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Chong S, Huynh B, Wong S, Woldeyesus T, Faulks M, El-Amin K, Thibeaux J, Lewis J, Harlin R, Carter M, Shatara R, Zhou C, Oni-Orisan A. Preferences and Perspectives of Black Male Barbershop Patrons on Receiving Health Care in Nontraditional Settings. Health Equity 2023; 7:835-842. [PMID: 38145054 PMCID: PMC10739686 DOI: 10.1089/heq.2023.0157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2023] [Indexed: 12/26/2023] Open
Abstract
Introduction Non-Hispanic Black men experience a disproportionate rate of morbidity and mortality from hypertension, cardiovascular disease, and other chronic conditions in the United States. Studies have demonstrated the efficacy of community-based health outreach in settings not traditionally utilized for health care. Understanding how potential future participants view health care services in nontraditional settings is a necessary step to ascertain the success of these interventions in the real world. Our study objective was to explore the preferences of Black male barbershop patrons regarding health care-provided services in these nontraditional settings. Methods We recruited patrons of a Black-owned barbershop in the San Francisco Bay Area. Study participants were asked to complete a survey assessing individual attitudes and preferences toward the idea of receiving health care services in traditional and nontraditional settings. Results Among non-Hispanic Black males (n=17), 81% agreed or strongly agreed that they would prefer to receive health care in traditional clinics. Receiving care at the pharmacy (56% agreed or strongly agreed) and the patient's own home (53% agreed or strongly agreed) were the next most preferred locations. A minority of participants agreed or strongly agreed that they preferred to receive health care in nontraditional settings: 47% for barbershops, 19% for churches, and 6% for grocery stores. Discussion Participants expressed preference for traditional over nontraditional settings, despite listing barriers that may be addressed, in part, by nontraditional settings. One potential reason for this is simply a lack of familiarity. Establishing and normalizing nontraditional clinical settings may allow for enhanced acceptance within Black communities, ultimately increasing health care access.
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Affiliation(s)
- Sarah Chong
- Department of Clinical Pharmacy, University of Maryland, Baltimore, Maryland, USA
| | - Brittany Huynh
- Department of Clinical Pharmacy, University of California San Francisco, San Francisco, California, USA
| | - Stephanie Wong
- Department of Clinical Pharmacy, University of California San Francisco, San Francisco, California, USA
| | - Temesgen Woldeyesus
- Department of Medicine, Stanford University, Palo Alto, California, USA
- Department of Clinical Programs, Roots Community Health Center, Oakland, California, USA
| | - Melvin Faulks
- Department of Clinical Programs, Roots Community Health Center, Oakland, California, USA
| | | | | | - Joseph Lewis
- Chicago 2 Barbershop, San Francisco, California, USA
| | - Robert Harlin
- Chicago 2 Barbershop, San Francisco, California, USA
| | - Mario Carter
- Chicago 2 Barbershop, San Francisco, California, USA
| | - Ramy Shatara
- Chicago 2 Barbershop, San Francisco, California, USA
| | - Crystal Zhou
- Department of Clinical Pharmacy, University of California San Francisco, San Francisco, California, USA
| | - Akinyemi Oni-Orisan
- Department of Clinical Pharmacy, University of California San Francisco, San Francisco, California, USA
- Institute for Human Genetics, University of California San Francisco, San Francisco, California, USA
- Department of Bioengineering and Therapeutic Sciences, University of California San Francisco, San Francisco, California, USA
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Moreira PM, Aguiar EC, Castro PR, Almeida KC, Dourado JA, Paula SM, Melo MF, Santos PM, Oliveira MG. Optimizing Hypertension Treatment in Older Patients Through Home Blood Pressure Monitoring by Pharmacists in Primary Care: The MINOR Clinical Trial. Clin Ther 2023; 45:941-946. [PMID: 37365046 DOI: 10.1016/j.clinthera.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 04/29/2023] [Accepted: 06/08/2023] [Indexed: 06/28/2023]
Abstract
PURPOSE Incorporating technology such as home blood pressure monitoring (HBPM) into the clinical routine generates opportunities to improve BP monitoring and control in primary health care. It is also important to prevent overtreatment. However, the combination of HBPM with collaborative drug therapy management (CDTM) has not yet been studied. This study aimed to assess the efficacy of combining HBPM with CDTM to optimize hypertension treatment for older patients. METHODS This open-label, parallel-group, randomized clinical trial was conducted between June 2021 and August 2022 in a Brazilian community pharmacy and included older patients (aged ≥60 years) with hypertension. Those who were classified as poorly adherent or nonadherent to the prescribed drug treatment or who were unable to perform HBPM were excluded. In the control group, participants received a BP monitor and instructions on how to perform HBPM. A general practitioner, who was provided a report with the obtained BP values, determined any changes to the treatment protocol. In the intervention group, a pharmacist enrolled participants in a drug therapy management protocol and provided the general practitioner with suggestions to optimize the antihypertensive drug therapy, in addition to the report with the BP values. The following outcomes were considered: the proportion of participants receiving deprescriptions of antihypertensive drugs, other treatment adjustments, and the difference in mean BP between the groups 45 days after performing HBPM. The study used a t test combined with Levene's test to calculate mean intergroup differences in BP, the paired t test to calculate mean intragroup differences in BP, and Pearson's χ2 test to determine intergroup differences in changes in drug therapy. FINDINGS In each group, 161 participants completed the trial. Antihypertensive agents were deprescribed for 31 (19.3%) participants in the intervention group versus 11 (6.8%) in the control group (P = 0.01). In addition, 14 (8.7%) participants were prescribed antihypertensive drugs in the intervention group versus 11 (6.8%) in the control group (P = 0.52). The mean office systolic BP and HBPM values were lower in the intervention group (P = 0.22 and P = 0.29, respectively). IMPLICATIONS Combining HBPM with a CDTM protocol effectively optimized antihypertensive treatment for older patients in a primary health care setting. CLINICALTRIALS gov identifier: NCT04861727.
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Affiliation(s)
- Pablo Maciel Moreira
- Programa de Pós-Graduação em Saúde Coletiva, Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Candeias, Vitória da Conquista, Brazil
| | - Erlan Canguçu Aguiar
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Candeias, Vitória da Conquista, Brazil; Programa de Pós-Graduação em Assistência Farmacêutica em Rede e Associação de Instituições de Ensino Superior, Faculdade de Farmácia, Universidade Federal da Bahia, Salvador, Brazil
| | - Priscila Ribeiro Castro
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Candeias, Vitória da Conquista, Brazil
| | - Kleiton Coelho Almeida
- Programa de Pós-Graduação em Assistência Farmacêutica em Rede e Associação de Instituições de Ensino Superior, Faculdade de Farmácia, Universidade Federal da Bahia, Salvador, Brazil
| | - July Anne Dourado
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Candeias, Vitória da Conquista, Brazil
| | - Sabrina Miranda Paula
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Candeias, Vitória da Conquista, Brazil
| | - Milena Flores Melo
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Candeias, Vitória da Conquista, Brazil
| | - Pablo Moura Santos
- Programa de Pós-Graduação em Assistência Farmacêutica em Rede e Associação de Instituições de Ensino Superior, Faculdade de Farmácia, Universidade Federal da Bahia, Salvador, Brazil
| | - Marcio Galvão Oliveira
- Programa de Pós-Graduação em Saúde Coletiva, Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Candeias, Vitória da Conquista, Brazil; Programa de Pós-Graduação em Assistência Farmacêutica em Rede e Associação de Instituições de Ensino Superior, Faculdade de Farmácia, Universidade Federal da Bahia, Salvador, Brazil.
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Jacob V, Reynolds JA, Chattopadhyay SK, Nowak K, Hopkins DP, Fulmer E, Bhatt AN, Therrien NL, Cuellar AE, Kottke TE, Clymer JM, Rask KJ. Economics of Team-Based Care for Blood Pressure Control: Updated Community Guide Systematic Review. Am J Prev Med 2023; 65:735-754. [PMID: 37121447 PMCID: PMC10527860 DOI: 10.1016/j.amepre.2023.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 04/24/2023] [Accepted: 04/24/2023] [Indexed: 05/02/2023]
Abstract
INTRODUCTION This paper examined the recent evidence from economic evaluations of team-based care for controlling high blood pressure. METHODS The search covered studies published from January 2011 through January 2021 and was limited to those based in the U.S. and other high-income countries. This yielded 35 studies: 23 based in the U.S. and 12 based in other high-income countries. Analyses were conducted from May 2021 through February 2023. All monetary values reported are in 2020 U.S. dollars. RESULTS The median intervention cost per patient per year was $438 for U.S. studies and $299 for all studies. The median change in healthcare cost per patient per year after the intervention was -$140 for both U.S. studies and for all studies. The median net cost per patient per year was $439 for U.S. studies and $133 for all studies. The median cost per quality-adjusted life year gained was $12,897 for U.S. studies and $15,202 for all studies, which are below a conservative benchmark of $50,000 for cost-effectiveness. DISCUSSION Intervention cost and net cost were higher in the U.S. than in other high-income countries. Healthcare cost averted did not exceed intervention cost in most studies. The evidence shows that team-based care for blood pressure control is cost-effective, reaffirming the favorable cost-effectiveness conclusion reached in the 2015 systematic review.
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Affiliation(s)
- Verughese Jacob
- Community Guide Program, Office of Scientific Evidence and Recommendations, Office of Science, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Jeffrey A Reynolds
- Community Guide Program, Office of Scientific Evidence and Recommendations, Office of Science, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sajal K Chattopadhyay
- Community Guide Program, Office of Scientific Evidence and Recommendations, Office of Science, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Keith Nowak
- Marion County Public Health Department, Indianapolis, Indiana
| | - David P Hopkins
- Community Guide Program, Office of Scientific Evidence and Recommendations, Office of Science, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Erika Fulmer
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ami N Bhatt
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia; ASRT, Inc., Atlanta, Georgia
| | - Nicole L Therrien
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Alison E Cuellar
- College of Health and Human Services, George Mason University, Fairfax, Virginia
| | | | - John M Clymer
- National Forum for Heart Disease & Stroke Prevention, Washington, District of Columbia
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Price E, Shirtcliffe A, Fisher T, Chadwick M, Marra CA. A systematic review of economic evaluations of pharmacist services. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2023; 31:459-471. [PMID: 37543960 DOI: 10.1093/ijpp/riad052] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 07/07/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND Challenges to the provision of health care are occurring internationally and are expected to increase in the future, further increasing health spending. As pharmacist roles are evolving and expanding internationally to provide individualised pharmaceutical care it is important to assess the cost-effectiveness of these services. OBJECTIVES To systematically synthesise the international literature regarding published economic evaluations of pharmacy services to assess their cost-effectiveness and clinical outcomes. METHODS A systematic review of economic evaluations of pharmacy services was conducted in MEDLINE, EMBASE, PubMed, Scopus, Web of Science, CINAHL, IPA and online journals with search functions likely to publish economic evaluations of pharmacy services. Data were extracted regarding the interventions, the time horizon, the outcomes and the incremental cost-effectiveness ratio. Studies' quality of reporting was assessed using the Consolidated Health Economic Evaluation Reporting Standard (CHEERS) statement. RESULTS Seventy-five studies were included in the systematic review, including 67 cost-effectiveness analyses, 6 cost-benefit analyses and 2 cost-consequence analyses. Of these, 57 were either dominant or cost-effective using a willingness-to-pay threshold of NZ$46 645 per QALY. A further 11 studies' cost-effectiveness were unable to be evaluated. Interventions considered to be most cost-effective included pharmacist medication reviews, pharmacist adherence strategies and pharmacist management of type 2 diabetes mellitus, hypertension and warfarin/INR monitoring. The quality of reporting of studies differed with no studies reporting all 28 items of the CHEERS statement. CONCLUSIONS There is strong economic evidence to support investment in extended pharmacist services, particularly those focussed on long-term chronic health conditions.
