral anticoagulants: a survey. J Pharm Pract Res 2019. [DOI: 10.1002/jppr.1509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Ricky D. Turgeon
- Department of Pharmacy Vancouver General Hospital Vancouver Canada
| | | | - Peter Thomson
- College of Pharmacy Faculty of Health Sciences University of Manitoba Manitoba Canada
| | - Tammy J. Bungard
- Division of Cardiology Faculty of Medicine and Dentistry University of Alberta Edmonton Alberta
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Zimmer S, Gray C, Roy C, Semchuk WM. Departmental Initiative to Improve Documentation in the Medical Record by Acute Care Pharmacists. Can J Hosp Pharm 2019. [DOI: 10.4212/cjhp.v72i2.2886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Zimmer S, Gray C, Roy C, Semchuk WM. Departmental Initiative to Improve Documentation in the Medical Record by Acute Care Pharmacists. Can J Hosp Pharm 2019; 72:151-154. [PMID: 31036977 PMCID: PMC6476581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Stephanie Zimmer
- , BSP, is with the Department of Pharmacy Services, Saskatchewan Health Authority - Regina, Regina, Saskatchewan
| | - Carolyn Gray
- , BSP, ACPR, is with the Department of Pharmacy Services, Saskatchewan Health Authority - Regina, Regina, Saskatchewan
| | - Caitlin Roy
- , BSP, ACPR, is with the Department of Pharmacy Services, Saskatchewan Health Authority - Regina, Regina, Saskatchewan
| | - William M Semchuk
- , MSc, PharmD, FCSHP, is with the Department of Pharmacy Services, Saskatchewan Health Authority - Regina, Regina, Saskatchewan
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Kary SJ, Roy CJ, Semchuk WM, Lavoie AJ. Transient Ischemic Attack in a High-Risk Cardiovascular Patient with Renal Dysfunction after Treatment with Rivaroxaban and Clopidogrel: A Case Report. Can J Hosp Pharm 2019. [DOI: 10.4212/cjhp.v72i1.2868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Kary SJ, Roy CJ, Semchuk WM, Lavoie AJ. Transient Ischemic Attack in a High-Risk Cardiovascular Patient with Renal Dysfunction after Treatment with Rivaroxaban and Clopidogrel: A Case Report. Can J Hosp Pharm 2019; 72:49-51. [PMID: 30828094 PMCID: PMC6391238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Steven J Kary
- , BSP, ACPR, is with the Saskatchewan Cancer Agency, Saskatoon, Saskatchewan
| | - Caitlin J Roy
- , BSP, ACPR, is with the Saskatchewan Health Authority - Regina Area, Regina, Saskatchewan
| | - William M Semchuk
- , BSP, MSc, PharmD, is with the Saskatchewan Health Authority - Regina Area, Regina, Saskatchewan
| | - Andrea J Lavoie
- , MD, FRCPC, is with the Saskatchewan Health Authority - Regina Area, Regina, Saskatchewan
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Abstract
OBJECTIVE To determine anticoagulant therapy at hospital discharge for patients with acute venous thromboembolism (VTE) and secondarily, to describe factors affecting choice of therapy. DESIGN A retrospective chart review. SETTING Canadian hospitals in Edmonton, Alberta (n=4), Regina, Saskatchewan (n=2) and rural Alberta (n=3) from April 2014 to March 2015. PARTICIPANTS All patients discharged with an acute VTE were screened. Those with atypical clots, another indication for anticoagulation, pregnancy/breast feeding or lifespan <3 months were excluded. PRIMARY AND SECONDARY OUTCOMES Primarily, we identified the proportion of patients discharged from hospital with acute VTE that were prescribed either traditional therapy (parenteral anticoagulant±warfarin) or a direct oral anticoagulant (DOAC). Secondarily, management based on setting, therapy choice based on deep vein thrombosis (DVT) versus pulmonary embolism (PE), clot burden and renal function was compared. DOAC dosing was assessed (when prescribed), length of hospital stay based on therapy was compared and planned follow-up in the community was described. RESULTS Among the 695 patients included, most were discharged following a diagnosis of PE (82.9%) on traditional therapy (parenteral anticoagulant±warfarin) (70.2%) with follow-up by either a family doctor (51.5%) or specialist/clinic (46.9%) postdischarge. Regional variation was most evident between urban and rural sites. Of those prescribed a DOAC (28.3%), the majority were dosed appropriately (85.8%). DOAC use did not differ between those with DVT and PE, was proportionately higher for less severe clots and declined with worsening renal function. Patients prescribed DOACs versus traditional therapy had a shorter length of stay (4 vs 7 days, respectively). CONCLUSIONS Uptake of DOAC therapy for acute VTE was modest and may have been influenced by the timing of the audit in relation to the approval of these agents for this indication. Future audits should occur to assess temporal changes and ongoing appropriateness of care delivery.
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Affiliation(s)
- Tammy J Bungard
- Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada
| | - Bruce Ritchie
- Division of Hematology, University of Alberta, Edmonton, Alberta, Canada
| | - Jennifer Bolt
- Pharmacy Services, Regina Qu'Appelle Health Region, Regina, Saskatchewan, Canada
| | - William M Semchuk
- Pharmacy Services, Regina Qu'Appelle Health Region, Regina, Saskatchewan, Canada
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Bungard TJ, Ritchie B, Bolt J, Semchuk WM. Anticoagulant therapies for acute venous thromboembolism: a comparison between those discharged directly from the emergency department versus hospital in two Canadian cities. BMJ Open 2018; 8:e022063. [PMID: 30385438 PMCID: PMC6224720 DOI: 10.1136/bmjopen-2018-022063] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 08/14/2018] [Accepted: 08/28/2018] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To compare the characteristics/management of acute venous thromboembolism (VTE) for patients either discharged directly from the emergency department (ED) or hospitalised throughout a year within two urban cities in Canada. DESIGN Retrospective medical record review. SETTING Hospitals in Edmonton, Alberta (n=4) and Regina, Saskatchewan (n=2) from April 2014 to March 2015. PARTICIPANTS All patients discharged from the ED or hospital with acute deep vein thrombosis or pulmonary embolism (PE). Those having another indication for anticoagulant therapy, pregnant/breast feeding or anticipated lifespan <3 months were excluded. PRIMARY AND SECONDARY OUTCOMES Primarily, to compare proportion of patients receiving traditional therapy (parenteral anticoagulant±warfarin) relative to a direct oral anticoagulant (DOAC) between the two cohorts. Secondarily, to assess differences with therapy selected based on clot burden and follow-up plans postdischarge. RESULTS 387 (25.2%) and 665 (72.5%) patients from the ED and hospital cohorts, respectively, were included. Compared with the ED cohort, those hospitalised were older (57.3 and 64.5 years; p<0.0001), more likely to have PE (35.7% vs 83.8%) with a simplified Pulmonary Embolism Severity Index (sPESI) ≥1 (31.2% vs 65.2%), cancer (14.7% and 22.3%; p=0.003) and pulmonary disease (10.1% and 20.6%; p<0.0001). For the ED and hospital cohorts, similar proportions of patients were prescribed traditional therapies (72.6% and 71.1%) and a DOAC (25.8% and 27.4%, respectively). For the ED cohort, DOAC use was similar between those with a sPESI score of 0 and ≥1 (35.1% and 34.9%, p=0.98) whereas for those hospitalised lower risk patients were more likely to receive a DOAC (31.4% and 23.8%, p<0.055). Follow-up was most common with family physicians for those hospitalised (51.5%), while specialists/VTE clinic was most common for those directly discharged from the ED (50.6%). CONCLUSIONS Traditional and DOAC therapies were proportionately similar between the ED and hospitalised cohorts, despite clear differences in patient populations and follow-up patterns in the community.
