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Mustafa M, Hatah E, Makmor-Bakry M. Integrating design thinking and implementation science principles in delivering a medication review service in the community pharmacy setting-An implementation testing study. PLoS One 2024; 19:e0304291. [PMID: 38870126 PMCID: PMC11175411 DOI: 10.1371/journal.pone.0304291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 05/04/2024] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND Medication review (MR) services are evidenced-based practices in which a systematic assessment of a patient's medication is conducted, primarily aiming to optimize drug therapy and minimize adverse drug events through pharmacist interventions. Although studies show that MR services are effective, the implementation of MR services in Malaysia has been challenging due to several barriers. An MR services blueprint was developed to be adapted to the Malaysian community pharmacy setting as part of tailoring strategies. OBJECTIVE Through utilizing the design thinking triple diamond model and implementation science principles, a powerful guide for healthcare researchers and stakeholders to assist with effective service implementation, this study aimed to evaluate the implementation testing and observe the effectiveness of the developed MR service blueprint. METHOD The study utilizes an effectiveness-implementation Type 3 hybrid implementation science framework conducted from May 2021 to April 2022. Employing a qualitative ethnographic approach, researchers observed pharmacy study sites during the implementation of MR services. Both qualitative and quantitative data were collected across exploration, preparation, testing, and operational phases. Implementation outcomes evaluated include phases, reach, fidelity, acceptability, as well as implementation barriers and strategies. MR intervention outcomes included service characteristics and the number and type of drug-related problems and interventions offered. RESULTS 17 community pharmacists were invited to pilot the MR service blueprint for six months in their setting. Of this, 78.5% (n = 11) of the pharmacies reached the testing phase, and 36% (n = 4) reached the implementation phase. Fifty-four patients were in the study, giving an implementation reach of 70%. The majority of surveyed patients expressed satisfaction with the service. The total DRP identified was 133, and 64 interventions were provided by the pharmacists. Facilitation strategies such as "Engage stakeholders by creating ownership of the change" and "Equip stakeholders with training" are needed to overcome the barriers. CONCLUSION This study marked the beginning of successful MR service implementation at Malaysian community pharmacies. Future studies with multi-level partnered strategies are required to reach full implementation and sustainability.
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Affiliation(s)
- Maali Mustafa
- Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur, Malaysia
- Faculty of Pharmacy, University of Cyberjaya, Persiaran Bestari, Cyberjaya, Selangor, Malaysia
| | - Ernieda Hatah
- Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur, Malaysia
| | - Mohd Makmor-Bakry
- Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur, Malaysia
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2
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Batten M, Koerner J, Kosari S, Naunton M, Lewis J, Strickland K. Assessing implementation fidelity of an on-site pharmacist intervention within Australian residential aged care facilities: A mixed methods study. BMC Health Serv Res 2023; 23:1166. [PMID: 37891564 PMCID: PMC10604517 DOI: 10.1186/s12913-023-10172-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 10/18/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND An on-site pharmacist (OSP) intervention was implemented which sought to improve medication management within residential aged care facilities (RACFs) in the Australian Capital Territory, Australia. The objectives of this mixed methods study were to evaluate the implementation fidelity of the OSP intervention and to determine the moderating factors which influenced delivery of this intervention. METHODS This convergent parallel mixed methods study was underpinned by Hasson's conceptual framework for implementation fidelity. Implementation fidelity for seven intervention RACFs was quantitatively assessed using three quantitative data sets: (1) range of OSP intervention activities delivered; (2) random sample of 10% of medication reviews assessed for quality; (3) proportion of residents who received at least one medication review. Semi-structured interviews (n = 14) with managers and OSPs across the intervention RACFs were conducted to identify moderating factors which may have influenced OSP intervention delivery. RESULTS The OSP intervention was generally delivered as intended with overall medium levels of implementation fidelity. This delivery was supported by a range of facilitation strategies with most participants perceiving that the intervention was delivered to a high standard. RACF managers and OSPs were mostly well engaged and responsive. A number of potential barriers (including the part-time OSP role, COVID-19 pandemic, RACFs spread out over a large area with significant distance between resident dwellings) and facilitators (including the pharmacist support meetings, OSPs who took time to establish relationships, RACF managers who actively supported OSPs and worked with them) for OSP intervention delivery were identified which have potential implications for the roll out of OSPs within Australian RACFs. CONCLUSION In this study, the implementation fidelity of OSP intervention delivery was assessed with overall medium levels of fidelity found across the intervention RACFs. This suggested that the OSP intervention can generally be delivered as intended in real world RACFs. OSP intervention delivery was influenced by a range of moderating factors, some of which posed barriers and others which facilitated the OSP intervention being delivered as intended.