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Affiliation(s)
- Emilia Price
- Division of Health Sciences, School of Pharmacy, University of Otago, Dunedin, New Zealand
| | - Andi Shirtcliffe
- Allied Health Office of the Chief Clinical Officers System Performance and Monitoring Ministry of Health, Wellington, New Zealand
| | - Thelma Fisher
- Centre for Pacific Health Information Services, University Library, University of Otago, Dunedin, New Zealand
| | - Martin Chadwick
- Office of the Chief Clinical Officers, Ministry of Health, Wellington, New Zealand
| | - Carlo A Marra
- Division of Health Sciences, School of Pharmacy, University of Otago, Dunedin, New Zealand
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de Souza Cazarim M, Cruz-Cazarim ELC, Boyd K, Wu O, Nunes AA. Effect of Medication Therapy Management by Pharmaceutical Care on Blood Pressure and Cardiovascular Risk in Hypertension: A Systematic Review, Meta-Analysis, and Meta-Regression. Pharmaceuticals (Basel) 2023; 16:845. [PMID: 37375792 DOI: 10.3390/ph16060845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 05/23/2023] [Accepted: 05/27/2023] [Indexed: 06/29/2023] Open
Abstract
Medication therapy management by pharmaceutical care (MTM-PC) has been shown to improve the effectiveness of antihypertensive treatments. The aim was to answer the question: what are the MTM-PC models and their impact on hypertensive patients' outcomes? This is a systematic review with meta-analysis. The search strategies were run on 27 September 2022 in the following databases: PubMed, EMBASE, Scopus, LILACs, Central Cochrane Library, Web of Science; and International Pharmaceutical Abstracts. The quality and bias risk was assessed by the Downs and Black instrument. Forty-one studies met the eligibility criteria and were included, Kappa = 0.86; 95% CI, 0.66-1.0; (p < 0.001). Twenty-seven studies (65.9%) had MTM-PC models outlined by the clinical team, showing as characteristics the mean of 10.0 ± 10.7 months of follow-up of hypertensive patients, with 7.7 ± 4.9 consultations. Instruments to assess the quality of life measured the enhancement by 13.4 ± 10.7% (p = 0.047). The findings of the meta-analysis show a mean reduction of -7.71 (95% CI, -10.93 to -4.48) and -3.66 (95% CI, -5.51 to -1.80), (p < 0.001) in mmHg systolic and diastolic pressures, respectively. Cardiovascular relative risk (RR) over ten years was 0.561 (95% CI, 0.422 to 0.742) and RR = 0.570 (95% CI, 0.431 to 0.750), considering homogeneous studies, I² = 0%. This study shows the prevalence of MTM-PC models outlined by the clinical team, in which there are differences according to the models in reducing blood pressure and cardiovascular risk over ten years with the improvement in quality of life.
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Affiliation(s)
- Maurilio de Souza Cazarim
- Department of Pharmaceutical Sciences, Faculty of Pharmacy, Federal University of Juiz de Fora, Juiz de Fora 36036-900, MG, Brazil
| | - Estael Luzia Coelho Cruz-Cazarim
- Department of Pharmaceutical Service, Faculty of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto 14040-903, SP, Brazil
| | - Kathleen Boyd
- Health Economics and Health Technology Assessment, University of Glasgow, Glasgow, G12 8QQ, UK
| | - Olivia Wu
- Health Economics and Health Technology Assessment, University of Glasgow, Glasgow, G12 8QQ, UK
| | - Altacílio Aparecido Nunes
- Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14048-900, SP, Brazil
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Ayogu EE, Yahaya RI, Isah A, Ubaka CM. Effectiveness of a pharmacist-led educational intervention on health outcomes in hypertension management at community pharmacies in Nigeria: A two-arm parallel single-blind randomized controlled trial. Br J Clin Pharmacol 2023; 89:649-659. [PMID: 36031952 DOI: 10.1111/bcp.15514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/16/2022] [Accepted: 08/23/2022] [Indexed: 01/18/2023] Open
Abstract
AIMS This study determined the impact of a pharmacist-led educational intervention on the health outcomes of hypertensive patients in community pharmacies. METHODS A 2-arm parallel single-blind randomized trial design was adopted among hypertensive patients in 4 pharmacies in Abuja and Lokoja, Nigeria. A pharmacist-led educational intervention was provided to the patients in the intervention group. The study outcomes, namely changes in adherence to medication, quality of life and cost of medication were measured using MARS-10, SF-12 and official price list, respectively. Independent and paired-sample t-tests were conducted on the data. RESULTS A total of 128 patients participated in the study. All of them completed the study and were included in the analysis: 70 in the control arm and 58 in the intervention arm. There was a significant improvement in components of Behaviour (2.57 vs. 2.98), Attitude (2.59 vs. 3.14) and Negative attitude (1.62 vs. 1.92). There was a better improvement in adherence in the intervention arm: 8.05 ± 1.32 vs. 6.55 ± 2.24; t = -4.65, P = .0001. There were no changes in the respondents' health status after intervention in both groups (P < .05). There was a weak inverse association between the physical health component and mental health component: R = -0.2, P = .04 and a positive association with overall adherence (R = 0.26, P = .004) in the intervention group, in whom the monthly cost of treatment decreased from N2233.1 to N2068.4. CONCLUSION Community pharmacy educational intervention improves health outcomes, particularly with adherence among patients with hypertension. Health-related quality of life of the patients improved, but the physical health component was better than that of the mental health component.
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Affiliation(s)
- Ebere Emilia Ayogu
- Department of Clinical Pharmacy and Pharmacy Management, University of Nigeria, Nsukka, Enugu State, Nigeria
| | - Rahmat Isa Yahaya
- Department of Clinical Pharmacy and Pharmacy Management, University of Nigeria, Nsukka, Enugu State, Nigeria
| | - Abdulmuminu Isah
- Department of Clinical Pharmacy and Pharmacy Management, University of Nigeria, Nsukka, Enugu State, Nigeria
| | - Chukwuemeka Michael Ubaka
- Department of Clinical Pharmacy and Pharmacy Management, University of Nigeria, Nsukka, Enugu State, Nigeria
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Mendonça TS, Oliveira WN, Belo VS, Silva ES, Pereira ML, Obreli-Neto PR, Baldoni AO. Clinical and humanistic impact of pharmacotherapeutic follow-up in patients with type 1 diabetes mellitus treated judicially. Diabetol Metab Syndr 2022; 14:61. [PMID: 35501843 PMCID: PMC9061226 DOI: 10.1186/s13098-022-00835-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 04/13/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND There is a lack of studies that assess the effectiveness of pharmacotherapeutic follow-up in the context of the judicialization of insulin analogues. AIMS To evaluate the clinical and humanistic impact of pharmacotherapeutic follow-up in patients with type 1 diabetes mellitus who receive insulin analogues by judicial decision in a Brazilian municipality. METHODS A quasi-experimental study of the before-and-after type was carried out through pharmacotherapeutic follow-up. Patients who accepted to participate in the study underwent laboratory tests of glycemic and lipid profile before and after the intervention, and underwent five pharmaceutical consultations. In addition, quality of life and health, knowledge, and skills related to insulin application techniques were analyzed. RESULTS 28 patients participated in all stages. Of these, most were female (53.6%), with a mean age of 32.8 ± 11.6 years. After the intervention, there was a reduction in blood glucose levels, blood pressure, and increased body mass index. In addition, there was greater knowledge and skills regarding insulin application techniques, improved quality of life, health, greater number of medications used, reduction of pharmacotherapeutic problems, and improvement in eating habits. CONCLUSION The pharmacotherapeutic follow-up promoted clinical and humanistic benefits, with improvement in quality of life and health.
