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Magedanz L, Silva HL, Galato D, Fernandez-Llimos F. Clinical pharmacy key performance indicators for hospital inpatient setting: a systematic review. Int J Clin Pharm 2024; 46:602-613. [PMID: 38570475 PMCID: PMC11133179 DOI: 10.1007/s11096-024-01717-x] [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: 01/11/2024] [Accepted: 02/21/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND Key performance indicators (KPIs) are quantifiable measures used to monitor the quality of health services. Implementation guidelines for clinical pharmacy services (CPS) do not specify KPIs. AIM To assess the quality of the studies that have developed KPIs for CPS in inpatient hospital settings. METHOD A systematic review was conducted by searching in Web of Science, Scopus, and PubMed, supplemented with citation analyses and grey literature searches, to retrieve studies addressing the development of KPIs in CPS for hospital inpatients. Exclusions comprised drug- or disease-specific studies and those not written in English, French, Portuguese, or Spanish. The Appraisal of Indicators through Research and Evaluation (AIRE) instrument assessed methodological quality. Domain scores and an overall score were calculated using an equal-weight principle. KPIs were classified into structure, process, and outcome categories. The protocol is available at https://doi.org/10.17605/OSF.IO/KS2G3 . RESULTS We included thirteen studies that collectively developed 225 KPIs. Merely five studies scored over 50% on the AIRE instrument, with domains #3 (scientific evidence) and #4 (formulation and usage) displaying low scores. Among the KPIs, 8.4% were classified as structure, 85.8% as process, and 5.8% as outcome indicators. The overall methodological quality did not exhibit a clear association with a major focus on outcomes. None of the studies provided benchmarking reference values. CONCLUSION The KPIs formulated for evaluating CPS in hospital settings primarily comprised process measures, predominantly suggested by pharmacists, with inadequate evidence support, lacked piloting or validation, and consequently, were devoid of benchmarking reference values.
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Affiliation(s)
- Lucas Magedanz
- Postgraduate Program in Health Sciences and Technologies, University of Brasília, Brasília, DF, Brazil
| | - Hiolanda Lêdo Silva
- Postgraduate Program in Health Sciences and Technologies, University of Brasília, Brasília, DF, Brazil
| | - Dayani Galato
- Postgraduate Program in Health Sciences and Technologies, University of Brasília, Brasília, DF, Brazil
| | - Fernando Fernandez-Llimos
- UCIBIO-Applied Molecular Biosciences Unit, i4HB-Institute for Health and Bioeconomy, Laboratory of Pharmacology, Faculty of Pharmacy, University of Porto, Porto, Portugal.
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Axtell S, Nixon B. Implementing Transitions of Care Services in a Primary Care Clinic: Role of the Pharmacist. J Pharm Pract 2024; 37:650-655. [PMID: 36930884 DOI: 10.1177/08971900231165833] [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: 03/19/2023]
Abstract
IntroductionPharmacists in primary care clinics improve medication adherence and reduce medication errors but these require further investigation to determine its potential impact on health care readmission rates. Methods: This review assessed the addition of a clinical pharmacist to the primary care provider's transitions of care appointment. The primary outcome of this review was the change in acute health care encounters (hospital readmissions and/or Emergency Department visits) in the 6-month period before to the 6 months following initial clinical pharmacist intervention. Each patient served as their own control. Secondary outcomes included the number and types of pharmacist interventions, percentage of pharmacist recommendations accepted, number and categories of drug-related problems (DRPs), nonadherence reasons, 30-day hospital readmission rate, 30-day Emergency Department (ED) rate, time to first hospital readmission, time to first ED readmission, and preventable readmission rate. Results: The total number of combined acute health care encounters in 6 months decreased by 15% from 280 at baseline to 238 after pharmacist intervention (P = .087) for the 206 patients included in the final analysis. The 30-day hospital readmission rate was 9.7% and the median time between first hospital readmission was 54.5 days (IQR 63.5). We identified a total number of 310 DRPs with a mean of 1.5 DRPs (SD 1.3) identified per patient. The providers accepted 88% of the pharmacists' recommendations. Conclusions: Clinical pharmacists embedded in a primary care setting demonstrated improved patient care during transitions of care by identifying and resolving drug-related problems, with a trend in decreasing acute health care utilization.