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Affiliation(s)
- Miranda Batten
- Health Research Institute, University of Canberra, Bruce, ACT, 2617, Australia.
| | - Jane Koerner
- Health Research Institute, University of Canberra, Bruce, ACT, 2617, Australia
| | - Sam Kosari
- Discipline of Pharmacy, Faculty of Health, University of Canberra, Bruce, ACT, 2617, Australia
| | - Mark Naunton
- Discipline of Pharmacy, Faculty of Health, University of Canberra, Bruce, ACT, 2617, Australia
| | - Joanne Lewis
- School of Nursing and Health, Avondale University, Wahroonga, NSW, 2076, Australia
| | - Karen Strickland
- School of Nursing, Midwifery and Public Health, University of Canberra, Bruce, ACT, 2617, Australia
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA, 6207, Australia
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Robberechts A, Michielsen M, Steurbaut S, De Meyer GRY, De Loof H. Key elements in the quality assessment of a type 3 medication review. Front Pharmacol 2023; 14:1258364. [PMID: 37860120 PMCID: PMC10582266 DOI: 10.3389/fphar.2023.1258364] [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] [Received: 07/13/2023] [Accepted: 09/18/2023] [Indexed: 10/21/2023] Open
Abstract
Background: Medication reviews are a structured evaluation of a patient's pharmacotherapy with the aim of optimizing medicines use and improving health outcomes. This entails detecting drug related problems and recommending interventions. A high level of quality is essential for the successful implementation of this service in community pharmacies but currently there is no instrument or tool to assess that overall quality. Aim: This study investigated the development of quality criteria of type 3 medication reviews (MR3s). Methods: After surveying the literature, an electronic questionnaire was developed to gather information about quality criteria for MR3. This survey, in Dutch, was distributed electronically. Four groups were queried: 1) pharmacists, mainly working in the Netherlands, involved in practice research and contacted through the PRISMA (Practice Research In Collaboration With Pharmacists) foundation, 2) Belgian pharmacy academics and pharmacists active in professional associations (APA), 3) Belgian pharmacists trained in medication review (MR) by the Royal Pharmacists Association of Antwerp (KAVA) and 4) Belgian pharmacy students. The survey included 57 criteria, divided into eight domains, which were ranked according to their importance by the participants. The results were analyzed statistically using the nonparametric Kruskal-Wallis test. Results: The survey was completed by 95 participants, including 42 PRISMA pharmacists, 19 APA pharmacists, 18 KAVA pharmacists and 16 pharmacy students. Opinions from participants from the different groups overlapped significantly. The use of simple and understandable language in the conversation with the patient was considered essential by the majority. Discussing the usefulness and purpose of a MR3 with the patient was also rated highly by all groups. Differences of opinion were present in aspects about laboratory values, the use of specific tools, and reporting to and consultation with the treating physician. The participants themselves formulated a limited number of additional assessment criteria. Conclusion: There was widespread agreement on the hierarchy of the quality assessment criteria for MR3s. Minor differences were related to the experience of the participants. With these results and a small number of suggested extra criteria, a quality assessment instrument for MR3 can be created.