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Affiliation(s)
- Thays S. Mendonça
- Programa de Pós-Graduação em Ciências da Saúde, Federal University of São João Del-Rei (UFSJ)–Campus Centro-Oeste Dona Lindu (CCO), Rua Sebastião Gonçalves Coelho, 400–Bairro Chanadour, Divinópolis, MG CEP:35501-296 Brazil
| | - William N. Oliveira
- Programa de Pós-Graduação em Ciências da Saúde, Federal University of São João Del-Rei (UFSJ)–Campus Centro-Oeste Dona Lindu (CCO), Rua Sebastião Gonçalves Coelho, 400–Bairro Chanadour, Divinópolis, MG CEP:35501-296 Brazil
| | - Vinícius S. Belo
- Programa de Pós-Graduação em Ciências da Saúde, Federal University of São João Del-Rei (UFSJ)–Campus Centro-Oeste Dona Lindu (CCO), Rua Sebastião Gonçalves Coelho, 400–Bairro Chanadour, Divinópolis, MG CEP:35501-296 Brazil
| | - Eduardo S. Silva
- Programa de Pós-Graduação em Ciências da Saúde, Federal University of São João Del-Rei (UFSJ)–Campus Centro-Oeste Dona Lindu (CCO), Rua Sebastião Gonçalves Coelho, 400–Bairro Chanadour, Divinópolis, MG CEP:35501-296 Brazil
| | - Mariana L. Pereira
- Programa de Pós-Graduação em Ciências da Saúde, Federal University of São João Del-Rei (UFSJ)–Campus Centro-Oeste Dona Lindu (CCO), Rua Sebastião Gonçalves Coelho, 400–Bairro Chanadour, Divinópolis, MG CEP:35501-296 Brazil
| | - Paulo R. Obreli-Neto
- Departamento de Farmácia, Centro Universitário das Faculdades Integradas de Ourinhos (UniFIO), Rodovia BR-153, Km 338 S/N Água do Cateto, Ourinhos, SP 19909-100 Brazil
| | - André O. Baldoni
- Núcleo de Ensino e Pesquisa em Farmácia Clínica (NEPeFaC), Federal University of São João Del-Rei (UFSJ), Rua Sebastião Gonçalves Coelho, 400 – Bairro Chanadour, Divinópolis, MG CEP:35501-296 Brazil
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Naqvi IA, Cheung YK, Strobino K, Li H, Tom SE, Husaini Z, Williams OA, Marshall RS, Arcia A, Kronish IM, Elkind MSV. TASC (Telehealth After Stroke Care): a study protocol for a randomized controlled feasibility trial of telehealth-enabled multidisciplinary stroke care in an underserved urban setting. Pilot Feasibility Stud 2022; 8:81. [PMID: 35410312 PMCID: PMC8995696 DOI: 10.1186/s40814-022-01025-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 03/07/2022] [Indexed: 11/10/2022] Open
Abstract
Background Hypertension is the most important modifiable risk factor for recurrent stroke, and blood pressure (BP) reduction is associated with decreased risk of stroke recurrence. However, hypertension remains poorly controlled in many stroke survivors. Black and Hispanic patients have a higher prevalence of uncontrolled BP and higher rates of stroke. Limited access to care contributes to challenges in post-stroke care. Telehealth After Stroke Care (TASC) is a telehealth intervention that integrates remote BP monitoring (RBPM) including nursing telephone support, tailored BP infographics and telehealth video visits with a multidisciplinary team approach including pharmacy to improve post-stroke care and reduce stroke disparities. Methods In this pilot trial, 50 acute stroke patients with hypertension will be screened for inclusion prior to hospital discharge and randomized to usual care or TASC. Usual care patients will be seen by a primary care nurse practitioner at 1–2 weeks and a stroke neurologist at 1 and 3 months. In addition to these usual care visits, TASC intervention patients will see a pharmacist at 4 and 8 weeks and will be enrolled in RBPM consisting of home BP monitoring with interval calls by a centralized team of telehealth nurses. As part of RBPM, TASC patients will be provided with a home BP monitoring device and electronic tablet that wirelessly transmits home BP data to the electronic health record. They will also receive tailored BP infographics that help explain their BP readings. The primary outcome will be feasibility including recruitment, adherence to at least one video visit and retention rates. The clinical outcome for consideration in a subsequent trial will be within-patient change in BP from baseline to 3 months after discharge. Secondary outcomes will be medication adherence self-efficacy and satisfaction with post-stroke telehealth, both measured at 3 months. Additional patient reported outcomes will include depression, cognitive function, and socioeconomic determinants. Multidisciplinary team competency and fidelity measures will also be assessed. Conclusions Integrated team-based interventions may improve BP control and reduce racial/ethnic disparities in post-stroke care. TASC is a post-acute stroke care model that is novel in providing RBPM with tailored infographics, and a multidisciplinary team approach including pharmacy. Our pilot will determine if such an approach is feasible and effective in enhancing post-stroke BP control and promoting self-efficacy. Trial registration ClinicalTrials.gov NCT04640519 Supplementary Information The online version contains supplementary material available at 10.1186/s40814-022-01025-z.
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Affiliation(s)
- Imama A Naqvi
- Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA. .,Division of Stroke and Cerebrovascular Diseases, Columbia University Medical Center, 710 West 168th Street, New York, NY, 10032, USA.
| | - Ying Kuen Cheung
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Kevin Strobino
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Hanlin Li
- NewYork-Presbyterian Hospital, New York, NY, USA
| | - Sarah E Tom
- Department of Neurology Vagelos College of Physicians and Surgeons and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | | | - Olajide A Williams
- Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Randolph S Marshall
- Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Adriana Arcia
- Columbia University School of Nursing, New York, NY, USA
| | - Ian M Kronish
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY, USA
| | - Mitchell S V Elkind
- Department of Neurology Vagelos College of Physicians and Surgeons and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
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Vordenberg SE, Kim J, Serlin DC, Fan AL, Mi Choe H. Pharmacist engagement in a community pharmacy hypertension management program in collaboration with an academic medical center. Am J Health Syst Pharm 2022; 79:1110-1114. [PMID: 35278307 DOI: 10.1093/ajhp/zxac081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
DISCLAIMER In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE To explore the perceptions of pharmacists and administrators who had an integral role in designing and operationalizing an integrated community pharmacist hypertension management program with collaboration between an academic medical center and a regional chain community pharmacy. SUMMARY Community pharmacists (n = 3), ambulatory care pharmacists (n = 2), medical directors (n = 2), and health-system (n = 1) and pharmacy (n = 1) administrators reported positive experiences engaging with the hypertension management program. Strengths of the program included comprehensive training by the ambulatory care pharmacists, community pharmacist access to the electronic health record (EHR), and primary care providers who were receptive to referring patients and accepting recommendations from the community pharmacists. All participants felt that the program had a positive outlook and saw opportunity for expansion, such as extended hours of operation, new locations, and additional pharmacists. CONCLUSION Pharmacists are well positioned to extend hypertension management programs from primary care clinics into local pharmacists if they have appropriate training, access to the EHR, and ongoing support from collaborating primary care offices. Additional research using implementation science methods is needed to further test the scalability and replicability of the program among different patient populations, community pharmacies, and health systems.
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Affiliation(s)
- Sarah E Vordenberg
- University of Michigan College of Pharmacy, Ann Arbor, MI, and University of Michigan Center for Bioethics and Social Sciences in Medicine, Ann Arbor, MI, USA
| | - Jae Kim
- University of Michigan College of Pharmacy, Ann Arbor, MI, USA
| | - David C Serlin
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Audrey L Fan
- Michigan Medicine-Northville Health Center, Northville, MI, USA
| | - Hae Mi Choe
- University of Michigan College of Pharmacy, Ann Arbor, MI, Michigan Medicine-Pharmacy Innovations and Partnerships, Ann Arbor, MI, and Michigan Medicine-University of Michigan Medical Group, Ann Arbor, MI, USA
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10
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Jay JS, Ijioma SC, Holdford DA, Dixon DL, Sisson EM, Patterson JA. The cost-effectiveness of pharmacist-physician collaborative care models vs usual care on time in target systolic blood pressure range in patients with hypertension: a payer perspective. J Manag Care Spec Pharm 2021; 27:1680-1690. [PMID: 34818090 PMCID: PMC10390951 DOI: 10.18553/jmcp.2021.27.12.1680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND: Hypertension is highly prevalent in the United States, affecting nearly half of all adults (43%). Studies have shown that pharmacist-physician collaborative care models (PPCCMs) for hypertension management significantly improve blood pressure (BP) control rates and provide consistent control of BP. Time in target range (TTR) for systolic BP is a novel measure of BP control consistency that is independently associated with decreased cardiovascular risk. There is no evidence that observed improvement in TTR for systolic BP with a PPCCM is cost-effective. OBJECTIVE: To compare the cost-effectiveness of a PPCCM with usual care for the management of hypertension from the payer perspective. METHODS: We used a decision analytic model with a 3-year time horizon based on published literature and publicly available data. The population consisted of adult patients who had a previous diagnosis of high BP (defined as office-based BP ≥ 140/90 mmHg) or were receiving antihypertensive medications. Effectiveness data were drawn from 2 published studies evaluating the effect of PPCCMs (vs usual care) on TTR for systolic BP and the impact of TTR for systolic BP on 4 cardiovascular outcomes (nonfatal myocardial infarction [MI], stroke, heart failure [HF], and cardiovascular disease [CVD] death). The model incorporated direct medical costs, including both programmatic costs (ie, direct costs for provider time) and downstream health care utilization associated with acute cardiovascular events. One-way sensitivity and threshold analyses examined model robustness. RESULTS: In base-case analyses, PPCCM hypertension management was associated with lower downstream medical expenditures (difference: -$162.86) and lower total program costs (difference: -$108.00) when compared with usual care. PPCCM was associated with lower downstream medical expenditures across all parameter ranges tested in the deterministic sensitivity analysis. For every 10,000 hypertension patients managed with PPCCM vs usual care over a 3-year time horizon, approximately 27 CVD deaths, 29 strokes, 21 nonfatal MIs, and 12 incident HF diagnoses are expected to be averted. CONCLUSIONS: This is the first study to evaluate the cost-effectiveness of PPCCM compared to usual care on TTR for systolic BP in adults with hypertension. PPCCM was less costly to administer and resulted in downstream health care savings and fewer acute cardiovascular events relative to usual care. Although further research is needed to evaluate the long-term costs and outcomes of PPCCM, payer coverage of PPCCM services may prevent future health care costs and improve patient cardiovascular outcomes. DISCLOSURES: No funding was received for the completion of this research. The authors have nothing to disclose. Study results were presented as an abstract at the AMCP 2021 Virtual, April 12-16, 2021.
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Affiliation(s)
- Jessica S Jay
- Center for Pharmacy Practice Innovation, Virginia Commonwealth University School of Pharmacy, Richmond
| | - Stephen C Ijioma
- Center for Pharmacy Practice Innovation, Virginia Commonwealth University School of Pharmacy, Richmond
| | - David A Holdford
- Center for Pharmacy Practice Innovation, Virginia Commonwealth University School of Pharmacy, Richmond
| | - Dave L Dixon
- Center for Pharmacy Practice Innovation, Virginia Commonwealth University School of Pharmacy, Richmond
| | - Evan M Sisson
- Center for Pharmacy Practice Innovation, Virginia Commonwealth University School of Pharmacy, Richmond
| | - Julie A Patterson
- Center for Pharmacy Practice Innovation, Virginia Commonwealth University School of Pharmacy, Richmond
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11
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So R, Al Hamarneh YN, Oleksyn C, Purschke M, Tsuyuki RT. Impact of a "Pharmacist First" innovative workflow plan in patients with hypertension and/or diabetes. Can Pharm J (Ott) 2021; 154:376-380. [PMID: 34777646 PMCID: PMC8581804 DOI: 10.1177/17151635211016498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Usual community pharmacy workflow, whereby patients might see a pharmacist at the end of the dispensing process, is not conducive to proactive patient-centred care. The objective of this study was to evaluate the impact of the "Pharmacist First" (P1st) workflow model on blood pressure and glycemic control in patients with hypertension and/or diabetes. This retrospective review was set in 2 community pharmacies that use the P1st model in the Greater Edmonton Region. The population entailed patients with hypertension and/or type 1 or 2 diabetes who received care via the P1st workflow model. The P1st workflow model places the patient in immediate contact with the pharmacist. The pharmacist first assesses prescription appropriateness, reviews relevant laboratory tests, discusses chronic disease control and addresses any questions or concerns the patient has before passing the prescription to be filled by a technician. This allows issues or concerns to be identified and addressed up front, rather than waiting until the prescription is filled and the patient is ready to leave the pharmacy. The primary outcome assessed in this study was change in blood pressure and/or A1C from baseline to the last follow-up visit. We reviewed 215 patient records. The mean age was 69.4 years (standard deviation 12.5), 51.2% of patients were male, 57.7% had hypertension, 5.6% had diabetes, and 36.7% had both. Median follow-up time was 4.2 months (interquartile range 2.5-9.3). In 203 patients with hypertension, systolic blood pressure was reduced from 139.83 mmHg to 131.26 mmHg (p < 0.001) and diastolic blood pressure from 80.26 mmHg to 76.86 mmHg (p < 0.001). In 87 patients with diabetes, A1C changed from 7.4% to 7.2% (p = ns). The P1st workflow model demonstrated significant improvements in blood pressure. Further investigation is needed to evaluate the effectiveness of this model with a control group, longer follow-up and evaluation of the patient experience.
