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McConnell M, Rogers W, Simeonova E, Wilson IB. Architecting Process of Care: A randomized controlled study evaluating the impact of providing nonadherence information and pharmacist assistance to physicians. Health Serv Res 2019; 55:136-145. [PMID: 31835278 PMCID: PMC6981078 DOI: 10.1111/1475-6773.13243] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To test the impact of connecting physicians, pharmacists, and patients to address medication nonadherence, and to compare different physician choice architectures. DATA SOURCES AND STUDY SETTING The study was conducted with 90 physicians and 2602 of their patients on medications treating chronic illness. STUDY DESIGN In this cluster randomized controlled trial, physicians were randomly assigned to an arm where the physician receives notification of patient nonadherence derived from real-time claims data, an arm where they receive this information and a pharmacist may contact patients either by default or by physician choice, and a control group. The primary outcome was resolving nonadherence within 30 days. We also considered physician engagement outcomes including viewing information about nonadherence and utilizing a pharmacist. DATA COLLECTION Physician engagement was constructed from metadata from the study website; adherence outcomes were constructed from medication claims. PRINCIPAL FINDINGS We see no differences between the treatment arms and control for the primary adherence outcome. The pharmacist intervention was 42 percentage points (95% CI: 28 pp-56 pp) more likely when it was triggered by default. CONCLUSIONS Access to a pharmacist and real-time nonadherence information did not improve patient adherence. Physician process of care was sensitive to choice architecture.
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Affiliation(s)
- Margaret McConnell
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - William Rogers
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts
| | | | - Ira B Wilson
- Brown University School of Public Health, Providence, Rhode Island
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Perrault EK, Beal JL. Patients' knowledge about pharmacists, technicians, and physicians. Am J Health Syst Pharm 2019; 76:1420-1425. [PMID: 34278412 DOI: 10.1093/ajhp/zxz169] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Including pharmacists within care teams can lead to positive health benefits, yet pharmacists remain underused. Misperceptions about pharmacists' duties and expertise compared to physicians' may contribute. This study sought to determine how well patients know the differences between pharmacists, technicians, and physicians regarding their duties and levels of education about medications. It also investigated how patients' perceptions affect their likelihood to initiate interactions with pharmacists, as well as reasons why they choose not to speak with pharmacists. METHODS An online survey of 477 U.S. adults was administered via Amazon's Mechanical Turk. Participants' knowledge of pharmacists', pharmacy technicians', and medical doctors' education and expertise were measured. Logistic regression determined whether patients' attitudes toward pharmacists predicted patient-pharmacist interactions. Participants' reasons for choosing to not talk to pharmacists about their medications were assessed via an open-ended response. RESULTS Patients generally know the duties pharmacists can perform compared to duties of technicians, but they incorrectly believe that physicians have more years of drug education than do pharmacists. Patients who have more positive attitudes toward pharmacists versus doctors are more likely to initiate interactions with pharmacists. Not seeing a need to interact, believing their doctors told them everything, or their ability to find information elsewhere (e.g., the Internet) were the 3 most cited reasons for not interacting with a pharmacist. CONCLUSION Reaching across disciplinary lines to colleagues in health communication may assist the pharmacy profession in finding ways to increase patients' knowledge and perceptions about the important role pharmacists can play, thereby increasing the likelihood of patients wanting to interact with pharmacists.
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Affiliation(s)
- Evan K Perrault
- Brian Lamb School of Communication, Purdue University, West Lafayette, IN
| | - Jenny L Beal
- Department of Pharmacy Practice, Purdue College of Pharmacy, West Lafayette, IN
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Huang C, Doucette WR, Andreski M, Pudlo A. Patient Experiences at Enhanced-Service Pharmacies in Iowa. Innov Pharm 2019; 10. [PMID: 34007554 PMCID: PMC7592870 DOI: 10.24926/iip.v10i2.1530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objectives As payment systems are evolving, the role of community pharmacists has expanded from simply dispensing prescriptions to actively providing care to patients. Little is known about patients' experiences with enhanced pharmacy services under the pay-forperformance model. In Iowa, Wellmark implemented its Value-Based Pharmacy Program (VBPP) where pharmacists receive capitation for performance on a set of quality measurements. Therefore, the objective of this study was to evaluate the quality of services and pharmacies from patients' perspective in VBPP. A structured interview guide developed from the service quality model was used for this study. Methods We conducted telephone interviews with patients from 6 community pharmacies participating in VBPP between December 2017 and January 2018. Patients who were aged between 21 and 90 years, had Wellmark prescription drug coverage, were currently on at least three medications with one or more of the medications for a chronic condition and had received enhanced pharmacy services were invited for the study. The semi-structured interview transcripts were coded and analyzed using an inductive approach of thematic analysis. Results Interviews were completed by 25 patients. Most of them were female and the average age was 59. More than half of the patients were taking at least five medications for chronic conditions. A majority of the patients received medication synchronization and immunization. A total of 13 themes across the service quality dimensions were identified. Patients thought their pharmacists were reliable, responsive, knowledgeable and trustworthy when they provided services. Pharmacy services were accessible and perceived as high quality. Privacy was not a big concern for most patients. Patients had a somewhat limited view regarding how pharmacists helped them maintain health. Conclusion Patients' perceptions of enhanced pharmacy services and pharmacies were generally positive while their understanding of pharmacists' clinical role was limited.
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Goode JR, Owen JA, Bennett MS, Burns AL. A marathon, not a sprint: Growth and evolution of community‐based pharmacy residency education and training. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2019. [DOI: 10.1002/jac5.1140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Jean‐Venable R. Goode
- PGY1 Community‐Based Pharmacy Residency Program Virginia Commonwealth University Richmond Virginia
| | - James A. Owen
- Practice and Science Affairs, American Pharmacists Association Washington District of Columbia
| | | | - Anne L. Burns
- American Pharmacists Association Washington District of Columbia
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Chevalier B, Watson BM, Barras MA, Cottrell WN. Developing Preliminary Steps in a Pharmacist Communication - Patient Outcome Pathway. Can J Hosp Pharm 2019; 72:271-281. [PMID: 31452538 PMCID: PMC6699868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Nonadherence to medication therapy has been associated with poor health outcomes and increased health care costs. The literature describes pharmacists as key health care professionals in identifying and addressing nonadherence issues but does not explain how and why effective pharmacist-patient communication affects patients' medication adherence. Previously published pathways used in linking effective physician-patient communication to patient outcomes are proposed for the context of pharmacist-patient communication. OBJECTIVES To develop preliminary steps in a pharmacist communication - patient outcome pathway, adapted from a physician-patient communication pathway. METHODS This longitudinal descriptive study, which took place in a large quaternary hospital, involved hospital pharmacists and patients. Patients' assessment of pharmacist communication behaviours and reporting of patient satisfaction occurred after the pharmacist-patient consultation. Medication-taking behaviour questionnaires were administered before the consultation and again 4 weeks after discharge. Developing the preliminary pathway (based on previously established physician communication pathways) involved 2 steps, with investigation of the following associations: (1) between patient-reported effective communication by pharmacists, as per the Communication Accommodation Theory (CAT), and patient satisfaction; and (2) between patient-reported pharmacist communication and satisfaction and patients' medication-taking behaviour. RESULTS Twelve pharmacists and 48 patients participated. For step 1, almost all patient-reported pharmacist communication behaviours were positively correlated with patient satisfaction statements. Strong associations between CAT-related pharmacist communication behaviours and patient satisfaction highlighted the pharmacists' behaviours that are important to patients and necessary for effective conversations to take place. In step 2, there were fewer correlations of medication-taking behaviour indices with pharmacist communication behaviours and patient satisfaction. CONCLUSIONS This study showed how a preliminary pharmacist communication - patient outcome pathway could be successfully adapted from existing physician communication pathways. Such pathways provide an initial platform upon which future pharmacist communication - patient outcome research can be built.
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Affiliation(s)
- Bernadette Chevalier
- , PhD, is an Honorary Fellow, School of Pharmacy, The University of Queensland, Queensland, Australia
| | - Bernadette M Watson
- , PhD, is a Professor in the Department of English, and Director, International Research Centre for the Advancement of Health Communication, The Hong Kong Polytechnic University, Hong Kong, SAR
| | - Michael A Barras
- , PhD, is an Associate Professor in the School of Pharmacy, The University of Queensland, and Deputy-Director in the Pharmacy Department, Princess Alexandra Hospital, Queensland, Australia
| | - William N Cottrell
- , PhD, is an Associate Professor and Director, Interprofessional Education, Faculty of Health and Behavioural Sciences, The University of Queensland, Queensland, Australia
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Jalal Z, Akhtar S, Finlay K, King K, Goel N, Ward J. Perceptions of UK Community Pharmacists on Current Consultation Skills and Motivational Interviewing as a Consultation Approach: A Qualitative Study. PHARMACY 2019; 7:E52. [PMID: 31159294 PMCID: PMC6630739 DOI: 10.3390/pharmacy7020052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 04/30/2019] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES Community pharmacists' roles in the UK are evolving; pharmacists currently deliver a wider range of clinical services with more patient-focused care. The objectives of this study were (i) to investigate UK community pharmacists' views on their current communication skills in pharmacist-patient facing consultations, and (ii) to explore the perceptions of UK community pharmacists towards the application of motivational interviewing (MI) in a pharmacy consultation. In-depth qualitative face-to-face, semi-structured interviews with ten practicing community pharmacists were carried out, ranging from 30-60 minutes in length. The interviews were audio recorded, transcribed verbatim and thematic analysis was employed. Four themes emerged from the data: (1) the fight for time; (2) wrestling with consultation styles; (3) a personal communication evolution; and (4) unfamiliar but engaging motivational interviewing. These themes demonstrated the juxtaposition between the desire for patient-centred care and the pressures of managing broader dispensing work. Participants were critical of academic and continuous professional learning (CPD) training in communication skills and there was a strong recognition of the potential role of MI in promoting patient autonomy and outcomes. Participants recognized a few elements of MI techniques in their current consultations, but welcomed further training on behavioral change for effective consultations, expressing a desire for practical MI-specific training. Face-to-face CPD of consultation skills is needed to avoid the feeling of isolation among UK practicing pharmacists and rigidity in consultation delivery. Support for community pharmacists from other pharmacy staff could relieve current pressures and allow pharmacists time to develop and acquire effective skills for patient facing roles. Behavioural change consultation skills training for pharmacists could be an effective strategy to address these current challenges.
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Affiliation(s)
- Zahraa Jalal
- School of Pharmacy, University of Birmingham, Birmingham B15 2TT, UK.
| | - Sania Akhtar
- School of Pharmacy, University of Birmingham, Birmingham B15 2TT, UK.
| | - Katherine Finlay
- School of Psychology and Wellbeing, The University of Buckingham, Buckingham, Bucks MK18 1EG, UK.
| | - Kathryn King
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London SE1 8WA, UK.
| | - Neera Goel
- School of Pharmacy, University of Birmingham, Birmingham B15 2TT, UK.
| | - Jonathan Ward
- Interactive Studies Unit, University of Birmingham, Birmingham B15 2TT, UK.
