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Medication assessment tool to detect care issues from routine data: a pilot study in primary care. Int J Clin Pharm 2014; 35:1063-74. [PMID: 23959916 DOI: 10.1007/s11096-013-9828-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Accepted: 06/29/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Medication assessment tools (MATs) may be implemented in routine electronic data sources in order to identify patients with opportunities for optimisation of medication therapy management (MTM) and follow-up by a multi-disciplinary team. OBJECTIVE (1) To demonstrate the use of a MAT for cardiovascular conditions (MAT CVC) as a means of profiling potential opportunities for MTM optimisation in primary care and (2) to assess the performance of MAT CVC in identifying actual opportunities for better care. SETTING Members of a pharmacotherapy discussion group, i.e. two single-handed general practitioners (GPs), three GP partners, and community pharmacists (CPs) from each of two community pharmacies, in a rural part of the Netherlands. METHODS MAT CVC comprises 21 medication assessment criteria, each of which is designed to detect a specific care issue and to check whether it is 'addressed' by provision of guideline recommended care or 'open' in the presence ('open explained') or absence ('open unexplained') of pre-specified explanations for guideline deviations. (1) Relevant data was extracted from linked GP and CP electronic records and MAT CVC assessment was conducted to profile the population of CVC patients registered with both, participating CPs and GPs, in terms of 'open unexplained' care issues. (2) A purposive sample of patients with 'open unexplained' care issues was reviewed by each patient's GP. MAIN OUTCOME MEASURES Number and proportion of 'open unexplained' care issues per MAT CVC criterion and per patient. The number of patients with MAT CVC detected 'open unexplained' care issues to be reviewed (NNR) in order to identify one that requires changes in MTM. RESULTS In 1,876 target group patients, MAT CVC identified 6,915 care issues, of which 2,770 (40.1 %) were 'open unexplained'. At population level, ten MAT CVC criteria had particularly high potential for quality improvement. At patient level, 1,277 (68.1 %) target group patients had at least one 'open unexplained' care issue. For patients with four or more 'open unexplained' care issues, the NNR was 2 (95 % CI 2-2). CONCLUSION The study demonstrates potential ways of using MA TCVC as a key component of a collaborative MTM system. Strategies that promote documentation and sharing of explanations for deviating from guideline recommendations may enhance the utility of the approach.
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Hale JC, Murawski MM, Ives TJ. Perceived successes and challenges of clinical pharmacist practitioners in North Carolina. J Am Pharm Assoc (2003) 2014; 53:640-3. [PMID: 24185431 DOI: 10.1331/japha.2013.12184] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To describe the successes and challenges reported by current (active) and formerly practicing (inactive) CPPs and to determine the reasons why inactive CPPs discontinued advanced practice. METHODS A sampling frame, consisting of all active and inactive CPPs, was obtained from the North Carolina Boards of Medicine and Pharmacy. An electronic survey was sent to 84 active and 32 inactive CPPs. Respondents were queried regarding qualifications, experience, and practice characteristics, perceived successes, and perceived challenges. RESULTS 54 active and 22 inactive CPPs responded. Among active CPPs, 28 (51.9%) reported improved patient care outcomes and 27 (50.0%) reported an expanded scope of practice. Regarding challenges, 30 (55.6%) identified billing for services and 19 (35.2%) noted reimbursement through third parties. Among inactive CPPs, 14 (63.6%) experienced improved patient care outcomes and 11 (50.0%) said their licensure created a practice model for learners. Billing (54.5%) and reimbursement (31.8%) were the top challenges experienced by inactive CPPs. A total of 12 inactive CPPs (54.5%) discontinued CPP licensure because it was not a requirement of their current position. Three (13.6%) discontinued because of insurmountable challenges that made it difficult to continue practice. CONCLUSION Although CPPs held a perception of improved patient care outcomes, billing for services and obtaining reimbursement were reported as the most prevalent challenges and may have played a major role in CPPs becoming inactive.
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Via-Sosa MA, Toro C, Travé P, March MA. Screening premorbid metabolic syndrome in community pharmacies: a cross-sectional descriptive study. BMC Public Health 2014; 14:487. [PMID: 24885099 PMCID: PMC4042002 DOI: 10.1186/1471-2458-14-487] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Accepted: 05/06/2014] [Indexed: 11/10/2022] Open
Abstract
Background Premorbid metabolic syndrome (pre-MetS) is a cluster of cardiometabolic risk factors characterised by central obesity, elevated fasting glucose, atherogenic dyslipidaemia and hypertension without established cardiovascular disease or diabetes. Community pharmacies are in an excellent position to develop screening programmes because of their direct contact with the population. The main aim of the study was to determine the prevalence of pre-MetS in people who visited community pharmacies for measurement of any of its five risk factors to detect the presence of other risk factors. The secondary aims were to study the presence of other cardiovascular risk factors and determine patients’ cardiovascular risk. Methods Cross-sectional, descriptive, multicentre study. Patients meeting selection criteria aged between 18 and 65 years who visited participating community pharmacies to check any of five pre-MetS diagnostic factors were included.The study involved 23 community pharmacies in Catalonia (Spain). Detection criteria for pre-MetS were based on the WHO proposal following IDF and AHA/NHBI consensus. Cardiovascular risk (CVR) was calculated by Regicor and Score methods. Other variables studied were smoking habit, physical activity, body mass index (BMI), and pharmacological treatment of dyslipidemia and hypertension. The data were collected and analysed with the SPSS programme. Comparisons of variables were carried out using the Student’s T-test, Chi-Squared test or ANOVA test. Level of significance was 5% (0.05). Results The overall prevalence of pre-MetS was 21.9% [95% CI 18.7-25.2]. It was more prevalent in men, 25.5% [95% CI 22.1-28.9], than in women, 18.6% [95% CI 15.5-21.7], and distribution increased with age. The most common risk factors were high blood pressure and abdominal obesity. About 70% of people with pre-MetS were sedentary and over 85% had a BMI ≥25 Kg/m2. Some 22.4% had two metabolic criteria and 27.2% of patients with pre-MetS had no previous diagnosis. Conclusions The prevalence of pre-MetS in our study (21.9%) was similar to that found in other studies carried out in Primary Care in Spain. The results of this study confirm emergent cardiometabolic risk factors such as hypertension, obesity and physical inactivity. Our study highlights the strategic role of the community pharmacy in the detection of pre-MetS in the apparently healthy population.
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Affiliation(s)
- Maria Angeles Via-Sosa
- Unit of Practice Pharmacy, Unidad de Prácticas Tuteladas, Faculty of Pharmacy, University of Barcelone, Catalonia, Spain.
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Ryan R, Santesso N, Lowe D, Hill S, Grimshaw J, Prictor M, Kaufman C, Cowie G, Taylor M. Interventions to improve safe and effective medicines use by consumers: an overview of systematic reviews. Cochrane Database Syst Rev 2014; 2022:CD007768. [PMID: 24777444 PMCID: PMC6491214 DOI: 10.1002/14651858.cd007768.pub3] [Citation(s) in RCA: 115] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Many systematic reviews exist on interventions to improve safe and effective medicines use by consumers, but research is distributed across diseases, populations and settings. The scope and focus of such reviews also vary widely, creating challenges for decision-makers seeking to inform decisions by using the evidence on consumers' medicines use.This is an update of a 2011 overview of systematic reviews, which synthesises the evidence, irrespective of disease, medicine type, population or setting, on the effectiveness of interventions to improve consumers' medicines use. OBJECTIVES To assess the effects of interventions which target healthcare consumers to promote safe and effective medicines use, by synthesising review-level evidence. METHODS SEARCH METHODS We included systematic reviews published on the Cochrane Database of Systematic Reviews and the Database of Abstracts of Reviews of Effects. We identified relevant reviews by handsearching databases from their start dates to March 2012. SELECTION CRITERIA We screened and ranked reviews based on relevance to consumers' medicines use, using criteria developed for this overview. DATA COLLECTION AND ANALYSIS We used standardised forms to extract data, and assessed reviews for methodological quality using the AMSTAR tool. We used standardised language to summarise results within and across reviews; and gave bottom-line statements about intervention effectiveness. Two review authors screened and selected reviews, and extracted and analysed data. We used a taxonomy of interventions to categorise reviews and guide syntheses. MAIN RESULTS We included 75 systematic reviews of varied methodological quality. Reviews assessed interventions with diverse aims including support for behaviour change, risk minimisation and skills acquisition. No reviews aimed to promote systems-level consumer participation in medicines-related activities. Medicines adherence was the most frequently-reported outcome, but others such as knowledge, clinical and service-use outcomes were also reported. Adverse events were less commonly identified, while those associated with the interventions themselves, or costs, were rarely reported.Looking across reviews, for most outcomes, medicines self-monitoring and self-management programmes appear generally effective to improve medicines use, adherence, adverse events and clinical outcomes; and to reduce mortality in people self-managing antithrombotic therapy. However, some participants were unable to complete these interventions, suggesting they may not be suitable for everyone.Other promising interventions to improve adherence and other key medicines-use outcomes, which require further investigation to be more certain of their effects, include:· simplified dosing regimens: with positive effects on adherence;· interventions involving pharmacists in medicines management, such as medicines reviews (with positive effects on adherence and use, medicines problems and clinical outcomes) and pharmaceutical care services (consultation between pharmacist and patient to resolve medicines problems, develop a care plan and provide follow-up; with positive effects on adherence and knowledge).Several other strategies showed some positive effects, particularly relating to adherence, and other outcomes, but their effects were less consistent overall and so need further study. These included:· delayed antibiotic prescriptions: effective to decrease antibiotic use but with mixed effects on clinical outcomes, adverse effects and satisfaction;· practical strategies like reminders, cues and/or organisers, reminder packaging and material incentives: with positive, although somewhat mixed effects on adherence;· education delivered with self-management skills training, counselling, support, training or enhanced follow-up; information and counselling delivered together; or education/information as part of pharmacist-delivered packages of care: with positive effects on adherence, medicines use, clinical outcomes and knowledge, but with mixed effects in some studies;· financial incentives: with positive, but mixed, effects on adherence.Several strategies also showed promise in promoting immunisation uptake, but require further study to be more certain of their effects. These included organisational interventions; reminders and recall; financial incentives; home visits; free vaccination; lay health worker interventions; and facilitators working with physicians to promote immunisation uptake. Education and/or information strategies also showed some positive but even less consistent effects on immunisation uptake, and need further assessment of effectiveness and investigation of heterogeneity.There are many different potential pathways through which consumers' use of medicines could be targeted to improve outcomes, and simple interventions may be as effective as complex strategies. However, no single intervention assessed was effective to improve all medicines-use outcomes across all diseases, medicines, populations or settings.Even where interventions showed promise, the assembled evidence often only provided part of the picture: for example, simplified dosing regimens seem effective for improving adherence, but there is not yet sufficient information to identify an optimal regimen.In some instances interventions appear ineffective: for example, the evidence suggests that directly observed therapy may be generally ineffective for improving treatment completion, adherence or clinical outcomes.In other cases, interventions may have variable effects across outcomes. As an example, strategies providing information or education as single interventions appear ineffective to improve medicines adherence or clinical outcomes, but may be effective to improve knowledge; an important outcome for promoting consumers' informed medicines choices.Despite a doubling in the number of reviews included in this updated overview, uncertainty still exists about the effectiveness of many interventions, and the evidence on what works remains sparse for several populations, including children and young people, carers, and people with multimorbidity. AUTHORS' CONCLUSIONS This overview presents evidence from 75 reviews that have synthesised trials and other studies evaluating the effects of interventions to improve consumers' medicines use.Systematically assembling the evidence across reviews allows identification of effective or promising interventions to improve consumers' medicines use, as well as those for which the evidence indicates ineffectiveness or uncertainty.Decision makers faced with implementing interventions to improve consumers' medicines use can use this overview to inform decisions about which interventions may be most promising to improve particular outcomes. The intervention taxonomy may also assist people to consider the strategies available in relation to specific purposes, for example, gaining skills or being involved in decision making. Researchers and funders can use this overview to identify where more research is needed and assess its priority. The limitations of the available literature due to the lack of evidence for important outcomes and important populations, such as people with multimorbidity, should also be considered in practice and policy decisions.