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Affiliation(s)
| | | | | | - Mary Purschke
- Mainstreet Home Health Pharmacy, Stony Plain, Alberta
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12
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Raczkiewicz D, Sarecka-Hujar B, Pawełczak-Barszczowska A, Bojar I. How do Polish pharmacy staff evaluate own qualifications, competences, relevance, motivation, effectiveness in health promotion? Health Promot Int 2021; 37:6308793. [PMID: 34165539 PMCID: PMC8851399 DOI: 10.1093/heapro/daab043] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Health promotion programmes are complex and need to engage all health care specialists, including pharmacists. Pharmacies are considered as a potentially ideal place for health promotion and education. To evaluate own qualifications, competences, relevance, motivation and effectiveness of Polish pharmacy staff with regard to health-related information provided to patients, which contributes to health promotion. 308 pharmacy staff from Lublin (Poland) were surveyed with a questionnaire prepared by the researchers and piloted previously. It consisted of 5 domains: qualifications, competences, relevance, motivation, and effectiveness of health promotion. Items in each domain were scored by respondents in 1 − 10 scale where 1 is ‘very low’ and 10 is ‘very high’. Pharmacy staff rated the relevance of health promotion the highest, while the lowest—own competences and effectiveness in health promotion. Female pharmacy staff assessed the relevance of health promotion significantly higher than males (7.1 vs. 6.1, p = 0.005). Higher self-assessments of qualifications, competences, relevance, motivation and effectiveness in health promotion were provided by: the youngest pharmacy staff, those with a short period of employment, and pharmacy staff working in pharmacies employing up to 3 persons. Qualification and competences in health promotion were assessed higher by pharmacy technicians and masters of pharmacy with post-graduate studies or professional specialization, or Ph.D. than by masters of pharmacy. Relevance and effectiveness in health promotion were evaluated higher by pharmacy staff in pharmacies serving more than 100 customers daily. There is a need to improve qualifications, competences, relevance, motivation and effectiveness in health promotion conducted by Polish pharmacy staff.
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Affiliation(s)
- Dorota Raczkiewicz
- Department of Medical Statistics, School of Public Health, Center of Postgraduate Medical Education, Kleczewska str 61/63, 01-826 Warsaw, Poland
| | - Beata Sarecka-Hujar
- Department of Basic Biomedical Science, Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia in Katowice, Kasztanowa str 3, 41-200 Sosnowiec, Poland
| | | | - Iwona Bojar
- Department of Women's Health, Institute of Rural Health, Jaczewskiego str 2, 20-090, Lublin, Poland
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13
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Stewart B, Brody A, Garwood CL, Zhang L, Levy PD. Implementation of Outpatient Pharmacist-led Hypertension Management for Under-Resourced Patients: A Pilot Study. Innov Pharm 2021; 12. [PMID: 34345511 PMCID: PMC8326696 DOI: 10.24926/iip.v12i2.3895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background: The purpose of this study was to implement and evaluate a pharmacist-led hypertension (HTN) program for under-resourced patients discharged from the emergency department (ED) or screened at community health events who are lacking a regular primary care provider (PCP) relationship. Methods: This was a single arm, prospective, pilot study to recruit patients from the Detroit Medical Center (DMC) Sinai Grace Hospital (SGH) ED and community health events. The outpatient pharmacist-led transitional care clinic (TCC) was implemented through a collaborative practice agreement (CPA) with ED physicians. Eligible patients 18 to 60 years with elevated blood pressure (BP) (> 140/90 mmHg) and lacking a PCP relationship were referred to the TCC for HTN management. The primary outcome measure was change in systolic and diastolic BP (SBP and DBP). Difference in BP values was evaluated using Wilcoxon Signed Ranks test and descriptive statistics were used to explain demographic data. Results: There were 116 patients enrolled May 2017 to August 2018; 44 (37.9%) completed visit one [cohort 1], 30 (25.9%) completed at least three visits [cohort 2], and 16 (13.8%) completed five visits [cohort 3]. Most patients were African American (AA) 97.7%, 47.8% were male, and an average of 42.11 (SD 9.70) years. For cohorts 2 and 3, there was significant reduction in BP between TCC visits one and two and the reduction was maintained through five visits for patients that remained in the study. Patients who completed five visits (n=16) showed a significant change from visit one to visit five in SBP of -23 mmHg (p=0.002) and achieved BP goal with an average SBP 139 mmHg (SD 19.33) and DBP 90 mmHg (SD 10.17). Conclusion: The pharmacist-led TCC was successfully implemented. Outpatient pharmacists collaborating with ED physicians increased access to HTN management with a positive impact on BP outcomes in an under-resourced population.
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Affiliation(s)
- Brittany Stewart
- Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University
| | - Aaron Brody
- Department of Emergency Medicine, School of Medicine and Integrative Biosciences Center, Wayne State University
| | - Candice L Garwood
- Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Department of Pharmacy, Harper University Hospital, Detroit Medical Center
| | - Liying Zhang
- Epidemiology Research Design Core, Department of Family Medicine and Public Health Sciences, Wayne State University
| | - Phillip D Levy
- Department of Emergency Medicine, School of Medicine and Integrative Biosciences Center, Wayne State University
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14
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Stroke patients' support: evaluation of knowledge, practices and training needs of French community pharmacists. Int J Clin Pharm 2021; 43:980-989. [PMID: 33387187 DOI: 10.1007/s11096-020-01204-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 11/16/2020] [Indexed: 10/22/2022]
Abstract
Background Stroke represents a major Public Health issue in industrialized countries because of its frequency and severity. In secondary stroke prevention, treatment efficacy is correlated to medication adherence. However, it remains suboptimal in stroke patients. Community pharmacists, in light of their positioning in the care pathway and proximity to patients, can play an essential role in patient support and improving treatment adherence. However, it is currently unknown whether pharmacists are ready to perform this task. Objective Evaluate knowledge, practices and training needs for community pharmacists in therapeutic stroke management to improve long term care for stroke patients. Setting Community pharmacies in the Rhone Alpes region (France). Method We conducted a cross sectional study via a standardized self-assessment questionnaire consisting of 40 questions divided into three parts. The latter was designed by a multidisciplinary team and distributed electronically to community pharmacists of the Rhône-Alpes region (France). Main outcome measure (a) global knowledge score on the pathology, risk factors and clinical care management, (b) description of the support practices for stroke patients, (c) training needs for pharmacists. Results The 104 participants presented a moderate level of knowledge (global score: 12/20 ± 3). Topics best mastered were: pathophysiology, target blood pressure and place of antiplatelets in the therapeutic strategy. Knowledge items that needed improvement were: warning signs correctly identified by 44% of participants, time delay for thrombolysis for which 14% answered correctly, target glycated hemoglobin levels were correct for 41%, and the 3 recommended antihypertensive drug classes were only identified by 5% of participants. Patient education received from pharmacists concerned dosage (89%), treatment adherence (88%), benefits (66%) and administration modalities of medicines (64%), management of risk factors (75% for diet, 73% for physical activity, 70% for smoking and 53% for alcohol). All pharmacists wanted additional training on risk factors and clinical management guidelines. Conclusion Based on this small study, the fragmented knowledge and varied practices promote the need for further training for pharmacists to optimize support of stroke patients. This study promotes the elaboration of training systems adapted to pharmacists' needs. This will help support the development of a targeted pharmaceutical care approach for stroke patients.
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15
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Impact of ‘Chief-Pharmacist System’ on drug expenditures and rational drug use. Int J Clin Pharm 2020; 42:167-173. [DOI: 10.1007/s11096-019-00954-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 12/12/2019] [Indexed: 11/25/2022]
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16
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Steed L, Sohanpal R, Todd A, Madurasinghe VW, Rivas C, Edwards EA, Summerbell CD, Taylor SJC, Walton RT. Community pharmacy interventions for health promotion: effects on professional practice and health outcomes. Cochrane Database Syst Rev 2019; 12:CD011207. [PMID: 31808563 PMCID: PMC6896091 DOI: 10.1002/14651858.cd011207.pub2] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Community pharmacies are an easily accessible and cost-effective platform for delivering health care worldwide, and the range of services provided has undergone rapid expansion in recent years. Thus, in addition to dispensing medication, pharmacy workers within community pharmacies now give advice on a range of health-promoting behaviours that aim to improve health and to optimise the management of long-term conditions. However, it remains uncertain whether these health-promotion interventions can change the professional practice of pharmacy workers, improve health behaviours and outcomes for pharmacy users and have the potential to address health inequalities. OBJECTIVES To assess the effectiveness and safety of health-promotion interventions to change community pharmacy workers' professional practice and improve outcomes for users of community pharmacies. SEARCH METHODS We searched MEDLINE, Embase, CENTRAL, six other databases and two trials registers to 6 February 2018. We also conducted reference checking, citation searches and contacted study authors to identify any additional studies. SELECTION CRITERIA We included randomised trials of health-promotion interventions in community pharmacies targeted at, or delivered by, pharmacy workers that aimed to improve the health-related behaviour of people attending the pharmacy compared to no treatment, or usual treatment received in the community pharmacy. We excluded interventions where there was no interaction between pharmacy workers and pharmacy users, and those that focused on medication use only. DATA COLLECTION AND ANALYSIS We used standard procedures recommended by Cochrane and the Effective Practice and Organisation of Care review group for both data collection and analysis. We compared intervention to no intervention or to usual treatment using standardised mean differences (SMD) and 95% confidence intervals (95% CI) (higher scores represent better outcomes for pharmacy user health-related behaviour and quality of life, and lower scores represent better outcomes for clinical outcomes, costs and adverse events). Interpretation of effect sizes (SMD) was in line with Cochrane recommendations. MAIN RESULTS We included 57 randomised trials with 16,220 participants, described in 83 reports. Forty-nine studies were conducted in high-income countries, and eight in middle-income countries. We found no studies that had been conducted in low-income countries. Most interventions were educational, or incorporated skills training. Interventions were directed at pharmacy workers (n = 8), pharmacy users (n = 13), or both (n = 36). The clinical areas most frequently studied were diabetes, hypertension, asthma, and modification of cardiovascular risk. Duration of follow-up of interventions was often unclear. Only five studies gave details about the theoretical basis for the intervention, and studies did not provide sufficient data to comment on health inequalities. The most common sources of bias were lack of protection against contamination - mainly in individually randomised studies - and inadequate blinding of participants. The certainty of the evidence for all outcomes was moderate. We downgraded the certainty because of the heterogeneity across studies and evidence of potential publication bias. Professional practice outcomes We conducted a narrative analysis for pharmacy worker behaviour due to high heterogeneity in the results. Health-promotion interventions probably improve pharmacy workers' behaviour (2944 participants; 9 studies; moderate-certainty evidence) when compared to no intervention. These studies typically assessed behaviour using a simulated patient (mystery shopper) methodology. Pharmacy user outcomes Health-promotion interventions probably lead to a slight improvement in health-related behaviours of pharmacy users when compared to usual treatment (SMD 0.43, 95% CI 0.14 to 0.72; I2 = 89%; 10 trials; 2138 participants; moderate-certainty evidence). These interventions probably also lead to a slight improvement in intermediate clinical outcomes, such as levels of cholesterol or glycated haemoglobin, for pharmacy users (SMD -0.43, 95% CI -0.65 to -0.21; I2 = 90%; 20 trials; 3971 participants; moderate-certainty evidence). We identified no studies that evaluated the impact of health-promotion interventions on event-based clinical outcomes, such as stroke or myocardial infarction, or the psychological well-being of pharmacy users. Health-promotion interventions probably lead to a slight improvement in quality of life for pharmacy users (SMD 0.29, 95% CI 0.08 to 0.50; I2= 82%; 10 trials, 2687 participants; moderate-certainty evidence). Adverse events No studies reported adverse events for either pharmacy workers or pharmacy users. Costs We found that health-promotion interventions are likely to be cost-effective, based on moderate-certainty evidence from five of seven studies that reported an economic evaluation. AUTHORS' CONCLUSIONS Health-promotion interventions in the community pharmacy context probably improve pharmacy workers' behaviour and probably have a slight beneficial effect on health-related behaviour, intermediate clinical outcomes, and quality of life for pharmacy users. Such interventions are likely to be cost-effective and the effects are seen across a range of clinical conditions and health-related behaviours. Nevertheless the magnitude of the effects varies between conditions, and more effective interventions might be developed if greater consideration were given to the theoretical basis of the intervention and mechanisms for effecting behaviour change.