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Affiliation(s)
- Tammy J Bungard
- Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada
| | - Bruce Ritchie
- Division of Hematology, University of Alberta, Edmonton, Alberta, Canada
| | - Jennifer Bolt
- Pharmacy Services, Regina Qu'Appelle Health Region, Regina, Saskatchewan, Canada
| | - William M Semchuk
- Pharmacy Services, Regina Qu'Appelle Health Region, Regina, Saskatchewan, Canada
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14
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Abstract
OBJECTIVE To report the proportion of patients discharged directly from the emergency department (ED) on traditional therapy (parenteral anticoagulant±warfarin) or a direct oral anticoagulant (DOAC) for the management of acute venous thromboembolism (VTE). DESIGN Retrospective medical record review across four EDs in Edmonton, Alberta, two in Regina, Saskatchewan and three in rural Alberta. SETTING EDs from April 2014 through March 2015. PARTICIPANTS Discharged directly from the ED with acute VTE. Patients were excluded if they had another indication for anticoagulants, were pregnant/breastfeeding or anticipated lifespan <3 months. PRIMARY AND SECONDARY OUTCOME MEASURES Primarily, the proportion of patients discharged directly from the ED that were prescribed traditional therapy or a DOAC, with comparisons between Edmonton, Regina and rural Alberta. Secondarily, therapy selection was compared based on deep vein thrombosis (DVT) versus pulmonary embolism (PE) and clot burden. Dosing of DOACs was assessed (when applicable) and follow-up in the community was compared. RESULTS After screening 1723 patients, 417 (24.2%) were included with DVT and PE occurring in 65.5% and 34.5%, respectively. More patients with PE were discharged from EDs in Edmonton (43%) than Regina (7%). Overall, the majority of patients were discharged on traditional therapy (70.7%), with 27.8% receiving a DOAC. Uptake of DOAC use was highest in rural Alberta (53.3%) compared with Edmonton (29.6%) and Regina (12.1%). DOACs were more commonly prescribed for PE (34.0%) than DVT (24.5%) (p=0.04), proximal versus distal DVT (28.4% and 17.3%; p<0.001), and when prescribed were appropriately dosed in 79.3%. Follow-up most commonly occurred via a VTE clinic in Edmonton or family physician in Regina and rural Alberta. CONCLUSIONS Regional variation in discharging patients directly from the ED with PE is evident. While traditional therapy is most common, uptake of DOACs was modest given the timing of indication approval.
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Affiliation(s)
- Tammy J Bungard
- Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada
| | - Bruce Ritchie
- Division of Hematology, University of Alberta, Edmonton, Alberta, Canada
| | - Jennifer Bolt
- Pharmacy Services, Regina Qu'Appelle Health Region, Regina, Saskatchewan, Canada
| | - William M Semchuk
- Pharmacy Services, Regina Qu'Appelle Health Region, Regina, Saskatchewan, Canada
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15
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Leblanc K, Semchuk WM, Papastergiou J, Snow B, Mandlsohn L, Kapoor V, Guirguis LM, Douketis JD, Geerts W, Gladstone DJ. A pharmacist checklist for direct oral anticoagulant management: Raising the bar. Can Pharm J (Ott) 2018. [PMID: 29531627 DOI: 10.1177/1715163518756926] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Kori Leblanc
- University Health Network (Leblanc), University of Toronto, Toronto.,Leslie Dan Faculty of Pharmacy (Leblanc, Papastergiou), University of Toronto, Toronto.,Regina Qu'Appelle Health Region (Semchuk), University of Saskatchewan, Saskatoon, Saskatchewan.,College of Pharmacy and Nutrition (Semchuk), University of Saskatchewan, Saskatoon, Saskatchewan.,John Papastergiou Pharmacy Ltd. (Papastergiou), Toronto.,Long Term Care Service (Snow), Roulston's Pharmacy, Simcoe.,Green Shield Canada (Mandlsohn), Willowdale.,Vinay Kapoor Drugs Ltd. (Kapoor), Thunder Bay, Ontario.,Faculty of Pharmacy and Pharmaceutical Sciences (Guirguis), University of Alberta.,Department of Medicine (Douketis), McMaster University, Hamilton.,Hurvitz Brain Sciences Program (Gladstone), Sunnybrook Research Institute, Toronto.,Thromboembolism Program (Geerts), Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Ontario.,Division of Neurology (Gladstone), Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Ontario.,Department of Medicine (Geerts, Gladstone), Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Ontario
| | - William M Semchuk
- University Health Network (Leblanc), University of Toronto, Toronto.,Leslie Dan Faculty of Pharmacy (Leblanc, Papastergiou), University of Toronto, Toronto.,Regina Qu'Appelle Health Region (Semchuk), University of Saskatchewan, Saskatoon, Saskatchewan.,College of Pharmacy and Nutrition (Semchuk), University of Saskatchewan, Saskatoon, Saskatchewan.,John Papastergiou Pharmacy Ltd. (Papastergiou), Toronto.,Long Term Care Service (Snow), Roulston's Pharmacy, Simcoe.,Green Shield Canada (Mandlsohn), Willowdale.,Vinay Kapoor Drugs Ltd. (Kapoor), Thunder Bay, Ontario.,Faculty of Pharmacy and Pharmaceutical Sciences (Guirguis), University of Alberta.,Department of Medicine (Douketis), McMaster University, Hamilton.,Hurvitz Brain Sciences Program (Gladstone), Sunnybrook Research Institute, Toronto.,Thromboembolism Program (Geerts), Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Ontario.,Division of Neurology (Gladstone), Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Ontario.,Department of Medicine (Geerts, Gladstone), Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Ontario
| | - John Papastergiou
- University Health Network (Leblanc), University of Toronto, Toronto.,Leslie Dan Faculty of Pharmacy (Leblanc, Papastergiou), University of Toronto, Toronto.,Regina Qu'Appelle Health Region (Semchuk), University of Saskatchewan, Saskatoon, Saskatchewan.,College of Pharmacy and Nutrition (Semchuk), University of Saskatchewan, Saskatoon, Saskatchewan.,John Papastergiou Pharmacy Ltd. (Papastergiou), Toronto.,Long Term Care Service (Snow), Roulston's Pharmacy, Simcoe.,Green Shield Canada (Mandlsohn), Willowdale.,Vinay Kapoor Drugs Ltd. (Kapoor), Thunder Bay, Ontario.,Faculty of Pharmacy and Pharmaceutical Sciences (Guirguis), University of Alberta.,Department of Medicine (Douketis), McMaster University, Hamilton.,Hurvitz Brain Sciences Program (Gladstone), Sunnybrook Research Institute, Toronto.,Thromboembolism Program (Geerts), Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Ontario.,Division of Neurology (Gladstone), Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Ontario.,Department of Medicine (Geerts, Gladstone), Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Ontario