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Affiliation(s)
- Anneleen Robberechts
- Meduplace, Royal Pharmacists Association of Antwerp (KAVA), Antwerp, Belgium
- Laboratory of Physiopharmacology, University of Antwerp, Antwerp, Belgium
- Research Group Clinical Pharmacology and Clinical Pharmacy, Centre for Pharmaceutical Research, Vrije Universiteit Brussel, Brussels, Belgium
| | - Melissa Michielsen
- Laboratory of Physiopharmacology, University of Antwerp, Antwerp, Belgium
| | - Stephane Steurbaut
- Research Group Clinical Pharmacology and Clinical Pharmacy, Centre for Pharmaceutical Research, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Hospital Pharmacy, Jette, Belgium
| | | | - Hans De Loof
- Laboratory of Physiopharmacology, University of Antwerp, Antwerp, Belgium
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Community pharmacist intervention to close statin gaps in diabetes care: The GuIDE-S study. J Am Pharm Assoc (2003) 2023; 63:108-117. [PMID: 36163125 DOI: 10.1016/j.japh.2022.08.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 08/22/2022] [Accepted: 08/25/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Statin therapy is recommended for people with type 2 diabetes (T2D) to lower cardiovascular risk; however, evidence suggests that significant gaps in statin therapy exist. OBJECTIVE To evaluate (1) the impact of a community pharmacist-led model for initiating statin therapy in people with type 2 diabetes (T2D) on statin initiation and (2) pharmacists' self-reported perceptions of the intervention feasibility and fidelity to the intervention. METHODS This was a type 1 hybrid effectiveness-implementation study of 9 intervention and 18 control pharmacies within a community pharmacy chain. Pharmacy staff proactively identified patients with T2D not taking a statin and prescribed a statin via a collaborative practice agreement or facilitated acquisition of a prescription from the patient's preferred prescriber. The eligible population included patients aged 18-84 years with T2D, who had filled ≥60 days' supply of one, noninsulin, diabetes medication in a rolling 6-month period, and who had not filled a statin during the same period. A Cox proportional hazards model was used to compare time to statin initiation. Pharmacists at intervention pharmacies completed a survey at 6 and 12 months after implementation (March and August 2019, respectively) to assess intervention feasibility and fidelity. RESULTS For the statin initiation analysis, 1670 intervention patients were matched to 3358 control patients. Overall, 26.3% (n=442) of intervention patients and 25.4% (n=854) of control patients initiated a statin within 12 months of their index date. There was no difference in statin initiation likelihood between intervention and control patients (hazard ratio: 1.00; 95% CI: 0.83, 1.21). Fifteen pharmacists completed the 6-month survey (33% response rate), and 12 completed the 12-month survey (26%). The intervention's feasibility score was 4.0 at 6 months and 4.2 at 12 months, indicating an increase in perceived feasibility. Fidelity decreased from 6 to 12 months. CONCLUSION The community pharmacist-led intervention resulted in more patients initiating statin therapy as compared to usual care; however, the differences were not statistically significant. Pharmacists perceived the intervention to be feasible; however, fidelity decreased over time.