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Communications Skills in the Pharmacy Profession: A Cross Sectional Survey of UK Registered Pharmacists and Pharmacy Educators. PHARMACY 2018; 6:pharmacy6040132. [PMID: 30545072 PMCID: PMC6306767 DOI: 10.3390/pharmacy6040132] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 12/08/2018] [Accepted: 12/10/2018] [Indexed: 12/14/2022] Open
Abstract
Objectives: To determine UK pharmacists' experiences of their current communication skills and undergraduate training and to identify communication skills training and teaching at UK schools of pharmacy. Methods: Two surveys were developed. The first survey was sent to UK practicing pharmacists examining their current communication skills and interest in behavioural counselling techniques such as Motivational Interviewing (MI). A second survey was sent to all UK Schools of Pharmacy investigating communication skills training and teaching. Results: In the first survey pharmacists reported low satisfaction with their undergraduate communication skills training. A convenience sample of 109 UK pharmacists responded to the first survey. Forty-four per cent (n = 48) of the respondents stated that they continued their professional development in communication skills after an undergraduate degree. Seventy (65.4%) were not familiar with behavioural counselling techniques such as MI. The most common patient consultation delivered by pharmacists was around adherence to medicine 22.4% (n = 50). Pharmacists expressed a need for further training in clinical areas such as mental health 25.7% (n = 80). Results from the second survey to pharmacy schools showed that Schools of Pharmacy response rate was 60% (18/30). All 18 schools stated that they teach health behaviour change consultation skills and this is mostly delivered by a clinical pharmacist. Teaching communication skills was mostly delivered as role play with peers (n = 17). Conclusion: This first national survey of communication skills training in Schools of Pharmacy shows that newer graduates have received more communication training compared to older graduates, however pharmacists' respondents still felt that they were under prepared for behaviour change patient consultations. MI training would be welcomed by those. Practice Implications: Structured courses in communication skills, including behavioural change techniques, are needed for practicing UK pharmacists.
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Urick BY, Ferreri SP, Shasky C, Pfeiffenberger T, Trygstad T, Farley JF. Lessons Learned from Using Global Outcome Measures to Assess Community Pharmacy Performance. J Manag Care Spec Pharm 2018; 24:1278-1283. [PMID: 30479196 PMCID: PMC10397585 DOI: 10.18553/jmcp.2018.24.12.1278] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION As value-based and alternative payment models proliferate, there is growing interest in measuring pharmacy performance. However, little research has explored the development and implementation of systems to measure pharmacy performance. Additionally, systems that currently exist rely on process and surrogate outcome measures that are not always relevant to patients and payers. PROGRAM DESCRIPTION This article describes the process used to design and implement a performance measurement program for a group of enhanced services pharmacies in North Carolina. This program was successful in measuring quality based on medication adherence, hospitalizations, emergency department visits, and total cost of medical care for nearly all North Carolina pharmacies. Measures were scored and combined into a single 11-point composite pharmacy performance score. To demonstrate the measures, we compared performance scores for enhanced services pharmacies (n = 119) to other North Carolina pharmacies (n = 1,616) during the baseline measurement period (March 1, 2015-May 31, 2015). Adherence measure scores for enhanced services pharmacies exceeded those of other pharmacies (P values < 0.0001-0.003), but total scores were not significantly different, with enhanced services pharmacy mean total scores of 6.54 vs. 6.29 for all other pharmacies (P = 0.115). OBSERVATIONS The program described provides an example of a composite performance measurement system that can be used to support alternative pharmacy payment models and shows that case-mix adjustment is possible for broad outcomes such as those used in this program. The measures used for the program depend on timely feeds of medical claims. Payers and pharmacy networks implementing a similar program may need to explore alternative structure or process measures. IMPLICATIONS As pharmacy payment models evolve, there may be value in collaboration between academics, pharmacists, and payers to bring different areas of expertise and perspectives into the performance measurement process. This program demonstrates that global outcome measurement is possible over a broad set of pharmacies and invites additional research to explore the validity of this and other methods to measure pharmacy quality and performance. DISCLOSURES The program described in this article was supported by Funding Opportunity Number 1C12013003897 from the U.S Department of Health and Human Services, Centers for Medicare & Medicaid Services. The contents provided are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agencies. Community Care of North Carolina received the grant and subcontracted with the UNC Eshelman School of Pharmacy to carry out this project. Shasky, Pfeiffenberger, and Trygstad are employed by Community Care of North Carolina. Urick and Ferreri are employed by the UNC Eshelman School of Pharmacy. Farley was employed by the UNC Eshelman School of Pharmacy during data collection for this project and reports consulting fees from UCB Pharmaceutical Company unrelated to this project. Pfeiffenberger reports membership on the Pharmacy Quality Alliance (PQA) task force on pharmacy level measures; Trygstad is a PQA board member; Urick is a member of a scientific advisory committee for PQA.
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Affiliation(s)
- Benjamin Y Urick
- 1 University of North Carolina Eshelman School of Pharmacy, Chapel Hill
| | | | | | | | | | - Joel F Farley
- 3 University of Minnesota College of Pharmacy, Minneapolis
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Xu XF, Feng YT, Tian YF, Wang HY. Pharmaceutical Care in Kidney Transplant Recipients: Behavioral and Physiologic Outcomes at 12 Months. Transplant Proc 2018; 50:2451-2456. [PMID: 30316377 DOI: 10.1016/j.transproceed.2018.04.049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 04/06/2018] [Accepted: 04/24/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND A variety of complex drug regimens are offered to kidney transplant recipients after transplantation. This study aimed to evaluate the behavioral and physiological outcomes of pharmaceutical care in this population. METHODS A cross-sectional prospective study was conducted, which collected and categorized kidney transplant recipients according to pharmaceutical care. In the IR group, patients had received irregular pharmaceutical care after transplantation, and in the RE group, patients had received regular intervention. Intervention included face-to-face interview, checkup for laboratory examinations, discovery of drug-related problems, and pharmaceutical consultation. Baseline knowledge for self-care was tested for patients in both groups. Correct concepts and medication guidance were consistently provided to enable patients to understand the importance of rejection prevention and knowledge for medication and renal care after transplantation. After 12 months, the same test was used to evaluate the outcomes for pharmaceutical care and a satisfaction questionnaire was used to assess for pharmacy service. RESULTS The study results revealed that patients in the RE group possessed better knowledge for self-care (P < .001); however, the differences at 12 months became insignificant (P = .72) after patients in the IR group had also received routine pharmaceutical care. Besides, serum creatinine level of the RE patients was stable without significant variation (P = .93), but it demonstrated a rising trend in IR patients (P < .01). Patients were greatly satisfactory with the intervention. CONCLUSIONS A consistent post-transplantation pharmaceutical care service is effective to substantially improve knowledge of post-transplantation self-care. Pharmaceutical care should be started as early as possible during the pre-transplant period and continue in a long-term follow-up.
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Affiliation(s)
- X F Xu
- Department of Pharmacy, Shanghai Second People's Hospital, Shanghai, China
| | - Y T Feng
- Graduate Institute of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC
| | - Y F Tian
- Department of General Surgery, Chi-Mei Medical Center, Tainan, Taiwan, ROC
| | - H Y Wang
- Department of Pharmacy, Chi-Mei Medical Center, Tainan, Taiwan, ROC; School of Pharmacy, Chia Nan University of Pharmacy & Science, Tainan, Taiwan, ROC.
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Carpenter DM, Roberts CA, Westrick SC, Ferreri SP, Kennelty KA, Look KA, Abraham O, Wilson C. A content review of online naloxone Continuing Education courses for pharmacists in states with standing orders. Res Social Adm Pharm 2018; 14:968-978. [DOI: 10.1016/j.sapharm.2017.11.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 09/20/2017] [Accepted: 11/17/2017] [Indexed: 01/27/2023]
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Turner K, Weinberger M, Renfro C, Ferreri S, Trygstad T, Trogdon J, Shea CM. The role of network ties to support implementation of a community pharmacy enhanced services network. Res Social Adm Pharm 2018; 15:1118-1125. [PMID: 30291004 DOI: 10.1016/j.sapharm.2018.09.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 07/10/2018] [Accepted: 09/25/2018] [Indexed: 01/11/2023]
Abstract
BACKGROUND Limited evidence exists on how to integrate community pharmacists into team-based care models, as the inclusion of community pharmacy services into alternative payment models is relatively new. To be successful in team-based care models, community pharmacies need to successfully build relationship with diverse stakeholders including providers, care managers, and patients. OBJECTIVES The aims of this study are to: (1) identify the role of network ties to support implementation of a community pharmacy enhanced services network, (2) describe how these network ties are formed and maintained, and (3) compare the role of network ties among high- and low-performing community pharmacies participating in an enhanced services network. METHODS Using a semi-structured interview guide, we interviewed 40 community pharmacy representatives responsible for implementation of a community pharmacy enhanced services program. We analyzed for themes using social network theory to compare network ties among 24 high- and 16 low-performing community pharmacies. RESULTS The study found that high-performing pharmacies had a greater diversity of network ties (e.g., relationships with healthcare providers, care managers, and public health agencies). High-performing pharmacies were able to use those ties to support implementation of NC-CPESN. High- and low-performing pharmacies used similar strategies for establishing ties with patients, such as motivational interviewing and assigning staff members to be responsible for engaging high-risk patients. High-performing pharmacies used additional strategies such as assessing patient preferences to support patient engagement, increasing patient receptivity towards enhanced services. CONCLUSIONS Community pharmacies may vary in their ability to develop relationships with other healthcare providers, care management and public agencies, and patients. As enhanced services interventions that require care coordination are scaled up and spread, additional research is needed to test implementation strategies that support community pharmacies with developing and maintaining relationships across a diverse group of stakeholders (e.g., healthcare providers, care managers, public health agencies, patients).
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Affiliation(s)
- Kea Turner
- Department of Health Policy and Management, University of North Carolina Gillings School of Global Public Health, Chapel Hill, USA.
| | - Morris Weinberger
- Department of Health Policy and Management, University of North Carolina Gillings School of Global Public Health, Chapel Hill, USA
| | - Chelsea Renfro
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center, Memphis, USA
| | - Stefanie Ferreri
- Division of Practice Advancement and Clinical Education, University of North Carolina Eshelman School of Pharmacy, USA
| | - Troy Trygstad
- Division of Practice Advancement and Clinical Education, University of North Carolina Eshelman School of Pharmacy, USA; Community Pharmacy Enhanced Services Network, Community Care of North Carolina, USA
| | - Justin Trogdon
- Department of Health Policy and Management, University of North Carolina Gillings School of Global Public Health, Chapel Hill, USA
| | - Christopher M Shea
- Department of Health Policy and Management, University of North Carolina Gillings School of Global Public Health, Chapel Hill, USA
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Chandrashekar P, Jain SH. Improving High-Risk Patient Care through Chronic Disease Prevention and Management. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2018; 46:773-775. [PMID: 30336093 DOI: 10.1177/1073110518804240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Pooja Chandrashekar
- Pooja Chandrashekar, A.B., is a Fullbright Fellow studying social policy in India. Sachin H. Jain, M.D., M.B.A., is an Adjunct Professor at the Stanford University School of Medicine and president of CareMore Health
| | - Sachin H Jain
- Pooja Chandrashekar, A.B., is a Fullbright Fellow studying social policy in India. Sachin H. Jain, M.D., M.B.A., is an Adjunct Professor at the Stanford University School of Medicine and president of CareMore Health
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Rose O, Richling I, Voigt K, Gottschall M, Köberlein-Neu J. Patient selection and general practitioners' perception of collaboration in medication review. Res Social Adm Pharm 2018; 15:521-527. [PMID: 30139537 DOI: 10.1016/j.sapharm.2018.06.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 06/19/2018] [Accepted: 06/28/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Implementation of collaborative Medication Review (MR) into routine care faces several barriers. OBJECTIVE The study aim was to gain information on patient selection for a MR by general practitioners (GPs). GP selection was compared to objective selection criteria on identifying patients, who would benefit from a MR the most. A secondary objective of this study was to get insight into GPs perception on interprofessional collaboration with pharmacists. METHODS GPs were interviewed for a qualitative study on expected outcomes of MR in former study patients. They were asked to select patients, for whom they expected a major benefit from the MR. Results were compared to objective selection criteria, obtained from the WestGem study. Further interviews were done on aspects of patient selection and perception of interprofessional collaboration, results were presented descriptively. RESULTS The study covered 6 GPs with 78 former study patients. GPs would have chosen 45 out of the 78 patients (57.7%) for a MR. According to changes in the Medication Appropriateness Index, 24 of these patients had a greater benefit from the MR. Patient selection by the number of prescribed drugs had reached a higher specificity at a cut-off of 9 drugs, compared to selection by the GP (67% vs. 61.5%). GPs mentioned medication safety, certain diseases, polymedication, multimorbidity as selection criteria. Increasing quality of therapy and better insight into the patient's drug regimen was appreciated by the GPs as perceived personal advantage of the MR. GPs preferred to have a MR initiated by themselves, but appraised concise interprofessional collaboration with pharmacists. CONCLUSIONS Patient selection for MR should take objective parameters into account and combine them with subjective impressions. GPs preferred the initiation of a MR by themselves but expressed a positive attitude towards collaboration with a pharmacist afterwards. Recommendations should be relevant and concise.