| | - Blair Snow
- University Health Network (Leblanc), University of Toronto, Toronto.,Leslie Dan Faculty of Pharmacy (Leblanc, Papastergiou), University of Toronto, Toronto.,Regina Qu'Appelle Health Region (Semchuk), University of Saskatchewan, Saskatoon, Saskatchewan.,College of Pharmacy and Nutrition (Semchuk), University of Saskatchewan, Saskatoon, Saskatchewan.,John Papastergiou Pharmacy Ltd. (Papastergiou), Toronto.,Long Term Care Service (Snow), Roulston's Pharmacy, Simcoe.,Green Shield Canada (Mandlsohn), Willowdale.,Vinay Kapoor Drugs Ltd. (Kapoor), Thunder Bay, Ontario.,Faculty of Pharmacy and Pharmaceutical Sciences (Guirguis), University of Alberta.,Department of Medicine (Douketis), McMaster University, Hamilton.,Hurvitz Brain Sciences Program (Gladstone), Sunnybrook Research Institute, Toronto.,Thromboembolism Program (Geerts), Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Ontario.,Division of Neurology (Gladstone), Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Ontario.,Department of Medicine (Geerts, Gladstone), Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Ontario
| | - Leilany Mandlsohn
- University Health Network (Leblanc), University of Toronto, Toronto.,Leslie Dan Faculty of Pharmacy (Leblanc, Papastergiou), University of Toronto, Toronto.,Regina Qu'Appelle Health Region (Semchuk), University of Saskatchewan, Saskatoon, Saskatchewan.,College of Pharmacy and Nutrition (Semchuk), University of Saskatchewan, Saskatoon, Saskatchewan.,John Papastergiou Pharmacy Ltd. (Papastergiou), Toronto.,Long Term Care Service (Snow), Roulston's Pharmacy, Simcoe.,Green Shield Canada (Mandlsohn), Willowdale.,Vinay Kapoor Drugs Ltd. (Kapoor), Thunder Bay, Ontario.,Faculty of Pharmacy and Pharmaceutical Sciences (Guirguis), University of Alberta.,Department of Medicine (Douketis), McMaster University, Hamilton.,Hurvitz Brain Sciences Program (Gladstone), Sunnybrook Research Institute, Toronto.,Thromboembolism Program (Geerts), Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Ontario.,Division of Neurology (Gladstone), Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Ontario.,Department of Medicine (Geerts, Gladstone), Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Ontario
| | - Vinay Kapoor
- University Health Network (Leblanc), University of Toronto, Toronto.,Leslie Dan Faculty of Pharmacy (Leblanc, Papastergiou), University of Toronto, Toronto.,Regina Qu'Appelle Health Region (Semchuk), University of Saskatchewan, Saskatoon, Saskatchewan.,College of Pharmacy and Nutrition (Semchuk), University of Saskatchewan, Saskatoon, Saskatchewan.,John Papastergiou Pharmacy Ltd. (Papastergiou), Toronto.,Long Term Care Service (Snow), Roulston's Pharmacy, Simcoe.,Green Shield Canada (Mandlsohn), Willowdale.,Vinay Kapoor Drugs Ltd. (Kapoor), Thunder Bay, Ontario.,Faculty of Pharmacy and Pharmaceutical Sciences (Guirguis), University of Alberta.,Department of Medicine (Douketis), McMaster University, Hamilton.,Hurvitz Brain Sciences Program (Gladstone), Sunnybrook Research Institute, Toronto.,Thromboembolism Program (Geerts), Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Ontario.,Division of Neurology (Gladstone), Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Ontario.,Department of Medicine (Geerts, Gladstone), Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Ontario
| | - Lisa M Guirguis
- University Health Network (Leblanc), University of Toronto, Toronto.,Leslie Dan Faculty of Pharmacy (Leblanc, Papastergiou), University of Toronto, Toronto.,Regina Qu'Appelle Health Region (Semchuk), University of Saskatchewan, Saskatoon, Saskatchewan.,College of Pharmacy and Nutrition (Semchuk), University of Saskatchewan, Saskatoon, Saskatchewan.,John Papastergiou Pharmacy Ltd. (Papastergiou), Toronto.,Long Term Care Service (Snow), Roulston's Pharmacy, Simcoe.,Green Shield Canada (Mandlsohn), Willowdale.,Vinay Kapoor Drugs Ltd. (Kapoor), Thunder Bay, Ontario.,Faculty of Pharmacy and Pharmaceutical Sciences (Guirguis), University of Alberta.,Department of Medicine (Douketis), McMaster University, Hamilton.,Hurvitz Brain Sciences Program (Gladstone), Sunnybrook Research Institute, Toronto.,Thromboembolism Program (Geerts), Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Ontario.,Division of Neurology (Gladstone), Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Ontario.,Department of Medicine (Geerts, Gladstone), Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Ontario
| | - James D Douketis
- University Health Network (Leblanc), University of Toronto, Toronto.,Leslie Dan Faculty of Pharmacy (Leblanc, Papastergiou), University of Toronto, Toronto.,Regina Qu'Appelle Health Region (Semchuk), University of Saskatchewan, Saskatoon, Saskatchewan.,College of Pharmacy and Nutrition (Semchuk), University of Saskatchewan, Saskatoon, Saskatchewan.,John Papastergiou Pharmacy Ltd. (Papastergiou), Toronto.,Long Term Care Service (Snow), Roulston's Pharmacy, Simcoe.,Green Shield Canada (Mandlsohn), Willowdale.,Vinay Kapoor Drugs Ltd. (Kapoor), Thunder Bay, Ontario.,Faculty of Pharmacy and Pharmaceutical Sciences (Guirguis), University of Alberta.,Department of Medicine (Douketis), McMaster University, Hamilton.,Hurvitz Brain Sciences Program (Gladstone), Sunnybrook Research Institute, Toronto.,Thromboembolism Program (Geerts), Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Ontario.,Division of Neurology (Gladstone), Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Ontario.,Department of Medicine (Geerts, Gladstone), Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Ontario
| | - William Geerts
- University Health Network (Leblanc), University of Toronto, Toronto.,Leslie Dan Faculty of Pharmacy (Leblanc, Papastergiou), University of Toronto, Toronto.,Regina Qu'Appelle Health Region (Semchuk), University of Saskatchewan, Saskatoon, Saskatchewan.,College of Pharmacy and Nutrition (Semchuk), University of Saskatchewan, Saskatoon, Saskatchewan.,John Papastergiou Pharmacy Ltd. (Papastergiou), Toronto.,Long Term Care Service (Snow), Roulston's Pharmacy, Simcoe.,Green Shield Canada (Mandlsohn), Willowdale.,Vinay Kapoor Drugs Ltd. (Kapoor), Thunder Bay, Ontario.,Faculty of Pharmacy and Pharmaceutical Sciences (Guirguis), University of Alberta.,Department of Medicine (Douketis), McMaster University, Hamilton.,Hurvitz Brain Sciences Program (Gladstone), Sunnybrook Research Institute, Toronto.,Thromboembolism Program (Geerts), Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Ontario.,Division of Neurology (Gladstone), Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Ontario.,Department of Medicine (Geerts, Gladstone), Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Ontario