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Affiliation(s)
- Rebecca Ryan
- Centre for Health Communication and Participation, School of Public Health and Human Biosciences, La Trobe University, Bundoora, VIC, Australia, 3086
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Rojas-Fernandez CH, Patel T, Lee L. An interdisciplinary memory clinic: a novel practice setting for pharmacists in primary care. Ann Pharmacother 2014; 48:785-95. [PMID: 24651163 DOI: 10.1177/1060028014526857] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Pharmacists have developed innovative practices in various settings as singular providers or as members of multidisciplinary or interdisciplinary teams. Examples include pharmacists practicing in heart failure, hypertension, or hyperlipidemia clinics. There is a paucity of literature describing pharmacists in interdisciplinary memory clinics and specifically pharmacists practicing in interdisciplinary, primary care-based memory clinics. New practice models should be disseminated to guide others in the development of similar models given the complexity of this population. Patients with dementia are more difficult to manage because of cognitive impairment, behavioral and psychological symptoms, the common presence of multiple comorbidities, and related polypharmacy and caregiver issues. These challenges require expertise in neurodegenerative disorders and geriatrics. The purpose of this article is to describe the role of clinical pharmacists providing care to patients with cognitive complaints in a primary care-based, interdisciplinary memory clinic, with a focus on how the pharmacist practices and is integrated in this collaborative care setting. Patients are assessed using an interdisciplinary approach, with team consensus for assessment and planning of care. Pharmacists' activities include assessment of (1) appropriateness of medications based on frailty, (2) medications that can impair cognition and/or function, (3) medication adherence and management skills, and (4) vascular risk factor control. Pharmacists provide education regarding medications and diseases, ensure appropriate transitions in care, and conduct home visits. Pharmacist participation in this clinic represents a novel opportunity to advance pharmacy practice in primary care, interdisciplinary models. Work is ongoing to describe outcomes attributable to pharmacist participation in this clinic.
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Cunico C, Picheth G, Correr CJ, Scartezini M. Assessing the adherence to and the therapeutic effectiveness of hypolipidemic agents in a population of patients in Brazil: a retrospective cohort study. Pharm Pract (Granada) 2014; 12:378. [PMID: 25035713 PMCID: PMC4100947 DOI: 10.4321/s1886-36552014000200002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 05/27/2014] [Indexed: 12/11/2022] Open
Abstract
Objective to evaluate the relation between patient adherence and therapeutic effectiveness of hypolipidemic
agents in clinical practice. Methods A retrospective cohort study of 417 patients using hypolipidemic drugs (simvastatin,
atorvastatin) between 2003 and 2010 was performed. The population studied consists of patients
assisted by the Public Health Service in the far-west region of the State of Santa Catarina, Brazil.
The Medication Possession Ratio obtained from pharmacy refill data was used to measure patient
adherence. Therapeutic effectiveness was evaluated based on the difference obtained in the serum
levels of total cholesterol, LDL-cholesterol, HDL-cholesterol and triglycerides, before and after
taking the drug, in an average time of 8.3 months. Results Following the treatment with hypolipidemic agents, it has been observed a reduction of
14.3% for total cholesterol, 19.6% for LDL-cholesterol, and 14.4% for
triglycerides. HDL-cholesterol increased by an 8.0% average. The major changes in lipid
profile were promoted by atorvastatin 20 mg daily. The medication adherence rate decreased over the
monitoring period. Adherence rates below 60% were associated with therapeutic failure, while
rates equal to 80% or higher were associated with the best response to the lipid-lowering
drugs. Conclusion Adherence to hypolipidemic agents is higher at the beginning of the treatment, but it decreases
over time, affecting the achievement of therapeutic goals.
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Affiliation(s)
- Cássia Cunico
- Municipal Health of the São Miguel do Oeste and State Health Administration of the State of Santa Catarina. Florianópolis ( Brazil )
| | - Geraldo Picheth
- Department of Medical Pathology, Federal University of Parana (UFPR) , Curitiba, PR ( Brazil )
| | - Cassyano J Correr
- Department of Pharmacy, Federal University of Parana (UFPR) Curitiba, PR ( Brazil )
| | - Marileia Scartezini
- Department of Medical Pathology, Federal University of Parana (UFPR) , Curitiba, PR ( Brazil )
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Dreischulte T. Integrated pharmaceutical care in the community: (how) can we turn vision into reality? DRUGS & THERAPY PERSPECTIVES 2014. [DOI: 10.1007/s40267-013-0095-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Saba M, Diep J, Saini B, Dhippayom T. Meta-analysis of the effectiveness of smoking cessation interventions in community pharmacy. J Clin Pharm Ther 2014; 39:240-7. [DOI: 10.1111/jcpt.12131] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Accepted: 12/16/2013] [Indexed: 12/22/2022]
Affiliation(s)
- M. Saba
- Faculty of Pharmacy; The University of Sydney; Sydney NSW Australia
| | - J. Diep
- Faculty of Pharmacy; The University of Sydney; Sydney NSW Australia
| | - B. Saini
- Faculty of Pharmacy; The University of Sydney; Sydney NSW Australia
| | - T. Dhippayom
- Faculty of Pharmaceutical Sciences; Naresuan University; Phitsanulok Thailand
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Xiao Z, Li Z, Xu F. Role of the Internet in patient education and counseling: a framework for health-care provider in developing China. PATIENT EDUCATION AND COUNSELING 2013; 93:411-412. [PMID: 23623177 DOI: 10.1016/j.pec.2013.03.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Accepted: 03/30/2013] [Indexed: 06/02/2023]
Affiliation(s)
- Zhijun Xiao
- Department of Pharmacy, Fengxian Hospital, Southern Medical University, Shanghai 201400, China
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Shoulders BR, Franks AS, Barlow PB, Williams JD, Farland MZ. Impact of pharmacists' interventions and simvastatin dose restrictions. Ann Pharmacother 2013; 48:54-61. [PMID: 24259645 DOI: 10.1177/1060028013511323] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND On June 8, 2011, the United States Food and Drug Administration (FDA) reported safety concerns regarding statin-related myopathies and advised further restrictions on simvastatin dosing. These restrictions reduced the maximum dose for specific patient characteristics, primarily certain concomitant medications. OBJECTIVE The purpose of this study was to compare the effectiveness of 2 different pharmacist-conducted educational interventions on appropriate simvastatin use in the primary care setting. METHODS This retrospective cohort analysis was conducted in 2 academic medical center clinics. Patients prescribed simvastatin before June 8, 2011, requiring dosage adjustment based on labeling changes were evaluated for study inclusion. The pharmacists' interventions included: 30-minute didactic session for prescribers or patient-specific recommendation communicated with the physician during the patient's follow-up visit. Primary outcomes were the number of patients prescribed FDA-recommended simvastatin doses after pharmacist intervention and the intervention's impact on low-density lipoprotein (LDL). RESULTS Medical record review identified 1173 patients prescribed simvastatin prior to June 8, 2011; 126 patients qualified for study inclusion. After controlling for baseline characteristics, the likelihood of patients being prescribed an appropriate dose postintervention increased if they were in the patient-specific recommendation group (odds ratio [OR] = 10.59; 95% CI = 3.43-32.69; P < .0001). LDL change occurred at a similar rate between intervention groups (P = .652). CONCLUSION Following FDA labeling changes for simvastatin, patient-specific recommendations made by pharmacists correlated with a greater likelihood of appropriate simvastatin dosing compared with a one-time didactic education session. Patient-specific recommendations positively affect prescribing habits and making steps to improve patient safety.
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Affiliation(s)
- Bethany R Shoulders
- University of Tennessee Health Science Center College of Pharmacy, Knoxville, TN, USA
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Puspitasari HP, Aslani P, Krass I. Australian community pharmacists' awareness and practice in supporting secondary prevention of cardiovascular disease. Int J Clin Pharm 2013; 35:1218-28. [PMID: 24057435 DOI: 10.1007/s11096-013-9854-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 09/12/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Pharmacists are well placed to identify, prevent and resolve medicine related problems as well as monitor the effectiveness of treatments in cardiovascular disease (CVD). Pharmacists' interventions in CVD secondary prevention have been shown to improve outcomes for clients with established CVD. OBJECTIVE To explore the scope of pharmacists' activities in supporting CVD secondary prevention. SETTING Community pharmacies in New South Wales, Australia. METHODS Twenty-one in-depth, semi-structured interviews with a range of community pharmacists were conducted. All interviews were audio-recorded and transcribed ad verbatim. Data were analyzed using a 'grounded-theory' approach by applying methods of constant comparison. MAIN OUTCOME MEASURE Community pharmacists' awareness and current practice in supporting secondary prevention of CVD. RESULTS Four key themes identified included 'awareness', 'patient counselling', 'patient monitoring', and 'perceptions of the role of pharmacists in CVD secondary prevention'. The pharmacists demonstrated a moderate understanding of CVD secondary prevention. There was considerable variability in the scope of practice among the participants, ranging from counselling only about medicines to providing continuity of care. A minority of pharmacists who had negative beliefs about their roles in CVD secondary prevention offered limited support to their clients. The majority of pharmacists, however, believed that they have an important role to play in supporting clients with established CVD. CONCLUSION Community pharmacists in Australia make a contribution to the care of clients with established CVD despite the gap in their knowledge and understanding of CVD secondary prevention. The scope of practice in CVD secondary prevention ranged from only counselling about medicines to offering continuity of care. The extent of pharmacists' involvement in offering disease management appears to be influenced by their beliefs regarding what is required within their scope of practice.