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Affiliation(s)
- Olaf Rose
- College of Pharmacy, Department of Pharmacotherapy & Translational Research, College of Pharmacy, University of Florida, USA.
| | - Ina Richling
- College of Pharmacy, Department of Pharmacotherapy & Translational Research, College of Pharmacy, University of Florida, USA
| | - Karen Voigt
- Department of General Practice/Medical Clinic III, Medical School, Technische Universität Dresden, Dresden, Germany
| | - Mandy Gottschall
- Department of General Practice/Medical Clinic III, Medical School, Technische Universität Dresden, Dresden, Germany
| | - Juliane Köberlein-Neu
- Center for Health Economics and Health Services Research, Schumpeter School of Business and Economics, University of Wuppertal, Germany
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Laven A, Deters MA, Rose O, Schwender H, Smaranda A, Waltering I, Laeer S. PharmAdhere: training German community pharmacists with Objective Structured Clinical Examinations. Int J Clin Pharm 2018; 40:1317-1327. [PMID: 30099664 DOI: 10.1007/s11096-018-0710-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 08/01/2018] [Indexed: 11/29/2022]
Abstract
Background Pharmacists who engage in Pharmaceutical Care need skills to optimise responsible medication use and increase medication adherence. Objectives We developed and evaluated a blended-learning programme for German community pharmacists that focused on conducting consultations in chronic diseases. Setting Community pharmacists in Germany. Method Interventional study with pre-post design. We combined e-learning with Objective Standardised Clinical Examinations (OSCEs) for emergency situations, initiation/implementation of medication therapy and detection of symptoms of four chronic diseases. Specific procedures were defined in the Pharmaceutical Action Plan. Skills were measured with a global analytical marking sheet derived from the Medication Related Consultation Framework and scored with the Canadian criticality/relevancy matrix. Time limits matched real practice scenarios. Main outcome measures Changes in knowledge (difference of test results before and after e-learning) and changes in skills (difference in scores of the OSCEs before and after training). Results 22 out of the 26 pharmacists enrolled, completed the study. The number of correctly answered questions increased significantly after the e-learning for all four indications with a mean number of additional correct answers between 3.86 and 4.9 points out of 15 (p < 0.001). The sums of the analytical checklist points in percentages increased significantly in all topics from the baseline summative OSCE to the final summative OSCE between 6.14 and 31.85% (p < 0.001). The maximum duration of consultation per patient was less than 10 min in all OSCEs. Conclusion The use of e-learning and OSCEs was well received by participants and is a successful method to deliver practical Pharmaceutical Care training.
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Affiliation(s)
- Anna Laven
- Institute of Clinical Pharmacy and Pharmacotherapy, Heinrich-Heine-University, Duesseldorf, Germany.
| | - Maira Anna Deters
- Institute of Clinical Pharmacy and Pharmacotherapy, Heinrich-Heine-University, Duesseldorf, Germany
| | - Olaf Rose
- College of Pharmacy, Department of Pharmacotherapy and Translational Research, University of Florida, Gainesville, USA
| | - Holger Schwender
- Mathematical Institute, Heinrich-Heine-University, Duesseldorf, Germany
| | - Alexandra Smaranda
- Servicio de Anestesiología y Reanimación, Hospital Central de la Cruz Roja, Madrid, Spain
| | - Isabell Waltering
- Institute of Pharmaceutical and Medicinal Chemistry, Westfaelische Wilhelms-University, Muenster, Germany
| | - Stephanie Laeer
- Institute of Clinical Pharmacy and Pharmacotherapy, Heinrich-Heine-University, Duesseldorf, Germany
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Taylor DG, Giuliano F, Hackett G, Hermes-DeSantis E, Kirby MG, Kloner RA, Maguire T, Stecher V, Goggin P. The pharmacist's role in improving the treatment of erectile dysfunction and its underlying causes. Res Social Adm Pharm 2018; 15:591-599. [PMID: 30057329 DOI: 10.1016/j.sapharm.2018.07.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 07/20/2018] [Indexed: 01/07/2023]
Abstract
Erectile dysfunction (ED), which worldwide is likely to affect in excess of 300 million men by 2025, is often either untreated or insufficiently treated. It can be a prelude to other serious illnesses and may be a cause or consequence of depression in affected individuals. Among men younger than 60 years of age, ED can be a robust early-stage indicator of vascular disease and type 2 diabetes. Untreated or inadequately treated ED can also be a sign of poor communication between health professionals and service users of all ages. Improved treatment of ED could cost-effectively prevent premature deaths and avoidable morbidity. The extension of community pharmacy‒based health care would enable more men living with ED to safely access effective medications, along with appropriate diagnostic services and support for beneficial lifestyle changes such as smoking cessation in conveniently accessible settings. The task of introducing improved methods of affordably addressing problems linked to ED exemplifies the strategic challenges now facing health care systems globally. Promoting professionally supported self-care in pharmacies has the potential to meet the needs of aging populations in progressively more effective ways.
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Affiliation(s)
- David G Taylor
- The UCL School of Pharmacy, 29-39 Brunswick Square, Bloomsbury, London, WC1N 1AX, UK.
| | - Francois Giuliano
- Neurourology R. Poincaré Hal Garches, Versailles Saint-Quentin University, 104 Boulevard Raymond Poincaré, Garches, 92380, France.
| | - Geoff Hackett
- Good Hope Hospital, Rectory Road, Sutton Coldfield, Birmingham, B75 7RR, UK.
| | - Evelyn Hermes-DeSantis
- Ernest Mario School of Pharmacy, Rutgers University, 160 Frelinghuysen Road, New Brunswick, NJ, 08854, USA.
| | - Michael G Kirby
- The Prostate Centre, 32 Wimpole St, Marylebone, London W1G 8GT, UK; University of Hertfordshire, Centre for Research in Primary and Community Care, College Lane, Hatfield, Hertfordshire, AL10 9AB, UK.
| | - Robert A Kloner
- Huntington Medical Research Institutes, 686 S Fair Oaks Ave, Pasadena, CA 91105, USA; Division of Cardiovascular Medicine, Dept. of Medicine, Keck School of Medicine at University of Southern California, 1975 Zonal Avenue, Los Angeles, CA, 90033, USA.
| | - Terry Maguire
- Queens University Belfast, University Road, Belfast, BT7 1NN, UK, Ireland.
| | - Vera Stecher
- Pfizer Inc, 235 E 42nd St, New York, NY, 10017, USA.
| | - Paul Goggin
- Pfizer Ltd, Discovery Park, Ramsgate Rd, Sandwich, CT13 9ND, UK.
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66
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Bacci JL, Berenbrok LA. Innovative Advances in Connectivity and Community Pharmacist Patient Care Services: Implications for Patient Safety. Pharmacotherapy 2018; 38:867-874. [PMID: 29878391 DOI: 10.1002/phar.2148] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The scope of community pharmacy practice has expanded beyond the provision of drug product to include the provision of patient care services. Likewise, the community pharmacist's approach to patient safety must also expand beyond prevention of errors during medication dispensing to include optimization of medications and prevention of adverse events throughout the entire medication use process. Connectivity to patient data and other health care providers has been a long-standing challenge in community pharmacy with implications for the delivery and safety of patient care. We describe three innovative advances in connectivity in community pharmacy practice that enhance patient safety in the provision of community pharmacist patient care services across the entire medication use process. Specifically, we discuss the growing use of immunization information systems, quality improvement platforms, and health information exchanges in community pharmacy practice and their implications for patient safety.
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Affiliation(s)
- Jennifer L Bacci
- Department of Pharmacy, University of Washington School of Pharmacy, Seattle, Washington
| | - Lucas A Berenbrok
- Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania
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Comparison of two training methods in community pharmacy: Project VACCINATE. J Am Pharm Assoc (2003) 2018; 58:S94-S100.e3. [DOI: 10.1016/j.japh.2018.04.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 03/20/2018] [Accepted: 04/03/2018] [Indexed: 11/23/2022]
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68
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Gatwood J, Hanley R, Moore JS, Hohmeier K. Community pharmacist led, employer-based wellness services: A pilot study. Res Social Adm Pharm 2018; 15:615-618. [PMID: 29909933 DOI: 10.1016/j.sapharm.2018.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 05/25/2018] [Accepted: 06/11/2018] [Indexed: 11/24/2022]
Abstract
The emphasis that United States employers are placing on employee wellness continues to grow; however, most attention has been paid to larger firms to gauge return-on-investment from a larger pool of enrollees. With fewer resources available to fund expansive wellness programs, smaller businesses need a cost-effective mechanism to provide such benefits. As the most accessible healthcare provider, community pharmacists are in an ideal position to support certain wellness programs for smaller businesses. This research piloted a community pharmacist-led, employer-sponsored wellness program for a self-insured financial services company in Tennessee. Employees with diabetes, hypertension, hyperlipidemia, asthma, or COPD were recruited from the partnering firm to receive live, one-on-one counseling from a community pharmacist over a calendar year. Each session was tailored to individual employee's needs and goals but generally focused on medication adherence, diet, exercise, and health maintenance strategies. Fifteen employees participated in the program, and improvements in clinical measures were not realized over the course of a year. Some, albeit not statistically significant, improvements were seen in self-reported medication adherence and quality of life; however, a trend toward some weight gain was observed. Results suggest that, similar to Medicare beneficiaries, working-age adults with certain chronic conditions may benefit from pharmacist-led MTM programs but deeper investigation is needed.
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Affiliation(s)
- Justin Gatwood
- University of Tennessee College of Pharmacy, 193Polk Avenue, Suite 2D, Nashville, TN, 37210, USA.
| | - Rhonda Hanley
- Medical Center Compounding Pharmacy, 2401 Ocoee St., Cleveland, TN, 37311, USA
| | - Joe S Moore
- Medical Center Compounding Pharmacy, 2401 Ocoee St., Cleveland, TN, 37311, USA
| | - Kenneth Hohmeier
- University of Tennessee College of Pharmacy, 193Polk Avenue, Suite 2D, Nashville, TN, 37210, USA
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Stanton-Robinson C, Al-Jumaili AA, Jackson A, Catney C, Veach S, Witry MJ. Evaluation of community pharmacist-provided telephone interventions to improve adherence to hypertension and diabetes medications. J Am Pharm Assoc (2003) 2018; 58:S120-S124. [PMID: 29891173 DOI: 10.1016/j.japh.2018.04.030] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 04/18/2018] [Accepted: 04/20/2018] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To 1) identify specific patient barriers and pharmacist interventions to medication adherence by means of the Drug Adherence Work-Up (DRAW) tool; and 2) measure patient adherence to antihypertensive and antidiabetic medications by calculating proportion of days covered (PDC) before and after pharmacist telephone adherence interview. DESIGN This prospective quality-improvement study consisted of telephonic interviews and targeted interventions to increase medication adherence based on patient-specific barriers. The baseline PDC was electronically calculated for each patient, and postintervention PDCs were manually calculated at 90 days and 180 days after baseline. The measurement period in each PDC calculation was 180 days. SETTING AND PATIENTS This study was conducted in a small-chain independent pharmacy in rural Midwest United States. Patients taking an antihypertensive or oral antidiabetic medication were identified through an online platform and contacted if they had a PDC of less than 80% during the previous 180 days. OUTCOME MEASURES Baseline and postinterview PDC were calculated for each patient who received an adherence interview. Frequency of specific barriers and pharmacist interventions were identified and analyzed. RESULTS Ninety-seven eligible patients were identified. Fifty-six patients participated in an interview. Of these, a total of 66 barriers to adherence were identified. Pharmacists implemented 76 interventions for these patients, and 43 patients were included in final PDC calculations. From baseline, 69.0% of patients with hypertension and 64.3% of patients with diabetes reached a PDC of greater than 80% within 3 months. The most frequently identified barrier was forgetfulness on routine days, and the most common interventions were patient education, deactivated drug, and recommend or start medication synchronization program. CONCLUSION Using pharmacists to identify and address patient barriers to adherence resulted in a significant increase in PDC among patients with hypertension and diabetes. The DRAW tool can be used in a community pharmacist-delivered telephonic intervention to improve medication adherence.