| | - David J Gladstone
- University Health Network (Leblanc), University of Toronto, Toronto.,Leslie Dan Faculty of Pharmacy (Leblanc, Papastergiou), University of Toronto, Toronto.,Regina Qu'Appelle Health Region (Semchuk), University of Saskatchewan, Saskatoon, Saskatchewan.,College of Pharmacy and Nutrition (Semchuk), University of Saskatchewan, Saskatoon, Saskatchewan.,John Papastergiou Pharmacy Ltd. (Papastergiou), Toronto.,Long Term Care Service (Snow), Roulston's Pharmacy, Simcoe.,Green Shield Canada (Mandlsohn), Willowdale.,Vinay Kapoor Drugs Ltd. (Kapoor), Thunder Bay, Ontario.,Faculty of Pharmacy and Pharmaceutical Sciences (Guirguis), University of Alberta.,Department of Medicine (Douketis), McMaster University, Hamilton.,Hurvitz Brain Sciences Program (Gladstone), Sunnybrook Research Institute, Toronto.,Thromboembolism Program (Geerts), Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Ontario.,Division of Neurology (Gladstone), Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Ontario.,Department of Medicine (Geerts, Gladstone), Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Ontario
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16
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Blackburn DF, Evans CD, Eurich DT, Mansell KD, Jorgenson DJ, Taylor JG, Semchuk WM, Shevchuk YM, Remillard AJ, Tran DA, Champagne AP. Community Pharmacists Assisting in Total Cardiovascular Health (CPATCH): A Cluster-Randomized, Controlled Trial Testing a Focused Adherence Strategy Involving Community Pharmacies. Pharmacotherapy 2016; 36:1055-1064. [DOI: 10.1002/phar.1831] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- David F. Blackburn
- College of Pharmacy & Nutrition; University of Saskatchewan; Saskatoon Saskatchewan Canada
| | - Charity D. Evans
- College of Pharmacy & Nutrition; University of Saskatchewan; Saskatoon Saskatchewan Canada
| | - Dean T. Eurich
- School of Public Health; University of Alberta; Edmonton Alberta Canada
| | - Kerry D. Mansell
- College of Pharmacy & Nutrition; University of Saskatchewan; Saskatoon Saskatchewan Canada
| | - Derek J. Jorgenson
- College of Pharmacy & Nutrition; University of Saskatchewan; Saskatoon Saskatchewan Canada
| | - Jeff G. Taylor
- College of Pharmacy & Nutrition; University of Saskatchewan; Saskatoon Saskatchewan Canada
| | | | - Yvonne M. Shevchuk
- College of Pharmacy & Nutrition; University of Saskatchewan; Saskatoon Saskatchewan Canada
| | - Alfred J. Remillard
- College of Pharmacy & Nutrition; University of Saskatchewan; Saskatoon Saskatchewan Canada
| | - David A. Tran
- College of Pharmacy & Nutrition; University of Saskatchewan; Saskatoon Saskatchewan Canada
| | - Anne P. Champagne
- Drug Plan and Extended Benefits Branch; Ministry of Health; Government of Saskatchewan; Regina Saskatchewan Canada
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17
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Lo E, Rainkie D, Semchuk WM, Gorman SK, Toombs K, Slavik RS, Forbes D, Meade A, Fernandes O, Spina SP. Measurement of Clinical Pharmacy Key Performance Indicators to Focus and Improve Your Hospital Pharmacy Practice. Can J Hosp Pharm 2016; 69:149-55. [PMID: 27168637 DOI: 10.4212/cjhp.v69i2.1543] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Elaine Lo
- PharmD, is with the University of British Columbia, Vancouver, British Columbia
| | - Daniel Rainkie
- PharmD, was, when this project began, a PharmD student at the University of British Columbia, Vancouver, British Columbia. He is now with the Qatar University College of Pharmacy, Doha, Qatar
| | - William M Semchuk
- PharmD, FCSHP, is with Regina Qu'Appelle Health Region Pharmacy Services, Regina, Saskatchewan, and the University of Saskatchewan, Saskatoon, Saskatchewan
| | - Sean K Gorman
- PharmD, is with Interior Health Pharmacy Services, Kelowna, British Columbia, and the University of British Columbia, Vancouver, British Columbia
| | - Kent Toombs
- BScPharm, is with the Pharmacy Department, Nova Scotia Health Authority, Halifax, Nova Scotia
| | - Richard S Slavik
- PharmD, FCSHP, is with Interior Health Pharmacy Services, Kelowna, British Columbia, and the University of British Columbia, Vancouver, British Columbia
| | - David Forbes
- BScPharm, MPA, is with Vancouver Island Health Authority Pharmacy Services, Nanaimo Regional General Hospital, Nanaimo, British Columbia
| | - Andrea Meade
- BScPharm, is with the Pharmacy Department, Nova Scotia Health Authority, Halifax, Nova Scotia
| | - Olavo Fernandes
- PharmD, FCSHP, is with the Pharmacy Department, University Health Network, and the University of Toronto, Toronto, Ontario
| | - Sean P Spina
- PharmD, FCSHP, is with Vancouver Island Health Authority Pharmacy Services, Royal Jubilee Hospital, Victoria, British Columbia, and the University of British Columbia, Vancouver, British Columbia
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Affiliation(s)
- Jennifer Bolt
- BScPharm, ACPR, PharmD, is Residency and Education Coordinator with the Department of Pharmacy, Regina Qu'Appelle Health Region, Regina, Saskatchewan
| | - Brittany Baranski
- BSc, BSP, ACPR, was, at the time of this study, a pharmacy resident in the Department of Pharmacy, Regina Qu'Appelle Health Region, Regina, Saskatchewan. She is now a Pharmacist with the Saskatoon Health Region, Saskatoon, Saskatchewan
| | - Ali Bell
- MA, MSc, is a Research Scientist, Research & Performance Support, Regina Qu'Appelle Health Region, Regina, Saskatchewan
| | - William M Semchuk
- MSc, PharmD, FCSHP, is Manager of Clinical Pharmacy Services with the Department of Pharmacy, Regina Qu'Apelle Health Region, Regina, Saskatchewan
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19