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Jorgenson D, Gubbels-Smith A, Farrell B, Ward N, Dolovich L, Jennings B. Characteristics of pharmacists who enrolled in the pilot ADAPT Education Program: Implications for practice change. Can Pharm J (Ott) 2013; 145:260-3. [PMID: 23509586 DOI: 10.3821/145.6.cpj260] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Expanding the role of community pharmacists: Policymaking in the absence of policy-relevant evidence? Health Policy 2013; 111:135-48. [DOI: 10.1016/j.healthpol.2013.04.003] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Revised: 03/23/2013] [Accepted: 04/02/2013] [Indexed: 01/08/2023]
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Giberson SF. Million Hearts(TM): pharmacist-delivered care to improve cardiovascular health. Public Health Rep 2013; 128:2-6. [PMID: 23277654 DOI: 10.1177/003335491312800102] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Tarn DM, Paterniti DA, Wenger NS, Williams BR, Chewning BA. Older patient, physician and pharmacist perspectives about community pharmacists' roles. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2012; 20:285-93. [PMID: 22953767 PMCID: PMC3442941 DOI: 10.1111/j.2042-7174.2012.00202.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To investigate older patient, physician and pharmacist perspectives about the role of pharmacists in pharmacist-patient interactions. METHODS Eight focus-group discussions were held in senior centres, community pharmacies and primary care physician offices. Participants were 42 patients aged 63 years and older, 17 primary care physicians and 13 community pharmacists. Qualitative analysis of the focus-group discussions was performed. KEY FINDINGS Participants in all focus groups indicated that pharmacists are a good resource for basic information about medications. Physicians appreciated pharmacists' ability to identify drug interactions, yet did not comment on other specific aspects related to patient education and care. Physicians noted that pharmacists often were hindered by time constraints that impeded patient counselling. Both patient and pharmacist participants indicated that patients often asked pharmacists to expand upon, reinforce and explain physician-patient conversations about medications, as well as to evaluate medication appropriateness and physician treatment plans. These groups also noted that patients confided in pharmacists about medication-related problems before contacting physicians. Pharmacists identified several barriers to patient counselling, including lack of knowledge about medication indications and physician treatment plans. CONCLUSIONS Community-based pharmacists may often be presented with opportunities to address questions that can affect patient medication use. Older patients, physicians and pharmacists all value greater pharmacist participation in patient care. Suboptimal information flow between physicians and pharmacists may hinder pharmacist interactions with patients and detract from patient medication management. Interventions to integrate pharmacists into the patient healthcare team could improve patient medication management.
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Affiliation(s)
- Derjung M. Tarn
- Department of Family Medicine, David Geffen School of Medicine at UCLA, 10880 Wilshire Blvd, Suite 1800, Los Angeles, CA 90024, Phone: (310) 794-8242; Fax: (310) 794-6097,
| | - Debora A. Paterniti
- Center for Healthcare Policy and Research and Department of Sociology, University of California-Davis, 2103 Stockton Blvd., 2224 Grange Bldg., Sacramento, CA 95817, Phone: (916) 734-2367; Fax (916) 734-2349,
| | - Neil S. Wenger
- General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, 911 Broxton, Los Angeles, CA 90024, Phone: (310) 794-2288; Fax: (310) 794-0732,
| | - Bradley R. Williams
- Clinical Pharmacy & Clinical Gerontology, University of Southern California School of Pharmacy, 1985 Zonal Avenue, Los Angeles, CA 90089-9121, Phone: (323) 442-1559; Fax: (323) 442-1395,
| | - Betty A. Chewning
- Sonderegger Research Center, School of Pharmacy, UW-Madison, 2523 Rennebohm Hall, 777 Highland Ave., Madison, WI 53705, Phone: (608) 263-4878,
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Van C, Costa D, Abbott P, Mitchell B, Krass I. Community pharmacist attitudes towards collaboration with general practitioners: development and validation of a measure and a model. BMC Health Serv Res 2012; 12:320. [PMID: 22978658 PMCID: PMC3507896 DOI: 10.1186/1472-6963-12-320] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2012] [Accepted: 09/06/2012] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Community Pharmacists and General Practitioners (GPs) are increasingly being encouraged to adopt more collaborative approaches to health care delivery as collaboration in primary care has been shown to be effective in improving patient outcomes. However, little is known about pharmacist attitudes towards collaborating with their GP counterparts and variables that influence this interprofessional collaboration. This study aims to develop and validate 1) an instrument to measure pharmacist attitudes towards collaboration with GPs and 2) a model that illustrates how pharmacist attitudes (and other variables) influence collaborative behaviour with GPs. METHODS A questionnaire containing the newly developed "Attitudes Towards Collaboration Instrument for Pharmacists" (ATCI-P) and a previously validated behavioural measure "Frequency of Interprofessional Collaboration Instrument for Pharmacists" (FICI-P) was administered to a sample of 1215 Australian pharmacists. The ATCI-P was developed based on existing literature and qualitative interviews with GPs and community pharmacists. Principal Component Analysis was used to assess the structure of the ATCI-P and the Cronbach's alpha coefficient was used to assess the internal consistency of the instrument. Structural equation modelling was used to determine how pharmacist attitudes (as measured by the ATCI-P) and other variables, influence collaborative behaviour (as measured by the FICI-P). RESULTS Four hundred and ninety-two surveys were completed and returned for a response rate of 40%. Principal Component Analysis revealed the ATCI-P consisted of two factors: 'interactional determinants' and 'practitioner determinants', both with good internal consistency (Cronbach's alpha = .90 and .93 respectively). The model demonstrated adequate fit (χ2/df = 1.89, CFI = .955, RMSEA = .062, 90% CI [.049-.074]) and illustrated that 'interactional determinants' was the strongest predictor of collaboration and was in turn influenced by 'practitioner determinants'. The extent of the pharmacist's contact with physicians during their pre-registration training was also found to be a significant predictor of collaboration (B = .23, SE = .43, p <.001). CONCLUSIONS The results of the study provide evidence for the validity of the ATCI-P in measuring pharmacist attitudes towards collaboration with GPs and support a model of collaboration, from the pharmacist's perspective, in which collaborative behaviour is influenced directly by 'interactional' and 'environmental determinants', and indirectly by 'practitioner determinants'.
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Affiliation(s)
- Connie Van
- Faculty of Pharmacy, The University of Sydney, Sydney, Australia
| | - Daniel Costa
- School of Psychology, The University of Sydney, Sydney, Australia
| | - Penny Abbott
- School of Medicine, University of Western Sydney, Sydney, Australia
| | | | - Ines Krass
- Faculty of Pharmacy, The University of Sydney, Sydney, Australia
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Hadi BA, Daas R, Zelkó R. A randomized, controlled trial of a clinical pharmacist intervention in microdiscectomy surgery - Low dose intravenous ketamine as an adjunct to standard therapy. Saudi Pharm J 2012; 21:169-75. [PMID: 23960832 DOI: 10.1016/j.jsps.2012.08.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2012] [Accepted: 08/15/2012] [Indexed: 12/18/2022] Open
Abstract
AIM The hypothesis that postoperative pain would be reduced by using 1 μg/kg/min of ketamine, both intra- and post-operatively, for lumbar microdiscectomy surgery was assessed by measuring morphine consumption. Patient side effects were reported. METHODS Forty-five patients undergoing microdiscectomy surgery were randomized under double-blind conditions into three groups: Group1 (G1) received normal saline, Group 2 (G2) ketamine (1 μg/kg/min) intra-operatively and Group 3 (G3) ketamine (1 μg/kg/min) both intra- and post-operatively. Morphine consumption, pain scores, nausea and vomiting, CNS disorders were recorded for 24 h post surgery. This study was conducted by applying the concept of a clinical pharmacist intervention. RESULTS The time for the first analgesia demand dose was significantly shorter (P < 0.05) in G117 ± 1.7 min than for G2 and G3. In G3 morphine consumption 6, 12, and 24 h after surgery was 3 ± 2.26, 9.2 ± 2.11 and 26.9 ± 2.71 mg. Total morphine consumption was significantly lower for G3 than for G1 or G2 (P < 0.05). The visual analog scale score (VAS) values were significantly lower in G3 (P < 0.05) than for the other groups during the first 24 h. The rate of nausea and vomiting was significantly higher in G1 vs G3 (P < 0.05). No difference in drug induced CNS disturbances was observed among the groups. CONCLUSIONS Using 1 μg/kg/min of ketamine hydrochloride intra- and post-operatively for microdiscectomy surgery could be an adjunct therapy to reduce postoperative morphine consumption minimizing its side effects. Collaborative clinical pharmacy practice on the basis of pharmacology had an effective role in improving the general outcome of microdiscectomy surgery.
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Affiliation(s)
- Bushra A Hadi
- Faculty of Pharmacy, Philadelphia University, P.O. Box 1, Amman 19392, Jordan
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68
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Ali M, Schifano F, Robinson P, Phillips G, Doherty L, Melnick P, Laming L, Sinclair A, Dhillon S. Impact of community pharmacy diabetes monitoring and education programme on diabetes management: a randomized controlled study. Diabet Med 2012; 29:e326-33. [PMID: 22672148 DOI: 10.1111/j.1464-5491.2012.03725.x] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIMS To evaluate the impact of a pharmacist-led patient education and diabetes monitoring programme on HbA(1c) and other cardiovascular risk factors in the community setting. METHODS Patients with Type 2 diabetes (n = 46) attending two community pharmacies in Hertfordshire, UK were randomized to one of two groups. Patients in the intervention group (n = 23) received a programme of education about diabetes, its treatment and associated cardiovascular risk factors. These patients were seen for monitoring/counselling by a community pharmacist on six occasions over a 12-month period. Measures included HbA(1c), BMI, blood pressure, blood glucose and lipid profile. Patients in the control group (n = 23) underwent these measurements at baseline and at 12 months only, without specific counselling or education over and above usual care. RESULTS HbA(1c) fell from 66 mmol/mol (8.2%) to 49 mmol/mol (6.6%) (P < 0.001) in intervention group, compared with reduction from 65 mmol/mol (8.1%) to 59 mmol/mol (7.5%) in the control group (P = 0.03). Blood pressure fell from 146/87 to 126/81 mmHg in the intervention group (P = 0.01) compared with no significant change in the control group (136/86 to 139/82 mmHg). Significant reductions in BMI (30.8 to 27 kg/m(2), P < 0.001) and blood glucose (8.8 to 6.9 mmol/l, P < 0.001) were also observed in the intervention group as compared with no significant changes in the control group. Lipid profile changes were mixed. In the intervention group, improvements were seen in diabetes-related quality of life (P = 0.001), diabetes knowledge (P = 0.018), belief about the need for medication (P = 0.004) and reduced concerns regarding medication (P < 0.001). CONCLUSIONS Education and counselling by community pharmacists can result in favourable improvements to the cardiovascular risk profile of patients with Type 2 diabetes.