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Evaluation approaches, tools and aspects of implementation used in pharmacist interventions in residential aged care facilities: A scoping review. Res Social Adm Pharm 2022; 18:3714-3723. [DOI: 10.1016/j.sapharm.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 02/15/2022] [Accepted: 05/07/2022] [Indexed: 11/21/2022]
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Cone C, Gundrum D, Lipsky MS. Evaluating Fidelity to Comprehensive Medication Management in Pharmacy Education Courses Teaching the Patient Care Process. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2022; 86:8565. [PMID: 34385167 PMCID: PMC10159449 DOI: 10.5688/ajpe8565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 07/26/2021] [Indexed: 05/06/2023]
Abstract
Objective. To evaluate fidelity to the comprehensive medication management (CMM) framework in a patient care skills course by using CMM essential functions to analyze the domains of content and competency.Methods. A mixed methods approach was used to compare the curriculum of the Pharmacist's Patient Care Process II skills course to the nationally developed CMM framework. The content of the course curriculum was mapped to the CMM framework and the percentage of omissions and deficiencies were calculated. Student competency was analyzed using pharmacy students' assessment scores.Results. Of the 102 class hours in the PPCP II course, 41.5 hours (40.7%) were spent teaching CMM content. Deficiencies in and omissions of content from the CMM framework were calculated at 14.3%, indicating an overall alignment with the CMM framework of 71.4%. For the competency domain, the percentage of students initially achieving competence ranged from 76.6% to 98.7% on formative assessments in 2018-2019 and 2019-2020, combined academic years. For the summative assessment, 87.5% in 2018-2019 and 69.2% in 2019-2020 achieved competency on their first attempt, with levels rising significantly to 98.8% and 98.7%, respectively, after remediation. Overall, 98.7% of students achieved competency in CMM-related course curriculum.Conclusion. About 70% of the CMM framework for the core domain of content can be covered in approximately 40 hours of direct curricular time, and the majority of students can achieve competency. The omissions of and deficiencies in CMM content identified in this study highlight opportunities for course improvement. Remediation of students with deficient skills resulted in a significant improvement in the percentage of students achieving competence in CMM.
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Affiliation(s)
- Catherine Cone
- Roseman University of Health Sciences, South Jordan, Utah
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7
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Nesbit SA, Haas CE, Carter BL, Kehoe WA, Jacobi J, D'Amico HR, Peace JT. Development of clinical pharmacy quality measures: A call to action. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2022. [DOI: 10.1002/jac5.1601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | | | | | | | - Judi Jacobi
- American College of Clinical Pharmacy Lenexa Kansas USA
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8
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Anderson EJ, Dhatt H, Vaffis S, Nelson ML, Warholak T, Campbell PJ, Black H, Kolobova I, Axon DR. Key informant perspectives about telephonic comprehensive medication review services in the United States. J Am Pharm Assoc (2003) 2022; 62:817-825.e1. [DOI: 10.1016/j.japh.2022.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 12/07/2021] [Accepted: 01/04/2022] [Indexed: 11/26/2022]
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Precision of Medication Therapy Problem Identification and Classification amongst Primary Care Clinic Pharmacists. PHARMACY 2021; 9:pharmacy9040179. [PMID: 34842816 PMCID: PMC8628995 DOI: 10.3390/pharmacy9040179] [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: 09/29/2021] [Revised: 10/27/2021] [Accepted: 10/31/2021] [Indexed: 11/30/2022] Open
Abstract
This study assesses the level of agreement on medication therapy problem (MTP) identification and classification between primary care, ambulatory care pharmacists within a health-system that recently implemented system-wide pharmacist provision of comprehensive medication management (CMM) services. Twenty standardized case vignettes were created and distributed to pharmacists who reviewed each case and identified and categorized MTPs. Outcomes include the number of MTPs identified, identification (yes/no) of specific MTPs within each case (e.g., need for a statin), and Pharmacy Quality Alliance (PQA) category used when classifying MTPs. The level of agreement on MTP identification/categorization was measured using intraclass correlation coefficient (ICC) and interpreted using the Landis and Koch interpretation scale. “Moderate agreement” was observed for the number of MTPs identified by pharmacists (ICC equal to 0.45; 95% confidence interval [CI]: 0.31 to 0.65). In approximately one-half of opportunities, the pharmacists agreed perfectly on the number of MTPs; in approximately one-third of opportunities, the number of MTPs identified varied by 1; and approximately one-tenth of the time, the number of MTPs varied by 2. In regard to the MTP identification (yes/no) and categorization, percent agreement was ≥73% across all MTPs. The results support the need for further training and education and provide the information necessary to target specific disease states.