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Affiliation(s)
- Liz Steed
- Queen Mary University of LondonCentre for Primary Care and Public Health, Barts and The London School of Medicine and DentistryBlizard Institute, Yvonne Carter Building58 Turner StreetLondonUKE1 2AT
| | - Ratna Sohanpal
- Queen Mary University of LondonCentre for Primary Care and Public Health, Barts and The London School of Medicine and DentistryBlizard Institute, Yvonne Carter Building58 Turner StreetLondonUKE1 2AT
| | - Adam Todd
- Newcastle UniversitySchool of PharmacyQueen Victoria RoadNewcastle upon TyneUKNE1 7RU
| | - Vichithranie W Madurasinghe
- Queen Mary University of LondonCentre for Primary Care and Public Health, Barts and The London School of Medicine and DentistryBlizard Institute, Yvonne Carter Building58 Turner StreetLondonUKE1 2AT
| | - Carol Rivas
- University College LondonDepartment of Social Science, UCL Institute of Education18 Woburn SquareLondonUKWC1H 0NR
| | - Elizabeth A Edwards
- Queen Mary University of LondonCentre for Primary Care and Public Health, Barts and The London School of Medicine and DentistryBlizard Institute, Yvonne Carter Building58 Turner StreetLondonUKE1 2AT
| | - Carolyn D Summerbell
- Durham UniversityDepartment of Sport and Exercise Sciences42 Old ElvetDurhamUKDH13HN
| | - Stephanie JC Taylor
- Queen Mary University of LondonCentre for Primary Care and Public Health, Barts and The London School of Medicine and DentistryBlizard Institute, Yvonne Carter Building58 Turner StreetLondonUKE1 2AT
- Queen Mary University of LondonAsthma UK Centre for Applied ResearchLondonUK
| | - RT Walton
- Queen Mary University of LondonCentre for Primary Care and Public Health, Barts and The London School of Medicine and DentistryBlizard Institute, Yvonne Carter Building58 Turner StreetLondonUKE1 2AT
- Queen Mary University of LondonAsthma UK Centre for Applied ResearchLondonUK
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Suhadi R, Virginia DM, Setiawan CH. The Effect of Health Education by Pharmacists on 10-Year Atherosclerotic Cardiovascular Disease Risk: A Cluster-Randomized Control Study in a Low Socioeconomic Status Javanese Population. J Prim Care Community Health 2019; 9:2150132718773674. [PMID: 29756523 PMCID: PMC5954577 DOI: 10.1177/2150132718773674] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Evidence from previous studies demonstrates that lifestyle modification reduces the incidence and complications of atherosclerotic cardiovascular disease. The study aimed to investigate the effect of a lifestyle intervention provided by pharmacists on the 10-year atherosclerotic cardiovascular disease (ASCVD) risk and quality of life (QoL) in a low socioeconomic status Javanese population. METHODS This research was a cluster-randomized controlled study of 1-year duration, conducted in a lower social economic community in the Sleman District of Yogyakarta, Indonesia. The eligible subjects were dichotomized into 2 groups: 40 to 55 years (n = 61 vs 65) and 56 to 70 years (n = 21 vs 43) for intervention and control subjects, respectively. The ASCVD score and risk factors within the age-based groups were analyzed using T test/Mann-Whitney test for continuous data or chi-square test for categorical data. RESULTS The intervention and control subjects had similar baseline characteristics ( P > .05), including the ASCVD risk with the low- and high-risk classification for younger and elder subjects, respectively. At final follow-up, the younger intervention subjects had lower 10-year ASCVD risk ( P = .001), higher high-density lipoprotein cholesterol ( P = .02), smoking status ( P = .001), persistence rate ( P = .03), and QoL value for the physical and social function domains ( P < .05) than the control subjects, whereas the elder intervention subjects only had better ASCVD risk score than controls ( P = .03). Smoking interacting with intervention was the most influential variable on ASCVD risk in logistic regression analysis. CONCLUSION The study demonstrates that the health education by the pharmacists produce significant outcomes of the ASCVD risk, smoking status, and QoL of physical and social function particularly in the younger group.
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Affiliation(s)
- Rita Suhadi
- 1 Sanata Dharma University, Yogyakarta, Indonesia
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Awdishu L, Singh RF, Saunders I, Yam FK, Hirsch JD, Lorentz S, Atayee RS, Ma JD, Tsunoda SM, Namba J, Mnatzaganian CL, Painter NA, Watanabe JH, Lee KC, Daniels CD, Morello CM. Advancing Pharmacist Collaborative Care within Academic Health Systems. PHARMACY 2019; 7:pharmacy7040142. [PMID: 31614555 PMCID: PMC6958419 DOI: 10.3390/pharmacy7040142] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 09/10/2019] [Accepted: 10/05/2019] [Indexed: 11/16/2022] Open
Abstract
Introduction: The scope of pharmacy practice has evolved over the last few decades to focus on the optimization of medication therapy. Despite this positive impact, the lack of reimbursement remains a significant barrier to the implementation of innovative pharmacist practice models. Summary: We describe the successful development, implementation and outcomes of three types of pharmacist collaborative care models: (1) a pharmacist with physician oversight, (2) pharmacist–interprofessional teams and (3) physician–pharmacist teams. The outcome measurement of these pharmacist care models varied from the design phase to patient volume measurement and to comprehensive quality dashboards. All of these practice models have been successfully funded by affiliated health systems or grants. Conclusions: The expansion of pharmacist services delivered by clinical faculty has several benefits to affiliated health systems: (1) significant improvements in patient care quality, (2) access to experts in specialty areas, and (3) the dissemination of outcomes with national and international recognition, increasing the visibility of the health system.
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Affiliation(s)
- Linda Awdishu
- San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, La Jolla, CA 92093, USA.
- San Diego Health System, University of California, La Jolla, CA 92093, USA.
| | - Renu F Singh
- San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, La Jolla, CA 92093, USA.
- San Diego Health System, University of California, La Jolla, CA 92093, USA.
| | - Ila Saunders
- San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, La Jolla, CA 92093, USA.
- San Diego Health System, University of California, La Jolla, CA 92093, USA.
| | - Felix K Yam
- San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, La Jolla, CA 92093, USA.
- Veterans Affairs San Diego Healthcare System, La Jolla, CA 92093, USA.
| | - Jan D Hirsch
- San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, La Jolla, CA 92093, USA.
- Irvine School of Pharmacy and Pharmaceutical Sciences, University of California, Irvine, CA 92697, USA.
| | - Sarah Lorentz
- San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, La Jolla, CA 92093, USA.
| | - Rabia S Atayee
- San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, La Jolla, CA 92093, USA.
- San Diego Health System, University of California, La Jolla, CA 92093, USA.
| | - Joseph D Ma
- San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, La Jolla, CA 92093, USA.
- San Diego Health System, University of California, La Jolla, CA 92093, USA.
| | - Shirley M Tsunoda
- San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, La Jolla, CA 92093, USA.
- San Diego Health System, University of California, La Jolla, CA 92093, USA.
| | - Jennifer Namba
- San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, La Jolla, CA 92093, USA.
- San Diego Health System, University of California, La Jolla, CA 92093, USA.
| | - Christina L Mnatzaganian
- San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, La Jolla, CA 92093, USA.
- San Diego Health System, University of California, La Jolla, CA 92093, USA.
| | - Nathan A Painter
- San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, La Jolla, CA 92093, USA.
- San Diego Health System, University of California, La Jolla, CA 92093, USA.
| | - Jonathan H Watanabe
- San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, La Jolla, CA 92093, USA.
| | - Kelly C Lee
- San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, La Jolla, CA 92093, USA.
- San Diego Health System, University of California, La Jolla, CA 92093, USA.
| | - Charles D Daniels
- San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, La Jolla, CA 92093, USA.
- San Diego Health System, University of California, La Jolla, CA 92093, USA.
| | - Candis M Morello
- San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, La Jolla, CA 92093, USA.
- Veterans Affairs San Diego Healthcare System, La Jolla, CA 92093, USA.