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Affiliation(s)
- M Ali
- School of Pharmacy, University of Hertfordshire, Hatfield, UK.
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69
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Touchette DR, Masica AL, Dolor RJ, Schumock GT, Choi YK, Kim Y, Smith SR. Safety-focused medication therapy management: A randomized controlled trial. J Am Pharm Assoc (2003) 2012; 52:603-12. [DOI: 10.1331/japha.2012.12036] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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70
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Odum L, Whaley-Connell A. The Role of Team-Based Care Involving Pharmacists to Improve Cardiovascular and Renal Outcomes. Cardiorenal Med 2012; 2:243-250. [PMID: 23381091 DOI: 10.1159/000341725] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The number of patients with cardiovascular and kidney disease in the United States continues to grow as the population ages, increasing the demand on the health care system and its providers. Many patients develop chronic conditions in which optimization of care is labor intensive, specifically hypertension, hyperlipidemia, diabetes, heart failure, and chronic kidney disease. Therefore, innovative and collaborative approaches to health care are warranted. Several team-based health care models have evolved and are gaining popularity, including the Patient-Centered Medical Home (PCMH) and Medication Therapy Management (MTM). Team-based care is widely supported in the literature, demonstrating significant improvement in cardiovascular and renal outcomes. This article will review the premises of PCMH and MTM, review the evidence and roles for team-based care specific to cardiovascular and renal outcomes, and introduce fundamentals to implement collaborative practice focusing on pharmacist-provider teams.
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Affiliation(s)
- Lauren Odum
- Harry S Truman Memorial Veterans Hospital and the Division of Pharmacy Practice and Administration, University of Missouri-Kansas City School of Pharmacy at MU, Columbia, Mo., USA
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71
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Molina López T, Domínguez Camacho JC, Palma Morgado D, Caraballo Camacho MDLO, Morales Serna JC, López Rubio S. [A review of the medication in polymedicated elderly with vascular risk: a randomised controlled trial]. Aten Primaria 2012; 44:453-60. [PMID: 22341703 PMCID: PMC7025269 DOI: 10.1016/j.aprim.2011.09.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2011] [Revised: 09/04/2011] [Accepted: 09/19/2011] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To analyse the effectiveness of a medication review based on intervention directed at improving the appropriateness of drug treatments according to the established guidelines, as well as blood pressure, serum lipid and blood glucose control in elderly patients on multiple medication, and cardiovascular disease or high risk of cardiovascular disease. DESIGN A randomised controlled trial with blind evaluation. SETTING Fourteen Primary Health Care centres in Andalusia PARTICIPANTS A total of 323 patients older than 65 on polypharmacy and cardiovascular disease or high risk of cardiovascular disease. INTERVENTION A pharmacist interviewed the patient, reviewed the appropriateness of the drug treatment, taking in account health record data, proposed modifications and communicated them to the general practitioner or nurse. The control group received usual health care. MAIN MEASUREMENTS Percentage of patients with appropriate use of low doses of acetylsalicylic acid, blood pressure, LDL-cholesterol, HbA(1c), and quality of life scores. RESULTS A total of 41% of patients (average age 74, 61% women) had cardiovascular disease. Ten months after the intervention (18.3% withdrawals), more patients in the intervention group used low dose acetylsalicylic acid than in the control group (52.3% vs 38.6%; P=.024). There were no differences between groups in intermediate clinic outcomes. Quality of life scores improve in intervention group by 6.1 points (100 points scale), but was not statistically significant (P=.051). CONCLUSION Clinical medication review improves the appropriateness of antiplatelet treatment in the elderly on polypharmacy and with high risk of cardiovascular disease. No improvement in biochemistry measurements was found.
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Affiliation(s)
- Teresa Molina López
- Servicio de Promoción del Uso Racional del Medicamento, Subdirección de Farmacia, Dirección General de Asistencia Sanitaria, Servicio Andaluz de Salud, Consejería de Salud, Junta de Andalucía, Spain.
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72
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Schultz AB, Chen CY, Burton WN, Edington DW. The burden and management of dyslipidemia: practical issues. Popul Health Manag 2012; 15:302-8. [PMID: 22823455 DOI: 10.1089/pop.2011.0081] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The objective of this study is to describe briefly the burden of dyslipidemia, and to discuss and present strategies for health professionals to improve dyslipidemia management, based on a review of selected literature focusing on interventions for dyslipidemia treatment adherence. Despite the availability of effective lifestyle and pharmaceutical therapies for dyslipidemias, they continue to present a significant economic burden in the United States. Adherence to evidence-based guidelines for the treatment of dyslipidemias is unsatisfactory. The reasons for medication nonadherence are complex and specific to each patient. The lack of progress in achieving optimal lipid targets is caused by many factors: patient (medication adherence, cost of medication, literacy), medication (adverse effects, complexity of regimen), provider (lack of adherence to evidence-based practice guidelines, poor communication), and the US healthcare system (being focused on acute care rather than prevention, lack of continuity of care, general lack of use of an electronic health record). Combined interventions that target each part of the system have been effective in improving treatment adherence and achieving lipid goals. Patients, providers, pharmacists, and employers all play a role in management of dyslipidemia. No single approach will solve the complex issue of improving dyslipidemia management. The required lifestyle changes are known and effective medications are available. The challenge is for all interested parties-including nurses, nurse practitioners, doctors, pharmacists, other health care professionals, employers, and health plans-to help patients achieve behavioral changes.
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Affiliation(s)
- Alyssa B Schultz
- University of Michigan Health Management Research Center, Ann Arbor, MI 48104-1688, USA.
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73
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Mc Namara KP, Dunbar JA, Philpot B, Marriott JL, Reddy P, Janus ED. Potential of pharmacists to help reduce the burden of poorly managed cardiovascular risk. Aust J Rural Health 2012; 20:67-73. [PMID: 22435766 DOI: 10.1111/j.1440-1584.2012.01259.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Rural areas require better use of existing health professionals to ensure capacity to deliver improved cardiovascular outcomes. Community pharmacists (CPs) are accessible to most communities and can potentially undertake expanded roles in prevention of cardiovascular disease (CVD). OBJECTIVE This study aims to establish frequency of contact with general practitioners (GPs) and CPs by patients at high risk of CVD or with inadequately controlled CVD risk factors. DESIGN, SETTING AND PARTICIPANTS Population survey using randomly selected individuals from the Wimmera region electoral roll and incorporating a physical health check and self-administered health questionnaire. Overall, 1500 were invited to participate. RESULTS The participation rate was 51% when ineligible individuals were excluded. Nine out of 10 participants visited one or both types of practitioner in the previous 12 months. Substantially more participants visited GPs compared with CPs (88.5% versus 66.8%). With the exception of excess alcohol intake, the median number of opportunities to intervene for every inadequately controlled CVD risk factor and among high risk patient groups at least doubled for the professions combined when compared with GP visits alone. CONCLUSION Opportunities exist to intervene more frequently with target groups by engaging CPs more effectively but would require a significant attitude shift towards CPs. Mechanisms for greater pharmacist integration into primary care teams should be investigated.
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Affiliation(s)
- Kevin P Mc Namara
- Greater Green Triangle University Department of Rural Health, Flinders University and Deakin University, Warrnambool, Victoria 3280, Australia.
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Impact of community pharmaceutical care on patient health and quality of drug treatment in Parkinson’s disease. Int J Clin Pharm 2012; 34:746-56. [DOI: 10.1007/s11096-012-9672-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Accepted: 07/02/2012] [Indexed: 11/27/2022]
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Rubio-Valera M, Jové AM, Hughes CM, Guillen-Solà M, Rovira M, Fernández A. Factors affecting collaboration between general practitioners and community pharmacists: a qualitative study. BMC Health Serv Res 2012; 12:188. [PMID: 22769570 PMCID: PMC3407479 DOI: 10.1186/1472-6963-12-188] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Accepted: 07/07/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although general practitioners (GPs) and community pharmacists (CPs) are encouraged to collaborate, a true collaborative relationship does not exist between them. Our objective was to identify and analyze factors affecting GP-CP collaboration. METHODS This was a descriptive-exploratory qualitative study carried out in two Spanish regions: Catalonia (Barcelona) and Balearic Islands (Mallorca). Face-to-face semi-structured interviews were conducted with GPs and CPs from Barcelona and Mallorca (January 2010-February 2011). Analysis was conducted using Colaizzi's method. RESULTS Thirty-seven interviews were conducted. The factors affecting the relationship were different depending on timing: 1) Before collaboration had started (prior to collaboration) and 2) Once the collaboration had been initiated (during collaboration). Prior to collaboration, four key factors were found to affect it: the perception of usefulness; the Primary Care Health Center (PCHC) manager's interest; the professionals' attitude; and geography and legislation. These factors were affected by economic and organizational aspects (i.e. resources or PCHC management styles) and by professionals' opinions and beliefs (i.e. perception of the existence of a public-private conflict). During collaboration, the achievement of objectives and the changes in the PCHC management were the key factors influencing continued collaboration. The most relevant differences between regions were due to the existence of privately-managed PCHCs in Barcelona that facilitated the implementation of collaboration. In comparison with the group with experience in collaboration, some professionals without experience reported a skeptical attitude towards it, reporting that it might not be necessary. CONCLUSIONS Factors related to economic issues, management and practitioners' attitudes and perceptions might be crucial for triggering collaboration. Interventions and strategies derived from these identified factors could be applied to achieve multidisciplinary collaboration.