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Affiliation(s)
- Sandra Axtell
- Cleveland Clinic Hillcrest Department of Pharmacy, Cleveland Clinic Hillcrest Primary Care, Mayfield Heights, OH, USA
| | - Bianca Nixon
- Cleveland Clinic Hillcrest Department of Pharmacy, Cleveland Clinic Hillcrest Primary Care, Mayfield Heights, OH, USA
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Alhmoud EN, Alrawi SFF, El-Enany R, Mohamed Ibrahim MI, Hadi MA. Impact of pharmacist-supported transition of care services in the Middle East and North Africa: a systematic review and meta-analysis. J Pharm Policy Pract 2024; 17:2323099. [PMID: 38476501 PMCID: PMC10930094 DOI: 10.1080/20523211.2024.2323099] [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] [Indexed: 03/14/2024] Open
Abstract
Background Transition of care (TOC) is associated with an increased risk of medication-related problems. Despite recent advancements in pharmacy practice and research in the Middle East and North Africa (MENA), the characteristics and impact of regional pharmacy-supported TOC interventions remain unclear.This systematic review and meta-analysis aimed to describe pharmacist-supported TOC interventions in the MENA region and evaluate their effectiveness. Methods PubMed, CINAHL, EMBASE, Web of Science, World Health Organization's International Clinical Trials Registry Platform (ICTRP) were searched from their inception to March 9, 2023, for experimental studies published in English, comparing pharmacist-supported TOC interventions with usual care for adults (age ≥18 years) discharged from the hospital. The risk of bias was evaluated using Cochrane's risk-of-bias tool for randomised trials (ROB2) and the risk of bias in non-randomised studies of interventions (ROBINS-I) tool for randomised and non-randomised studies respectively. Narrative syntheses and meta-analysis methods were employed depending on the outcomes evaluated. Results Twelve studies (n = 2377 subjects), 10 randomised controlled trials and 2 quasi-experimental studies, were included. Most studies had high or serious risk of bias. The included studies were quite heterogeneous in terms of nature and the delivery of intervention, and assessment of outcome measures. Compared to the usual care group, pharmacist-led TOC interventions contributed to a significant reduction in preventable drug-related (N = 2) and cardiac-related healthcare utilisation (N = 1), a significant reduction in preventable adverse drug events (ADEs) (Odds ratio (OR) 0.34, 95% CI: 0.13-0.94) and an improvement in medication adherence. However, all-cause hospitalisation and medication discrepancies were not significantly reduced. Conclusion Pharmacy-supported TOC interventions may improve patient outcomes in the MENA region. However, considering the limited quality of evidence and the variability in intervention delivery, future well-designed clinical trials are needed.
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Affiliation(s)
| | | | - Rasha El-Enany
- Pharmacy Department, Hamad Medical Corporation, Doha, Qatar
| | | | - Muhammad Abdul Hadi
- Department of Clinical Pharmacy and Practice, College of Pharmacy, QU Health, Qatar University, Doha, Qatar
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Pitman SK, Clouse A, Hiner M, So J. Admission medication history quality: Considering nonprescription medications, limited English proficiency, and medication history sources. Am J Health Syst Pharm 2024; 81:e45-e48. [PMID: 37788586 DOI: 10.1093/ajhp/zxad249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Indexed: 10/05/2023] Open
Affiliation(s)
- Stuart K Pitman
- University of Iowa Hospitals and Clinics, Iowa City, IA, and University of Iowa College of Pharmacy, Iowa City, IA, USA
| | - Alexis Clouse
- UnityPoint Health-Iowa Methodist Medical Center, Des Moines, IA, USA
| | - Micah Hiner
- M Health Fairview St. John's Hospital, Maplewood, MN, USA
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Montross M, Douthit S, Learn L, Dombrowski SK, Hanna C, Gruver B. Impact of interdisciplinary case management and pharmacist transitions of care interventions on 30-day readmissions. Res Social Adm Pharm 2023:S1551-7411(23)00254-1. [PMID: 37198058 DOI: 10.1016/j.sapharm.2023.05.004] [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: 03/06/2023] [Revised: 04/14/2023] [Accepted: 05/08/2023] [Indexed: 05/19/2023]
Abstract
BACKGROUND Pharmacists and case managers positively impact patient health outcomes during the transition of care from the hospital to the home. However, the combination of both specialties completing post-discharge telephone calls has not been clearly studied. OBJECTIVES The primary outcome of this research was to identify the combined impact of post-discharge telephone calls from both pharmacists and case managers on all cause 30-day hospital readmissions when compared to a call from either group alone. Secondary outcomes included 30-day emergency department visits and types of medication therapy problems identified by pharmacists during the call. METHODS This retrospective study included high risk patients eligible for a post-discharge telephone call from both pharmacy and case management from January 1, 2021 to September 1, 2021. Patients were excluded if they did not complete a telephone call from either group or were deceased within 30 days of discharge. Results were analyzed using descriptive and chi square analyses. RESULTS Eighty-five hospital discharges were included in the study, with 24 patients receiving post-discharge telephone calls from both case management and pharmacy, and 61 patients receiving a call from either group alone. Thirty-day all cause readmissions occurred in 13% of the combined group versus 26% in either group alone (p = 0.171). Thirty-day all cause emergency department visits were 8% in the combined group versus 11% in either group alone (p = 0.617). Of the 38 post-discharge encounters completed by pharmacists, 120 medication therapy problems were identified, averaging over 3 medication issues per patient. CONCLUSIONS Collaboration amongst pharmacists and case managers has the potential to positively impact patient outcomes upon discharge from the hospital. Health systems should work to integrate transitions of care services performed across disciplines.