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Armistead LT, Ferreri SP. Improving Value Through Community Pharmacy Partnerships. Popul Health Manag 2018; 22:5-8. [PMID: 29757078 DOI: 10.1089/pop.2018.0040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Lori T Armistead
- 1 Center for Medication Optimization through Practice and Policy , UNC Eshelman School of Pharmacy, Chapel Hill, North Carolina
| | - Stefanie P Ferreri
- 2 Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy , Chapel Hill, North Carolina
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Weber ZA, Kaur P, Hundal A, Ibriga SH, Bhatwadekar AD. Effect of the pharmacist-managed cardiovascular risk reduction services on diabetic retinopathy outcome measures. Pharm Pract (Granada) 2018; 17:1319. [PMID: 31015869 PMCID: PMC6463412 DOI: 10.18549/pharmpract.2019.1.1319] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 01/20/2019] [Indexed: 12/27/2022] Open
Abstract
Background: Diabetic retinopathy (DR) is a progressive, sight-threatening long-term
complication of diabetes. Diabetes disease management reduces the risk of
developing or progression to a severe form of DR. However, there are no
reports of the potential role of pharmacists in DR progression. Objective: For this study, we performed a retrospective data analysis of patients with
diabetes seen at cardiovascular risk reduction services provided by
pharmacists with an objective to determine the potential role of pharmacists
in the DR progression. These services involve pharmacists working in
collaborative drug therapy management (CDTM), using a collaborative practice
agreement (CPA) with primary care physicians. Methods: Patient records and ophthalmological notes were collected for 317 individuals
seen by the pharmacists (intervention group) and 320 individuals seen only
by a physician (control). Results: Statistical analysis was performed on 148 individuals in an intervention
group and 120 individuals in the control group for which complete records
were available. Retinopathy progression remained stable in 89.6 % of
individuals in the intervention group compared to 87.9% in the
control group. Moreover, the relative risk of retinopathy progressing to a
severe form was 1.17 for the control group compared the intervention
group. Conclusions: Our studies provide a proof-of-concept that pharmacists-managed care
possesses a potential role in protection from DR, and paves a way for future
pharmacists managed care with an emphasis on reducing diabetic
complications.
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Affiliation(s)
- Zachary A Weber
- Clinical Associate Professor of Pharmacy Practice. College of Pharmacy, Purdue University. West Lafayette, IN (United States).
| | - Palakpreet Kaur
- Department of Ophthalmology, Indiana University, Indianapolis, IN (United States).
| | - Amrita Hundal
- Indiana University-Purdue University Indianapolis. Indianapolis, IN (United States).
| | - Somnooma H Ibriga
- Statistics Consultant. Department of Statistics, Purdue University. West Lafayette, IN (United States).
| | - Ashay D Bhatwadekar
- Department of Ophthalmology, Indiana University; & Adjunct Assistant Professor of Pharmacy Practice, College of Pharmacy, Purdue University. Indianapolis, IN (United States).
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The use of think-aloud protocols to identify a decision-making process of community pharmacists aimed at improving CMS Star Ratings scores. Res Social Adm Pharm 2018; 14:262-268. [DOI: 10.1016/j.sapharm.2017.03.052] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Accepted: 03/21/2017] [Indexed: 11/22/2022]
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Winslade N, Tamblyn R. Determinants of community pharmacists' quality of care: a population-based cohort study using pharmacy administrative claims data. BMJ Open 2017; 7:e015877. [PMID: 28939571 PMCID: PMC5623573 DOI: 10.1136/bmjopen-2017-015877] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 06/02/2017] [Accepted: 07/19/2017] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To determine if a prototype pharmacists' services evaluation programme that uses linked community pharmacy claims and health administrative data to measure pharmacists' performance can be used to identify characteristics of pharmacies providing higher quality of care. DESIGN Population-based cohort study using community pharmacy claims from 1 November 2009 to 30 June 2010. SETTING All community pharmacies in Quebec, Canada. PARTICIPANTS 1742 pharmacies dispensing 8 655 348 antihypertensive prescriptions to 760 700 patients. PRIMARY OUTCOME MEASURE Patient adherence to antihypertensive medications. PREDICTORS Pharmacy level: dispensing workload, volume of pharmacist-provided professional services (eg, refusals to dispense, pharmacotherapy recommendations), pharmacy location, banner/chain, pharmacist overlap and within-pharmacy continuity of care. Patient level: sex, age, income, patient prescription cost, new/chronic therapy, single/multiple antihypertensive medications, single/multiple prescribers and single/multiple dispensing pharmacies. Dispensing level: prescription duration, time of day dispensed and antihypertensive class. Multivariate alternating logistic regression estimated predictors of the primary outcome, accounting for patient and pharmacy clustering. RESULTS 9.2% of dispensings of antihypertensive medications were provided to non-adherent patients. Male sex, decreasing age, new treatment, multiple prescribers and multiple dispensing pharmacies were risk factors for increased non-adherence. Pharmacies that provided more professional services were less likely to dispense to non-adherent hypertensive patients (OR: 0.60; 95% CI: 0.57 to 0.62) as were those with better scores on the Within-Pharmacy Continuity of Care Index. Neither increased pharmacists' services for improving antihypertensive adherence per se nor increased pharmacist overlap impacted the odds of non-adherence. However, pharmacist overlap was strongly correlated with dispensing workload. There was significant unexplained variability among pharmacies belonging to different banners and chains. CONCLUSIONS Pharmacy administrative claims data can be used to calculate pharmacy-level characteristics associated with improved quality of care. This study supports the importance of pharmacist's professional services and continuity of pharmacist's care.
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Affiliation(s)
- Nancy Winslade
- Department of Medicine, McGill University, Montreal, Quebec, Canada
- Winslade Consultants, Ottawa, Ontario, Canada
| | - Robyn Tamblyn
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada
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Doucette WR, McDonough RP, Herald F, Goedken A, Funk J, Deninger MJ. Pharmacy performance while providing continuous medication monitoring. J Am Pharm Assoc (2003) 2017; 57:692-697. [PMID: 28844583 DOI: 10.1016/j.japh.2017.07.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Revised: 07/10/2017] [Accepted: 07/14/2017] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The aim of this work was to assess the effects of continuous medication monitoring (CoMM) on: 1) total costs of care; 2) proportion of days covered (PDC) rates; and 3) use of high-risk medications by older patients. DESIGN Cohort design. SETTING AND PARTICIPANTS A reimbursed CoMM program was implemented in a community pharmacy to manage problems with medications being dispensed to beneficiaries of a commercial insurer. Pharmacists assessed medications being dispensed, interacted with patients in the pharmacy, and documented their actions. Claims data compared the pharmacy performance for 3 study groups after 12 months of CoMM: group 1, patients with prescriptions dispensed only at the study pharmacy; group 2, patients with prescriptions dispensed from the study pharmacy and other pharmacies; and group 3, patients with no prescriptions dispensed by the study pharmacy. For the analyses, individuals in group 1 (CoMM-only group) were matched with those in group 2 and group 3 by age band, gender, risk category, and utilization band. MAIN OUTCOME MEASURES The variables of interest were per-member per-month total health care costs, medication adherence (PDC), and the use of high-risk medications in older adults. RESULTS At 12 months, per-member per-month total costs of care were significantly lower (P < 0.05) for group 1 versus group 2 ($309 difference) and for group 1 versus group 3 ($298 difference). At 12 months the average PDC for group 1 was significantly higher than for group 2 (3.8% difference) and group 3 (2.6% difference). No significant differences were found in the use of high-risk medications. CONCLUSION A CoMM program in a community pharmacy was associated with lower total costs of care and better medication adherence. Paying pharmacists to proactively address the safety, effectiveness, and adherence of medications at the time of dispensing can support optimization of medication therapy.
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Bussell JK, Cha E, Grant YE, Schwartz DD, Young LA. Ways Health Care Providers Can Promote Better Medication Adherence. Clin Diabetes 2017; 35:171-177. [PMID: 28761220 PMCID: PMC5510928 DOI: 10.2337/cd016-0029] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
| | - EunSeok Cha
- Chungnam National University, Daejeon, South Korea
- Emory University, Atlanta, GA
| | | | | | - Lara A. Young
- University of North Carolina at Chapel Hill, Chapel, Hill, NC
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McCartney E, Bacci JL, Ossman KL, Richardson RM, DelPizzo D, DeJames J, McGivney MS. Mobile application features sought after by patients of a regional grocery store chain pharmacy. J Am Pharm Assoc (2003) 2017; 56:62-66.e1. [PMID: 26802923 DOI: 10.1016/j.japh.2015.11.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 08/24/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To determine the mobile application features for pharmacy services sought after by patients of a grocery store chain pharmacy. METHODS Key informant interviews were conducted at 5 Giant Eagle Pharmacy locations in the Greater Pittsburgh area. Patients older than 35 years who receive 1 prescription monthly from Giant Eagle and use a smartphone daily were eligible to participate. Interviews were audio recorded, and transcripts underwent thematic analysis. RESULTS Twenty-four interviews were conducted from February to March 2014. The average age of participants was 51 years. About one-half of the participants (46%) were currently using mobile applications to manage their health. Three themes emerged regarding patients' desires for a mobile application: design that fosters an improved, convenient pharmacy experience; features that support the self-management of health; and design that increases personalized, timely access to pharmacists. CONCLUSION This qualitative analysis revealed that pharmacy patients desire a mobile application that improves the convenience of their pharmacy experience, enables them to self-manage their health, and increases their access to their pharmacist.