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Affiliation(s)
- Maria Rubio-Valera
- Research and Development Unit, Fundació Sant Joan de Déu, Calle Picasso 13, Sant Boi de Llobregat, Barcelona, 08830, Spain
- Red de Investigación en Actividades Preventivas y Promoción de la Salud (RedIAPP), Barcelona, Spain
| | - Anna Maria Jové
- Red de Investigación en Actividades Preventivas y Promoción de la Salud (RedIAPP), Barcelona, Spain
- Primary Care Health Center Manso, Catalan Health Service (ICS), Carrer de Manso 19, Barcelona, 08015, Spain
| | - Carmel M Hughes
- Clinical and Practice Research Group, Queen’s University Belfast, School of Pharmacy, Medical Biology Center, 97 Lisburn Road, Belfast, BT9 7BL, UK
| | - Mireia Guillen-Solà
- Red de Investigación en Actividades Preventivas y Promoción de la Salud (RedIAPP), Barcelona, Spain
- Primary Health Care Center Mallorca, Research Unit, Health care Services of Balearic Isles (IB-Salut), Calle Reina Esclaramunda 9, Palma de Mallorca, 07003, Spain
| | - Marta Rovira
- Red de Investigación en Actividades Preventivas y Promoción de la Salud (RedIAPP), Barcelona, Spain
- Primary Health Care Center Mallorca, Research Unit, Health care Services of Balearic Isles (IB-Salut), Calle Reina Esclaramunda 9, Palma de Mallorca, 07003, Spain
| | - Ana Fernández
- Research and Development Unit, Fundació Sant Joan de Déu, Calle Picasso 13, Sant Boi de Llobregat, Barcelona, 08830, Spain
- Red de Investigación en Actividades Preventivas y Promoción de la Salud (RedIAPP), Barcelona, Spain
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Renet S, Rochais É, Bussières JF, Lebel D, Tanguay C, Bourdon O. [Prioritization of healthcare programs by pharmacy students from France and from Quebec, according to the perceived impact of a decentralized pharmacist]. ANNALES PHARMACEUTIQUES FRANÇAISES 2012; 70:94-103. [PMID: 22500961 DOI: 10.1016/j.pharma.2012.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Revised: 12/29/2011] [Accepted: 01/05/2012] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Healthcare decision makers need to establish priorities and their decisions must be justified. However, few data is available on the prioritization process of the healthcare programs that should benefit from decentralized pharmacists. PATIENTS AND METHODS The main objective was to prioritize healthcare programs according to the perceived impact of a decentralized pharmacist for outpatient and inpatient clienteles. The secondary objective was to compare the prioritization made by pharmacy students from two Quebec universities and from one French university. Two different approaches were developed (perceived impact according to three indicators and according to the global impact). RESULTS The majority of healthcare programs with a high evidence based literature quality score (5/6 outpatient programs and 5/8 inpatient programs) were highly prioritized by at least two out of three cohorts. The median rank that was attributed for each healthcare program was significantly different between the three cohorts for 8/17 (47%) of outpatient programs and for 10/18 (56%) of inpatient programs. DISCUSSION A higher rank was attributed to healthcare programs when the evidence based literature quality score was high. The prioritization was also influenced by the difference in pharmaceutical practice between France and Quebec (e.g. sterilization and medical devices in France). CONCLUSIONS This study presented two approaches for the prioritization of healthcare programs that should benefit from a decentralized pharmacist, according to students from France and from Quebec.
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Affiliation(s)
- S Renet
- Unité de recherche en pratique pharmaceutique, département de pharmacie, CHU Sainte-Justine, 3175, chemin de la Côte Sainte-Catherine, Montréal, Québec, H3T 1C5 Canada
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Brown D, Portlock J, Rutter P. Review of services provided by pharmacies that promote healthy living. Int J Clin Pharm 2012; 34:399-409. [PMID: 22527479 DOI: 10.1007/s11096-012-9634-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Accepted: 03/29/2012] [Indexed: 11/26/2022]
Abstract
BACKGROUND The recognition that community pharmacies have the potential to make a greater contribution to promoting public health has led to a new concept, called the Healthy Living Pharmacy (HLP). These are designed to meet public health needs through a tiered commissioning framework delivering health and well being services through community pharmacy, tailored to local requirements for tackling health inequalities. AIM To search the literature for quality evidence to support the inclusion of services in the HLP portfolio and suggest areas where more evidence is required. METHOD A systematic review of the research literature covering the period January 1990-August 2011 inclusive, using MEDLINE, EMBASE, Pharmline, NHS Evidence and the Cochrane databases. On-line searching of the grey literature (e.g. conference proceedings) was also carried out. Standard methods of assessing quality were employed. RESULTS A total of 377 papers were included. Over time, there was a marked increase in frequency of publications reflecting a growing pharmacy interest in the public healthcare agenda; over a third (35 %) of papers appeared in the last three-year study period. The body of research had a wide geographical basis; contributions were as follows: UK (51.5 %), US (20.4 %), Australia/New Zealand (9.8 %), Europe (7.7 %) and Canada (7.2 %). The topics of contraception, cardiovascular disease prevention, diabetes and smoking cessation accounted for 40 % of included papers. The literature supports the introduction of specific community pharmacy services, targeted at customer groups, both with and without pre-existing diseases. Good evidence exists for smoking cessation, cardiovascular disease prevention, hypertension and diabetes. Some good evidence exists for interventions on asthma and heart failure. The evidence supporting weight management, sexual health, osteoporosis detection, substance abuse and chronic obstructive pulmonary disease is weak and needs development. CONCLUSION There is strong evidence for the role of community pharmacy in a range of services, not only aimed at improving general health, but also maintaining the health of those with existing disease. In other areas, the evidence is less strong and further research is required to justify their inclusion in a HLP portfolio.
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Affiliation(s)
- David Brown
- University of Portsmouth, Portsmouth, Hampshire, UK.
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78
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Charrois TL, Zolezzi M, Koshman SL, Pearson G, Makowsky M, Durec T, Tsuyuki RT. A Systematic Review of the Evidence for Pharmacist Care of Patients With Dyslipidemia. Pharmacotherapy 2012; 32:222-33. [DOI: 10.1002/j.1875-9114.2012.01022.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
| | | | | | | | | | - Tamara Durec
- Durec Information Services Inc.; St. Albert; Alberta; Canada
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Patwardhan A, Duncan I, Murphy P, Pegus C. The value of pharmacists in health care. Popul Health Manag 2012; 15:157-62. [PMID: 22313438 DOI: 10.1089/pop.2011.0030] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The American health care system is concerned about the rise of chronic diseases and related resource challenges. Management of chronic disease traditionally has been provided by physicians and nurses. The growth of the care management industry, in which nurses provide remote telephonic monitoring and coaching, testifies to the increasing need for care management and to the value of nonphysician clinicians. However, this model is challenged by a number of factors, including low enrollment and the growing shortage of nurses. The challenges to the traditional model are causing policy makers and payers to consider innovative models. One such model includes the pharmacist as an essential provider of care. Not only is the number of pharmacists growing, but they are playing an ever broader role in a variety of settings. This article broadly surveys the current state of pharmacist provision of care management services and highlights the increasingly proactive role played by Walgreen Co. toward this trend, using recently conducted research. Pharmacists are making a noticeable impact on and contribution to the care of chronic diseases by improving adherence to medications, a key factor in the improvement of outcomes. Literature also suggests that pharmacies are increasingly encouraging, expanding, and highlighting the role and contributions of their professional pharmacists. Although the role of the pharmacist in chronic care management is still developing, it is likely to grow in the future, given the needs of the health care system and patients.
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80
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Melchiors AC, Correr CJ, Venson R, Pontarolo R. An analysis of quality of systematic reviews on pharmacist health interventions. Int J Clin Pharm 2011; 34:32-42. [PMID: 22183578 DOI: 10.1007/s11096-011-9592-0] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2011] [Accepted: 11/29/2011] [Indexed: 01/08/2023]
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81
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Elias MN, Burden AM, Cadarette SM. The impact of pharmacist interventions on osteoporosis management: a systematic review. Osteoporos Int 2011; 22:2587-96. [PMID: 21720894 PMCID: PMC3169776 DOI: 10.1007/s00198-011-1661-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2010] [Accepted: 02/25/2011] [Indexed: 01/22/2023]
Abstract
UNLABELLED We completed a systematic review of the literature to examine the impact of pharmacist interventions in improving osteoporosis management. Results from randomized controlled trials suggest that pharmacist interventions may improve bone mineral density testing and calcium intake among patients at high risk for osteoporosis. INTRODUCTION Pharmacists play a key role in many healthcare systems by helping patients manage chronic diseases. We completed a systematic review of the literature to identify randomized controlled trials (RCTs) that have examined the impact of pharmacy interventions in narrowing two gaps in osteoporosis management: identifying at-risk individuals and improving adherence to therapy. METHODS We searched the electronic databases of EMBASE, HealthStar, International Pharmaceutical Abstracts, MEDLINE, and PubMed from database development to April 2010, examined grey literature, and completed manual searches of reference lists to identify English-language research that examined osteoporosis management interventions within pharmacy practice. Results from RCTs were abstracted and assessed for bias. RESULTS We identified 25 studies that examined pharmacist interventions in osteoporosis management: 16 cohort, 5 cross-sectional, 1 historical/ecological control, and 3 RCTs. RCT interventions included osteoporosis educational and counseling programs, screening by pharmacists based on risk factor assessment or bone mineral density testing, and physician contact or recommendations for patients to follow-up with a general practitioner. Results from the three RCTs suggest that pharmacist interventions may improve bone mineral density testing (targeted screening) and calcium intake among patients at high risk for osteoporosis. However, two of the three RCTs had high risk of bias, and no study examined the impact of pharmacist intervention on osteoporosis treatment adherence. CONCLUSIONS Data support the potential role for pharmacists to help reduce gaps in osteoporosis management through improved identification of high-risk patients. More research is needed to examine pharmacist interventions on osteoporosis treatment adherence.