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10
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Comprehensive medication management research gap areas: A call to action for clinical pharmacy researchers. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2021. [DOI: 10.1002/jac5.1476] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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11
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McClurg M. CMM
alphabet soup: Making sense of our
ABCs. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2021. [DOI: 10.1002/jac5.1511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Mary McClurg
- University of North Carolina at Chapel Hill Eshelman School of Pharmacy Chapel Hill North Carolina USA
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McFarland MS, Ourth H, Frank D, Mambourg S, Tran M, Morreale A. Development and validation of a systematic process for expansion of clinical pharmacy activities for comprehensive medication management in primary care within the Department of Veterans Affairs. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2021. [DOI: 10.1002/jac5.1449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- M. Shawn McFarland
- Clinical Pharmacy Practice Office U.S. Department of Veterans Affairs Washington DC USA
| | - Heather Ourth
- Clinical Pharmacy Practice Office U.S. Department of Veterans Affairs Washington DC USA
| | - Dana Frank
- Veterans Integrated Service Network 12 Chicago Illinois USA
| | - Scott Mambourg
- Veterans Integrated Service Network 21 Pleasant Hill California USA
| | - Michael Tran
- Clinical Pharmacy Practice Office U.S. Department of Veterans Affairs Washington DC USA
| | - Anthony Morreale
- Clinical Pharmacy Practice Office U.S. Department of Veterans Affairs Washington DC USA
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McFarland MS, Badowski ME. “Tele”‐ing the story of clinical pharmacy: Providing comprehensive medication management in a virtual environment. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2021. [DOI: 10.1002/jac5.1491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- M. Shawn McFarland
- National Clinical Pharmacy Practice Program Manager, US Department of Veterans Affairs Clinical Pharmacy Practice Office Murfressboro Tennessee USA
| | - Melissa E. Badowski
- University of Illinois Chicago College of Pharmacy, Pharmacy Practice Chicago Illinois USA
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14
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Melton T, Jasmin H, Johnson HF, Coley A, Duffey S, Renfro CP. Describing the delivery of clinical pharmacy services via telehealth: A systematic review. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2021. [DOI: 10.1002/jac5.1486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Tyler Melton
- University of Tennessee Health Science Center College of Pharmacy Knoxville Tennessee USA
| | - Hilary Jasmin
- University of Tennessee Health Science Center Health Sciences Library Memphis Tennessee USA
| | - Haden F. Johnson
- University of Tennessee Health Science Center College of Pharmacy Memphis Tennessee USA
| | - Annika Coley
- University of Tennessee Health Science Center College of Pharmacy Memphis Tennessee USA
| | - Sawyer Duffey
- University of Tennessee Health Science Center College of Pharmacy Memphis Tennessee USA
| | - Chelsea P. Renfro
- University of Tennessee Health Science Center College of Pharmacy Memphis Tennessee USA
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Blanchard CM, Yannayon M, Sorge L, Frail C, Funk K, Ward C, Livet M, Sorensen T, McClurg MR. Establishing a common language for the comprehensive medication management patient care process: Applying implementation science to standardize care delivery. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2021. [DOI: 10.1002/jac5.1496] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Carrie M. Blanchard
- University of North Carolina at Chapel Hill Eshelman School of Pharmacy Chapel Hill North Carolina USA
| | - Mary Yannayon
- University of North Carolina at Chapel Hill Eshelman School of Pharmacy Chapel Hill North Carolina USA
| | - Lindsay Sorge
- University of Minnesota College of Pharmacy Minneapolis Minnesota USA
| | - Caitlin Frail
- University of Minnesota College of Pharmacy Minneapolis Minnesota USA
| | - Kylee Funk
- University of Minnesota College of Pharmacy Minneapolis Minnesota USA
| | - Caryn Ward
- Frank Porter Graham Child Development Institute at The University of North Carolina at Chapel Hill Chapel Hill North Carolina USA
| | - Melanie Livet
- University of North Carolina at Chapel Hill Eshelman School of Pharmacy Chapel Hill North Carolina USA
| | - Todd Sorensen
- University of Minnesota College of Pharmacy Minneapolis Minnesota USA
| | - Mary Roth McClurg
- University of North Carolina at Chapel Hill Eshelman School of Pharmacy Chapel Hill North Carolina USA