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Fernandes O, Gorman SK, Slavik RS, Semchuk WM, Shalansky S, Bussières JF, Doucette D, Bannerman H, Lo J, Shukla S, Chan WWY, Benninger N, MacKinnon NJ, Bell CM, Slobodan J, Lyder C, Zed PJ, Toombs K. Development of clinical pharmacy key performance indicators for hospital pharmacists using a modified Delphi approach. Ann Pharmacother 2015; 49:656-69. [PMID: 25780250 DOI: 10.1177/1060028015577445] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [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] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Key performance indicators (KPIs) are quantifiable measures of quality. There are no published, systematically derived clinical pharmacy KPIs (cpKPIs). OBJECTIVE A group of hospital pharmacists aimed to develop national cpKPIs to advance clinical pharmacy practice and improve patient care. METHODS A cpKPI working group established a cpKPI definition, 8 evidence-derived cpKPI critical activity areas, 26 candidate cpKPIs, and 11 cpKPI ideal attributes in addition to 1 overall consensus criterion. Twenty-six clinical pharmacists and hospital pharmacy leaders participated in an internet-based 3-round modified Delphi survey. Panelists rated 26 candidate cpKPIs using 11 cpKPI ideal attributes and 1 overall consensus criterion on a 9-point Likert scale. A meeting was facilitated between rounds 2 and 3 to debate the merits and wording of candidate cpKPIs. Consensus was reached if 75% or more of panelists assigned a score of 7 to 9 on the consensus criterion during the third Delphi round. RESULTS All panelists completed the 3 Delphi rounds, and 25/26 (96%) attended the meeting. Eight candidate cpKPIs met the consensus definition: (1) performing admission medication reconciliation (including best-possible medication history), (2) participating in interprofessional patient care rounds, (3) completing pharmaceutical care plans, (4) resolving drug therapy problems, (5) providing in-person disease and medication education to patients, (6) providing discharge patient medication education, (7) performing discharge medication reconciliation, and (8) providing bundled, proactive direct patient care activities. CONCLUSIONS A Delphi panel of hospital pharmacists was successful in determining 8 consensus cpKPIs. Measurement and assessment of these cpKPIs will serve to advance clinical pharmacy practice and improve patient care.
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Affiliation(s)
- Olavo Fernandes
- University Health Network Pharmacy Department, Toronto, ON, Canada University of Toronto, Toronto, ON, Canada
| | - Sean K Gorman
- Interior Health Pharmacy Services, Kelowna, BC, Canada The University of British Columbia, Vancouver, BC, Canada
| | - Richard S Slavik
- Interior Health Pharmacy Services, Kelowna, BC, Canada The University of British Columbia, Vancouver, BC, Canada
| | - William M Semchuk
- Regina Qu'Appelle Health Region Pharmacy Services, Regina, SK, Canada University of Saskatchewan, Saskatoon, SK, Canada
| | - Steve Shalansky
- The University of British Columbia, Vancouver, BC, Canada Lower Mainland Pharmacy Services, Providence Healthcare, Vancouver, BC, Canada
| | - Jean-François Bussières
- Département de pharmacie et unité de recherche en pratique pharmaceutique, CHU Sainte-Justine, Montréal, QC, Canada Université de Montréal, QC, Canada
| | - Douglas Doucette
- Horizon Health Network Pharmacy Services, Moncton, NB, Canada Dalhousie University, Halifax, NS, Canada
| | | | - Jennifer Lo
- Sunnybrook Health Sciences Centre Pharmacy Department, Toronto, ON, Canada
| | - Simone Shukla
- Foothills Medical Centre Pharmacy Department, Calgary, AB, Canada
| | - Winnie W Y Chan
- St Michael's Hospital Pharmacy Department, Toronto, ON, Canada
| | - Natalie Benninger
- University Health Network-Toronto Rehabilitation Institute Pharmacy Department, Toronto, ON, Canada
| | - Neil J MacKinnon
- James L Winkle College of Pharmacy, University of Cincinnati, Cincinnati, OH, USA
| | - Chaim M Bell
- University of Toronto, Toronto, ON, Canada Mount Sinai Hospital, Toronto, ON, Canada Institute for Clinical Evaluative Sciences (ICES), Toronto, ON, Canada
| | - Jeremy Slobodan
- Alberta Health Services Pharmacy Services, Red Deer, AB, Canada
| | - Catherine Lyder
- Canadian Society of Hospital Pharmacists, Ottawa, ON, Canada
| | - Peter J Zed
- The University of British Columbia, Vancouver, BC, Canada
| | - Kent Toombs
- Capital District Health Authority Pharmacy Department, Halifax, NS, Canada
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Semchuk WM, Levac B, Lara M, Shakespeare A, Evers T, Bolt J. Management of stroke prevention in canadian patients with atrial fibrillation at moderate to high risk of stroke. Can J Hosp Pharm 2013; 66:296-303. [PMID: 24159232 DOI: 10.4212/cjhp.v66i5.1286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 11/10/2022]
Abstract
BACKGROUND Many patients with atrial fibrillation who are at moderate to high risk of stroke do not receive anticoagulation with vitamin K antagonists (VKAs) in accordance with recommendations. OBJECTIVE To determine (1) why Canadian patients with atrial fibrillation who are potentially eligible for VKA do not receive this therapy, (2) why Canadian primary care physicians discontinue VKA therapy, and (3) why VKA therapy is perceived as difficult to manage. METHODS The study involved a chart review of 3 cohorts of patients with nonvalvular atrial fibrillation at moderate to high risk of stroke: patients who had never received VKA treatment (VKA-naive), those whose treatment had been discontinued, and those whose VKA treatment was considered difficult to manage. RESULTS Charts for 187 patients (mean age 78.4 years, standard deviation 8.9 years) treated at 39 primary care sites were reviewed (62 treatment-naive, 42 with therapy discontinued, and 83 whose therapy was considered difficult to manage). Atrial fibrillation was paroxysmal in 82 (44%) of the patients, persistent in 47 patients (25%), and permanent in 58 (31%). One patient in each of the 3 cohorts had experienced a stroke during the 6 months before study participation. Bleeding events were more frequent among patients who had discontinued VKA therapy than in the other 2 groups. Among those whose therapy was discontinued and those whose therapy was difficult to manage, the mean time in the therapeutic range was 46.3% and 56.4%, respectively. The most common reason for not initiating VKA therapy in treatment-naive patients was the transient nature of atrial fibrillation (25/62 [40%]). The most common reason for discontinuation of VKA therapy was a bleeding event (10/42 [24%]). The presence of a concomitant chronic disease was the most common reason that a patient's therapy was considered difficult to manage (46/83 [55%]). CONCLUSIONS VKA therapy was not initiated or was discontinued for various reasons. Multiple comorbid conditions made management of VKA therapy more difficult. These findings reflect the challenges that primary care physicians experience in managing the care of patients with atrial fibrillation.