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Affiliation(s)
- MeiLing Montross
- Geisinger/Prime Med, 790 Northern Blvd. Suite L, Clarks Summit, PA, 18411, USA.
| | - Sabra Douthit
- Geisinger Medical Center, 100 N Academy Avenue, Danville, PA, 17822, USA.
| | - Leonard Learn
- Geisinger Telepharmacy, 58-60 Public Square, Wilkes-Barre, PA, 18701, USA.
| | | | - Christina Hanna
- Wilkes University Nesbitt School of Pharmacy, 84 West South Street, Wilkes-Barre, PA, 18766, USA.
| | - Brenda Gruver
- Wilkes University Nesbitt School of Pharmacy, 84 West South Street, Wilkes-Barre, PA, 18766, USA.
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Taliaferro L, McCarron M, Boylan PM, Bennett K, Shreffler M, Neely S, Walton B. Evaluation of Naloxone Co-Prescribing Rates for Older Adults Receiving Opioids via a Meds-to-Beds Program. J Pain Palliat Care Pharmacother 2023; 37:16-25. [PMID: 36512672 DOI: 10.1080/15360288.2022.2140244] [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: 12/15/2022]
Abstract
Over 10,000 older adults died from opioid overdose in 2019. Naloxone is an underutilized antidote that could prevent many opioid overdose-related deaths. There is a paucity of literature evaluating naloxone prescribing through meds-to-beds programs and in older adults. This single-center, retrospective, observational cohort study aimed to assess prescribing patterns of naloxone in patients 65 years and older who were prescribed opioids via a meds-to-beds program between December 2020 and November 2021. All patients 65 years and older dispensed an opioid via meds-to-beds were included. Patients receiving hospice or comfort care or those with unavailable records were excluded. The primary outcome was to assess the frequency of naloxone co-prescribing with opioid prescriptions via meds-to-beds. The 144 patients included were primarily females with a median age of 69 years old and opioid prescriptions for 45 morphine milligram equivalents daily. Two patients were prescribed naloxone (1.4%), one of whom was ultimately dispensed naloxone (0.7%). Of the 65 prescribers included in our study, the incidence of naloxone co-prescribing (2/65, 3.1%) was no different from a previously-reported rate among prescribers (3/179, 1.7%), p = 0.61. Naloxone co-prescribing for older adults receiving opioid prescriptions through a meds-to-beds program was low and opportunities for program enhancement exist.
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Pestka DL, Maxson R, Bradley S, Hsu Y, Traynor A, St. Peter WL. Determining best practices to delivering comprehensive medication management in practices with patients with chronic kidney disease: A qualitative study. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2022. [DOI: 10.1002/jac5.1700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
| | | | | | - Yu‐Chia Hsu
- University of Minnesota College of Pharmacy Minneapolis Minnesota USA
| | - Andrew Traynor
- University of Minnesota College of Pharmacy Minneapolis Minnesota USA
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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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Stranges PM, Jarrett JB. Medication counseling initiative on medication safety in kidney transplant patients. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2022. [DOI: 10.1002/jac5.1573] [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)
- Paul M. Stranges
- Department of Pharmacy Practice University of Illinois Chicago College of Pharmacy Chicago Illinois USA
| | - Jennie B. Jarrett
- Department of Pharmacy Practice University of Illinois Chicago College of Pharmacy Chicago Illinois USA
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