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77
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Lester CA, Mott DA, Chui MA. The Influence of a Community Pharmacy Automatic Prescription Refill Program on Medicare Part D Adherence Metrics. J Manag Care Spec Pharm 2017; 22:801-7. [PMID: 27348281 PMCID: PMC7891841 DOI: 10.18553/jmcp.2016.22.7.801] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The Centers for Medicare & Medicaid Services (CMS) include measures of medication adherence within its Medicare Part D star ratings program. These adherence measures have motivated the development of new methods to improve patient adherence. Automatic prescription refill programs in community pharmacies are an intervention that has seen widespread adoption in recent years. These automatic refill programs anticipate and initiate prescription refills on a standardized, recurrent basis. As a result, prescription refills may be filled before a patient typically might initiate a refill. This study measures the effect of an automatic prescription refill program on 3 adherence metrics used by CMS within Medicare Part D star ratings. OBJECTIVE To compare the value of Medicare Part D adherence metrics for an automatic prescription refill program relative to standard prescription refills. METHODS Prescription dispensing data (January 1, 2014-December 31, 2014) from a chain of 29 pharmacies in a midwestern state were used to conduct this analysis. A post-only, quasi-experimental design separated patients into automatic and standard prescription refill cohorts. Refill adherence was calculated using proportion of days covered (PDC) for each of the 3 adherence metrics used by CMS for statins, renin angiotensin aldosterone system antagonists (RASA), and noninsulin diabetes medications. The adherence rate was defined as the proportion of patients with a PDC ± 80%. Inclusion criteria for patients followed the Pharmacy Quality Alliance technical specifications. Chi-square analysis and multiple logistic regression were used to examine differences in PDC > 80% between the 2 study cohorts. RESULTS There were 1,018, 1,006, and 368 patients for the automatic refill cohort and 3,928, 3,409, and 1,207 patients for the standard refill cohort in the statin, RASA, and diabetes adherence metrics, respectively. The mean age [SD] of patients was between 79.2 [±8.5] and 80.8 [±9.9] years across all cohorts. Patients in the automatic prescription refill program tended to take less than 1 additional chronic medication compared with the standard refill prescription cohort. The proportion of adherent patients ranged from 73.6% to 76.4% for standard refill cohorts and 77.5% to 83.6% for automatic refill cohorts. Differences between study cohorts were statistically significant for all the adherence metrics based on the chi-square test (P < 0.05). Patients enrolled in the automatic prescription refill program were more likely to be adherent to the statin (OR = 1.51, 95% CI = 1.26-1.82), RASA (OR = 1.20, 95% CI = 1.01-1.42), and diabetes (OR = 1.44, 95% CI = 1.06-1.96) metrics. CONCLUSIONS Patients enrolled in the automatic prescription refill program were more likely to be adherent to their medications. Enrollment in automatic prescription refill programs could be encouraged by health plans and pharmacists because of their potential effect on Medicare Part D star ratings. DISCLOSURES The project described was supported by the Clinical and Translational Science Award (CTSA) program through the NIH National Center for Advancing Translational Sciences (NCATS), grant UL1TR000427. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. Lester is employed as a pharmacist in the participating pharmacy chain. The authors report no other relevant conflict of interest. Study concept and design were primarily contributed by Lester, with assistance from the other authors. Lester took the lead in data collection, along with Chui, and data interpretation was performed by Lester, Mott, and Chui. The manuscript was written primarily by Lester, along with Mott, and revised by Lester, Mott, and Chui.
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Affiliation(s)
- Corey A Lester
- 1 Social and Administrative Sciences Division, School of Pharmacy, University of Wisconsin-Madison
| | - David A Mott
- 1 Social and Administrative Sciences Division, School of Pharmacy, University of Wisconsin-Madison
| | - Michelle A Chui
- 1 Social and Administrative Sciences Division, School of Pharmacy, University of Wisconsin-Madison
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Krall J, Durdock K, Johnson P, Kanter J, Koshinsky J, Thearle M, Siminerio L. Exploring Approaches to Facilitate Diabetes Therapy Intensification in Primary Care. Clin Diabetes 2017; 35:100-105. [PMID: 28442825 PMCID: PMC5391815 DOI: 10.2337/cd16-0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Jodi Krall
- University of Pittsburgh Diabetes Institute, Pittsburgh, PA
| | - Kendra Durdock
- Penn State Hershey Medical Group Care Management, Penn State Hershey, Hershey, PA
| | | | - Justin Kanter
- University of Pittsburgh Diabetes Institute, Pittsburgh, PA
| | | | | | - Linda Siminerio
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA
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Jörntén-Karlsson M, Pintat S, Molloy-Bland M, Berg S, Ahlqvist M. Patient-Centered Interventions to Improve Adherence to Statins: A Narrative Synthesis of Systematically Identified Studies. Drugs 2017; 76:1447-1465. [PMID: 27677773 PMCID: PMC5047948 DOI: 10.1007/s40265-016-0640-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Poor adherence to statins increases cardiovascular disease risk. We systematically identified 32 controlled studies that assessed patient-centered interventions designed to improve statin adherence. The limited number of studies and variation in study characteristics precluded strict quality criteria or meta-analysis. Cognitive education or behavioural counselling delivered face-to-face multiple times consistently improved statin adherence compared with control groups (7/8 and 3/3 studies, respectively). None of four studies using medication reminders and/or adherence feedback alone reported significantly improved statin adherence. Single interventions that improved statin adherence but were not conducted face-to-face included cognitive education in the form of genetic test results (two studies) and cognitive education via a website (one study). Similar mean adherence measures were reported for 17 intervention arms and were thus compared in a sub-analysis: 8 showed significantly improved statin adherence, but effect sizes were modest (+7 to +22 % points). In three of these studies, statin adherence improved despite already being high in the control group (82-89 vs. 57-69 % in the other studies). These three studies were the only studies in this sub-analysis to include cognitive education delivered face-to-face multiple times (plus other interventions). In summary, the most consistently effective interventions for improving adherence to statins have modest effects and are resource-intensive. Research is needed to determine whether modern communications, particularly mobile health platforms (recently shown to improve medication adherence in other chronic diseases), can replicate or even enhance the successful elements of these interventions while using less time and fewer resources.
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Affiliation(s)
| | | | - Michael Molloy-Bland
- Research Evaluation Unit, Oxford PharmaGenesis, Oxford, UK
- School of Medicine, Pharmacy and Health, Durham University, Stockton-on-Tees, UK
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Taitel MS, Mu Y, Gooptu A, Lou Y. Impact of late-to-refill reminder calls on medication adherence in the Medicare Part D population: evaluation of a randomized controlled study. Patient Prefer Adherence 2017; 11:373-379. [PMID: 28280310 PMCID: PMC5338963 DOI: 10.2147/ppa.s127997] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES This study evaluates a nationwide pharmacy chain's late-to-refill (LTR) reminder program that entails local pharmacists placing reminder calls to Medicare Part D patients. METHODS We conducted a randomized controlled study among 735,218 patients who exhibited nonadherent behavior by not refilling a maintenance medication 3 days from an expected refill date. Patients were randomly assigned to an intervention group who received LTR reminder calls or to a control group. We used Walgreens pharmaceutical claims data from 2015 to estimate the impact of LTR calls on short-term and annual adherence. RESULTS The initial refill rate within the first 14 days of the expected refill date significantly increased in the intervention group by 22.8% (6.09 percentage points) compared to the control group (P<0.001). The proportion of days covered (PDC) in the intervention group increased significantly by 1.5% (0.856 percentage points) relative to the control group (P<0.001) over 365 days. Patients in the intervention group were significantly more adherent (PDC ≥80%) by 3% (0.97 percentage points) compared to the control group (P<0.001). Over a 270-day follow-up period, persistence significantly increased by 2.15 days in the intervention group (P<0.001). CONCLUSION Results from this study suggest that LTR reminder calls increased adherence for Medicare Part D patients who are late in refilling their medications and therefore have the potential to reduce their risk for hospitalization and health care costs. Additionally, the intervention increased the number of patients with PDC ≥80% by ~3%, positively impacting Medicare Part D plan quality rating.
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Affiliation(s)
- Michael S Taitel
- Health Analytics, Research & Reporting, Walgreen Co., Deerfield, IL, USA
| | - Ying Mu
- Health Analytics, Research & Reporting, Walgreen Co., Deerfield, IL, USA
| | - Angshuman Gooptu
- Health Analytics, Research & Reporting, Walgreen Co., Deerfield, IL, USA
| | - Youbei Lou
- Health Analytics, Research & Reporting, Walgreen Co., Deerfield, IL, USA
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81
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Albanese NP, Pignato AM, Monte SV. Provider Perception of Pharmacy Services in the Patient-Centered Medical Home. J Pharm Pract 2016; 30:612-620. [PMID: 27887032 DOI: 10.1177/0897190016679759] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Despite the positive data on clinical outcomes, cost savings, and provider experience, no study has surveyed providers to evaluate what pharmacy services they find to be worthwhile. OBJECTIVE To determine what clinical, cost/access, and educational pharmacy services providers in a patient-centered medical home (PCMH) consider worthwhile and the perceived barriers to successful pharmacist incorporation. METHODS A cross-sectional online survey was distributed to primary care physicians, nurse practitioners, and physician assistants in a PCMH physician group. RESULTS The survey response rate was 78%. Top-tier clinical services were identified as medication counseling, reconciliation, adherence assessment, polypharmacy assessment, and drug information. Formulary review was the only top-tier cost- or access-related service. Top-tier educational services included new black-boxed warnings, drug market withdrawals, and new drug reviews. Ninety-one percent of providers were comfortable referring to a pharmacist for diabetes medication selection and dose titration, but no other disease state eclipsed 75%. More than twice as many providers found the pharmacy service to be very or extremely valuable when the pharmacist is physically located in the office versus virtual interactions (70% vs 34%). CONCLUSION Top-tier clinical, cost/access, and educational services considered worthwhile by providers in a PCMH have been identified. In addition to these services, when developing or evaluating a pharmacy service, special attention should be paid to provider preference for physical location in the office and perceived barriers to the pharmacist availability, concern over complex disease management competency and patient confusion as to the role of the pharmacist.
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Affiliation(s)
- Nicole P Albanese
- 1 School of Pharmacy and Pharmaceutical Sciences, State University of New York at Buffalo, Buffalo, NY, USA
| | - Alyssa M Pignato
- 2 Buffalo Medical Group, State University of New York at Buffalo School of Pharmacy and Pharmaceutical Sciences, Buffalo, NY, USA.,3 Excellus Blue Cross Blue Shield, Rochester, NY, USA
| | - Scott V Monte
- 1 School of Pharmacy and Pharmaceutical Sciences, State University of New York at Buffalo, Buffalo, NY, USA
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82
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Hohmeier KC, Borja-Hart N. Are patient's simply unaware? A cross-sectional study of website promotion of community pharmacy adherence-related services in Tennessee. Res Social Adm Pharm 2016; 12:1004-1009. [PMID: 26706404 DOI: 10.1016/j.sapharm.2015.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 11/07/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Medication adherence rates can impact patient outcomes, quality of life, and health care costs. Community pharmacists who offer adherence-related services are well positioned to bolster medication adherence rates. One means for patients to learn more about these services is through the pharmacy's website. However, the prevalence of pharmacies' promotion of adherence services through the internet is unknown. OBJECTIVES The present study aimed to quantify the online promotion of pharmacies' adherence-related services. METHODS This was a cross-sectional, observational study of websites representing licensed community pharmacies. One-hundred and sixty-nine community pharmacy websites, representing 1161 of community pharmacies in Tennessee (U.S. State), were included in the observational analysis. RESULTS The most commonly promoted adherence-related service was online refills (81.1%). Auto refill, medication synchronization, and packaging systems were promoted on <20% pharmacy websites. Types of promoted adherence services differed between chain and independent pharmacy websites. CONCLUSIONS Despite 67% of pharmacies offering adherence-related services, only a fraction of them promote these services online. Patient awareness represents a hidden and often unaddressed variable in increasing adherence. Future studies should investigate whether increasing website promotion of these services would increase service use, and potentially improve adherence rates.