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Affiliation(s)
- William M Semchuk
- , MSc, PharmD, is with Pharmacy Practice in the Regina Qu'Appelle Health Region, Regina, Saskatchewan
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Abstract
BACKGROUND Many patients who experience a venous thromboembolic event have cancer, and thrombosis is much more prevalent in patients with cancer than in those without it. Thrombosis is the second most common cause of death in cancer patients and cancer is associated with a high rate of recurrence of venous thromboembolism (VTE), bleeding, requirement for long-term anticoagulation and poorer quality of life. METHODS A literature review was conducted to identify guidelines and evidence pertaining to anticoagulation prophylaxis and treatment for patients with cancer, with the goal of identifying opportunities for pharmacists to advocate for and become more involved in the care of this population. RESULTS Many clinical trials and several guidelines providing guidance to clinicians in the treatment and prevention of VTE in patients with cancer were identified. Current clinical evidence and guidelines suggest that cancer patients receiving care in hospital with no contraindications should receive VTE prophylaxis with unfractionated heparin (UFH), a low-molecular-weight heparin (LMWH) or fondaparinux. Patients who require surgery for their cancer should receive prophylaxis with UFH, LMWH or fondaparinux. Cancer patients who have experienced a VTE event should receive prolonged anticoagulant therapy with LMWH (at least 3 months to 6 months). No routine prophylaxis is required for the majority of ambulatory patients with cancer who have not experienced a VTE event. Most publicly funded drug plans in Canada have developed criteria for funding of LMWH therapy for patients with cancer. CONCLUSIONS Evidence suggests that LMWH for 3 to 6 months is the preferred strategy for most cancer patients who have experienced a thromboembolic event and for hospital inpatients, but this is often not implemented in practice. Concerns about adherence with injectable therapy should not prevent use of these agents. Pharmacists should assess cancer patients for their risk of VTE and should advocate for optimal VTE pharmacotherapy as appropriate. If LMWH is the preferred agent, on the basis of the evidence, the pharmacist should educate the patients appropriately and work with the prescriber to ensure best care.
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Bungard TJ, Bucci C, Kertland H, Leblanc K, Pickering J, Semchuk WM. A Systematic Approach to Stroke Prevention for Patients with Atrial Fibrillation. Can Pharm J (Ott) 2011. [DOI: 10.3821/1913-701x-144.6.287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Strokes occurring as a result of atrial fibrillation are common and typically result in severe disability or death. Over the past half century, therapeutic options for stroke prophylaxis, based on either antiplatelet (typically acetylsalicylic acid) or warfarin therapy, have remained virtually unchanged. However, as of mid-2011, promising data have emerged and Health Canada has approved a novel oral anticoagulant, dabigatran. This article provides a systematic 4-step process to guide clinicians in assessing, implementing and monitoring stroke prophylaxis for individual patients. First, identify the patient's risk of stroke with user-friendly scoring systems (CHADS2 and CHA2DS2-VASc). Second, determine the patient's risk of major bleeding with a validated scoring system (HAS-BLED) and ongoing clinical evaluation. Third, balance these benefits and the risks of available agents as they pertain to the individual patient. Fourth, select the appropriate antithrombotic therapy, with an understanding of the key features of available agents, as well as the patient's characteristics and preferences. Regular monitoring and patient adherence with therapy are necessary to ensure the long-term appropriateness of therapy, given that most patients with atrial fibrillation will require lifelong stroke prophylaxis and an individual's stroke risk generally increases with age. The pharmacist is in an excellent position to provide this type of assessment and follow-up.
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Affiliation(s)
- Tammy J. Bungard
- Division of Cardiology, Department of Medicine (Bungard), University of Alberta, Edmonton, AB; Sunnybrook Health Sciences Centre and University of Toronto (Bucci), Toronto, ON; St. Michael's Hospital and University of Toronto (Kertland), Toronto, ON; Department of Pharmacy and Peter Munk Cardiac Centre, University Health Network and University of Toronto (Leblanc), Toronto, ON; Cardiac and Vascular Program, Hamilton Health Sciences (Pickering), Hamilton, ON; and Pharmacy Practice, Regina Qu'Appelle
| | - Claudia Bucci
- Division of Cardiology, Department of Medicine (Bungard), University of Alberta, Edmonton, AB; Sunnybrook Health Sciences Centre and University of Toronto (Bucci), Toronto, ON; St. Michael's Hospital and University of Toronto (Kertland), Toronto, ON; Department of Pharmacy and Peter Munk Cardiac Centre, University Health Network and University of Toronto (Leblanc), Toronto, ON; Cardiac and Vascular Program, Hamilton Health Sciences (Pickering), Hamilton, ON; and Pharmacy Practice, Regina Qu'Appelle
| | - Heather Kertland
- Division of Cardiology, Department of Medicine (Bungard), University of Alberta, Edmonton, AB; Sunnybrook Health Sciences Centre and University of Toronto (Bucci), Toronto, ON; St. Michael's Hospital and University of Toronto (Kertland), Toronto, ON; Department of Pharmacy and Peter Munk Cardiac Centre, University Health Network and University of Toronto (Leblanc), Toronto, ON; Cardiac and Vascular Program, Hamilton Health Sciences (Pickering), Hamilton, ON; and Pharmacy Practice, Regina Qu'Appelle
| | - Kori Leblanc
- Division of Cardiology, Department of Medicine (Bungard), University of Alberta, Edmonton, AB; Sunnybrook Health Sciences Centre and University of Toronto (Bucci), Toronto, ON; St. Michael's Hospital and University of Toronto (Kertland), Toronto, ON; Department of Pharmacy and Peter Munk Cardiac Centre, University Health Network and University of Toronto (Leblanc), Toronto, ON; Cardiac and Vascular Program, Hamilton Health Sciences (Pickering), Hamilton, ON; and Pharmacy Practice, Regina Qu'Appelle
| | - Jennifer Pickering
- Division of Cardiology, Department of Medicine (Bungard), University of Alberta, Edmonton, AB; Sunnybrook Health Sciences Centre and University of Toronto (Bucci), Toronto, ON; St. Michael's Hospital and University of Toronto (Kertland), Toronto, ON; Department of Pharmacy and Peter Munk Cardiac Centre, University Health Network and University of Toronto (Leblanc), Toronto, ON; Cardiac and Vascular Program, Hamilton Health Sciences (Pickering), Hamilton, ON; and Pharmacy Practice, Regina Qu'Appelle
| | - William M. Semchuk
- Division of Cardiology, Department of Medicine (Bungard), University of Alberta, Edmonton, AB; Sunnybrook Health Sciences Centre and University of Toronto (Bucci), Toronto, ON; St. Michael's Hospital and University of Toronto (Kertland), Toronto, ON; Department of Pharmacy and Peter Munk Cardiac Centre, University Health Network and University of Toronto (Leblanc), Toronto, ON; Cardiac and Vascular Program, Hamilton Health Sciences (Pickering), Hamilton, ON; and Pharmacy Practice, Regina Qu'Appelle
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Grieve K, Koshman SL, Pearson GJ, Semchuk WM, Padwal R, Thompson A. Low-dose ASA Use for Primary Prevention of Cardiovascular Disease in Patients without Diabetes: When Should You Recommend it? A Case-Based Approach. Can Pharm J (Ott) 2011. [DOI: 10.3821/1913-701x-144.6.278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Kyle Grieve
- Faculty of Pharmacy and Pharmaceutical Sciences (Grieve, Thompson) and the Faculty of Medicine and Dentistry (Koshman, Pearson, Padwal), University of Alberta, Edmonton, Alberta; and the College of Pharmacy and Nutrition (Semchuk), University of Saskatchewan, Saskatoon, Saskatchewan. At the time this paper was written, Kyle Grieve was a pharmacy student with the Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, and is now a pharmacist at East Kootenay Regional Hospital, Cranbrook,