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McFarland MS, Buck ML, Crannage E, Armistead LT, Ourth H, Finks SW, McClurg MR. Assessing the Impact of Comprehensive Medication Management on Achievement of the Quadruple Aim. Am J Med 2021; 134:456-461. [PMID: 33472055 DOI: 10.1016/j.amjmed.2020.12.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 12/01/2020] [Accepted: 12/01/2020] [Indexed: 01/01/2023]
Abstract
Nonoptimized medication regimens cost patients and payors in the United States more than $528 billion in additional health care expenses each year. Comprehensive medication management is a patient-centered approach to medication optimization delivered by a clinical pharmacist working with the patient, physicians, and other members of the health care team. Comprehensive medication management ensures medications are assessed for appropriateness, effectiveness, and safety given the patient's clinical status, comorbidities, and other medications, as well as the patient's ability to take the medications as intended and adhere to the regimen. This article reviews the growing body of literature demonstrating the value of comprehensive medication management in achieving the quadruple aim of health care: better care, reduced health care costs, an improved patient experience, and provider well-being.
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Affiliation(s)
- M Shawn McFarland
- National Clinical Pharmacy Practice Program Manager, Clinical Practice Integration and Model Advancement, Clinical Pharmacy Practice Office, Pharmacy Benefits Management Services, Veterans Health Administration, Washington, DC.
| | - Marcia L Buck
- Director, Clinical Practice Advancement, American College of Clinical Pharmacy, Washington, DC
| | - Erica Crannage
- Associate Professor, Department of Pharmacy Practice, University of Health Sciences and Pharmacy in St. Louis, St. Louis, Mo
| | - Lori T Armistead
- Senior Research Associate, Clinical Coordinator, Center for Medication Optimization, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill
| | - Heather Ourth
- National Program Manager for the Clinical Pharmacy Practice Program and Outcomes Assessment, Veterans Health Administration, Washington, DC
| | - Shannon W Finks
- Professor, Department of Clinical Pharmacy and Translational Sciences, University of Tennessee Health Science Center, Memphis
| | - Mary Roth McClurg
- Professor and Executive Vice Dean-Chief Academic Officer, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill
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Blanchard CM, Duboski V, Graham J, Webster L, Kern MS, Wright EA, Gionfriddo MR. A mixed methods evaluation of the implementation of pharmacy services within a team-based at-home care program. Res Social Adm Pharm 2021; 17:1978-1988. [PMID: 33745855 DOI: 10.1016/j.sapharm.2021.02.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 02/25/2021] [Accepted: 02/26/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Sub-optimal medication use results in significant avoidable morbidity, mortality, and costs. Programs, such as comprehensive medication management (CMM), can help to optimize medication use, improve outcomes, and reduce costs. However, implementing programs like CMM can be challenging and differences in how CMM has been implemented may be responsible for observed heterogeneity in the outcomes associated with CMM. OBJECTIVE(S) Describe the implementation strategies utilized in implementing CMM telephonically within a team-based at-home care program and evaluate the implementation process. METHODS The implementation of CMM was facilitated using various implementation strategies including: develop educational material and conduct training, change record system, audit and feedback, learning collaborative, quality monitoring, readiness assessment, and implementation team formation. The impact of these strategies as well as pharmacist and team member perspectives on the implementation of CMM were examined using mixed methods and guided by Proctor's conceptual model for implementation. RESULTS The pharmacists felt that most of the implementation strategies used to facilitate consistent delivery of CMM were useful, but were unable to successfully implement all of them. Despite this, significant increases in fidelity to steps of the patient care process was achieved. The pharmacists felt that CMM was acceptable, appropriate for patient population, and feasible, but barriers (e.g., the telephonic and remote nature of the practice, the evolving nature of the program, and the difficulty in coordinating care between the patients primary care team and the care team affiliated with the program) affected the feasibility and organizational fit of CMM within this team-based, at-home care program. General pharmacy services, however, were seen as acceptable, appropriate, and feasible. CONCLUSION Deliberately designing and utilizing a variety of implementation strategies can facilitate the implementation of CMM and significantly increase fidelity to the patient care process. To improve feasibility and organizational fit of CMM, additional barriers and challenges need to be addressed.