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Dawoud DM, Haines A, Wonderling D, Ashe J, Hill J, Varia M, Dyer P, Bion J. Cost Effectiveness of Advanced Pharmacy Services Provided in the Community and Primary Care Settings: A Systematic Review. PHARMACOECONOMICS 2019; 37:1241-1260. [PMID: 31179514 DOI: 10.1007/s40273-019-00814-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
BACKGROUND Pharmacists working in community and primary care are increasingly developing advanced skills to provide enhanced services, particularly in dealing with minor acute illness. These services can potentially free-up primary care physicians' time; however, it is not clear whether they are sufficiently cost effective to be recommended for wider provision in the UK. OBJECTIVE The aim of this study was to review published economic evaluations of enhanced pharmacy services in the community and primary care settings. METHODS We undertook a systematic review of economic evaluations of enhanced pharmacy services to inform NICE guidelines for emergency and acute care. The review protocol was developed and agreed with the guideline committee. The National Health Service Economic Evaluation Database, Health Technology Assessment Database, Health Economic Evaluations Database, MEDLINE and EMBASE were searched in December 2016 and the search was updated in March 2018. Studies were assessed for applicability and methodological quality using the NICE Economic Evaluation Checklist. RESULTS Of 3124 records, 13 studies published in 14 papers were included. The studies were conducted in the UK, Spain, The Netherlands, Australia, Italy and Canada. Settings included community pharmacies, primary care/general practice surgeries and patients' homes. Most of the studies were assessed as partially applicable with potentially serious limitations. Services provided in community and primary care settings were found to be either dominant or cost effective, at a £20,000 per quality-adjusted life-year threshold, compared with usual care. Those delivered in the patient's home were not found to be cost effective. CONCLUSIONS Advanced pharmacy services appear to be cost effective when delivered in community and primary care settings, but not in domiciliary settings. Expansion in the provision of these services in community and primary care can be recommended for wider implementation.
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Affiliation(s)
- Dalia M Dawoud
- Clinical Pharmacy Department, Faculty of Pharmacy, Cairo University, Kasr El Aini Street, Cairo, Egypt.
| | - Alexander Haines
- Toronto Health Economics and Technology Assessment Collaborative, Toronto, ON, Canada
| | - David Wonderling
- National Guideline Centre, Royal College of Physicians, London, UK
| | - Joanna Ashe
- National Guideline Centre, Royal College of Physicians, London, UK
| | - Jennifer Hill
- National Guideline Centre, Royal College of Physicians, London, UK
| | - Mihir Varia
- NHS Herts Valleys Clinical Commissioning Group, Hertfordshire, UK
| | - Philip Dyer
- Diabetes, Endocrinology and Acute Internal Medicine, Diabetes Centre, University Hospitals Birmingham NHS Foundation Trust, Heartlands Hospital, Birmingham, UK
| | - Julian Bion
- Intensive Care Medicine, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Intensive Care Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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20
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Costa S, Horta MR, Santos R, Mendes Z, Jacinto I, Guerreiro J, Cary M, Miranda A, Helling DK, Martins AP. Diabetes policies and pharmacy-based diabetes interventions in Portugal: a comprehensive review. J Pharm Policy Pract 2019; 12:5. [PMID: 30937173 PMCID: PMC6427867 DOI: 10.1186/s40545-019-0166-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 02/18/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pharmacy-based interventions are complex public health endeavors which include, but are not restricted to, the conventional medication supply role. In diabetes, such interventions may improve patients' outcomes. The aim of this study was to review relevant policies and research developed in Portugal directed at pharmacy-based diabetes interventions, and to inform future policies, practice and research in collaborative practice with primary care. RESEARCH METHOD An exploratory review of diabetes legislation and policy papers, as well as a comprehensive review in Embase, MEDLINE (via Ovid and PubMed), Google Scholar, and grey literature until November 2017 was performed. RESULTS Sixteen policy papers and 10 studies were included in the analysis. Positive evidence from pharmacy interventions was retrieved concerning screening individuals at risk, screening uncontrolled patients, managing diabetes, and supporting self-monitoring. CONCLUSIONS Some consistency in favorable findings, but also room for improvements in health policies, intervention design and research methods, were observed.
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Affiliation(s)
- Suzete Costa
- USFarmácia® Collaborative Care Project, Associação Nacional das Farmácias, R. Marechal Saldanha, 1, 1249-069 Lisboa, Portugal
| | - Maria Rute Horta
- Department of Pharmacy Services, Associação Nacional das Farmácias, R. Marechal Saldanha, 1, 1249-069 Lisboa, Portugal
| | - Rita Santos
- Post-Graduate School of Health & Management (EPGSG), Associação Nacional das Farmácias, R. Marechal Saldanha, 1, 1249-069 Lisboa, Portugal
| | - Zilda Mendes
- Centre for Health Evaluation & Research (CEFAR), Associação Nacional das Farmácias, R. Marechal Saldanha, 1, 1249-069 Lisboa, Portugal
| | - Isabel Jacinto
- Department of Pharmacy Services, Associação Nacional das Farmácias, R. Marechal Saldanha, 1, 1249-069 Lisboa, Portugal
| | - José Guerreiro
- Centre for Health Evaluation & Research (CEFAR), Associação Nacional das Farmácias, R. Marechal Saldanha, 1, 1249-069 Lisboa, Portugal
| | - Maria Cary
- Centre for Health Evaluation & Research (CEFAR), Associação Nacional das Farmácias, R. Marechal Saldanha, 1, 1249-069 Lisboa, Portugal
| | - Ana Miranda
- Registo Oncológico Nacional, IPO Lisboa, R. Prof. Lima Basto, 1099-023 Lisboa, Portugal
| | - Dennis K. Helling
- University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, 8189 East 5th Avenue, Denver, CO 80230 USA
| | - Ana Paula Martins
- Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, Lisboa, Portugal
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21
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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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22
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What supports hospital pharmacist prescribing in Scotland? – A mixed methods, exploratory sequential study. Res Social Adm Pharm 2018; 14:488-497. [DOI: 10.1016/j.sapharm.2017.06.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 06/01/2017] [Accepted: 06/15/2017] [Indexed: 11/23/2022]
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23
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Rosenthal MM, Holmes ER. The Professional Culture of Community Pharmacy and the Provision of MTM Services. PHARMACY 2018; 6:E25. [PMID: 29561823 PMCID: PMC6025126 DOI: 10.3390/pharmacy6020025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 03/15/2018] [Accepted: 03/19/2018] [Indexed: 12/05/2022] Open
Abstract
The integration of advanced pharmacy services into community pharmacy practice is not complete. According to implementation research understanding professional culture, as a part of context, may provide insights for accelerating this process. There are three objectives in this study. The first objective of this study was to validate an adapted version of an organizational culture measure in a sample of United States' (US) community pharmacists. The second objective was to examine potential relationships between the cultural factors identified using the validated instrument and a number of socialization and education variables. The third objective was to examine any relationships between the scores on the identified cultural factors and the provision of MTM services. This study was a cross-sectional online survey for community pharmacists in the southeastern US. The survey contained questions on socialization/education, respondents' self-reported provision of medication therapy management (MTM) services, and the organizational culture profile (OCP). Analyses included descriptive statistics, a principle components analysis (PCA), independent samples t-test, and multivariate ordinal regression. A total of 303 surveys were completed. The PCA revealed a six-factor structure: social responsibility, innovation, people orientation, competitiveness, attention to detail, and reward orientation. Further analysis revealed significant relationships between social responsibility and years in practice, and people orientation and attention to detail and pharmacists' training and practice setting. Significant positive relationships were observed between social responsibility, innovation, and competitiveness and the increased provision of MTM services. The significant relationships identified between the OCP factors and community pharmacist respondents' provision of MTM services provides an important starting point for developing interventions to improve the uptake of practice change opportunities.
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Affiliation(s)
- Meagen M Rosenthal
- Department of Pharmacy Administration, School of Pharmacy, University of Mississippi, 223 Faser Hall, University, MS 38677-1848, USA.
| | - Erin R Holmes
- Department of Pharmacy Administration, School of Pharmacy, University of Mississippi, 223 Faser Hall, University, MS 38677-1848, USA.
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24
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Zhang D, Wang G, Joo H. A Systematic Review of Economic Evidence on Community Hypertension Interventions. Am J Prev Med 2017; 53:S121-S130. [PMID: 29153113 PMCID: PMC5819001 DOI: 10.1016/j.amepre.2017.05.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 04/24/2017] [Accepted: 05/08/2017] [Indexed: 01/05/2023]
Abstract
CONTEXT Effective community-based interventions are available to control hypertension. It is important to determine the economics of these interventions. EVIDENCE ACQUISITION Peer-reviewed studies from January 1995 through December 2015 were screened. Interventions were categorized into educational interventions, self-monitoring interventions, and screening interventions. Incremental cost-effectiveness ratios were summarized by types of interventions. The review was conducted in 2016. EVIDENCE SYNTHESIS Thirty-four articles were included in the review (16 from the U.S., 18 from other countries), including 25 on educational interventions, three on self-monitoring interventions, and six on screening interventions. In the U.S., five (31.3%) studies on educational interventions were cost saving. Among the studies that found the interventions cost effective, the median incremental costs were $62 (range, $40-$114) for 1-mmHg reduction in systolic blood pressure (SBP) and $13,986 (range, $6,683-$58,610) for 1 life-year gained. Outside the U.S., educational interventions cost from $0.62 (China) to $29 (Pakistan) for 1-mmHg reduction in SBP. Self-monitoring interventions, evaluated in the U.S. only, cost $727 for 1-mmHg reduction in SBP and $41,927 for 1 life-year gained. For 1 quality-adjusted life-year, screening interventions cost from $21,734 to $56,750 in the U.S., $613 to $5,637 in Australia, and $7,000 to $18,000 in China. Intervention costs to reduce 1 mmHg blood pressure or 1 quality-adjusted life-year were higher in the U.S. than in other countries. CONCLUSIONS Most studies found that the three types of interventions were either cost effective or cost saving. Quality of economic studies should be improved to confirm the findings.
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Affiliation(s)
- Donglan Zhang
- Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, Georgia.
| | - Guijing Wang
- Division for Heart Disease and Stroke Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Heesoo Joo
- Division of Global Migration and Quarantine, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
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25
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Cost-utility analysis of physician-pharmacist collaborative intervention for treating hypertension compared with usual care. J Hypertens 2017; 35:178-187. [PMID: 27684354 DOI: 10.1097/hjh.0000000000001126] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To estimate long-term costs and outcomes attributable to a physician-pharmacist collaborative intervention compared with physician management alone for treating essential hypertension. METHODS A Markov model cohort simulation with a 6-month cycle length to predict acute coronary syndrome, stroke, and heart failure throughout lifetime was performed. A cohort of 399 patients was obtained from two prospective, cluster randomized controlled clinical trials implementing physician-pharmacist collaborative interventions in community-based medical offices in the Midwest, USA. Framingham risk equations and other algorithms were used to predict the vascular diseases. SBP reduction due to the interventions deteriorated until 5 years. Direct medical costs using a payer perspective were adjusted to 2015 dollar value, and the main outcome was quality-adjusted life years (QALYs); both were discounted at 3%. The intervention costs were estimated from the trials, whereas the remaining parameters were from published studies. A series of sensitivity analyses including changing patient risks of vascular diseases, probabilistic sensitivity analysis, and a cost-effectiveness acceptability curve were performed. RESULTS The lifetime incremental costs were $26 807.83 per QALY (QALYs gained = 0.14). The intervention provided the greatest benefit for the high-risk patients, moderate benefit for the trial patients, and the lowest benefit for the low-risk patients. If a payer is willing to pay $50 000 per QALY gained, in 48.6% of the time the intervention would be cost-effective. CONCLUSION Team-based care such as a physician-pharmacist collaboration appears to be a cost-effective strategy for treating hypertension. The intervention is most cost-effective for high-risk patients.