| | - Sheri L. Koshman
- Faculty of Pharmacy and Pharmaceutical Sciences (Grieve, Thompson) and the Faculty of Medicine and Dentistry (Koshman, Pearson, Padwal), University of Alberta, Edmonton, Alberta; and the College of Pharmacy and Nutrition (Semchuk), University of Saskatchewan, Saskatoon, Saskatchewan. At the time this paper was written, Kyle Grieve was a pharmacy student with the Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, and is now a pharmacist at East Kootenay Regional Hospital, Cranbrook,
| | - Glen J. Pearson
- Faculty of Pharmacy and Pharmaceutical Sciences (Grieve, Thompson) and the Faculty of Medicine and Dentistry (Koshman, Pearson, Padwal), University of Alberta, Edmonton, Alberta; and the College of Pharmacy and Nutrition (Semchuk), University of Saskatchewan, Saskatoon, Saskatchewan. At the time this paper was written, Kyle Grieve was a pharmacy student with the Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, and is now a pharmacist at East Kootenay Regional Hospital, Cranbrook,
| | - William M. Semchuk
- Faculty of Pharmacy and Pharmaceutical Sciences (Grieve, Thompson) and the Faculty of Medicine and Dentistry (Koshman, Pearson, Padwal), University of Alberta, Edmonton, Alberta; and the College of Pharmacy and Nutrition (Semchuk), University of Saskatchewan, Saskatoon, Saskatchewan. At the time this paper was written, Kyle Grieve was a pharmacy student with the Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, and is now a pharmacist at East Kootenay Regional Hospital, Cranbrook,
| | - Raj Padwal
- Faculty of Pharmacy and Pharmaceutical Sciences (Grieve, Thompson) and the Faculty of Medicine and Dentistry (Koshman, Pearson, Padwal), University of Alberta, Edmonton, Alberta; and the College of Pharmacy and Nutrition (Semchuk), University of Saskatchewan, Saskatoon, Saskatchewan. At the time this paper was written, Kyle Grieve was a pharmacy student with the Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, and is now a pharmacist at East Kootenay Regional Hospital, Cranbrook,
| | - Ann Thompson
- Faculty of Pharmacy and Pharmaceutical Sciences (Grieve, Thompson) and the Faculty of Medicine and Dentistry (Koshman, Pearson, Padwal), University of Alberta, Edmonton, Alberta; and the College of Pharmacy and Nutrition (Semchuk), University of Saskatchewan, Saskatoon, Saskatchewan. At the time this paper was written, Kyle Grieve was a pharmacy student with the Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, and is now a pharmacist at East Kootenay Regional Hospital, Cranbrook,
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Evans CD, Eurich DT, Lamb DA, Taylor JG, Jorgenson DJ, Semchuk WM, Mansell KD, Blackburn DF. Retrospective observational assessment of statin adherence among subjects patronizing different types of community pharmacies in Canada. J Manag Care Pharm 2009; 15:476-84. [PMID: 19610680 PMCID: PMC10437791 DOI: 10.18553/jmcp.2009.15.6.476] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Community pharmacies vary widely in terms of ownership structures, location, and dispensing policies. It is unknown if an association exists between the type of community pharmacy and the degree of medication adherence exhibited by patrons-patients. OBJECTIVE To describe adherence to statin therapy among subjects patronizing different types of community pharmacy categories (department- mass merchandise, chain-franchise, and independent-banner) in Saskatchewan, Canada, between 2000 and 2005. METHODS Study data were obtained from the Saskatchewan Drug Plan and Extended Benefits database, which is maintained by the government of Saskatchewan, Canada. The study included all subjects who (a) filled a statin prescription within selected community pharmacies between January 1, 2000, and December 31, 2005; (b) had no record of statin prescriptions during the year prior to the first statin prescription, according to the records of the Saskatchewan Drug Plan and Extended Benefits; and (c) demonstrated active utilization in the drug plan database for at least 1 year after the first statin prescription. The proxy criterion for activity was any dispensing record for statin or nonstatin medications at least 1 year following the index claim. Statin adherence level was estimated as tablets per day, defined as the total number of tablets dispensed divided by the total number of days of observation. Each subject's observation period began on the index date and ended on the earlier of (a) 30 days after the last recorded fill for any type of prescription medication (statin or nonstatin), or (b) December 31, 2005. The primary end point was the proportion of subjects within each pharmacy category who maintained an adherence level of 80% or greater during their individual observation period. Additional adherence calculations were performed for each of 3 time periods, beginning on the index date and ending on days 365, 729, and 1094 (i.e., 1, 2, and 3 years). Patients were included in the analysis for each time period if they met a proxy criterion for availability for observation, defined as the dispensing of any drug at least 1 day after the end date of each period. Pearson chi square tests were used to assess the significance of differences in baseline characteristics and adherence proportions, comparing pharmacy categories. Logistic regression analysis estimated the odds of an adherence level of at least 80% during the individual observation period, adjusting for pharmacy category, sex, age 65 years or older, known low-income drug coverage, number of distinct drug classes filled concurrently during the first year of observation, loyalty to index pharmacy, and length of observation. Using similar methods, we also estimated "pharmacy loyalty" by calculating the proportion of subjects who refilled 75% or more of their statin prescriptions at the pharmacy that dispensed their first statin prescription. RESULTS From an initial sample of 12,818 subjects who had at least 1 pharmacy claim for a statin in the period from January 1, 2000, through December 31, 2005, 8699 subjects met the inclusion criteria. Subjects were observed for a mean (SD, range) of 3.7 (1.7, 1.0-7.0) years after the index statin prescription. During the first year following the index claim, statin adherence rates were at least 80% for 1799 of 3761 (47.8%) patrons of department-mass merchandise, 1778 of 3235 (55.0%) patrons of chain-franchise, and 921 of 1703 (54.1%) patrons of independent-banner stores (P < 0.001). Measured from the index date through day 1094, 869 of 2292 (37.9%), 874 of 1887 (46.3%), and 457 of 975 (46.9%) subjects in the department-mass merchandise, chain-franchise, and independent banner categories, respectively, had a statin adherence level of at least 80% (P < 0.001). In logistic regression analysis, pharmacy category type was significantly associated with statin adherence; subjects in the chain franchise and independent-banner categories were more likely to be adherent to their statin medications during their observation periods than were those in the department-mass merchandise category (adjusted odds ratio [OR] = 1.36, 95% CI = 1.23-1.50, P < 0.001 and OR = 1.39, 95% CI = 1.24-1.57, P < 0.001, respectively). From the index date through day 1094, 1752 of 2292 (76.4%), 1475 of 1887 (78.2%), and 795 of 975 (81.5%) subjects remained pharmacy-loyal in the department-mass merchandise, chain franchise, and independent-banner categories, respectively (P = 0.006). Controlling for several potential confounders using logistic regression, independent-banner pharmacy patrons were more likely to remain pharmacy- loyal during their observation periods than were those patronizing department-mass merchandise (adjusted OR = 1.34, 95% CI = 1.16-1.54, P < 0.001) or chain-franchise stores (adjusted OR = 1.22, 95% CI = 1.06-1.42, P = 0.009). CONCLUSION One year after their first statin fill, subjects demonstrated low rates of adherence, ranging from 48% to 55%, regardless of the type of pharmacy they patronized. Although the differences by type of pharmacy reached statistical significance, their clinical importance is not evident, reinforcing the fact that the problem of nonadherence appears to exist among all types of community pharmacies, regardless of their categorization.