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Affiliation(s)
- Carrie M Blanchard
- Center for Medication Optimization, Division of Practice Advancement and Clinical Education UNC Eshelman School of Pharmacy, Chapel Hill, NC, USA.
| | - Vanessa Duboski
- Center for Pharmacy Innovation and Outcomes, Geisinger, Danville, PA, USA
| | - Jove Graham
- Center for Pharmacy Innovation and Outcomes, Geisinger, Danville, PA, USA
| | | | - Melissa S Kern
- Center for Pharmacy Innovation and Outcomes, Geisinger, Danville, PA, USA
| | - Eric A Wright
- Center for Pharmacy Innovation and Outcomes, Geisinger, Danville, PA, USA
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Clements JN, Emmons RP, Anderson SL, Chow M, Coon S, Irwin AN, Mukherjee SM, Sease JM, Thrasher K, Witek SR. Current and future state of quality metrics and performance indicators in comprehensive medication management for ambulatory care pharmacy practice. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2021. [DOI: 10.1002/jac5.1406] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
| | | | | | - Marissa Chow
- American College of Clinical Pharmacy Lenexa Kansas USA
| | - Scott Coon
- American College of Clinical Pharmacy Lenexa Kansas USA
| | | | | | | | - Kim Thrasher
- American College of Clinical Pharmacy Lenexa Kansas USA
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Measuring implementation of medication optimization services: Development and validation of an implementation outcomes questionnaire. Res Social Adm Pharm 2021; 17:1623-1630. [PMID: 33526353 DOI: 10.1016/j.sapharm.2021.01.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 12/23/2020] [Accepted: 01/03/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Implementation outcomes serve as progress and success indicators of the implementation process. They are also key antecedents to achieving the more traditional clinical outcomes typically associated with a service. Despite their importance, there are few implementation outcomes measures with appropriate psychometric properties, none of which have yet been adapted for medication optimization services. OBJECTIVES This study aims to develop and validate the Implementation Outcomes Questionnaire (IOQ) to assess implementation of medication optimization services, starting with Comprehensive Medication Management (CMM). The resulting IOQ is a 40-item self-report instrument for six implementation outcomes, including adoption, acceptability, feasibility, appropriateness, penetration, and sustainability. METHODS A three-phase approach was used to develop and validate the IOQ. Development of the instrument, Phase I, was informed by a targeted search of existing implementation outcomes measures in other fields, a review of suitableoptions options by an expert panel, and item adaptation. To assess content validity, Phase II, an internal vetting process was conducted using an adapted version of Rubio and colleagues' methodology. Evidence of reliability and construct validity, Phase III, was obtained through a pilot test with 167 pharmacists within 78 different care settings. RESULTS Overall, the results supported the reliability and validity (both content and construct) of the IOQ, with further psychometric testing needed for adoption. The items' relevance, clarity, and alignment with each implementation concept were high, except for Penetration. As a result, the Penetration items were refined for further use. Best-fit models were identified for each outcome based on the MCFA analyses, thereby providing insights into the factor structures and interpretation for each measure. Cronbach' alphas indicated good internal consistency. CONCLUSIONS This questionnaire is the first of its kind tailored to medication optimization services, starting with CMM. Access to this survey should facilitate measurement of implementation outcomes, thereby increasing the likelihood of achieving the desired clinical outcomes.
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