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Affiliation(s)
- M. N. Elias
- Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, ON M5S 3M2 Canada
| | - A. M. Burden
- Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, ON M5S 3M2 Canada
| | - S. M. Cadarette
- Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, ON M5S 3M2 Canada
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Clinical pharmacists and basic scientists: do patients and physicians need this collaboration? Int J Clin Pharm 2011; 33:886-94. [DOI: 10.1007/s11096-011-9562-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Desrochers JF, Lemieux JP, Morin-Bélanger C, Paradis FSM, Lord A, Bell R, Berbiche D, Bárcena PQ, Séguin NC, Desforges K, Legris MÈ, Sauvé P, Lalonde L. Development and validation of the PAIR (Pharmacotherapy Assessment in Chronic Renal Disease) criteria to assess medication safety and use issues in patients with CKD. Am J Kidney Dis 2011; 58:527-35. [PMID: 21778005 DOI: 10.1053/j.ajkd.2011.04.020] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2010] [Accepted: 04/15/2011] [Indexed: 11/11/2022]
Abstract
BACKGROUND Explicit criteria for judging medication safety and use issues in patients with chronic kidney disease (CKD) are lacking. STUDY DESIGN Quality improvement report. SETTING & PARTICIPANTS Nephrologists (n = 4), primary care physicians (n = 2), hospital pharmacists with expertise in nephrology (n = 4), and community pharmacists (n = 2). The PAIR (Pharmacotherapy Assessment in Chronic Renal Disease) criteria were applied retrospectively to 90 patients with CKD in a randomized study. QUALITY IMPROVEMENT PLAN Development of an explicit set of criteria to enable rapid and systematic detection of drug-related problems (DRPs). Using a RAND method, experts judged the clinical significance of DRPs and the appropriateness of a community pharmacist intervention. The PAIR criteria include 50 DRPs grouped into 6 categories. OUTCOMES DRPs detected using the PAIR criteria compared with implicit clinical judgment by nephrology pharmacists. MEASUREMENTS Prevalence of DRPs and reliability, validity, and responsiveness of the PAIR criteria. RESULTS A mean of 2.5 DRPs/patient (95% CI, 2.0-3.1) was identified based on the PAIR criteria compared with 3.9 DRPs/patient (95% CI, 3.4-4.5) based on clinical judgment of nephrology pharmacists. Inter-rater reliability coefficients (κ) by PAIR category varied from 0.80-1.00, with an intraclass correlation coefficient (ICC) of 0.93 (95% CI, 0.89-0.95) for total DRPs per patient. Test-retest reliability coefficients by category varied from 0.74-1.00, with an ICC of 0.91 (95% CI, 0.82-0.96) for total DRPs per patient. During the study, the mean number of DRPs per patient did not change significantly when assessed using the PAIR criteria and clinical judgment. LIMITATION The prevalence of PAIR DRPs may be underestimated due to the retrospective nature of the validation. CONCLUSION The prevalence of DRPs requiring the intervention of community pharmacists is high in patients with CKD. The PAIR criteria are reliable, but their responsiveness remains to be shown.
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84
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Salgado TM, Moles R, Benrimoj SI, Fernandez-Llimos F. Pharmacists' interventions in the management of patients with chronic kidney disease: a systematic review. Nephrol Dial Transplant 2011; 27:276-92. [PMID: 21719712 DOI: 10.1093/ndt/gfr287] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Patients with chronic kidney disease have multiple comorbidities and require complicated therapeutic regimens. The role of pharmacists caring for these patients has been documented, but no review of the impact of these interventions has occurred to date. The aim of this work is to assess the impact of pharmacists' interventions in patients with chronic kidney disease. METHODS Medline, International Pharmaceutical Abstracts, Pharmacy Abstracts and the Cochrane Library were searched for quantitative studies addressing the contribution of pharmacists' interventions in patients with chronic kidney disease. Quality of controlled studies was assessed using the Downs and Black scale. RESULTS The search identified 37 studies (38 articles), involving 4743 participants, eligible for inclusion in the review. An uncontrolled design corresponded with 80% of the studies. Twenty-one articles (55.3%) reported outcome measures and process indicators, 4 (10.5%) reported only outcome measures and 13 (34.2%) reported only process indicators. Pharmacists identified 2683 drug-related problems in 1209 patients. The results from eight controlled studies (average quality score 0.57, SD = 0.10) demonstrated that pharmacists' interventions reduced all-cause hospitalisations [mean (SD) 1.8 (2.4) versus 3.1 (3.0), P = 0.02] and cumulative time hospitalised [mean (SD) 9.7 (14.7) versus 15.5 (16.3) days, P = 0.06], reduced the incidence of end-stage renal disease or death in patients with diabetic nephropathy (14.8 versus 28.2 per 100 patient-years, adjusted relative risk 60%, P < 0.001), improved management of anemia (mean 69.8 versus 43.9%, P = 0.0001 and 64.8 versus 40.4%, P = 0.043 patients on goal hemoglobin and transferrin saturation, respectively), blood pressure [systolic mean (SD) 145.3 (16.8) versus 175.8 (33.9) mmHg, P = 0.029; diastolic mean (SD) 77.0 (10.2) versus 91.8 (12.0) mmHg, P = 0.020], calcium and phosphate parameters [serum phosphate levels mean (SD) 1.81 (0.54) versus 2.07 (0.25) mmol/L, P = 0.03; calcium-phosphate product mean (SD) 4.43 (1.20) versus 4.80 (0.51) mmol(2)/L(2), P = 0.04] and lipid management [total cholesterol mean (SD) 4.4 (1.1) versus 5.0 (1.4) mmol/L, P = 0.06; low density lipoprotein cholesterol mean (SD) 2.3 (0.9) versus 2.8 (1.0) mmol/L, P = 0.013]. Results from uncontrolled studies revealed positive impact of pharmacists' interventions on reduced number of transplant rejections [mean (SD) 0.22 (0.42) versus 0.50 (0.51) episodes, P = 0.008] and adverse events (49 in 16.0% patients versus 73 in 21.3% patients, P < 0.05). CONCLUSIONS The evidence of pharmacists' interventions in patients with chronic kidney disease is sparse, of variable quality and with heterogeneous outcomes. On the basis of best available evidence, pharmacists' interventions may have a positive impact on outcomes of patients with chronic kidney disease.
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Affiliation(s)
- Teresa M Salgado
- Research Institute for Medicines and Pharmaceutical Sciences (iMed.UL), Faculty of Pharmacy, University of Lisbon, Lisbon, Portugal
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85
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Blalock SJ, Casteel C, Roth MT, Ferreri S, Demby KB, Shankar V. Impact of enhanced pharmacologic care on the prevention of falls: a randomized controlled trial. ACTA ACUST UNITED AC 2011; 8:428-40. [PMID: 21335296 DOI: 10.1016/j.amjopharm.2010.09.002] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2010] [Indexed: 11/16/2022]
Abstract
BACKGROUND Falls are the leading cause of both fatal and nonfatal injuries among older adults in the United States. Medications that affect the central nervous system are known to increase the risk of falling. OBJECTIVE The purpose of this study was to assess the effects of a community pharmacy-based falls-prevention program targeting high-risk older adults on the rates of recurrent falls, injurious falls, and filling prescriptions for medications that have been associated with an increased risk of falling. METHODS This was a randomized controlled trial of participants recruited through a community pharmacy chain in North Carolina. The 2-year study consisted of a 1-year "look-back" period before randomization and a 1-year follow-up period after randomization. Patients were eligible to participate if they were ≥65 years of age, had fallen at least once during the 1-year period preceding enrollment, and were taking medications associated with an increased risk of falling. Medications classified as high risk included benzodiazepines, antidepressants, anticonvulsants, sedative hypnotics, opioid analgesics, antipsychotics, and skeletal muscle relaxants. Participants were assigned to either the intervention arm or the control arm; participants in the intervention arm were invited to attend a face-to-face medication consultation conducted by a community pharmacy resident, whereas those in the control arm received no medication consultation. The primary end point was the rate of recurrent falls during the 1-year followup period. Secondary end points were the total number of prescriptions for high-risk medications filled during the follow-up period and either discontinued use or a reduction in the dosage of a high-risk medication during the follow-up period. RESULTS One hundred eighty-six patients (132 women, 54 men; 88.7% white) were enrolled. Intention-to-treat (ITT) analyses revealed no significant differences in the rates of recurrent falls, injurious falls, or filling prescriptions for high-risk medications. However, 13 patients in the intervention group either discontinued use of a high-risk medication or had the dosage reduced during the follow-up period, compared with 5 patients in the control group (χ(2) = 3.94; P < 0.05). As-treated analyses revealed numeric reductions in the rates of falls (rate ratio [RR] = 0.76; 95% CI, 0.53-1.09), injurious falls (RR= 0.67; 95% CI, 0.43-1.05), and filling prescriptions for high-risk medications (RR= 0.85; 95% CI, 0.72-1.03) after receipt of the intervention, but the differences were not statistically significant. CONCLUSIONS Results of this study support the feasibility of using community pharmacies to deliver a falls-prevention program targeting high-risk older adults. Although the ITT analyses revealed no significant reduction in the rate of recurrent falls, injurious falls, or overall use of high-risk medications, individuals in the intervention group were more likely than those in the control group to discontinue use of a high-risk medication or have the dosage reduced during the 1-year follow-up period. More work is needed to evaluate the intervention using a larger sample size that provides greater power to detect clinically meaningful effects of reduction in the use of high-risk medications on preventing or reducing falls in the high-risk population.
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Affiliation(s)
- Susan J Blalock
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, NC, USA
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86
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Martin BA, Chewning BA. Evaluating pharmacists' ability to counsel on tobacco cessation using two standardized patient scenarios. PATIENT EDUCATION AND COUNSELING 2011; 83:319-324. [PMID: 21237610 PMCID: PMC3110982 DOI: 10.1016/j.pec.2010.12.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2010] [Revised: 12/03/2010] [Accepted: 12/12/2010] [Indexed: 05/30/2023]
Abstract
OBJECTIVES To evaluate the impact that role-playing two pre/post standardized patient scenarios within a tobacco cessation training program had on pharmacists' counseling skills. Second, to analyze the validity of the observation coding tool used to evaluate pharmacist's role-play performance. METHODS Pharmacists performed two role-playing scenarios which incorporated national guidelines, the 5A's counseling process, and the "preparation" and "action" phases of the transtheoretical model. Pharmacists' performance was evaluated with an observation coding tool. RESULTS Pharmacists' (n=25) counseling performance improved significantly post-training (p<0.02: Action Scenario; p<0.004: Preparation Scenario). More than 50% of pharmacists provided patient-directed tobacco consultation services in the one year following training. The observation tool score for the "action phase" scenario was highly associated with pharmacists' subsequent delivery of tobacco cessation services in community practice. CONCLUSION Role-playing facilitated pharmacists' skill development. The evaluation tool and Action Scenario may be powerful for predicting pharmacists' delivery of tobacco cessation services. PRACTICE IMPLICATIONS Incorporating role-playing and structured tools for performance evaluation can help enhance pharmacist performance during training and predict service delivery in community practice. Together they could facilitate tailored feedback to help pharmacists struggling with the difficult task of extending cognitive service roles in practice.
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Affiliation(s)
- Beth A Martin
- University of Wisconsin School of Pharmacy, Madison, USA.