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26
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Félix J, Ferreira D, Afonso-Silva M, Gomes MV, Ferreira C, Vandewalle B, Marques S, Mota M, Costa S, Cary M, Teixeira I, Paulino E, Macedo B, Barbosa CM. Social and economic value of Portuguese community pharmacies in health care. BMC Health Serv Res 2017; 17:606. [PMID: 28851428 PMCID: PMC5576248 DOI: 10.1186/s12913-017-2525-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 08/08/2017] [Indexed: 11/22/2022] Open
Abstract
Background Community pharmacies are major contributors to health care systems across the world. Several studies have been conducted to evaluate community pharmacies services in health care. The purpose of this study was to estimate the social and economic benefits of current and potential future community pharmacies services provided by pharmacists in health care in Portugal. Methods The social and economic value of community pharmacies services was estimated through a decision-model. Model inputs included effectiveness data, quality of life (QoL) and health resource consumption, obtained though literature review and adapted to Portuguese reality by an expert panel. The estimated economic value was the result of non-remunerated pharmaceutical services plus health resource consumption potentially avoided. Social and economic value of community pharmacies services derives from the comparison of two scenarios: “with service” versus “without service”. Results It is estimated that current community pharmacies services in Portugal provide a gain in QoL of 8.3% and an economic value of 879.6 million euros (M€), including 342.1 M€ in non-remunerated pharmaceutical services and 448.1 M€ in avoided expense with health resource consumption. Potential future community pharmacies services may provide an additional increase of 6.9% in QoL and be associated with an economic value of 144.8 M€: 120.3 M€ in non-remunerated services and 24.5 M€ in potential savings with health resource consumption. Conclusions Community pharmacies services provide considerable benefit in QoL and economic value. An increase range of services including a greater integration in primary and secondary care, among other transversal services, may add further social and economic value to the society. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2525-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Suzete Costa
- Centre for Health Evaluation & Research, National Association of Pharmacies (CEFAR), Lisbon, Portugal
| | - Maria Cary
- Centre for Health Evaluation & Research, National Association of Pharmacies (CEFAR), Lisbon, Portugal
| | - Inês Teixeira
- Centre for Health Evaluation & Research, National Association of Pharmacies (CEFAR), Lisbon, Portugal
| | - Ema Paulino
- Portuguese Pharmaceutical Society, Lisbon, Portugal
| | - Bruno Macedo
- Portuguese Pharmaceutical Society, Lisbon, Portugal
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27
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Brunisholz KD, Olson J, Anderson JW, Hays E, Tilbury PM, Winter B, Rickard J, Hamilton S, Parkin G. "Pharming out" support: a promising approach to integrating clinical pharmacists into established primary care medical home practices. J Int Med Res 2017; 46:234-248. [PMID: 28789606 PMCID: PMC6011325 DOI: 10.1177/0300060517710885] [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] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective Embedding clinical pharmacists into ambulatory care settings needs to be assessed in the context of established medical home models. Methods A retrospective, observational study examined the effectiveness of the Intermountain Healthcare Collaborative Pharmacist Support Services (CPSS) program from 2012–2015 among adult patients diagnosed with diabetes mellitus (DM) and/or high blood pressure (HBP). Patients who attended this program were considered the intervention (CPSS) cohort. These patients were matched using propensity scores with a reference group (no-CPSS cohort) to determine the effect of achieving disease management goals and time to achievement. Results A total of 17,684 patients had an in-person office visit with their provider and 359 received CPSS (the matched no-CPSS cohort included 999 patients). CPSS patients were 93% more likely to achieve a blood pressure goal < 140/90 mmHg, 57% more likely to achieve HbA1c values < 8%, and 87% more likely to achieve both disease management goals compared with the reference group. Time to goal achievement demonstrated increasing separation between the study cohorts across the entire study period (P < .001), and specifically, at 180 days post-intervention (HBP: 48% vs 27% P < .001 and DM: 39% vs 30%, P < .05). Conclusions CPSS participation is associated with significant improvement in achievement of disease management goals, time to achievement, and increased ambulatory encounters compared with the matched no-CPSS cohort.
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Affiliation(s)
| | - Jeff Olson
- 1 Intermountain Healthcare, Salt Lake City, UT, USA
| | | | - Emily Hays
- 1 Intermountain Healthcare, Salt Lake City, UT, USA
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Abstract
In recent years a number of countries have extended prescribing rights to pharmacists in a variety of formats. The latter includes independent prescribing, which is a developing area of practice for pharmacists in secondary care. Potential opportunities presented by wide scale implementation of pharmacist prescribing in secondary care include improved prescribing safety, more efficient pharmacist medication reviews, increased scope of practice with greater pharmacist integration into acute patient care pathways and enhanced professional or job satisfaction. However, notable challenges remain and these need to be acknowledged and addressed if a pharmacist prescribing is to develop sufficiently within developing healthcare systems. These barriers can be broadly categorised as lack of support (financial and time resources), medical staff acceptance and the pharmacy profession itself (adoption, implementation strategy, research resources, second pharmacist clinical check). Larger multicentre studies that investigate the contribution of hospital-based pharmacist prescribers to medicines optimisation and patient-related outcomes are still needed. Furthermore, a strategic approach from the pharmacy profession and leadership is required to ensure that pharmacist prescribers are fully integrated into future healthcare service and workforce strategies.
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Houle SKD, Charrois TL, McAlister FA, Kolber MR, Rosenthal MM, Lewanczuk R, Campbell NRC, Tsuyuki RT. Pay-for-performance remuneration for pharmacist prescribers' management of hypertension: A substudy of the RxACTION trial. Can Pharm J (Ott) 2016; 149:345-351. [PMID: 27829858 DOI: 10.1177/1715163516671745] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND To be sustainable, pharmacists providing direct patient care must receive appropriate payment for these services. This prespecified substudy of the RxACTION trial (a randomized trial of pharmacist prescribing vs usual care in patients with above-target blood pressure [BP]) aimed to determine if BP reduction achieved differed between patients whose pharmacist was paid by pay-for-performance (P4P) vs fee-for-service (FFS). METHODS Within RxACTION, patients with elevated BP assigned to the pharmacist prescribing group were further randomized to P4P or FFS payment for the pharmacist. In FFS, pharmacists received $150 for the initial visit and $75 for follow-up visits. P4P included FFS payments plus incentives of $125 and $250 for each patient who reached 50% and 100% of the BP target, respectively. The primary outcome was difference in change in systolic BP between P4P and FFS groups. RESULTS A total of 89 patients were randomized to P4P and 92 to the FFS group. Patients' average (SD) age was 63.0 (13.2) years, 49% were male and 76% were on antihypertensive drug therapy at baseline, taking a median of 2 (interquartile range = 1) medications. Mean systolic BP reductions in the P4P and FFS groups were 19.7 (SD = 18.4) vs 17.0 (SD = 16.4) mmHg, respectively (p = 0.47 for the comparison of deltas and p = 0.29 after multivariate adjustment). CONCLUSIONS This trial of pharmacist prescribing found substantial reductions in systolic BP among poorly controlled hypertensive individuals but with no appreciable difference when pharmacists were paid by P4P vs FFS.