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Affiliation(s)
- Charity D Evans
- University of Saskatchewan, College of Pharmacy and Nutrition, 110 Science Place, Saskatoon, Saskatchewan S7N 5C9, Canada
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Lamb DA, Eurich DT, McAlister FA, Tsuyuki RT, Semchuk WM, Wilson TW, Blackburn DF. Changes in adherence to evidence-based medications in the first year after initial hospitalization for heart failure: observational cohort study from 1994 to 2003. Circ Cardiovasc Qual Outcomes 2009; 2:228-35. [PMID: 20031842 DOI: 10.1161/circoutcomes.108.813600] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The use of evidence-based medications in patients with heart failure has increased over the past 10 years. We aimed to determine whether adherence to these medications has also increased during this time. METHODS AND RESULTS A retrospective cohort was created using administrative databases from the province of Saskatchewan, Canada. Subjects discharged alive from their first hospitalization for heart failure between 1994 and 2003 were eligible. Those filling a prescription for a beta-blocker (BB), angiotensin-converting enzyme inhibitor (ACEI), or angiotensin receptor blocker (ARB) within 6 months of discharge were followed for 1 year after the initial prescription. Of 8805 eligible patients, 67% of BB users (941/1414) and 74% of ACEI/ARB users (4441/5991) exhibited optimal adherence at 1 year (defined as >or=80% adherence calculated from pharmacy refill records). When grouped by year of initial heart failure hospitalization, the proportion of optimally adherent patients improved from 54% to 75% with BB and from 67% to 80% with ACEI/ARBs between 1994/1995 and 2002/2003 (P for trend <0.001 for both). Mean 1-year adherence improved from 71% to 83% for BB and 80% to 88% for ACEI/ARBs. After adjustment using multivariable logistic regression, subjects discharged in 2003 were significantly more likely to exhibit optimal adherence to a BB (odds ratio, 2.04; 95% CI, 1.21 to 3.44) or an ACEI/ARB (odds ratio, 1.65; 95% CI, 1.30 to 2.08) than those prescribed therapy in 1994/1995. CONCLUSIONS One-year adherence to BB and ACEI/ARB is improving over time in patients discharged after first heart failure hospitalization. Patients taking multiple cardiac medications were not any less likely to exhibit optimal adherence than patients taking only 1 medication.
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Affiliation(s)
- Darcy A Lamb
- College of Pharmacy & Nutrition and the College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Lamb DA, Blackburn DF, PausJenssen AM, Semchuk WM, Robertson P. Heart failure: Back to basics for pharmacists. Can Pharm J (Ott) 2008. [DOI: 10.3821/1913-701x(2008)141[48:hfbtbf]2.0.co;2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Blackburn DF, Dobson RT, Blackburn JL, Wilson TW, Stang MR, Semchuk WM. Adherence to statins, beta-blockers and angiotensin-converting enzyme inhibitors following a first cardiovascular event: a retrospective cohort study. Can J Cardiol 2005; 21:485-8. [PMID: 15917876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
BACKGROUND Population studies of statin adherence are generally restricted to one to two years of follow-up and do not analyze adherence to other drugs. OBJECTIVES To report long-term adherence rates for statins, angiotensin-converting enzyme (ACE) inhibitors and beta-blockers in patients who recently experienced a first cardiovascular event. METHODS Linked administrative databases in the province of Saskatchewan were used in this retrospective cohort study. Eligible patients received a new statin prescription within one year of their first cardiovascular event between 1994 and 2001. Adherence to statins, beta-blockers and ACE inhibitors was assessed from the first statin prescription to a subsequent cardiovascular event. RESULTS Of 1221 eligible patients, the proportion of patients adherent to statin medications dropped to 60.3% at one year and 48.8% at five years. The decline in the proportion of adherent patients was most notable during the first two years (100% to 53.7%). Several factors were associated with statin adherence, including age (P = 0.012), number of physician service days (P = 0.037), chronic disease score (P = 0.032), beta-blocker adherence (P < 0.001) and ACE inhibitor adherence (P < 0.001). Adherence to beta-blockers and ACE inhibitors was very similar to adherence to statin medications at each year of follow-up. CONCLUSIONS Patients who exhibit optimal adherence over one to two years after their initial cardiovascular event generally remain adherent over subsequent years. Also, adherence to beta-blockers and ACE inhibitors is significantly associated with statin adherence in a subset of patients; however, overall adherence to all three drugs was similarly poor.
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Affiliation(s)
- David F Blackburn
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Canada.
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DeVries A, Semchuk WM, Betcher JG. Ketoconazole in the prevention of acute respiratory distress syndrome. Pharmacotherapy 1998; 18:581-7. [PMID: 9620108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
We conducted a critical review of the literature on ketoconazole in preventing acute respiratory distress syndrome (ARDS), a serious disorder associated with high mortality. Two double-blind, prospective, placebo-controlled, randomized trials compared ketoconazole with placebo for prophylaxis of ARDS. In one trial, compared with placebo, ketoconazole resulted in a reduced frequency of ARDS (6% vs 31%, p<0.01), lower plasma thromboxane B2 levels (33 vs 75 pg/ml, p<0.05), and shorter intensive care unit stay (7 vs 15.5 days, p<0.05). In the second trial the drug reduced the frequency of ARDS (15% vs 64%, p=0.002), lowered thromboxane B2 levels (83 vs 143 pg/ml), and reduced mortality (15% vs 39%, p=0.05) compared with placebo. Larger multicenter studies are warranted to validate the findings of these two trials.
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Affiliation(s)
- A DeVries
- Department of Pharmacy, Plains Health Centre, Regina, Saskatchewan, Canada
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