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87
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George J, McNamara K, Stewart K. The roles of community pharmacists in cardiovascular disease prevention and management. Australas Med J 2011; 4:266-72. [PMID: 23393519 DOI: 10.4066/amj.2011.698] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
There is ample evidence in the international literature for pharmacist involvement in the prevention and management of cardiovascular disease (CVD) conditions in primary care. Systematic reviews and meta-analyses have confirmed the significant clinical benefits of pharmacist interventions for a range of CVD conditions and risk factors. Evidence generated in research studies of Australian community pharmacist involvement in CVD prevention and management is summarised in this article.Commonwealth funding through the Community Pharmacy Agreements has facilitated research to establish the feasibility and effectiveness of new models of primary care involving community pharmacists. Australian community pharmacists have been shown to effect positive clinical, humanistic and economic outcomes in patients with CVD conditions. Improvements in blood pressure, lipid levels, medication adherence and CVD risk have been demonstrated using different study designs. Satisfaction for GPs, pharmacists and consumers has also been reported. Perceived 'turf' encroachment, expertise of the pharmacist, space, time and remuneration are challenges to the implementation of disease management services involving community pharmacists.
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Affiliation(s)
- J George
- Centre for Medicine Use and Safety, Monash University, Australia
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88
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Evans CD, Watson E, Eurich DT, Taylor JG, Yakiwchuk EM, Shevchuk YM, Remillard A, Blackburn D. Diabetes and cardiovascular disease interventions by community pharmacists: a systematic review. Ann Pharmacother 2011; 45:615-28. [PMID: 21558487 DOI: 10.1345/aph.1p615] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To systematically review and assess the quality of studies evaluating community pharmacist interventions for preventing or managing diabetes or cardiovascular disease (CVD) and/or their major risk factors. DATA SOURCES A comprehensive literature search was performed using MEDLINE (1950-February 2011), EMBASE (1980-February 2011), International Pharmaceutical Abstracts (1970-February 2011), Cumulative Index to Nursing and Allied Health Literature (1982-June 2007), and Cochrane Central Register of Controlled Trials (1898-February 2011). Search terms included: community pharmacy(ies), community pharmacist(s), cardiovascular, diabetes, and intervention. The grey literature was searched using the ProQuest Dissertations and Theses, Theses Canada, and OAlster databases. STUDY SELECTION AND DATA EXTRACTION Articles published in English or French with all study designs were considered for the review. Studies were included if they contained interventions designed to reduce the incidence, risk, or mortality of CVD or diabetes; affect clinical indicators of CVD or diabetes mellitus (including hypertension, dyslipidemia, or hemoglobin A(1c)); and/or improve adherence to treatment strategies. Only studies involving interventions carried out primarily by pharmacists in community pharmacy settings were included. Study quality was assessed using a checklist validated for both randomized and nonrandomized studies. DATA SYNTHESIS A total of 4142 studies were initially identified, with 40 meeting our inclusion criteria. Eleven studies were randomized controlled trials, 4 were cluster randomized trials, and 2 studies had randomized before-after designs. The remaining studies were controlled before-after (n = 2), cohort (n = 4), and uncontrolled before-after (n = 17) designs. Interventions focused on diabetes (n = 12), hypertension (n = 9), medication adherence (n = 9), lipids (n = 5), evidence-based medication initiation or optimization (n = 3), risk factor prediction scores (n = 1), and body mass index (n = 1). All studies contained interventions focused at the patient level and the majority of studies (34/40) involved interventions directed at both the physician and patient. No specific intervention emerged as superior, and study quality was generally poor, making it difficult to determine the true effect of the interventions. CONCLUSIONS Poor study quality, time-intensive interventions, and unproven clinical significance warrant the need for further high-quality studies of community pharmacist interventions for preventing or managing diabetes or CVD and/or their major risk factors.
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Affiliation(s)
- Charity D Evans
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, Canada
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89
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Dupuis S, Turgeon N, Beauchesne MF. Projet pilote d'implantation D'un programme de revue de la médication en pharmacie communautaire. Can Pharm J (Ott) 2011. [DOI: 10.3821/1913-701x-144.3.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Sébastien Dupuis
- De la Faculté de pharmacie, Université de Montréal (Dupuis, Turgeon, Beauchesne); pharmacie Simard et Turgeon, Pointe-Claire (Turgeon); Centre hospitalier universitaire de Sherbrooke (Beauchesne), Sherbrooke, Québec
| | - Nathalie Turgeon
- De la Faculté de pharmacie, Université de Montréal (Dupuis, Turgeon, Beauchesne); pharmacie Simard et Turgeon, Pointe-Claire (Turgeon); Centre hospitalier universitaire de Sherbrooke (Beauchesne), Sherbrooke, Québec
| | - Marie-France Beauchesne
- De la Faculté de pharmacie, Université de Montréal (Dupuis, Turgeon, Beauchesne); pharmacie Simard et Turgeon, Pointe-Claire (Turgeon); Centre hospitalier universitaire de Sherbrooke (Beauchesne), Sherbrooke, Québec
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90
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Catalán-Arlandis JL. [The computerised prescription in Primary Care and its impact on drug spending using time series analysis]. ACTA ACUST UNITED AC 2011; 26:18-27. [PMID: 21334242 DOI: 10.1016/j.cali.2010.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2009] [Revised: 07/26/2010] [Accepted: 11/04/2010] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To describe the monthly costs of drugs per standardized patient in the Doctor Peset health department in Valencia, Spain and to correlate them with the computerization of prescription in primary care clinics using time series analysis. Other objectives were to identify internal causes that could explain the variations observed, and to evaluate the drug costs associated with these variations. MATERIAL AND METHODS Observational and retrospective study to analyse the variables: a) monthly costs of drugs by standardized patient and b) number of defined daily doses (DDD) per 1000 inhabitants and per day of drugs used to prevent cardiovascular risk prescribed by the Primary Care doctors of the Doctor Peset health department in Valencia, between January 2001 and August 2009. Time series were adjusted using ARIMA models. The impact of computerization was assessed using an intervention analysis on time series. RESULTS ARIMA models for the monthly costs of drugs by standardized patient shows that this indicator was increased by 4.9% in August 2007. The modelling of daily DDD per 1000 inhabitants showed an increase of 8.5% on the same date. Both increases occurred together with the introduction of the computerized prescription in Primary Care clinics. The pharmacoeconomic study estimated that drug costs associated with the trend changes increased by 11,365,409 euros within the period September 2007 to August 2009. CONCLUSIONS The computerization of prescription in Primary Care clinics can be correlated with an increase in the monthly costs of drugs per standardized patient and with the number of daily DDD per 1000 inhabitants of drugs to reduce the cardiovascular risk by 4.5% and 8.5%, respectively.
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Affiliation(s)
- J L Catalán-Arlandis
- Servicio de Farmacia, Atención Primaria del Departamento Valencia-Doctor Peset, Valencia, España, Hospital Universitario Doctor Peset, Valencia, España.
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91
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Rubio-Valera M, Serrano-Blanco A, Magdalena-Belío J, Fernández A, García-Campayo J, March Pujol M, López del Hoyo Y. Effectiveness of Pharmacist Care in the Improvement of Adherence to Antidepressants: A Systematic Review and Meta-Analysis. Ann Pharmacother 2011; 45:39-48. [DOI: 10.1345/aph.1p429] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background Pharmacists can play a decisive role in the management of ambulatory patients with depression who have poor adherence to antidepressant drugs. Objective To systematically evaluate the effectiveness of pharmacist care in improving adherence of depressed outpatients to antidepressants. Methods A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted. RCTs were identified through electronic databases (MEDLINE, Cochrane Central Register of Controlled Trials, Institute for Scientific Information Web of Knowledge, and Spanish National Research Council) from inception to April 2010, reference lists were checked, and experts were consulted. RCTs that evaluated the impact of pharmacist interventions on improving adherence to antidepressants in depressed patients in an outpatient setting (community pharmacy or pharmacy service) were included, Methodologic quality was assessed and methodologic details and outcomes were extracted in duplicate. Results: Six RCTs were identified. A total of 887 patients with an established diagnosis of depression who were initiating or maintaining pharmacologic treatment with antidepressant drugs and who received pharmacist care (459 patients) or usual care (428 patients) were included in the review. The most commonly reported interventions were patient education and monitoring, monitoring and management of toxicity and adverse effects, adherence promotion, provision of written or visual information, and recommendation or implementation of changes or adjustments in medication. Overall, no statistical heterogeneity or publication bias was detected. The pooled odds ratio, using a random effects model, was 1.64 (95% CI 1.24 to 2.17). Subgroup analysis showed no statistically significant differences in results by type of pharmacist involved, adherence measure, diagnostic tool, or analysis strategy. Conclusions: These results suggest that pharmacist intervention is effective in the improvement of patient adherence to antidepressants. However, data are still limited and we would recommend more research in this area, specifically outside of the US.
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Affiliation(s)
- Maria Rubio-Valera
- Research and Development Unit, Fundado Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain; Associated Clinical Group, Red de Investigación en Actividades Preventivas y Promoción de la Salud en Atención Primarla, RedlAPP, Spain
| | - Antoni Serrano-Blanco
- Research and Development Unit, Fundació Sant Joan de Déu, Sant Boi de Llobregat, Barcelona; Mental Health Group, Red de Investigación en Actividades Preventivas y Promoción de la Salud en Atención Primaria
| | - Jesús Magdalena-Belío
- Letux Health Centre, Letux, Zaragoza, Spain; Mental Health Group, Red de Investigación en Actividades Preventivas y Promoción de la Salud en Atención Primaria
| | - Ana Fernández
- Research and Development Unit, Fundació Sant Joan de Déu, Sant Boi de Llobregat, Barcelona; Mental Health Group, Red de Investigación en Actividades Preventivas y Promoción de la Salud en Atención Primaria
| | - Javier García-Campayo
- Department of Psychiatry, Miguel Servet University Hospital, University of Zaragoza, Spain; Mental Health Group, Red de Investigación en Actividades Preventivas y Promoción de la Salud en Atención Primaria
| | - Marian March Pujol
- Estades en Pràctiques Tutelades Unit, School of Pharmacy, University of Barcelona
| | - Yolanda López del Hoyo
- Department of Psychology and Sociology, University of Zaragoza; Mental Health Group, Red de Investigación en Actividades Preventivas y Promoción de la Salud en Atención Primaria
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Abstract
BACKGROUND One approach postulated to improve the provision of health care is effective utilization of team-based care including pharmacists. OBJECTIVE The objective of this study was to conduct a comprehensive systematic review with focused meta-analyses to examine the effects of pharmacist-provided direct patient care on therapeutic, safety, and humanistic outcomes. METHODS The following databases were searched from inception to January 2009: NLM PubMed; Ovid/MEDLINE; ABI/INFORM; Health Business Fulltext Elite; Academic Search Complete; International Pharmaceutical Abstracts; PsycINFO; Cochrane Database of Systematic Reviews; National Guideline Clearinghouse; Database of Abstracts of Reviews of Effects; ClinicalTrials.gov; LexisNexis Academic Universe; and Google Scholar. Studies selected included those reporting pharmacist-provided care, comparison groups, and patient-related outcomes. Of these, 56,573 citations were considered. Data were extracted by multidisciplinary study review teams. Variables examined included study characteristics, pharmacists' interventions/services, patient characteristics, and study outcomes. Data for meta-analyses were extracted from randomized controlled trials meeting meta-analysis criteria. RESULTS A total of 298 studies were included. Favorable results were found in therapeutic and safety outcomes, and meta-analyses conducted for hemoglobin A1c, LDL cholesterol, blood pressure, and adverse drug events were significant (P < 0.05), favoring pharmacists' direct patient care over comparative services. Results for humanistic outcomes were favorable with variability. Medication adherence, patient knowledge, and quality of life-general health meta-analyses were significant (P < 0.05), favoring pharmacists' direct patient care. CONCLUSIONS Pharmacist-provided direct patient care has favorable effects across various patient outcomes, health care settings, and disease states. Incorporating pharmacists as health care team members in direct patient care is a viable solution to help improve US health care.