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Affiliation(s)
- Sherilyn K D Houle
- School of Pharmacy (Houle, Tsuyuki), University of Waterloo, Kitchener, Ontario; the Faculty of Pharmacy and Pharmaceutical Sciences (Charrois), the EPICORE Centre/COMPRIS (Charrois, McAlister, Kolber, Tsuyuki), the Department of Medicine (McAlister, Lewanczuk, Tsuyuki) and the Department of Family Medicine (Kolber), University of Alberta, Edmonton; the Cumming School of Medicine (Campbell), University of Calgary, Calgary, Alberta; and the School of Pharmacy (Rosenthal), University of Mississippi, Oxford, Mississippi, USA
| | - Theresa L Charrois
- School of Pharmacy (Houle, Tsuyuki), University of Waterloo, Kitchener, Ontario; the Faculty of Pharmacy and Pharmaceutical Sciences (Charrois), the EPICORE Centre/COMPRIS (Charrois, McAlister, Kolber, Tsuyuki), the Department of Medicine (McAlister, Lewanczuk, Tsuyuki) and the Department of Family Medicine (Kolber), University of Alberta, Edmonton; the Cumming School of Medicine (Campbell), University of Calgary, Calgary, Alberta; and the School of Pharmacy (Rosenthal), University of Mississippi, Oxford, Mississippi, USA
| | - Finlay A McAlister
- School of Pharmacy (Houle, Tsuyuki), University of Waterloo, Kitchener, Ontario; the Faculty of Pharmacy and Pharmaceutical Sciences (Charrois), the EPICORE Centre/COMPRIS (Charrois, McAlister, Kolber, Tsuyuki), the Department of Medicine (McAlister, Lewanczuk, Tsuyuki) and the Department of Family Medicine (Kolber), University of Alberta, Edmonton; the Cumming School of Medicine (Campbell), University of Calgary, Calgary, Alberta; and the School of Pharmacy (Rosenthal), University of Mississippi, Oxford, Mississippi, USA
| | - Michael R Kolber
- School of Pharmacy (Houle, Tsuyuki), University of Waterloo, Kitchener, Ontario; the Faculty of Pharmacy and Pharmaceutical Sciences (Charrois), the EPICORE Centre/COMPRIS (Charrois, McAlister, Kolber, Tsuyuki), the Department of Medicine (McAlister, Lewanczuk, Tsuyuki) and the Department of Family Medicine (Kolber), University of Alberta, Edmonton; the Cumming School of Medicine (Campbell), University of Calgary, Calgary, Alberta; and the School of Pharmacy (Rosenthal), University of Mississippi, Oxford, Mississippi, USA
| | - Meagen M Rosenthal
- School of Pharmacy (Houle, Tsuyuki), University of Waterloo, Kitchener, Ontario; the Faculty of Pharmacy and Pharmaceutical Sciences (Charrois), the EPICORE Centre/COMPRIS (Charrois, McAlister, Kolber, Tsuyuki), the Department of Medicine (McAlister, Lewanczuk, Tsuyuki) and the Department of Family Medicine (Kolber), University of Alberta, Edmonton; the Cumming School of Medicine (Campbell), University of Calgary, Calgary, Alberta; and the School of Pharmacy (Rosenthal), University of Mississippi, Oxford, Mississippi, USA
| | - Richard Lewanczuk
- School of Pharmacy (Houle, Tsuyuki), University of Waterloo, Kitchener, Ontario; the Faculty of Pharmacy and Pharmaceutical Sciences (Charrois), the EPICORE Centre/COMPRIS (Charrois, McAlister, Kolber, Tsuyuki), the Department of Medicine (McAlister, Lewanczuk, Tsuyuki) and the Department of Family Medicine (Kolber), University of Alberta, Edmonton; the Cumming School of Medicine (Campbell), University of Calgary, Calgary, Alberta; and the School of Pharmacy (Rosenthal), University of Mississippi, Oxford, Mississippi, USA
| | - Norman R C Campbell
- School of Pharmacy (Houle, Tsuyuki), University of Waterloo, Kitchener, Ontario; the Faculty of Pharmacy and Pharmaceutical Sciences (Charrois), the EPICORE Centre/COMPRIS (Charrois, McAlister, Kolber, Tsuyuki), the Department of Medicine (McAlister, Lewanczuk, Tsuyuki) and the Department of Family Medicine (Kolber), University of Alberta, Edmonton; the Cumming School of Medicine (Campbell), University of Calgary, Calgary, Alberta; and the School of Pharmacy (Rosenthal), University of Mississippi, Oxford, Mississippi, USA
| | - Ross T Tsuyuki
- School of Pharmacy (Houle, Tsuyuki), University of Waterloo, Kitchener, Ontario; the Faculty of Pharmacy and Pharmaceutical Sciences (Charrois), the EPICORE Centre/COMPRIS (Charrois, McAlister, Kolber, Tsuyuki), the Department of Medicine (McAlister, Lewanczuk, Tsuyuki) and the Department of Family Medicine (Kolber), University of Alberta, Edmonton; the Cumming School of Medicine (Campbell), University of Calgary, Calgary, Alberta; and the School of Pharmacy (Rosenthal), University of Mississippi, Oxford, Mississippi, USA
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30
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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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Napier P, Norris P, Braund R. Could it be done safely? Pharmacists views on safety and clinical outcomes from the introduction of an advanced role for technicians. Res Social Adm Pharm 2015; 11:814-23. [DOI: 10.1016/j.sapharm.2014.12.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 12/22/2014] [Accepted: 12/22/2014] [Indexed: 11/16/2022]
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Obreli-Neto PR, Marusic S, Guidoni CM, Baldoni ADO, Renovato RD, Pilger D, Cuman RKN, Pereira LRL. Economic evaluation of a pharmaceutical care program for elderly diabetic and hypertensive patients in primary health care: a 36-month randomized controlled clinical trial. J Manag Care Spec Pharm 2015; 21:66-75. [PMID: 25562774 PMCID: PMC10398185 DOI: 10.18553/jmcp.2015.21.1.66] [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: 11/05/2022]
Abstract
BACKGROUND Most diabetic and hypertensive patients, principally the elderly, do not achieve adequate disease control and consume 5%-15% of annual health care budgets. Previous studies verified that pharmaceutical care is useful for achieving adequate disease control in diabetes and hypertension. OBJECTIVE To evaluate the economic cost and the incremental cost-effectiveness ratio (ICER) per quality-adjusted life-year (QALY) of pharmaceutical care in the management of diabetes and hypertension in elderly patients in a primary public health care system in a developing country. METHODS A 36-month randomized controlled clinical trial was performed with 200 patients who were divided into a control group (n = 100) and an intervention group (n = 100). The control group received the usual care offered by the Primary Health Care Unit (medical and nurse consultations). The intervention group received the usual care plus a pharmaceutical care intervention. The intervention and control groups were compared with regard to the direct costs of health services (i.e., general practitioner, specialist, nurse, and pharmacist appointments; emergency room visits; and drug therapy costs) and the ICER per QALY. These evaluations used the health system perspective. RESULTS No statistically significant difference was found between the intervention and control groups in total direct health care costs ($281.97 ± $49.73 per patient vs. $212.28 ± $43.49 per patient, respectively; P = 0.089); pharmaceutical care added incremental costs of $69.60 (± $7.90) per patient. The ICER per QALY was $53.50 (95% CI = $51.60-$54.00; monetary amounts are given in U.S. dollars). Every clinical parameter evaluated improved for the pharmaceutical care group, whereas these clinical parameters remained unchanged in the usual care group. The difference in differences (DID) tests indicated that for each clinical parameter, the patients in the intervention group improved more from pre to post than the control group (P < 0.001). CONCLUSIONS While pharmaceutical care did not significantly increase total direct health care costs, significantly improved health outcomes were seen. The mean ICER per QALY gained suggests a favorable cost-effectiveness.
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Meschia JF, Bushnell C, Boden-Albala B, Braun LT, Bravata DM, Chaturvedi S, Creager MA, Eckel RH, Elkind MSV, Fornage M, Goldstein LB, Greenberg SM, Horvath SE, Iadecola C, Jauch EC, Moore WS, Wilson JA. Guidelines for the primary prevention of stroke: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2014; 45:3754-832. [PMID: 25355838 PMCID: PMC5020564 DOI: 10.1161/str.0000000000000046] [Citation(s) in RCA: 989] [Impact Index Per Article: 98.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this updated statement is to provide comprehensive and timely evidence-based recommendations on the prevention of stroke among individuals who have not previously experienced a stroke or transient ischemic attack. Evidence-based recommendations are included for the control of risk factors, interventional approaches to atherosclerotic disease of the cervicocephalic circulation, and antithrombotic treatments for preventing thrombotic and thromboembolic stroke. Further recommendations are provided for genetic and pharmacogenetic testing and for the prevention of stroke in a variety of other specific circumstances, including sickle cell disease and patent foramen ovale.
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Howard-Thompson A, Farland MZ, Byrd DC, Airee A, Thomas J, Campbell J, Cassidy R, Morgan T, Suda KJ. Pharmacist-physician collaboration for diabetes care: cardiovascular outcomes. Ann Pharmacother 2014; 47:1471-7. [PMID: 24285763 DOI: 10.1177/1060028013504738] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Only 23% of patients are meeting all goals for cardiovascular complications of diabetes. OBJECTIVE The purpose of our study is to evaluate the effect of a pharmacist-physician collaboration on attainment of cardiovascular-related goals in patients with type 2 diabetes. METHODS This prospective, multicenter cohort enrolled patients from 7 practice sites that were members of the University of Tennessee Pharmacist Practice Based Research Network (UT Pharm Net). Patients were included if they were diagnosed with type 2 diabetes, at least 18 years of age and English speaking. Pregnant patients were excluded. Patients were followed for 12 months after enrollment. Primary cardiovascular outcomes included reduction in systolic blood pressure, diastolic blood pressure, and low-density lipoprotein (LDL) as well as the proportion of patients achieving a blood pressure goal of <130/80 mm Hg and proportion of patients achieving an LDL goal of <100 mg/dL. RESULTS For the 206 patients enrolled, the average age was 59.7 years; the majority were male (59.7%) and white (66%). When compared with baseline, the postintervention mean systolic (P < .0001), diastolic blood pressure (P = .0003), and LDL (P < .0001) decreased significantly. The proportion of patients achieving a blood pressure of <130/80 mm Hg increased 21.8% (P < .0001), and the proportion of patients achieving an LDL of <100 mg/dL increased 12% (P = .0023). CONCLUSIONS The results of our study indicate that collaborative management has a positive impact on decreasing cardiovascular risk and assists patients in attaining national goals for blood pressure and cholesterol.
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Affiliation(s)
- Amanda Howard-Thompson
- University of Tennessee Health Science Center College of Pharmacy, Memphis Campus, TN, USA
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Clinical services for obstructive sleep apnea patients in pharmacies: the Australian experience. Int J Clin Pharm 2014; 36:460-8. [PMID: 24562977 DOI: 10.1007/s11096-014-9926-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2013] [Accepted: 02/11/2014] [Indexed: 01/06/2023]
Abstract
BACKGROUND In Australia, certain pharmacies have undertaken a role in the management of the chronic sleep disorder, obstructive sleep apnea. The perspectives of pharmacy staff involved in this niche clinical service have never been formally collated on a national scale. The experiences of Australian pharmacies could provide a template for pharmacies in other health systems to adopt similar roles. OBJECTIVE To provide an overview of the perspectives of pharmacy staff involved in Continuous Positive Airway Pressure (CPAP) and sleep apnea-related services. Specifically, to describe clinical and structural elements, explore benefits and barriers, investigate viability, and gauge perspectives on future directions. SETTING Australian community pharmacies involved in CPAP and sleep apnea-related services. METHOD Cross-sectional mail survey. A questionnaire designed to meet the study objectives was developed by the researchers and mailed to all pharmacies in Australia providing CPAP services during the period of study recruitment. Pharmacies were identified through the distributor lists of the major CPAP manufacturers and a comprehensive Internet search. Non-responders were contacted in two subsequent recruitment rounds. MAIN OUTCOME MEASURE Self-reported sleep apnea service specifics. RESULTS A response rate of 55 % was achieved (n = 106 questionnaires valid for data entry). Benefits of providing a CPAP service included meeting patient and community needs, and professional satisfaction. Barriers included the cost of CPAP equipment to patients and lack of time. A majority of pharmacies (71 %) reported the service was financially viable despite most (63 %) not charging a 'fee for service.' Respondents expressed the view that CPAP provision should remain a specialist area of practice within the pharmacy profession. Key areas identified for improvement within the service were: (1) Staff training and knowledge (2) Promotion of the service and increasing public awareness (3) Infrastructure and expansion (4) Inter-professional collaboration and communication (5) Patient follow-up. CONCLUSION The provision of CPAP and sleep apnea-related services can be a viable and rewarding experience for pharmacists. The role may need to remain a specialised area for those willing to invest significantly in the service--in time, staff, resources and finances.
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Franklin BE, Farland MZ, Thomas J, McFarland MS, Ray SM, Byrd DC. Pharmacoeconomic Analysis of the Diabetes Initiative Program. Ann Pharmacother 2013; 47:1627-34. [DOI: 10.1177/1060028013506883] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Brandi E. Franklin
- University of Tennessee Health Science Center College of Pharmacy, Memphis, TN, USA
| | - Michelle Z. Farland
- University of Tennessee Health Science Center College of Pharmacy, Knoxville, TN, USA
| | - Jeremy Thomas
- University of Arkansas for Medical Sciences College of Pharmacy, Little Rock, AR, USA
| | | | - Shaunta’ M. Ray
- University of Tennessee Health Science Center College of Pharmacy, Knoxville, TN, USA
| | - Debbie C. Byrd
- University of Tennessee Health Science Center College of Pharmacy, Knoxville, TN, USA
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