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Affiliation(s)
- Kenneth C Hohmeier
- Department of Clinical Pharmacy, University of Tennessee Health Science Center, 193 Polk Avenue, Suite 2D, Nashville, TN 37210, USA.
| | - Nancy Borja-Hart
- Department of Clinical Pharmacy, University of Tennessee Health Science Center, 193 Polk Avenue, Suite 2D, Nashville, TN 37210, USA
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83
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Blackburn DF, Evans CD, Eurich DT, Mansell KD, Jorgenson DJ, Taylor JG, Semchuk WM, Shevchuk YM, Remillard AJ, Tran DA, Champagne AP. Community Pharmacists Assisting in Total Cardiovascular Health (CPATCH): A Cluster-Randomized, Controlled Trial Testing a Focused Adherence Strategy Involving Community Pharmacies. Pharmacotherapy 2016; 36:1055-1064. [DOI: 10.1002/phar.1831] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- David F. Blackburn
- College of Pharmacy & Nutrition; University of Saskatchewan; Saskatoon Saskatchewan Canada
| | - Charity D. Evans
- College of Pharmacy & Nutrition; University of Saskatchewan; Saskatoon Saskatchewan Canada
| | - Dean T. Eurich
- School of Public Health; University of Alberta; Edmonton Alberta Canada
| | - Kerry D. Mansell
- College of Pharmacy & Nutrition; University of Saskatchewan; Saskatoon Saskatchewan Canada
| | - Derek J. Jorgenson
- College of Pharmacy & Nutrition; University of Saskatchewan; Saskatoon Saskatchewan Canada
| | - Jeff G. Taylor
- College of Pharmacy & Nutrition; University of Saskatchewan; Saskatoon Saskatchewan Canada
| | | | - Yvonne M. Shevchuk
- College of Pharmacy & Nutrition; University of Saskatchewan; Saskatoon Saskatchewan Canada
| | - Alfred J. Remillard
- College of Pharmacy & Nutrition; University of Saskatchewan; Saskatoon Saskatchewan Canada
| | - David A. Tran
- College of Pharmacy & Nutrition; University of Saskatchewan; Saskatoon Saskatchewan Canada
| | - Anne P. Champagne
- Drug Plan and Extended Benefits Branch; Ministry of Health; Government of Saskatchewan; Regina Saskatchewan Canada
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84
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Cochran G, Hruschak V, DeFosse B, Hohmeier KC. Prescription opioid abuse: pharmacists' perspective and response. INTEGRATED PHARMACY RESEARCH AND PRACTICE 2016; 5:65-73. [PMID: 29354541 PMCID: PMC5741039 DOI: 10.2147/iprp.s99539] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Opioid medication abuse and overdose are major concerns for public health, and a number of responses to address these issues have taken place across the US. Pharmacists and the pharmacy profession have made important contributions as a part of the response to this national crisis. This article provides a brief review of the antecedents, driving forces, and health status of patients involved in the opioid medication and overdose epidemic. This review further discusses pharmacy-based actions that have been undertaken to address this issue, including prescription drug monitoring, take-back, and naloxone training/distribution programs. This review likewise examines current efforts underway in the field to educate practitioners and needed future steps that must be taken by pharmacists in order to continue the profession's pivotal role in working toward resolving this national public health problem. In particular, evidence and arguments are presented for proactively identifying and intervening with patients who abuse and/or are at risk for overdose. Continued and active engagement by pharmacists in these efforts has the potential to result in important reductions in opioid medication abuse and overdose and improvements for patient's health.
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Affiliation(s)
- Gerald Cochran
- Department of Psychiatry, School of Medicine
- School of Social Work, University of Pittsburgh, Pittsburgh, PA
| | | | - Brooke DeFosse
- Department of Clinical Pharmacy, College of Pharmacy, University of Tennessee, Memphis, TN, USA
| | - Kenneth C Hohmeier
- Department of Clinical Pharmacy, College of Pharmacy, University of Tennessee, Memphis, TN, USA
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85
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Abstract
OBJECTIVES This study tested screening feasibility and described the behavioral, mental, and physical health of patients filling prescriptions for opioid medications in the community pharmacy setting. METHODS We conducted a cross-sectional survey in rural/urban community pharmacies with adult noncancer patients. The survey included validated measures for opioid medication misuse risk, drug and alcohol use, and physical and mental health problems. Descriptive statistics were calculated, and bivariate and multivariable logistic regression evaluated relationships between opioid medication misuse risk and patient demographics, behavioral, mental, and physical health. RESULTS A total of 164 patients completed the survey (87% response rate), revealing positive screens for prescription opioid misuse risk (14.3%), illicit drug use (7.3%), hazardous alcohol use (21.4%), depression (25.8%), and posttraumatic stress disorder (PTSD; 17.1%). Bivariate analyses revealed increased odds of a positive opioid medication misuse risk score with a positive screen for illicit drug use in the previous year (odds ratio = 3.91; 95% confidence interval [CI], 1.05-14.63) and PTSD (odds ratio = 6.7; 95% CI, 2.54-17.69). In adjusted multivariable analyses, these relationships strengthened such that a positive screen for illicit drug use (adjusted odds ratio = 12.96; 95% CI, 2.18-76.9) and PTSD (adjusted odds ratio = 13.3; 95% CI, 3.48-50.66) increased odds for a positive opioid medication misuse risk score. CONCLUSIONS Findings confirmed the feasibility of screening risk factors and positive opioid medication misuse risk among community pharmacy patients. Future research should validate these findings as a foundation to intervention development.
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86
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Winslade N, Eguale T, Tamblyn R. Optimising the changing role of the community pharmacist: a randomised trial of the impact of audit and feedback. BMJ Open 2016; 6:e010865. [PMID: 27207626 PMCID: PMC4885441 DOI: 10.1136/bmjopen-2015-010865] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To evaluate the impact of comparative performance feedback to community pharmacists on provision of professional services and the quality of patients' medication use. DESIGN Randomised, controlled, single-blind trial. SETTING All 1833 community pharmacies in the Quebec province, Canada. PARTICIPANTS 1814 pharmacies not opting out and with more than 5 dispensings of the target medications during the 6-month baseline were randomised by a 2×2 factorial design to feedback first for hypertension adherence (907 control, 907 intervention) followed by randomisation for asthma adherence (791 control, 807 intervention). 1422 of 1814 pharmacies had complete information available during the follow-up for hypertension intervention (706 intervention, 716 control), and 1301 of 1598 had the follow-up information for asthma (657 intervention, 644 control). INTERVENTION Using provincial billing data to measure performance, mailed comparative feedback reported the pharmacy-level percentage of dispensings to patients non-adherent to antihypertensive medications or overusing asthma rescue inhalers. PRIMARY AND SECONDARY OUTCOME MEASURES The number of hypertension/asthma services billed per pharmacy and percentage of dispensings to non-adherent patients over the 12 months post intervention. RESULTS Feedback on the asthma measure led to increased provision of asthma services (control 0.2, intervention 0.4, RR 1.58, 95% CI 1.02 to 2.46). However, this did not translate into reductions in patients' overuse of rescue inhalers (control 45.5%, intervention 44.6%, RR 0.99, 95% CI 0.98 to 1.01). For non-adherence to antihypertensive medications, feedback resulted in no difference in either provision of hypertension services (control 0.7, intervention 0.8, RR 1.25, 95% CI 0.86 to 1.82) or antihypertensive treatment adherence (control 27.9%, intervention 28.0%, RR 1.0, 95% CI 0.99 to 1.00). Baseline performance did not influence results, and there was no evidence of a cumulative effect with repeated feedback. CONCLUSIONS Comparative pharmacy performance feedback increased the provision of asthma pharmacists' services but did not improve the performance on medication-use measures. Billing data can be used to evaluate the impact of billable services rendered by pharmacists on the quality of patients' medication use.
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Affiliation(s)
- Nancy Winslade
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Tewodros Eguale
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada
- Massachusetts College of Pharmacy and Health Sciences, Boston, Massachusetts, USA
| | - Robyn Tamblyn
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada
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87
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Cochran G, Bacci JL, Ylioja T, Hruschak V, Miller S, Seybert AL, Tarter R. Prescription opioid use: Patient characteristics and misuse in community pharmacy. J Am Pharm Assoc (2003) 2016; 56:248-256.e6. [PMID: 27053277 PMCID: PMC4886233 DOI: 10.1016/j.japh.2016.02.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 02/11/2016] [Accepted: 02/12/2016] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Opioid pain medication misuse is a major concern for US public health. The purpose of this article is to: 1) describe the demographic and physical, behavioral, and mental health characteristics of patients who fill opioid medications in community pharmacy settings; and 2) describe the extent of opioid medication misuse behaviors among these patients. DESIGN We recruited and screened a convenience sample of patients with the use of a tablet computer-based assessment protocol that examined behavioral, mental, and physical health. Descriptive and inferential statistics were calculated to describe respondents and their opioid medication misuse and health characteristics. SETTING Patients were screened in 2 urban and 2 rural community pharmacies in southwestern Pennsylvania. PARTICIPANTS Survey participants were adult patients filling opioid pain medications who were not currently receiving treatment for a cancer diagnosis. INTERVENTION None. MAIN OUTCOME MEASURES Validated screening measures included the Prescription Opioid Misuse Index, Alcohol Use Disorders Identification Test C, Short Form 12, Drug Abuse Screening Test 10, Primary Care Post-traumatic Stress Disorder (PTSD) screen, and the Patient Health Questionnaire 2. RESULTS A total of 333 patients were screened (71.2% response rate). Nearly the entire population reported pain above and general health below national norms. Hydrocodone (19.2%) and morphine (20.8%) were found to be the medications with the highest rates of misuse-with hydrocodone having more than 4 times higher odds of misuse compared with other medications (adjusted odds ratio [AOR] 4.48, 95% confidence interval [CI] 1.1-17.4). Patients with positive screens for illicit drug use (AOR 8.07, 95% CI 2.7-24.0), PTSD (AOR 5.88, 95% CI 2.3-14.7), and depression (AOR 2.44, 95% CI 1.0-5.9) also had significantly higher odds for misuse compared with those with negative screening results. CONCLUSION These findings provide important foundational data that suggest implementation of regular opioid misuse screening protocols within community pharmacies. Such screening activities could foster a culture of prevention and overall reduction for misuse among patients filling opioid medications in community pharmacies.
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88
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Wang Y, Yeo QQ, Ko Y. Economic evaluations of pharmacist-managed services in people with diabetes mellitus: a systematic review. Diabet Med 2016; 33:421-7. [PMID: 26433008 DOI: 10.1111/dme.12976] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/29/2015] [Indexed: 11/28/2022]
Abstract
AIM To review and evaluate the most recent literature on the economic outcomes of pharmacist-managed services in people with diabetes. BACKGROUND The global prevalence of diabetes is increasing. Although pharmacist-managed services have been shown to improve people's health outcomes, the economic impact of these programmes remains unclear. METHODS A systematic review was conducted of six databases. Study inclusion criteria were: (1) original research; (2) evaluation of pharmacist-managed services in people with diabetes; (3) an economic evaluation; (4) English-language publication; and (5) full-text, published between January 2006 and December 2014. The quality of the full economic evaluations reviewed was evaluated using the Consolidated Health Economic Evaluation Reporting Standards checklist. RESULTS A total of 2204 articles were screened and 25 studies were selected. These studies were conducted in a community pharmacy (n = 10), a clinic- /hospital-based outpatient facility (n = 8), or others. Pharmacist-managed services included targeted education (n = 24), general pharmacotherapeutic monitoring (n = 21), health screening or laboratory testing services (n = 9), immunization services (n = 2) and pharmacokinetic monitoring (n = 1). Compared with usual care, pharmacist-managed services resulted in cost savings that varied from $7 to $65,000 ($8 to $85,000 in 2014 US dollars) per person per year, and generated higher quality-adjusted life years with lower costs. Benefit-to-cost ratios ranged from 1:1 to 8.5:1. Among the 25 studies reviewed, 11 were full economic evaluations of moderate quality. CONCLUSIONS Pharmacist-managed services had a positive return in terms of economic viability. With the expanding role of pharmacists in the healthcare sector, alongside increasing health expenditure, future economic studies of high quality are needed to investigate the cost-effectiveness of these services.