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93
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Relationship between drug-related problems and health outcomes: a cross-sectional study among cardiovascular patients. ACTA ACUST UNITED AC 2010; 32:512-9. [DOI: 10.1007/s11096-010-9401-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2009] [Accepted: 05/17/2010] [Indexed: 11/25/2022]
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Cavaco A, Roter D. Pharmaceutical consultations in community pharmacies: utility of the Roter Interaction Analysis System to study pharmacist–patient communication. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2010. [DOI: 10.1211/ijpp.18.03.0003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Affiliation(s)
- Afonso Cavaco
- Social Pharmacy Department, Faculty of Pharmacy, University of Lisbon, Lisbon, Portugal
| | - Debra Roter
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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95
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Villeneuve J, Genest J, Blais L, Vanier MC, Lamarre D, Fredette M, Lussier MT, Perreault S, Hudon E, Berbiche D, Lalonde L. A cluster randomized controlled Trial to Evaluate an Ambulatory primary care Management program for patients with dyslipidemia: the TEAM study. CMAJ 2010; 182:447-55. [PMID: 20212029 DOI: 10.1503/cmaj.090533] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Few studies have reported the efficacy of collaborative care involving family physicians and community pharmacists for patients with dyslipidemia. METHODS We randomly assigned clusters consisting of at least two physicians and at least four pharmacists to provide collaborative care or usual care. Under the collaborative care model, pharmacists counselled patients about their medications, requested laboratory tests, monitored the effectiveness and safety of medications and patients' adherence to therapy, and adjusted medication dosages. After 12 months of follow-up, we assessed changes in low-density lipoprotein (LDL) cholesterol (the primary outcome), the proportion of patients reaching their target lipid levels and changes in other risk factors. RESULTS Fifteen clusters representing a total of 77 physicians and 108 pharmacists were initially recruited, and a total of 51 physicians and 49 pharmacists were included in the final analyses. The collaborative care teams followed a total of 108 patients, and the usual care teams followed a total of 117 patients. At baseline, mean LDL cholesterol level was higher in the collaborative care group (3.5 v. 3.2 mmol/L, p = 0.05). During the study, patients in the collaborative care group were less likely to receive high-potency statins (11% v. 40%), had more visits with health care professionals and more laboratory tests, were more likely to have their lipid-lowering treatment changed and were more likely to report lifestyle changes. At 12 months, the crude incremental mean reduction in LDL cholesterol in the collaborative care group was -0.2 mmol/L (95% confidence interval [CI] -0.3 to -0.1), and the adjusted reduction was -0.05 (95% CI -0.3 to 0.2). The crude relative risk of achieving lipid targets for patients in the collaborative care group was 1.10 (95% CI 0.95 to 1.26), and the adjusted relative risk was 1.16 (95% CI 1.01 to 1.34). INTERPRETATION Collaborative care involving physicians and pharmacists had no significant clinical impact on lipid control in patients with dyslipidemia. International Standard Randomized Controlled Trial register no. ISRCTN66345533.
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96
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Gerrald KR, Dixon DL, Barnette DJ, Williams VG. Evaluation of a pharmacist-managed lipid clinic that uses point-of-care lipid testing. J Clin Lipidol 2010; 4:120-5. [DOI: 10.1016/j.jacl.2010.02.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2009] [Revised: 02/01/2010] [Accepted: 02/01/2010] [Indexed: 10/19/2022]
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Fabbio KL, Bradley M, Chrymko M. Evaluation of a Pharmacist-Managed Telephone Lipid Clinic at a Veterans Affairs Medical Center. Ann Pharmacother 2010; 44:50-6. [DOI: 10.1345/aph.1m276] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Heart disease is one of the leading causes of death and disability in the US, with dyslipidemia being a significant risk factor. Pharmacist-managed lipid clinics have been shown to be effective in lowering low-density lipoprotein cholesterol (LDL-C) values in the veteran population. In addition, telephone-managed clinics are known to be an effective method to manage anticoagulation therapy. This type of appointment is very convenient; it reduces travel and waiting times, costs, and potential no-show rates. OBJECTIVE To assess changes in LDL-C levels from baseline to follow-up and number of patients attaining LDL-C goals during enrollment in the pharmacist-managed telephone lipid clinic (PMTLC). METHODS A retrospective chart review was conducted on all patients enrolled in the clinic who had follow-up laboratory data available. Baseline LDL-C values were compared with values obtained at follow-up. Patients' total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), and triglyceride (TG) values were also collected and analyzed for improvement. The agents used, number of antidyslipidemic medications, and the incidence of adverse drug reactions prior to and during clinic enrollment were also collected. RESULTS Patients in the PMTLC had a mean ± SD reduction in LDL-C of 44.3 ± 45.2 mg/dL (p < 0.001). In addition, 10 (28%) patients achieved the LDL-C goal (p = 0.002). Mean reductions in TC and TG levels were 44 mg/dL (18%) and 14.6 mg/dL (8%), respectively. There was no significant change in HDL-C levels. CONCLUSIONS The PMTLC at the Erie, PA, Veterans Affairs Medical Center demonstrated statistically significant reduction in patients' LDL-C levels and increase in the number of patients attaining LDL-C goal.
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Affiliation(s)
- Kristin L Fabbio
- Kristin L Fabbio PharmD, at time of the study, PGY1 Pharmacy Resident, Department of Veterans Affairs Medical Center, Erie, PA; now, Assistant Professor of Pharmacy Practice, Arnold and Marie Schwartz College of Pharmacy and Allied Health Sciences, Long Island University, Brooklyn, NY
| | - Matthew Bradley
- Matthew Bradley PharmD BCPS, at time of the study, Clinical Pharmacy Specialist, Department of Veterans Affairs Medical Center, Erie; now, Clinical Pharmacy Specialist, Department of Veterans Affairs Medical Center, Cincinnati, OH
| | - Margaret Chrymko
- Margaret Chrymko PharmD FASHP, Clinical Pharmacy Specialist, Department of Veterans Affairs Medical Center, Erie
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98
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Dettloff RW, Glosner P, Moroney SM. Establishing the Role of the Pharmacist in the Patient-Centered Medical Home… The Opportunity is Now. J Pharm Technol 2009. [DOI: 10.1177/875512250902500502] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The patient-centered medical home (PCMH) is an approach to delivering comprehensive, continuous, coordinated care across all life stages and has been hypothesized to be one potential solution to the discrepancy between the high cost but low quality of health care in the US. Although a plethora of literature exists on how pharmacy interventions can improve the quality of patient care through medication therapy management programs, there is a paucity of data supporting pharmacists' involvement in PCMHs. Pharmacists are uniquely trained and positioned to make important contributions to PCMHs as medication care coordinators. The opportunity is now for pharmacists to establish their role within this medical setting.
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Affiliation(s)
- Richard W Dettloff
- RICHARD W DETTLOFF PharmD BCPS, Medical Outcomes Specialist, Pfizer Inc., Rockford, MI
| | - Patricia Glosner
- PATRICIA GLOSNER PharmD, Medical Outcomes Specialist, Pfizer Inc
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99
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Pellegrino AN, Martin MT, Tilton JJ, Touchette DR. Medication therapy management services: definitions and outcomes. Drugs 2009; 69:393-406. [PMID: 19323584 DOI: 10.2165/00003495-200969040-00001] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
In the US, the Medicare Modernization Act of 2003 required that Medicare Part D insurers provide medication therapy management (MTM) services (MTMS) to selected beneficiaries, with the goals of providing education, improving adherence, or detecting adverse drug events and medication misuse. These broad goals and variety in MTM programmes available make assessment of these programmes difficult. The objectives of this article are to review the definitions of MTMS proposed by various stakeholders, and to summarize and evaluate the outcomes of MTMS consistent with those that may be offered in Medicare Part D or reimbursed by State Medicaid programmes. MTM programmes are approved by the Centers for Medicare and Medicaid Services (CMS). Pharmacy, medical and insurance organizations have provided guidelines and definitions for MTM programmes, distinguishing them from other types of community pharmacy activities. MTM has been distinguished from disease state management because of the focus on medications and multiple conditions. It differs from patient counselling because it is delivered independent of dispensing and involves collaboration with patients and providers. There is no consensus on the recommended mode of delivery (i.e. face-to-face or by telephone) for MTM. A MEDLINE search was conducted to identify articles published after 2000 using the search terms 'medication therapy management' and 'medication management'. Studies with outcomes evaluating community-based programmes consistent with MTMS, regardless of MTMS reimbursement source, were included in the review. Seven publications describing four MTMS were identified. For each of the identified articles, we describe the study design, service setting, inclusion criteria and outcomes. An additional three surveys describing multiple MTMS were identified and are summarized. Finally, ongoing efforts by CMS to evaluate the success of MTMS in the US are described. To date, there are limited outcomes available for MTMS. The wide variety of MTMS offered means that evaluations of individual programmes are necessary. Despite the potential benefits of MTMS, there are numerous challenges to providing MTMS, including reimbursement, justification of the service and stakeholder acceptance of the services. There remains a need for adequately funded, prospective, controlled studies of MTM programmes using strong designs to advance our knowledge of the effectiveness of various interventions and methods of delivery, and for naturalistic studies assessing the impact of CMS approved MTM programmes.
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Affiliation(s)
- Annette N Pellegrino
- Department of Pharmacy Practice, University of Illinois at Chicago College of Pharmacy, Chicago, Illinois 60612, USA
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100
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Charrois TL, Tsuyuki RT. Comment: sensitivity of patient outcomes to pharmacist interventions. Part III: systematic review and meta-analysis in hyperlipidemia management. Ann Pharmacother 2009; 43:793-4; author reply 794. [PMID: 19336643 DOI: 10.1345/aph.1k618a] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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