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Affiliation(s)
- Y Wang
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Q Q Yeo
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore
| | - Y Ko
- School of Pharmacy, College of Pharmacy, Taipei Medical University, Taiwan
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89
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Tueller SJ, Deboeck PR, Van Dorn RA. Getting less of what you want: reductions in statistical power and increased bias when categorizing medication adherence data. J Behav Med 2016; 39:969-980. [PMID: 26921166 DOI: 10.1007/s10865-016-9727-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 02/19/2016] [Indexed: 10/22/2022]
Abstract
Medication adherence is thought to be the principal clinical predictor of positive clinical outcomes, not only for serious mental illnesses such as schizophrenia, bipolar disorder, or depression, but also for physical conditions such as diabetes. Consequently, research on medication often looks not only at medication condition (e.g., placebo, standard medication, investigative medication), but also at adherence in taking those medications within each medication condition. The percentage (or proportion) scale is one of the more frequently employed and easily interpretable measures. Patients can be 0 % adherent, 100 % adherent, or somewhere in between. For simplicity, many reported adherence analyses dichotomize or trichotomize the adherence predictor when estimating its effect on outcomes of interest. However, the methodological literature shows that the practice of categorizing continuously distributed predictors reduces statistical power at best and, at worst, can severely bias parameter estimates. This can result in inflated Type I errors (false positive acceptance of null adherence effects) or Type II errors (false negative rejection of true adherence effects). We extend the methodological literature on categorization to the construct of adherence. The measurement scale of adherence leads to a diverse family of potential distributions including uniform, n-shaped, u-shaped (i.e., bimodal), positively skewed, and negatively skewed. Using a simulation study, we generated negative, null, and positive "true" effects of adherence on simulated continuous and binary outcomes. We then estimated the adherence effect with and without categorizing the adherence variable. We show how parameter estimates and standard errors can be severely biased when categorizing adherence. The categorization of adherence is shown to cause null effects to become positive or negative depending on the distribution of the simulated adherence variable, inflating Type I errors. When the adherence effect was significantly different from zero, categorization can render the effect null, inflating Type II errors. We recommend that adherence be measured continuously and analyzed without categorization when using it as a predictor in regression models.
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Affiliation(s)
- Stephen J Tueller
- RTI International, 3040 E. Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC, 27709, USA.
| | | | - Richard A Van Dorn
- RTI International, 3040 E. Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC, 27709, USA
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90
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Sun P, Lian J. Treatment adherence in newly diagnosed type 2 diabetes: patient characteristics and long-term impact of adherence on inpatient care utilization. Postgrad Med 2016; 128:338-45. [PMID: 26849064 DOI: 10.1080/00325481.2016.1151326] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES The purpose of this study was to evaluate the impact of antidiabetic medication adherence on hospital utilization in patients with newly diagnosed type 2 diabetes mellitus (T2D). This study specifically analyzed patients with newly diagnosed T2D with the intent of lessening intragroup disease severity differences, and adjusting for a range of other clinical and demographic characteristics. METHODS This retrospective US claims database study evaluated adults with newly diagnosed T2D who started antidiabetic medications in 2005-2009, had ≥ 2 antidiabetic medication claims after their first (baseline). Medication adherence was evaluated using the medication possession ratio (MPR) of any or all antidiabetic medication(s) during the 3-year post-baseline period. Repeated-measures analyses examined changes in inpatient utilization from the pre- to post-baseline period. The impact of adherence on hospital utilization during the post-baseline period was evaluated with a logistic regression model to adjust for confounding factors. RESULTS The study included 192,717 patients (mean age, 55.0 years). Mean MPR for antidiabetic therapy was 0.74. MPR was highest in elderly patients and Medicare beneficiaries. Mean annualized inpatient admissions during the 3-year post-baseline period were significantly lower in patients with MPR ≥ 0.80 (1.4) than in those with MPR < 0.80 (2.2; P < 0.05). Logistic regression analysis, adjusting for patient characteristics and prior inpatient utilization, showed 39% lower odds of hospitalization (OR = 0.61; 95% CI = 0.534-0.693) for patients with MPR ≥ 0.80. People with T2D-related complications or hospitalization had approximately 2- to 3-fold higher risk of subsequent hospitalization. CONCLUSIONS In newly diagnosed T2D patients with antidiabetic therapy in the first three ensuing years, higher antidiabetic medication adherence was significantly associated with lower hospital inpatient utilization before and after adjusting for patient characteristics.
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Affiliation(s)
- Peter Sun
- a Health Economics and Outcomes Research Division, Kailo Research Group , Fishers , IN , USA
| | - Jean Lian
- b Formerly Health Economics and Outcomes Research Division, Novo Nordisk , Plainsboro , NJ , USA
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91
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Brummel A, Carlson AM. Comprehensive Medication Management and Medication Adherence for Chronic Conditions. J Manag Care Spec Pharm 2016; 22:56-62. [PMID: 27015052 PMCID: PMC10397616 DOI: 10.18553/jmcp.2016.22.1.56] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The beneficial clinical effects of medication adherence have been consistently reported across most chronic diseases. Medication nonadherence carries significant economic and clinical burden. Medication therapy management (MTM) services aim to optimize pharmacotherapy and improve medication adherence. OBJECTIVE To evaluate the impact of exposure to face-to-face comprehensive medication management (CMM) services on medication adherence across 4 classes of chronic disease medications: oral diabetes medications, statins, angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs), and beta-blockers. METHODS Pharmacy claims of continuously enrolled employees of a large Midwest integrated health system were retrieved for the period 2007-2011. Retrospective analysis was used to compare medication adherence measured using proportion of days covered (PDC) in employees who received CMM with employees who did not (control group). The pharmacy MTM program used the Patient-Centered Primary Care Collaborative standard of care. The CMM group's index date was the date of the first CMM visit; the non-CMM group's index date was randomly chosen from all therapeutic class-specific prescription claims dates. For each therapeutic class, patients with at least 1 prescription fill in both the measurement period (365 days post-index) and the baseline period (365 days pre-index) were included. The primary outcome measure was the PDC. RESULTS The CMM group had consistently higher and statistically significant PDC levels across all the therapeutic classes in the measurement period (P < 0.05) when looking at the unadjusted comparison. In the multivariate models, CMM exposure was associated with higher PDC; the difference between groups was statistically significant in all therapeutic classes except for oral diabetes medications (oral diabetes medications: 0.0403, 95% confidence limits [CL] = -0.0050, 0.0850; statins: 0.0769, 95% CL = 0.0480, 0.1050; ACEIs/ARBs: 0.1083; 95% CL = 0.0710, 0.1450; and beta-blockers: 0.0484; 95% CL = 0.0060, 0.0910). Logistic regression showed that the CMM group had an increased probability of meeting the 80% PDC cut-point for statins (3.36, 95% CL = 0.048, 0.105); ACEIs/ARBs (3.57, 95% CL = 2.35, 5.42); and beta-blockers (2.56, 95% CL = 1.57, 4.18). CONCLUSIONS Exposure to face-to-face CMM services resulted in improvement of medication adherence. CMM is a powerful practice model that should be encouraged by insurers and health plan administrators to increase rates of medication adherence.
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Pringle J, Coley KC. Improving medication adherence: a framework for community pharmacy-based interventions. INTEGRATED PHARMACY RESEARCH AND PRACTICE 2015; 4:175-183. [PMID: 29354532 PMCID: PMC5741023 DOI: 10.2147/iprp.s93036] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Evidence supports that patient medication adherence is suboptimal with patients typically taking less than half of their prescribed doses. Medication nonadherence is associated with poor health outcomes and higher downstream health care costs. Results of studies evaluating pharmacist-led models in a community pharmacy setting and their impact on medication adherence have been mixed. Community pharmacists are ideally situated to provide medication adherence interventions, and effective strategies for how they can consistently improve patient medication adherence are necessary. This article suggests a framework to use in the community pharmacy setting that will significantly improve patient adherence and provides a strategy for how to apply this framework to develop and test new medication adherence innovations. The proposed framework is composed of the following elements: 1) defining the program's pharmacy service vision, 2) using evidence-based, patient-centered communication and intervention strategies, 3) using specific implementation approaches that ensure fidelity, and 4) applying continuous evaluation strategies. Within this framework, pharmacist interventions should include those services that capitalize on their specific skill sets. It is also essential that the organization's leadership effectively communicates the pharmacy service vision. Medication adherence strategies that are evidence-based and individualized to each patient's adherence problems are most desirable. Ideally, interventions would be delivered repeatedly over time and adjusted when patient's adherence circumstances change. Motivational interviewing principles are particularly well suited for this. Providing effective training and ensuring that the intervention can be delivered with fidelity within a specified workflow process are also essential for success. Utilizing this proposed framework will lead to greater and consistent success when implementing pharmacist-led medication adherence interventions in the community pharmacy setting.
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Affiliation(s)
- Janice Pringle
- Program Evaluation and Research Unit, Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kim C Coley
- Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA, USA
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93
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Getting lost among the guidelines: the difference between patient-focused treatment and population management. Am J Med 2015; 128:e73. [PMID: 26387005 DOI: 10.1016/j.amjmed.2014.12.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 12/10/2014] [Accepted: 12/10/2014] [Indexed: 11/20/2022]
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94
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Bacci JL, McGrath SH, Pringle JL, Maguire MA, McGivney MS. Implementation of targeted medication adherence interventions within a community chain pharmacy practice: The Pennsylvania Project. J Am Pharm Assoc (2003) 2015; 54:584-93. [PMID: 25379980 DOI: 10.1331/japha.2014.14034] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To identify facilitators and barriers to implementing targeted medication adherence interventions in community chain pharmacies, and describe adaptations of the targeted intervention and organizational structure within each individual pharmacy practice. DESIGN Qualitative study. SETTING Central and western Pennsylvania from February to April 2012. PARTICIPANTS Rite Aid pharmacists staffed at the 118 Pennsylvania Project intervention sites. MAIN OUTCOME MEASURES Qualitative analysis of pharmacists' perceptions of facilitators and barriers experienced, targeted intervention and organizational structure adaptations implemented, and training and preparation prior to implementation. RESULTS A total of 15 key informant interviews were conducted from February to April 2012. Ten pharmacists from "early adopter" practices and five pharmacists from "traditionalist" practices were interviewed. Five themes emerged regarding the implementation of targeted interventions, including all pharmacists' need to understand the relationship of patient care programs to their corporation's vision; providing individualized, continual support and mentoring to pharmacists; anticipating barriers before implementation of patient care programs; encouraging active patient engagement; and establishing best practices regarding implementation of patient care services. CONCLUSION This qualitative analysis revealed that there are a series of key steps that can be taken before the execution of targeted interventions that may promote successful implementation of medication therapy management in community chain pharmacies.
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95
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Rose O, Schaffert C, Czarnecki K, Mennemann HS, Waltering I, Hamacher S, Felsch M, Herich L, Köberlein J. Effect evaluation of an interprofessional medication therapy management approach for multimorbid patients in primary care: a cluster-randomized controlled trial in community care (WestGem study protocol). BMC FAMILY PRACTICE 2015. [PMID: 26198433 PMCID: PMC4508809 DOI: 10.1186/s12875-015-0305-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background Pharmaceutical practice worldwide is developing towards patient care. Medication Review (MR) and Medication Therapy Management (MTM) are evolving as the most prominent services in pharmaceutical care and have a strong potential to provide a large benefit for patients and society. MTMs can only be performed in an interprofessional, collaborative setting. Several international studies have explored the effects of a MTM on the quality of therapy and costs. For Germany the data is still deficient. This study aims to provide data on the effects of an interprofessional MTM regarding quality of therapy, quality of life, costs and cost-effectiveness. Method/Design The study is designed as a cluster-randomized controlled trial in primary care, involving 12 outpatient clinics (clusters) and 165 patients. Primary care units are allocated to interventions using a Stepped Wedge Design. All units are initially assigned to the control group. After a 6 month observation period, general practitioners (GP) are randomly allocated to one of three groups and the interprofessional medication therapy management approach is implemented sequentially per each group with a lag of 3 months between. The primary outcome is the change in the quality of therapy measured by the MAI (Medication Appropriateness Index). Secondary outcomes include changes in the number of drug related problems, medication complexity, changes in drug-adherence, changes in health-status and function, quality of life, direct costs and the incremental cost-effectiveness ratio. The acceptance of the interprofessional Medication Therapy Management approach is assessed by qualitative methods. Discussion The patient interview and brown bag review are activities, typically provided by the pharmacist. In this trial the patient is blinded to the pharmacist. The strength of having the patient blinded to the pharmacists is to exclude skepticism of the patient toward unknown pharmacies, which might be a major confounder in a regional and community setting. A weakness is that some patient related data might reach the pharmacists in a way, which might differ from self-acquired data. Trial registration Current controlled trials ISRCTN41595373.
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Affiliation(s)
- Olaf Rose
- Department of Clinical Pharmacy, University of Bonn, An der Immenburg 4, 53121, Bonn, Germany. .,Elefanten-Apotheke gegr 1575, Steinstr. 14, 48565, Steinfurt, Germany.
| | - Corinna Schaffert
- Centre of Health Care Management and Public Health, Schumpeter School of Business and Economics, University of Wuppertal, Wuppertal, Germany.
| | - Kathrin Czarnecki
- Centre of Health Care Management and Public Health, Schumpeter School of Business and Economics, University of Wuppertal, Wuppertal, Germany.
| | - Hugo S Mennemann
- Muenster University of Applied Science, Robert-Koch-Str. 30, 48149, Muenster, Germany.
| | - Isabel Waltering
- Department of Pharmacy, University of Muenster, Corrensstr. 48, 48149, Muenster, Germany.
| | - Stefanie Hamacher
- Institute of Medical Statistics, Informatics and Epidemiology, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
| | - Moritz Felsch
- Institute of Medical Statistics, Informatics and Epidemiology, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
| | - Lena Herich
- Institute of Medical Statistics, Informatics and Epidemiology, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
| | - Juliane Köberlein
- Centre of Health Care Management and Public Health, Schumpeter School of Business and Economics, University of Wuppertal, Wuppertal, Germany.
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96
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Wiler JL, Welch S, Pines J, Schuur J, Jouriles N, Stone-Griffith S. Emergency department performance measures updates: proceedings of the 2014 emergency department benchmarking alliance consensus summit. Acad Emerg Med 2015; 22:542-53. [PMID: 25899754 DOI: 10.1111/acem.12654] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 11/03/2014] [Accepted: 11/12/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The objective was to review and update key definitions and metrics for emergency department (ED) performance and operations. METHODS Forty-five emergency medicine leaders convened for the Third Performance Measures and Benchmarking Summit held in Las Vegas, February 21-22, 2014. Prior to arrival, attendees were assigned to workgroups to review, revise, and update the definitions and vocabulary being used to communicate about ED performance and operations. They were provided with the prior definitions of those consensus summits that were published in 2006 and 2010. Other published definitions from key stakeholders in emergency medicine and health care were also reviewed and circulated. At the summit, key terminology and metrics were discussed and debated. Workgroups communicated online, via teleconference, and finally in a face-to-face meeting to reach consensus regarding their recommendations. Recommendations were then posted and open to a 30-day comment period. Participants then reanalyzed the recommendations, and modifications were made based on consensus. RESULTS A comprehensive dictionary of ED terminology related to ED performance and operation was developed. This article includes definitions of operating characteristics and internal and external factors relevant to the stratification and categorization of EDs. Time stamps, time intervals, and measures of utilization were defined. Definitions of processes and staffing measures are also presented. Definitions were harmonized with performance measures put forth by the Centers for Medicare and Medicaid Services (CMS) for consistency. CONCLUSIONS Standardized definitions are necessary to improve the comparability of EDs nationally for operations research and practice. More importantly, clear precise definitions describing ED operations are needed for incentive-based pay-for-performance models like those developed by CMS. This document provides a common language for front-line practitioners, managers, health policymakers, and researchers.
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Affiliation(s)
- Jennifer L. Wiler
- Department of Emergency Medicine; University of Colorado School of Medicine; Aurora CO
| | - Shari Welch
- Intermountain Institute for Healthcare Delivery Research; Salt Lake City UT
- Emergency Department Benchmarking Alliance; Newark DE
| | - Jesse Pines
- Department of Emergency Medicine; George Washington University; Washington DC
| | - Jeremiah Schuur
- Department of Emergency Medicine; Brigham and Women's Hospital and Harvard University; Boston MA
| | - Nick Jouriles
- Department of Emergency Medicine; Northeast Ohio Medical University; Akron OH
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97
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Hsu JC, Ross-Degnan D, Wagner AK, Cheng CL, Yang YHK, Zhang F, Lu CY. Utilization of oral antidiabetic medications in Taiwan following strategies to promote access to medicines for chronic diseases in community pharmacies. J Pharm Policy Pract 2015; 8:15. [PMID: 25949816 PMCID: PMC4422418 DOI: 10.1186/s40545-015-0035-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 04/01/2015] [Indexed: 12/03/2022] Open
Abstract
Objectives Taiwan’s National Health Insurance (NHI) has encouraged physicians to use “chronic medication prescriptions” for patients with stable chronic diseases since 1995. Patients are allowed to refill such prescriptions at community pharmacies for a maximum of three months’ supply of medications without revisiting the doctor. In 2006, NHI initiated strategies targeting the public, doctors, and healthcare facilities to enhance the overall rate of chronic medication prescriptions, aiming to achieve 30% by 2010. We examined prescribing and dispensing of oral antidiabetic drugs from 2001 to 2010, before and after the start of the promotion strategies for chronic medication prescriptions in 2006. Methods Using outpatient care data from the NHI database and the interrupted time series design, we analyzed changes in rate of chronic medication prescriptions, share of prescriptions filled at community pharmacies, and share of reimbursed expenditures accounted by community pharmacies. Results During 2001-2010, the rate of chronic medication prescriptions for diabetes increased steadily by about 3% per year (from 3.5% to 26.2%). Three years after the promotion strategies, there was a non-significant reduction of 8.7% (95% confidence interval [CI]: -17.35%, 0.05%) in the rate of chronic medication prescriptions but increases in prescription refills at community pharmacies and associated reimbursed expenditures: 12.8% (95% C.I.:1.66%, 23.98%) and 15.8% (95% C.I.: -1.35%, 33.02%) respectively. Conclusions While rate of chronic medication prescriptions was not significantly affected by the 2006 promotion strategy, shares of prescriptions refilled at community pharmacies and associated expenditures increased slightly but significantly.
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Affiliation(s)
- Jason C Hsu
- School of Pharmacy and Institute of Clinical Pharmacy and Pharmaceutical Sciences, National Cheng Kung University, Tainan, Taiwan
| | - Dennis Ross-Degnan
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA USA
| | - Anita K Wagner
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA USA
| | - Ching-Lan Cheng
- School of Pharmacy and Institute of Clinical Pharmacy and Pharmaceutical Sciences, National Cheng Kung University, Tainan, Taiwan
| | - Yea-Huei Kao Yang
- School of Pharmacy and Institute of Clinical Pharmacy and Pharmaceutical Sciences, National Cheng Kung University, Tainan, Taiwan
| | - Fang Zhang
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA USA
| | - Christine Y Lu
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA USA
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98
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Krall J, Gabbay R, Zickmund S, Hamm ME, Williams KR, Siminerio L. Current perspectives on psychological insulin resistance: primary care provider and patient views. Diabetes Technol Ther 2015; 17:268-74. [PMID: 25551737 DOI: 10.1089/dia.2014.0268] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Psychological insulin resistance (PIR) refers to reluctance of providers to prescribe and patients to take insulin. Processes and tools have been developed to address PIR. The purpose of this qualitative study was to examine current understanding and opinions of insulin therapy of primary care providers (PCPs) and patients with type 2 diabetes (both naive to insulin and insulin users). SUBJECTS AND METHODS Providers (n=23 PCPs) and patients (n=96) participated in 1:1 interviews and 12 racially/ethnically diverse focus groups, respectively, conducted by trained qualitative researchers using pilot-tested scripts. Participants examined insulin devices and needles while specific questions were asked about insulin therapy. Recorded sessions were transcribed and analyzed. RESULTS Salient themes related to injection resistance, patient adherence, health system barriers, and education emerged during the sessions. Provider knowledge about insulin injection devices and approaches varied and was often limited, particularly regarding needle sizes, which influenced prescribing practices and patient education. Other barriers included limited time and personnel. However, PCPs placed priority on continuing education on devices, needles, insulin adjustment, educational approaches, and cost. Patient focus groups revealed a strong desire for knowledge on injection logistics, particularly by insulin users who felt that they had received inadequate education. Most patients had limited experience with tools like shorter needles but would consider injecting if presented. Those who had self-injection experience were more willing to accept insulin. Cost concerns and need for information were frequently reported. CONCLUSIONS Findings reveal that programs and tools designed to address problems associated with PIR have yet to be fully realized.
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Affiliation(s)
- Jodi Krall
- 1 University of Pittsburgh Diabetes Institute , Pittsburgh, Pennsylvania
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99
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Boeni F, Arnet I, Hersberger KE. Adherence counseling during patient contacts in swiss community pharmacies. Patient Prefer Adherence 2015; 9:597-605. [PMID: 25960642 PMCID: PMC4423509 DOI: 10.2147/ppa.s76027] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Numerous studies showed the effectiveness of pharmaceutical care in improving medication adherence in primary care patients. However, in daily pharmacy practice, the provision of pharmaceutical care appears to be limited. We aimed at quantifying the content of counseling by community pharmacy staff during patient contacts, especially adherence counseling, and at investigating pharmacist views about their practice of adherence counseling. PATIENTS AND METHODS A Master's student in Pharmacy observed patient contacts at selected community pharmacies in the region of Basel, Switzerland. Content of counseling was manually ticked on a checklist with predefined themes (administration, dose, effect, and adherence). Pharmacists working in the pharmacy were interviewed on triggers, topics, and barriers in adherence counseling. RESULTS In 20 community pharmacies and during a total of 148.1 hours, 1,866 patient contacts were observed. During the 1,476 patient contacts including the dispensing of one or more medications, counseling was provided to 799 (54.1%) patients; with 735 (49.8%) patients counseled about administration, 362 (24.5%) about dose, 267 (18.1%) about effect, and 99 (6.7%) about adherence. Significantly more patients received counseling when they obtained prescribed versus over-the-counter medication (P=0.002), a new prescription versus a repeat prescription (P<0.001), or when they were served by a pharmacist versus by another staff member (P<0.001). Of the 33 interviewed pharmacists, all except one reported actively approaching patients for adherence counseling. Triggers included medication-related and patient-related factors. The pharmacists named predominantly product-centered topics of adherence counseling. The most cited barriers were rejection of counseling by the patient and lack of time. CONCLUSION Half of the patients receiving one or more medications were counseled, and only 6.7% of all contacts included adherence counseling. Future studies should clarify how barriers to adherence counseling at the community pharmacy can be overcome.
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Affiliation(s)
- Fabienne Boeni
- Pharmaceutical care research group, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
- Correspondence: Fabienne Boeni, Pharmaceutical care research group, Department of Pharmaceutical sciences, University of Basel, Klingelbergstrasse 50, CH-4056 Basel, Switzerland, Tel +41 61 267 15 29, Fax +41 61 267 14 26, Email
| | - Isabelle Arnet
- Pharmaceutical care research group, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
| | - Kurt E Hersberger
- Pharmaceutical care research group, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
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